Fertility Friends Support Forum banner
21 - 40 of 54 Posts

·
Registered
Joined
·
594 Posts
Discussion Starter · #21 ·
Lubricant

EWCM = Egg White Cervical Mucus. Mucus of an egg white consistency is what a lot of women produce preceding ovulation, which helps the sperm to swim up the cervix to meet the egg. This is the best lubrication if you are trying to conceive.

Note your body produces EWCM "before" you ovulate. This is as it's believed that sperm can last UP TO 72hours, whereas an egg only about 12 hours. The EWCM helps the sperm to swim up nice and high, so that when the egg - with the shorter life span travels down the fallopian tube, nice young healthy sperm are already waiting to fertilise it. ^HappySperm^ ^sperm^ . The life span of both egg and sperm is an important point when timing sex when ttc - as the sperm has a longer life span, you want to have sex BEFORE you ovulate, so that nice young healthy sperm are waiting for that egg when you ovulate.

However if you need some help, most commonly known lubricants SHOULD NOT be used if you are trying to conceive as they can damage or kill the sperm. See this article about how most lubricants can harm sperm:

http://www.storknet.com/cubbies/infertility/lubricants.htm

Some of us on the PR Thread discovered this lubricant last year, called PreSeed, which is supposed to be sperm friendly to help couples trying to conceive. It can be purchased from this website.

http://www.preseed.co.uk/

This post contains an unconfirmed link/information and readers are reminded that fertilityfriends.co.uk or its owners are not responsible for the content of external internet sites
 

·
Registered
Joined
·
594 Posts
Discussion Starter · #22 ·
IVA (In Vitro Activation)

This is an area of very new research, completely stunning for us PRs - though obviously it will be sometime before they are able to use this research on humans...... though in saying that IVF itself happened very quickly once discovered, so who knows! They have tested this on human ovarian tissue, though outside the body.

I think of it this way. I have POF. When I go for a scan to count antral follicles, they see about 4. This means that in an IVF cycle, I'd only be likely to have - if I'm really lucky, one egg, as I only have 4 active follicles to stimulate. However, this doesn't mean that I don't have other dormant follicles. What if they could wake up those dormant follicles, making them active follicles, so that in an IVF cycle, I had say.... 20 follicles to stimulate. My chances of a successful cycle go up dramatically.

IVA seems to be where "primordial follicles" that are dormant are activiated so that they are able to produce mature eggs. They go on to say in this article it could one day be used in treating infertility resulting from a reduced number of follicles, such as primary ovarian insufficiency (POI), which of course means if it benifits POI then DOR (diminished ovarian reserve) patients would also benefit.

http://www.nih.gov/news/health/aug2010/nichd-04.htm

NIH-Funded Researchers Generate Mature Egg Cells From Early Ovarian Follicles Technique Successful in Mice, May Offer Women New Options for Fertility Treatment Researchers supported by the National Institutes of Health have for the first time activated mouse egg cells at the earliest stage of their development and brought them to maturity. In a related experiment, the researchers replicated the finding by also bringing human eggs to maturity in the laboratory.

Current infertility treatment techniques stimulate immature eggs so they develop to the stage at which the eggs can be fertilized, but these techniques work only on eggs at a comparatively late stage of development. These later-stage eggs are few in number and much more difficult to recover than the early-stage eggs used by the researchers in this study.

Using the new technique, the researchers brought dormant mouse eggs to full maturity within the laboratory. The eggs then were fertilized and transferred into female mice, which carried them to term.
The human eggs were not fertilized. The technique is still in its early stages, has not been sufficiently studied for human use and will require several more years of study.

According to the researchers, one day this technique could be used to treat female infertility, particularly forms of infertility in which the supply of available eggs is diminished or limited. Similarly, the technique could be combined with efforts to bank the ovarian tissue of women in need of cancer therapy that might cause infertility.

"The researchers have developed a promising new technique that may someday provide additional options for women seeking treatment for certain forms of infertility," said Alan E. Guttmacher, M.D., director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the NIH Institute that funded the study.
The findings appear online in the Proceedings of the National Academy of Sciences.

First author Jing Li conducted the research with Stanford University colleagues Yuan Cheng, Cynthia Klein and Aaron J.W. Hsueh; Kazuhiro Kawamura of Akita University; and Shuang Liu, Shu Liu and En-Kui Duan of the Chinese Academy of Sciences.
Immature egg cells are encased in structures known as ovarian follicles. At birth, most women have about 400,000 small, or primordial, follicles. Most of them remain dormant, with about 1,000 primordial follicles activated per month. After reaching the reproductive years, about 20-30 medium-size follicles are present at the beginning of the menstrual cycle, and, typically, only one follicle develops further and gives rise to the mature egg. Current fertility treatments focus on the comparatively small number of medium-size ovarian follicles already in the later stages of development.

