Monthly Archives: October 2009

Surrogate Pregnancy after transfer of Cryoshipped, Vitrified Human Blastocysts

Rotunda achieved its first pregnancy with Cryoshipped Vitrified embryos from USA and transferring them into a surrogate mother.

Till now, we have received frozen embryos from many countries and successfully transferred them into surrogate mothers at Rotunda. Most of these embryos were frozen by the slow freezing process. As vitrification is becoming popular as a method of choice for freezing gametes, we have started receiving vitrified embryos from world over. Our first case of cryoshipped, vitrified blastocyst transfer has resulted in a pregnancy.

A short history lesson:

In 1972 preimplantation mammalian embryos were first successfully cryopreserved. The method was very time consuming. Slow cooling was used (1 degree/min or less) to about -80 degrees Centigrade. Then the embryos were placed in liquid nitrogen.

The embryos also needed to be thawed slowly and a cryoprotectant added and removed in many gradual steps. This was a lot of work.

The first reported pregnancy in humans from frozen embryos was in 1983.

Most of the research has been done on mouse embryos. Development of frozen thawed mouse embryos, in vitro and in vivo, is not statistically reduced as compared to their nonfrozen counterparts.

Research continues in this area and human embryo freezing and thawing protocols have improved tremendously over the past 25 years. Hopefully, the newer vitrification technique will prove to have equivalent success rates with human blastocyst embryos transferred fresh or after freezing and thawing.

What is the difference between slow freezing and vitrification?

Patients who undergo IVF may have several eggs collected. The eggs are then fertilized with a sperm and checked for fertilization. Fertilized eggs are called embryos. A patient may have multiple high quality embryos eligible for embryo transfer back to the uterus. A certain number of embryos are chosen for embryo transfer, and the surplus of high quality embryos can be cryopreserved for future use.

Previously, embryos were cryopreserved using a slow freeze method. Embryos were run through different solutions of media toStorage of Cryopreserved embryosdehydrate the cells of water and replace it with cryoprotectant. Then the cryoprotected embryos were individually labeled and stored in cryopreservation straws, which were put in special freezers. These freezers slowly (-0.3 degrees Celsius per minute), cooled the embryos to -35 degrees Celsius using liquid nitrogen. They were then stored in liquid nitrogen (-196 degrees Celsius). At that extremely cold temperature, cellular activity is essentially brought to a halt, allowing the embryos to remain viable indefinitely.

When patients decide to use their cryopreserved embryos to try for a pregnancy, the embryos are removed from the liquid nitrogen, warmed and run through solutions of media to remove the cryoprotectant and rehydrate the cells with water. During cryopreservation, the formation of intracellular ice crystals can damage the cells of the embryo, decreasing future viability. Therefore, new methods were developed to improve cryopreservation techniques.

vitrification-hook 1Recent technical advancement in the field of cryobiology has opened up various options for freezing gametes and embryos at different developmental stages. The tendency of the IVF world to switch over to natural cycle IVF and to elective single-embryo transfer has put cryotechnology in the forefront of IVF. Vitrification method is gaining popularity as the method of choice for gamete/embryo cryopreservation.

Vitrification is a new process for cryopreserving embryos. Through vitrification, the water molecules in an embryo are removed and replaced with a higher concentration of cryoprotectant than in the slow freeze method. The embryos are then plunged directly into liquid nitrogen. This drastic (-12,000 degrees Celsius per minute) freezing creates a glass transition temperature, commonly called a “glass” state, and the embryos are vitrified. This quick freezing reduces the chance for intercellular ice crystals to be formed, thus decreasing the degeneration of cells upon thawing for embryo transfer.

In 1998, it was shown that vitrification using an EG-based vitrification solution (EFS40) (Kasai et al., 1990) with conventional cryo-straws was effective for human embryos at the 4- to 8-cell stage (Mukaida et al., 1998). The effectiveness of vitrification was confirmed for human embryos at the 8- to 16-cell stage (Saito et al., 2000) and the morula stage (Yokota et al., 2001b), also using EG-based solutions.

Many studies show survival rates of vitrified embryos to be far higher than survival rates of slow freeze embryos. Thus far at Rotunda, vitrification results are very encouraging, and we are excited to offer this cutting edge technology to our patients.

For more information about vitrification, ask to speak to the embryologist at your center.

Vitrification, a cutting edge technology for cryopreservation of embryos, is now available at Rotunda – Center for Human Reproduction.