An enzyme known as PTEN keeps the early follicles dormant until they are ready to be activated. In the current study, researchers bathed one of each pair of ovaries from three-day-old mice in a substance that erases the braking effect of PTEN together with a second substance, 740Y-P, to activate dormant follicles. After two days, the researchers saw early signs of activation in most follicles in the treated ovaries.

The researchers then transplanted pairs of ovaries into adult mice and gave the animals daily injections of follicle stimulating hormone (FSH). Although FSH spurs activated egg cells to mature, it cannot activate dormant follicles. After two weeks, the ovaries treated with the PTEN blocker and 740Y-P were visibly larger and more than three times heavier than the untreated ovaries.
The treated ovaries also had up to six times more follicles in advanced stages of development than did the untreated ovaries, and a greater percentage of the treated ovaries contained egg cells that had reached maturity. The researchers then collected and fertilized the mature egg cells from the treated ovaries. From 118 two-cell embryos transferred into host mothers, 20 healthy mouse pups were born.

The researchers examined the same technique using primordial follicle-rich ovarian cortical tissues removed during the treatment of women with ovarian cancer. After treating sections of tissue with the same PTEN-blocking substance for 24 hours, the researchers transplanted the ovarian tissue into mice and gave the animals FSH injections every two days to stimulate egg development.

The sections of transplanted tissue each contained more than 50 primordial follicles. While 96 percent of follicles in the tissue had been dormant at the time it was transplanted, the researchers found that after six months, 89 percent of ovarian follicles in the treated tissue had begun to mature, compared with 40 percent in the untreated tissue. In addition, four times as many follicles had matured to advanced stages in the treated tissue. The researchers also confirmed the treated tissue contained 27 mature egg cells, compared with one in the untreated tissue.

"Although primordial follicles are far more numerous than later-stage follicles, they had been inaccessible for fertility treatments in their dormant state," said Dr. Hsueh, the article's senior author. "Activating them using this technique holds the promise of expanding the options for women seeking treatment for infertility."

Dr. Hsueh said that this technique for stimulating dormant ovarian follicles, which he and his coworkers termed in vitro activation (IVA), ultimately could be used in treating infertility resulting from a reduced number of follicles, such as primary ovarian insufficiency (POI) [http://poi.nichd.nih.gov/], a disorder in which women have only a small number of follicles, which often fail to reach maturity. Similarly, for cancer patients about to undergo procedures that eliminate fertility, primordial follicles could be removed and frozen, then reactivated at a time when the woman is ready to have children.

The researchers plan to continue their research in animals, examining the safety of the PTEN blocker and other activating agents and testing the feasibility of auto-transplants, in which the stimulated ovarian tissue would be transplanted to a patient's arm or elsewhere in the body to mature. Such transplanted tissue would be easy to retrieve when the mature eggs are ready for fertilization.

This post contains an unconfirmed link/information and readers are reminded that fertilityfriends.co.uk or its owners are not responsible for the content of external internet sites
 

·
Registered
Joined
·
784 Posts
Thanks for the post re IVA Sam, very interesting.

Going back to lubricants, I just wanted to say as well as the PreSeed you mention there is also a product called Sasmar Conceive Plus, which is claimed to be sperm friendly and freely available from Boots and no doubt most other chemists.

Also wanted to add thought that DH and I had always used lubricants not knowing of the damage they can cause until we came across the Sasmar lubricant and started using that. However, earlier this year I started taking High Strength Evening Primrose Oil capsules which is supposed to be good for supporting the cycle generally and helping in the production of EWCM specifically and I have to say we've not needed to use lubricant at all since then at any time in my cycle. Makes for much better BMS!  ;)

HS EPO capsules should be taken one a day from first day of cycle up until ovulation only.
 

·
Registered
Joined
·
594 Posts
Discussion Starter · #24 ·
CHR conducting trial into drug for women suffering from "implantation failure". Also mentions the trial of DHEA for women with POF.

CHR is, thus, currently conducting two new clinical trials of a medication that has been approved by the FDA for other clinical purposes. This means that in already conducted clinical trials, the drug's benefits were thought to outweigh associated risks, at least in the original indication.

Laboratory studies in animals suggest that this compound contributes to signaling between embryo and uterus. Animals that lack this compound demonstrate poor embryo implantation. This compound may, therefore, also be important for embryo implantation in humans.

For this reason, Dr. Gleicher has been using this compound on an experimental basis (with appropriate consent) in women with suspected implantation failure for approximately 10 years. Because implantation failure is a rarely suspected diagnosis, sporadic use over 10 years has not allowed development of statistically significant data. CHR investigators (and others), however, have been suspecting that this compound might enhance embryo implantation in general.

Trying this approach in a modified way over the past summer, we had very promising results and, therefore, decided to launch clinical trials after receiving formal approval from our Institutional Review Board (IRB). These trials test the hypothesis that this compound improves the quality of the endometrium and thus improves pregnancy rates with IVF.

Participation is offered to all CHR patients undergoing IVF. Those agreeing to participate will be asked to sign an informed consent describing the trial and possible risks and benefits of participation. They will also be asked to fill out brief study forms, describing themselves, their habits and reproductive histories.

Half of the women in the trial will receive the compound as an infusion and the other half will receive only salt water (i.e., placebo). Neither patients nor physicians will know to which group patients are randomly assigned. The study will be conducted as a cross-over study, in which those patients who received placebo in the first round and did not conceive will automatically be given the compound in a second cycle.

If you are interested in participating in this trial, please contact us, specifying "thin endometrium trial."
Results of the study will be analyzed on an interim basis. Should at any point proof be established that this compound, indeed, improves implantation, we will end the trial, and begin to offer treatments routinely.

Two other clinical trials, both involving DHEA, are ongoing and still recruiting patients: One enrolls women with premature ovarian failure (POF), also called primary ovarian insufficiency (POI); the other is seeking women with so-called "unexplained" infertility. Our center, of course, does not believe that this diagnosis really exists. Instead, we believe many with this diagnosis suffer from undiagnosed premature ovarian aging (POA). Therefore, they may benefit from DHEA supplementation as sole treatment.

Thus, combined, CHR currently offers 4 ongoing clinical trials, quite a number for one center. CHR's IRB in its most recent meeting, indeed, also approved a 5th trial but we are currently holding off starting this study because we do not want to overburden our staff. Stay tuned, however; never a dull moment at CHR RESEARCH!

/links
 

·
Registered
Joined
·
20 Posts
Hi all,
am finding this thread incredibly interesting and would just like to thank all the contributers hugely as all this exciting research has set me on a positive new course of action and really has helped me cope with my fertility problems when so low.
Fortunately we have some fab friends in the medical proffession who have sent us this link to a scientific paper which I hope is of interest to you
http://humrep.oxfordjournals.org/content/21/11/2845.full
Many thanks
Brimstone

/links
 

·
Registered
Joined
·
932 Posts
This is information extracted from a follow-up letter from my US consultant to help me determine what to do next. I think some of it may be of general interest:

Diminished ovarian reserve (DOR)-beginning with your earliest treatment, it has been apparent that you produce fewer eggs than your age, general health and medical history would predict. For this reason, I believe that Fragile X Premutation (FMR1) Carrier testing is in order. It has been estimated that 1 of every 260 women is a carrier for this pre-mutation. This makes FMR1-carrier status a fairly common condition. Unfortunately, it is even more common in women with DOR (estimated between 4 and 8%). If you are a carrier, your options may be to more seriously consider working with an egg donor or to consider prenatal/pre-implantation carrier testing. Here is a link to Genzyme the company that we typically send this important lab test to: http://www.genzymegenetics.com/Our-Services/Reproductive-Testing/fragile-x-testing.aspx
Consideration of genetic testing-As we discussed, I believe that an unaddressed aspect your medical history is related to the egg/embryo quality. I have attached a blog that I wrote about year ago (see below) describing the frequency of genetic abnormalities as the cause of pregnancy loss. This post explains how/why these abnormalities often go undetected by standard karyotype testing. More importantly, we do have techniques available today that can offer this information prior to embryo transfer. As we discussed, there are several genetic techniques available to provide this information at present but the one that I feel would best suit your needs would the Gene Security Network's Parental Support technology. Here is a link to their site: http://www.genesecurity.net/preimplantation-genetic-diagnosis-for-aneuploidy/who-can-benefit-from-gsn-testing . As I explained to you, we are able to biopsy the embryos of sufficient quality and development on day 3 and have the results back prior to embryo transfer. Better still, when abnormalities are detected, we can gain insight as to whether it was the sperm or the egg (or both) which were abnormal. This can have prognostic/diagnostic implications in the event that a successful pregnancy does not result. Other steps to optimize egg quality-We did review the various option available to optimize the quality and number of eggs that you are able to produce. As I mentioned, we do not currently have the ability to correct abnormalities within an egg but we may reduce their chance of formation through the following:

  • Oral contraceptive use pre-cycle- I realize that you have not done well on a levonorgesterol containing pill (Microgynon). Instead, I would encourage the use of a drospironone based pill like Yaz which often improves rather than worsens hormone-related mood problems. http://www.yaz-us.com
  • Supplements-I have attached a recent blog post that I wrote cautioning against the use of DHEA but encouraging the use of CoQ10 and resveratrol. There have also been more recent studies supporting the use of melatonin (see below) and Vitamin D as well.

Attachment 1 New Hope for Couples with Recurrent Early Pregnancy Loss Posted by Robert Greene, M.D. at http://thegreeneguide.wordpress.com/page/2 Greene Guide

Few disorders can be more difficult to diagnose or more frustrating to treat then recurrent early pregnancy loss (REPL). Traditional diagnostic criteria call for at least three pregnancy losses prior to evaluation and treatment of this vexing problem. With more women choosing to delay pregnancy until their thirties or even their forties, REPL can create an additional burden on their already limited opportunities to achieve a successful pregnancy. Ironically, as women age they are more likely to experience a miscarriage when/if they do become pregnant. A new technique called comparative genomic hybridization (CGH) offers couples some reassurance.
Studies show that most pregnancy losses (50-70%) are due to genetic abnormalities. In fact, the earlier that miscarriage occurs the more likely it is to be due to abnormal changes in the DNA. These are not typically abnormalities that are detected by testing the parents but rather spontaneous mutations that occur during early development. Moreover, they often go undetected by the most commonly used technique for genetic assessment, called G-banded karyotype analysis. That's because karyotype analysis has limited resolution. It is only able to detect the addition or deletion of relatively large portions of the genetic code. By contrast however, CGH is able to detect genetic changes that are far smaller. In fact, this technique has been reported to identify genetic causes for unexplained mental retardation in about 10% of patients that had previously had a "normal" conventional genetic karyotype. Moreover, a study in the current issue of the journal Obstetrics & Gynecology found that CGH was able to identify genetic abnormalities in 13% of miscarriages that were missed using conventional genetic testing. More exciting still is the potential of CGH to detect certain abnormalities before birth.
Maybe the best use of this technique however is when testing is performed on embryos prior to becoming pregnant. Combining CGH with in vitro fertilization (IVF) allows us to perform a biopsy upon an embryo for genetic analysis prior to transfer into a woman's uterus. Early data using IVF with CGH has been very reassuring. We're finding that by identifying and transferring only the embryos that are determined to be genetically competent-meaning without identifiable deletions or additions to the genetic code-we may be able to double or even triple the chance of a healthy live birth. Since this technique is still relatively new, more studies are needed before it is widely accepted but it is already revolutionizing the diagnosis and treatment of couples seeking fertility treatment.
Although we still recommend prenatal screening once pregnancy is established, CGH can dramatically reduce the anxiety of couples during those critical weeks of the first trimester; especially those with a history of recurrent early pregnancy loss. Remembering when my wife and I conceived-both of us are in our forties-I know that we would have had fewer sleepless nights early in our pregnancy had we been able to have CGH as part of our fertility treatment. There is certainly an additional therapeutic benefit of that stress reduction as well!