Advertisements

Leave a comment

Filed under Uncategorized

The MOGS Indo-Israeli Workshop & Conference on Fetal Diagnosis & Intervention

Shalom & Namaskaar! The MOGS Indo-Israeli Year is well on its way with the second clinical meeting creating waves in the Ob-Gyn community in India. We had a star-studded faculty from both India & Israel. Prof Israel Shapiro is the President of the Israel Society of Ultrasound in Obstetrics & Gynecology. He is the Coordinator of the Scientific Meetings of the Society. He is also the Chairman of the Academic School of Ultrasound in Obstetrics & Gynecology. He is attached to the Department of Obstetrics & Gynecology at the Bnai-Zion Medical Center, Haifa. He has vast experience in Industrial Counseling and is currently the Consultant of General Electric (GE Healthcare) in developing ultrasound equipment.In fact, he developed the first transvaginal probe prototype with Elscint in Israel eons ago!Prof Shlomo Lipitz was awarded his MD degree in 1984 from The Hebrew University, Jerusalem and thereafter completed a Clinical Fellowship at The Fetal Medicine Unit, Department of Obstetrics & Gynecology, University College Hospital, London. He is now the Director of The Fetal Medicine Unit at The Sheba Medical Center, Israel. His areas of interest are Amniocentesis, Chorion Villus and Fetal Blood Sampling, Intrauterine Fetal Blood Transfusions, Shunts, Multifetal Pregnancy Reductions, Laser Therapy in Twin-Twin Transfusion Syndrome and Bipolar Coagulation in Monochorionic Twins.Prof Reuven Achiron is the Director of the Ultrasound Unit at the Department of Obstetrics & Gynecology at the Chaim Sheba Medical Center, Tel Hashomer. He has been invited to the World Congress of Ultrasound in Obstetrics & Gynecology thirteen times. He is a Member of the International Ultrasound Society and has been on the Editorial Board of the journal Ultrasound in Obstetrics & Gynecology. He has published six monographs and over 130 original articles on Obstetric Ultrasound & Fetal Diagnosis.Dr Chander Lulla is one of the pioneers of ultrasound in India and is the most-sought after interventional sonologist in this part of the world. He is affiliated to the Nowrosjee Wadia Maternity General Hospital as well as to the Jaslok Hospital in Mumbai. The formidable four were all set to showcase their skills to an eager audience sitting in two different auditoriums; the PG students in the Main Lecture Theatre at KEM hospital & the practicing gynecologists at the ITC Grand Central which is a kilometer away.

The Indo-Israeli workshop on fetal diagnosis and intervention organized by the Mumbai Obstetric and Gynecological Society and Seth G.S. Medical College, KEM hospital (Department of Obstetrics & Gynecology) was held on 6th June 2009 in the department of Obstetrics & Gynecology, KEM hospital. The workshop equipment was provided by Wipro GE Healthcare. Prof Reuven Achiron , Prof Shlomo Lipitz and Dr. C.P. Lulla demonstrated live 2-D and 3-D fetal ultrasound all through the day from 9am to 5pm with a short Lunch break! Live scanning of eleven cases was performed with detailed interaction with the audience. Normal first, second and third trimester ultrasounds, malformation scans, 3-D ultrasound and an interventional procedure of placental biopsy as a prenatal diagnostic technique in a case of thalassemia were demonstrated. Various congenital malformations including cranial, cardiac, pulmonary, renal, skeletal and gastrointestinal were demonstrated. The correct methodology for anomaly detection and the management protocols were discussed. The postgraduate students and the delegates at ITC Grand Central found the workshop very informative and useful for clinical practice.
.
The Conference on Fetal Diagnosis and Intervention was held the next day -the 7th June 2009, Sunday at the ITC Grand Central, Parel, Mumbai. There were 145 registrations for this event. The opening session was on free communications. Dr Shailesh Kore was awarded the prize for the best paper. His subject was prediction of preeclampsia by placental laterality. This was followed by a session on the journey of a fetus from the womb to the pediatric operation theatre. It was a collaborative effort by Dr Nitin Chaubal and Dr Sanjay Oak.The Israeli Faculty were thoroughly impressed with this presentation & congratulated both the speakers (see video). Prior to the Key-note addresses, we played the National Anthems of both countries. This was a truly emotional moment for our invited guests. The international faculty presented the Keynote Addresses on Applications of current ultrasound in fetal medicine (Professor Reuven Achiron) and Diagnosis and treatment of complications of monochorionic twins (Professor Shlomo Lipitz).

The post lunch session was a visual treat with twelve videos from invited faculty.Prof. Shapiro’s video was the run away winner of this Video film session (see video). This was followed by invited lectures by Dr C P Lulla, Dr Aniruddha Badade and Dr Sameer Dikshit.

The Dr M Y Raval Oration was delivered by Professor Israel Shapiro on the subject of “Three Dimensional Ultrasound: Gimmick or Breakthrough”. This 100 minute oration was founded on years of experience, data, images and personal insights. It was laced with the right dose of humor and received a standing ovation from the audience (see video).

The chairpersons ensured that the sessions were interactive and kept the program running on schedule. The venue was well-appointed and hospitable. Once again, on behalf of MOGS we would like to express our thanks to the superlative Banqueting team at the ITC Grand Central. I would also like to mention that the success of this meeting was shaped in a large way with the untiring efforts of the hands-on conveners Dr Sulbha Arora & Dr Parikshit Tank. The MOGS office staff ensured that the Registration Desk & other admin formalities purred on smoothly like a BMW engine! Thank you delegates – We had delegates from Arunachal, Bihar, Haryana, Gujarat, Maharashtra & Sri Lanka too! I am still receiving positive feedback on this meeting from doctors who were not present , but have heard about this meeting from registered delegates. This is really heartening & we look forward to the Late Dr Avabai Wadia Workshop & Conference on Contraception in September 2009. Before I pen off, I would like to express my gratitude to the supporters of MOGS who were present in the exhibition hall on both days. Thank you Danny for making our Indo-Israeli dream a reality. Lakhaim!

Leave a comment

Filed under Uncategorized

Egg Donation

For many couples, being infertile no longer means having to go through life without children. Modern science and continued research in this direction has helped millions of couples all over the world become parents to a healthy child. Even issues that were once thought to make it impossible to conceive a child can now be overcome. One such female fertility problem is having a lack of eggs available for fertilisation.

What is Egg Donation

So what is a woman to do if her eggs have been found to be of poor quality or low quantity? Using an egg donor can significantly increase your chances of pregnancy. Compared to a your own eggs, using donor eggs are typically a better option when you do not have a very good ovarian reserve.

Ovarian reserve is the quantity and quality of eggs present in a woman’s body and this number differs for from every woman. In some cases, in spite of a high number of follicles, a woman may not have her eggs mature due to issues like premature ovarian failure. Other women may have eggs that are incapable of being fertilised or implanting on the uterine wall due to structural defects.

On the whole, donor eggs may be a better option when:

– Premature ovarian failure due to genetic or auto-immune disorders has been diagnosed or has occurred due to radiation therapy or artificial removal of the ovaries

– A woman is over 40 and is going through or has already gone through menopause

– There has been no response to fertility drugs

– There is a high level of FSH in the blood (FSH is a hormone that stimulates follicles to mature into eggs. If its level is too high in the blood, it signifies fewer eggs present in the body.)

– A woman cannot conceive in spite of repeated IVF cycles

– There is a risk of transferring genetic disease, like haemophilia, to the child from the mother

Physical Considerations

Doctors recommend that if a couple is opting for donor eggs, the mother should undergo a detailed medical analysis to check whether her body is suitable for pregnancy or if she is at a health risk. This particularly becomes important for women aged 40 years or more.

The uterus is also checked for deformations such as fibroids and scarred tissues that may not allow the egg to implant.

Psychological Considerations

The decision of using an egg that is not yours is a difficult one. The choice of the donor, her being known or anonymous, the ethical or religious aspects, the choice of telling the child, the involvement of relatives and friends and most importantly the parents’ firm will to use donor eggs are some aspects of the issue that have to be dealt with.

Psychological counseling can be very helpful for couples in this regard to make a concrete decision.

Selection of Donor

Choosing a donor is a crucial aspect. She might be a family friend, relative or a person known to you. There are also many organisations and online sites that provide a list of donors who are willing to donate eggs. If you are already attending a fertility clinic, they too may have a pool of egg donors from which you can choose. Some couples have also successfully advertised for donors, though this may not be a safe approach, as the person’s background cannot be sufficiently verified.

Depending on how you locate your donor, the donor may remain anonymous. For instance, if your infertility clinic offers an egg donor program, you will likely be able to read about a donor’s health history, physical traits, education level, possibly profession and other general information. However, you will not learn the donors name, address or any other information that will allow you to identify them.