Attachment 2
What else can I do to improve the quality of my eggs?
Unlike men, it is very difficult to assess a woman's fertility at any given time. A man simply needs a quick trip to the video closet to collect a sperm specimen for viewing under the microscope; whereas it is only through the process of IVF that it is possible to truly assess the quality of a woman's eggs. This entails several weeks of medication to prepare for an egg retrieval at which time her eggs are collected, fertilized and then monitored for normal embryo development prior to placing them back in her body to implant and become a pregnancy. There is no comparable test. As a result, recommendations of treatment to improve egg quality have been based upon unproven and often misguided observations.   One of the more popular myths has been to encourage women to consume wheat grass. Although the suggestion is harmless enough, the only basis for its link to "improved fertility" can be traced back to a Kansas farmer from the 1930's named Charles Schnabel. He claimed that when he fed wheat grass to his ailing chickens that they not only recovered but increased their egg laying potential. Not the best model to making assumptions about human egg quality. Another folk remedy is the use of royal jelly. This is a special secretion made by honey bees and fed to future generations in order to cultivate the conversion of a drone to a fertile queen bee. Unfortunately, it doesn't work as well in humans and has been linked to severe allergic reactions, asthma and even in rare situations death. Analysis of this chemical product reveals that it is little more than vitamins and other healthy nutrients. I think the lesson here is that good nutrition is important which is why it is a good idea to start a prenatal vitamin at least 3 months prior to trying to conceive. A more recent recommendation has been for women with low ovarian reserve to take the pre-hormone supplement DHEA. While there is limited data that it may cause a slight increase in the number of eggs produced- in this clinical trial the average participant went from producing three eggs to four-there was not any demonstration of an improved pregnancy rate. From a practical standpoint, since it required 90 days of the supplement prior to undergoing IVF these patients may have produced even more eggs by going through 2 or 3 cycles of IVF instead. Most importantly, without a measureable improvement in pregnancy rate, it is premature to suggest that this may improve egg quality. There are ongoing studies which may provide insight as to whether there are some women that can benefit from this treatment but at this point the question remains unresolved. In fact, the available research is given a "C" grade indicating "there is unclear scientific evidence for its use." A well researched suggestion has been to optimize the energy storage/ utilization of the egg through supplementation with CoEnzyme Q10. This has not been considered a necessary supplement since your body can manufacture this on its own. However, the human egg has the greatest energy demand of any cell in the body; and its needs go up considerably during the process of follicle growth. It was therefore theorized that supplementing with CoQ10 could improve egg quality. Early studies have confirmed this theory. Finally, it's worth mentioning that avoiding harmful chemicals is also likely to improve egg quality as well. There is a growing list of toxins referred to as endocrine disrupting chemicals (EDC's) that have been linked to diminished fertility and reduced egg quality in animals. Many of these same products have been tied to a reduction in male fertility which is easier to track through diminished sperm counts and decreased motility. Until it's confirmed that EDC's don't compromise egg quality as well, I recommend that you take steps to reduce your exposure to chemicals like Bisphenol A (BPA) and phthalates. In summary, here are some steps you can take and have confidence that you're doing all that you can to optimize your chance becoming pregnant:

  • Avoid well intended but not well researched recommendations
  • Begin a prenatal vitamin several months before you want to become pregnant
  • Take CoEnzyme Q10 to optimize the quality of your eggs-typical dose is 100 mg taken two or three times each day
Consider modifying your food choices, cooking preparation, personal care products and lifestyle to reduce your exposure to endocrine disrupting chemicals. If you need some specific advice, check out my book PERFECT HORMONE BALANCE FOR FERTILITY which is loaded with useful charts, tables and tips.

/links
 

·
Registered
Joined
·
45 Posts
I thought this artilce might be relevant (think it's currently main thought of to help PCOS women in danger of over responding but I think would be good for poor responders where every egg counts):
http://doctorandpatient.blogspot.com/2010/06/magic-of-in-vitro-maturation-of-oocytes.html

The Magic of In-Vitro Maturation of oocytes

This is a guest post from Dr. Sai, Senior Embryologist, Malpani Infertility Clinic Pvt. Ltd.

Mrs. Bhatt had very poor ovarian reserve. Her AMH level was 0.3 ng/ml and she had reached the oopause . We advised her to use donor eggs but she was quite certain she wanted to have a baby with her own eggs. We explained to her that her prognosis was bleak, but she was determined, and requested us to do our best to help her to have a baby with her own eggs.

We superovulated her aggressively using a letrozole - antagon protocol, with 750 IU of HMG daily. She had a very poor ovarian response as expected, and grew only one follicle. We advised her to cancel the cycle, but she was very keen on getting pregnant and requested us to proceed with the treatment. Dr. Anjali did the egg collection and retrieved one oocycte cumulus complex from the follicle after flushing it multiple times. When I stripped the oocyte, it unfortunately turned out to be immature - it was a germinal vesicle stage egg.

We decided to keep the egg for In vitro Maturation ( IVM) .The egg matured exactly after 20 hours. I performed ICSI on that egg. It fertilized and we transferred the embryo back into the uterus on day 2. It was a gorgeous 4-Cell Embryo.

Even though we got only one embryo, the patient was very happy that at least we had helped her to reach this stage. She had been mentally prepared to get zero eggs and zero embryos, so this was quite a positive development from her point of view. Thanks to the technique of In vitro Maturation, they got a beautiful embryo to transfer.