In general, women between the ages of 18 and 35 who are physically healthy, non-smokers, with no hereditary or sexually transmitted diseases and who are psychologically fit are most suited to become donors.

Donor’s Check-Up

In order to ensure that a donor is physically, genetically and psychologically healthy for the donation, she has to undergo a number of tests. These may include:

– Blood tests to know the blood group, blood count and check for any infectious diseases might be passed on to the child

– HIV tests

– Hepatitis B and C tests

– Test for syphilis

– Medical history of the donor and her family to ensure that no hereditary problems are present

– The level of hormones present to know how fertile she is and whether her eggs are healthy enough

Psychological counseling is also advised to know her better as well as prepare her for the process.

The Procedure

Once you have decided to use donor eggs, the first step involves consultation with a physician or an organisation providing the donors. This helps in identifying your needs better and also answers any queries you might have regarding the procedure. The consultant also tries to find out your physical characteristics, likes, and dislikes to best match you with a donor.

After the selection of the donor comes the evaluation cycle phase.

Egg Donation Cycle

When the process of pregnancy takes place naturally, the uterus of the mother prepares itself by thickening the lining of the inner wall, while the body automatically produces an increase of hormones, like estrogen and progesterone, for the conception. But in the case of pregnancy with donor eggs, a mother’s body is not prepared for pregnancy and therefore the hormones have to be artificially induced.

A prospective mother will undergo an evaluation to determine the correct amount of estrogen and other hormonal supplements to be administered prior to transferring a fertilised donor egg. This is done by measuring your blood estrogen level and through ultrasound check ups to observe the uterine lining. The doctor may also give oral or estrogen injections to raise your hormone levels, which you may continue to take for a period of 10 to 14 days.

Then, the donor and the mother’s cycle are synchronized with the help of birth control pills. Once this has been done, the donor is given fertility drugs to promote a greater number of eggs being matured during her cycle. Meanwhile, you are given the appropriate dose of estrogen to prepare your uterus for the embryo.

A day before your donor under goes egg retrieval, you are given progestrone vaginally or with an injection. When the donors egg are retrieved, your partner will provide a semen sample that day so that his sperm can be combined that day with the freshly retrieved eggs. After 3 to 5 days, once the embryos have formed, two to three embryos will be transferred to your uterus as it normally would during an IVF procedure.

You will continue to receive estrogen and progestrone doses to help encourage a pregnancy. 10 to 11 days after the embryo transfer, a pregnancy test is carried out to check the success of the procedure.

Benefits

There are a number of benefits to using donor eggs:

– A donor egg from a younger woman increases the chances of conception to 50% as compared to 15% to 18% with your own eggs. This is because donor eggs are of better quality and there are more numbers of eggs available for fertilisation.

– As the donor egg provides a better chance of fertilisation, you may not have to undergo as many IVF cycles thereby saving yourself from the physical, mental, and financial anxieties associated with each cycle.

– Donor eggs provide an opportunity to conceive a child whose genetic make up resembles one of the parents.

– You are able to experience the process of giving birth when the fertilised egg is placed inside your uterus, which is not possible with an adopted child.

Risk Factors

A common fear of parents is that their child will be born with a genetic defect. Donors, however, are usually extensively checked for any signs of physical and genetic abnormalities. As a result, the chances of your child being affected by genetic problems caused by a donor are significantly reduced. However, they cannot be completely eliminated.

Unlike donor sperm, which is frozen and quarantined for at least six months, donor eggs are not frozen. This is because the freezing technique for eggs has yet to be perfected; in fact, freezing eggs typically damages the egg making it unusable. Therefore, fresh eggs must be used when you opt for donor eggs. Some infections, like HIV, may not produce a positive result until months after the infection, which means, although a donor may be tested, there is still a chance that she, and her eggs, could have a serious infection.

Other risks associated with this procedure include those associated with the IVF process itself as well as the chance of miscarriage if your body does not respond to the embryo. Furthermore, because two to three embryos are transferred, your risk of a multiple pregnancy occurring is increased.

Success Rate

Research has shown that there is about a 48% to 50% chance of conceiving using donor eggs. For women above the age of 40, who in general have a lower quality and quantity of eggs, the chances of conceiving with a donor egg is 5 times more than with their own eggs.

2 Comments

Filed under Uncategorized