We kept our fingers crossed - and 14 days after the transfer, she was on top of the moon when the HCG result was positive, confirming that she was pregnant ! Her pregnancy is now progressing well !

So what is in vitro maturation ? and how do we do it ?

In vitro maturation, as the name suggests, refers to the process of maturing immature oocytes outside human ovaries, in the IVF lab.

Applications of In vitro maturationof oocytes :

Oocyte donors, to preserve their eggs in egg bank.
Fertility preservation for women with cancer who are undergoing gonadotoxic chemotherapy.
Fertility preservation for young women without partners needing IVF treatment.
Poor responders to ovarian stimulation.
Patients with lots of immature eggs after egg collection.
Patients with PCOS syndrome, leading to retrieval of lots of immature eggs, after being hyperstimulated.

Mature Oocyte Immature oocytes

In vitro Maturation medium is now commercially available.

At our centre we use "SAGE In vitro Maturation medium"

It is not a ready to use medium. One has to prepare it.

Maturation media is usually supplemented with recombinant FSH and hCG.

The protocol for preparation of In vitro maturation medium is as follows :

Solution A = 1 ml IVF culture medium

Solution B = We use Menogon ( HMG). This powder contains a mixture of 75 IU
FSH and 75 IU LH. Dissolve this in 1 ml of IVF culture medium (A).

Solution C = 1 ml of Fresh Oocyte Maturation Medium in a test tube.

Solution D = Add 10 ul Solution B into Solution C

Solution D is now prepared Oocyte Maturation Medium.

In Vitro Maturation of Oocytes :
In Vitro Maturation on cumulus-enclosed oocytes :

Done on oocytes retrieved from small sized follicles.
Done on oocytes with apparently compact cumulus complexes

Immature oocyte cumulus complex

Immediately after retrieval, cumulus-enclosed immature oocytes are placed in a specialized IVM medium for 24-48 hours.
Generally germinal vesicle-stage oocytes that matured within 30 hours of culture are developmentally more competent than are oocytes necessitating longer time to mature.
After IVM, mature oocytes are transferred to traditional IVF media for insemination and embryo culture.
Insemination of IVM-Mature oocytes can be done by either Conventional IVF technique or ICSI. ICSI has been our preferred method as oocytes are frequently denuded of granulosa cells for evaluation of maturational status. ICSI has been used to increase the chances of fertilization whether or not a male factor has been detected.
In Vitro Maturation on Stripped oocytes :

Done on Germinal Vesicle stage oocytes (confirmed after denuding them of the surrounding cumulus cells)
All Germinal Vesicle Stage oocytes are kept in Specialized IVM medium for 24-48 hours.
After IVM, Mature ( metaphase II) oocytes are transferred to traditional IVF Medium for ICSI.
Germinal Vesicle Stage oocyte. The germinal vesicle is the clear vacuole within the cytoplasm.

Photo of the egg after IVM. It has now become mature ( metaphase II - MII) . You can see that the germinal vesicle has dissolved and the polar body can be seen at 12 o'clock.

IVM is not a panacea for all problems - and not all immature eggs will mature in vitro using this technique. However, it does allow us an additional option, and can be very helpful when treating poor ovarian responders !

/links
 

·
Registered
Joined
·
594 Posts
Discussion Starter · #28 ·
Excellent artilce above from Tinks, really interesting.

Below is from the CHRs research that they send by email each month. Interesting for those of us who have problems with lining.
Inadequately thin endometrium Readers of the UPDATE will recall that, a few months ago, we reported to have discovered a new way to improve inadequately thin endometrium, which has been resistant to currently available remedies. At that time we were not at liberty to go into further details but, now, after a manuscript describing our initial experience in four cases has been accepted for publication, we can be a bit more specific.
Infertility patients, of course, know that we always carefully evaluate their endometrial thickness. The reason is simple: if the endometrium is too thin, pregnancy rates are low. Ideally, we like to reach an endometrial thickness of ca. 9mm, but anything above 7mm is considered acceptable.
Unfortunately, many patients have a very hard time reaching this benchmark. Various treatments have, therefore, been applied in such patients, starting with increasing estrogen dosages to vasodilators, like Atenolol and Viagra®. In some patients these remedies help, but approximately 1% of all patients are simply resistant to all known treatments. In such cases, options become very limited: either one is willing to accept lower pregnancy chances or one cancels the embryo transfer and freezes all embryos, hoping that future cycles may produce better endometrial linings. Since that rarely happens, such patients often end up using their embryos in a gestational carrier (surrogate).
A number of months ago CHR's Medical Director, Dr. Gleicher, encountered such a patient who had come to CHR from out of state. Just a few days before tentative embryo transfer, her endometrium was not only extremely thin despite all of the above described treatments, but on ultrasound also demonstrated to contain fluid (later shown to be thick mucus). The patient refused an all-freeze and asked whether there weren't any "experimental" options available. For almost 10 years, on rare occasions, Dr. Gleicher had been using a medication called granulocyte colony-stimulating factor (G-CSF) in women with suspected implantation failure. G-CSF is a widely used drug in medicine, mostly in clinical oncology to restitute while blood cell (WBCs) counts in cancer patients after they received chemotherapy. G-CSF stimulates WBCs and is, therefore, a so-called cytokine.
Cytokines are very important in endometrial function. Even though the embryo implantation process is not well understood yet, it is clear that it involves many different cytokines. A U.S. patent claims that G-CSF is effective as treatment of repeated unexplained pregnancy loss and implantation failure. The literature is filled with studies suggesting that CSF may play an important role at practically every stage of the reproductive process from ovulation, over fertilization into implantation and pregnancy maintenance. Indeed, a company announced just a week ago in a press release that adding G-CSF to human embryo growth media improved implantation chances of embryos.
Nobody, however, ever suggested or tried G-CSF in attempts to expand chronically thin endometrium until that one day, when above noted patient asked Dr. Gleicher, whether he couldn't think of "anything" to save her cycle.
This is when Dr. Gleicher decided to give G-CSF a try, since he had wondered for years whether this cytokine may not have a proliferative effect on endometrium.
G-CSF is usually administered either intravenously (I.V.) or by subcutaneous injection (s. c.), While Dr. Gleicher had in the past used the medication s. c., he decided in this case to apply it directly to the endometrial cavity. And the rest has become history because this patient miraculously improved her endometrium within 48 hours from treatment, and underwent successful embryo transfer.
As happens so often in medicine, when something unusual occurs, it repeats itself: Within a few weeks two more cases of chronically thin endometrium presented themselves, and received the same kind of treatment from Dr. Gleicher and Dr. Barad, Clinical Director of the Center's ART Program. Both cases reached embryo transfer!
Dr. Gleicher also told a friend and colleague from another New York City-based IVF center about these experiences, who asked permission to use the same protocol on one of his patients, who at exactly that time faced the same problem. This patient, too, improved her endometrium, and went on to embryo transfer.
As noted earlier, a prestigious medical journal has accepted a report about these four cases in record time because their initial severity and improvement, subsequent to G-CSF treatment, was really absolutely remarkable. This, however, is not the end of the story: We haven't told you yet anything about what happened after these four patients had successful embryo transfers. But for that part of the story you will have to wait until the paper is published. Stay tuned!
CHR is currently in the midst of two prospectively randomized clinical trials of G-CSF: In one, we are further investigating the power of G-CSF to expand endometrial thickness. In a second, we are trying to determine whether G-CSF has in general the potential of improving pregnancy rates with IVF. If you are interested in participating, please contact us (and specify that you are interested in CSF study).

/links
 

·
Registered
Joined
·
594 Posts
Discussion Starter · #29 ·
I couldn't agree more,  ^idiot^  completely threw me too.  The only explainations I could come up with were

a) there are so many different types of immune cells, maybe the cytokines that Gleicher is injecting are something completely different to the immunes we are clobbering with immunes tx i.e. there are many types of cytokines
b) maybe having them in your blood, and injecting them directly into youru uterus is different - though i can't see how this would make a difference and
c) Gleicher has tried this on such a small number of women that it is meaningless................

P.S. hello darling Nix.
xoxoxo
 

·
Registered
Joined
·
594 Posts
Discussion Starter · #30 ·
Intralipids in the daily mail! Nothing in here most of you ladies don't already know, though wonderful to see IVIG \ intralipids is being widely recognised (finally), though as stated in the article it doesn't work for everyone.

The thing I found most interesting was itralipid tx was quoted as costing £200 per woman -did they mean per woman or per tx? I needed tx every 3 weeks for about 10months...and I'm sure I paid more than £200 per tx, though I'd have to check to confirm. It would be worth ringing the daily mail to ask who is offering intralipids at £200 per woman!!!

http://www.dailymail.co.uk/health/article-1343723/Soya-based-fertility-treatment-hold-key-cutting-number-miscarriages.html

Absolute best of luck and baby dust to anyone reading this.
Soya-based fertility treatment may cut miscarriages and boost pregnancy up to six-fold
An experimental fertility treatment increases the odds of an IVF pregnancy up to six times while also inhibiting chemicals which cause miscarriages, a study has found.
When women who had gone through IVF time and time again without success were given a soya-based substance, half became pregnant.
In contrast, fewer than one in ten of those who had conventional fertility treatment alone conceived.
Sweet dreams: Thousands of women could be spared the heartache of miscarriage by a new fertility treatment that boosts the odds of pregnancy up to six-fold The doctors behind the remarkable study believe that the Intralipid liquid, a fat and calorie-rich potion normally used when tube-feeding very sick patients, could help many more women achieve their dream of motherhood.
Improving success rates would spare women the emotional and financial pain of going through repeated IVF treatments, only for them to fail. The liquid also stems the production by the body of harmful chemicals which can lead to miscarriage.
George Ndukwe, of the Care fertility clinic in Nottingham, said: 'Every day in my clinic I see women who have had numerous IVF cycles all with the same negative outcome and no baby.
'I also regularly see couples who have suffered the misery of repeated miscarriages.
'People talk about the financial implications but the emotional one is as bad or, I would say, worse.
'These women are at the bottom of a dark pit and can't climb out and can't see the light.
Heartache: IVF costs up to £3,500 a time and doesn't work for everyone. At around £200 per woman, Intralipid, is a much cheaper option We are devoting our attention to finding answers when nature goes wrong.'
Dr Ndukwe, the clinic's medical director, believes that up to one in four women who struggle conceiving have faulty immune systems.
It is thought that extra high levels of white blood cells called natural killer cells 'fight' the pregnancy by triggering the production of chemicals that attack the placenta or the embryo.
The chemicals are already known to trigger rheumatoid arthritis and the arthritis drug Humira has shown promise in boosting pregnancy rates.
However, it costs up to £3,500 per patient and does not work for everyone.
At around £200 per woman, Intralipid, which is given through a drip around a week before a woman has IVF, is much cheaper.
And the latest research, to be
presented at a British Fertility
Society conference on Thursday, shows it is also more effective at stemming production of the harmful chemicals.
Dr Ndukwe said: 'This infusion is inexpensive, well tolerated and easy to administer.'
The fertility expert ran his trial on a group of women who had failed to become pregnant despite enduring an average of six IVF attempts each. One woman had tried and failed at IVF 12 times.
Half of those treated became pregnant, compared with just 9 per cent of those not given the fatty substance.
Other doctors are trying to use steroids to lower levels of natural killer cells in the body.
Professor Siobhan Quenby, of Solihull Hospital and Warwick University, has already successfully used an asthma drug to curb the immune system response in a pilot trial of women who had suffered repeated miscarriages.

Read more: http://www.dailymail.co.uk/health/article-1343723/Soya-based-fertility-treatment-hold-key-cutting-number-miscarriages.html#ixzz1DUfcXEQ6

/links
 

·
Registered
Joined
·
594 Posts
Discussion Starter · #31 ·
Code:
VIAGRA AND IVF
Code:
Dr Sher and Dr Fish from USA reported that three out of four women became pregnant after taking the drug Viagra while undergoing IVF treatment. These women had already experienced many failed IVF treatments. The reason beyond the use of Viagra was to increase the blood flow to the uterus and to improve both the pattern and thickness of the endometrium. Viagra suppositories rather than oral tablets were used in order to reduce the side effects such as headaches and low blood pressure because it deliver the drug near the proximity of the uterus. A large randomized study needs to validate the efficacy and  safety of this treatment which, if proven, may offer hope for some women who can not conceive because of the poor quality of their endometrium.
Code:
A longer interview with Dr Sher on the use of Viagra
Code:
http://www.storknet.com/cubbies/infertility/exgs1.htm
Viagra used to thicken lining in the uterus - BBC article
http://news.bbc.co.uk/1/hi/health/741125.stm

As always I'm thinking about women with POF. I wonder if "increasing the blood supply" to the uterus could help with follicle development? I think I'll add this to my list of things to try on myself..... now if only someone would hand me some Viagra suppositories :)

/links
 

·
Registered
Joined
·
2,244 Posts
I've emailed a few compounding pharmacies to find out what's in the viagra suppositories, no answers yet. It's not good science for folks to be publishing papers that cannot be reproduced because they don't say what is actually in the pills! However I suspect that will change as this treatment catches on a bit.

Wanted to add this article to the research listing, I was able to download it & it is kinda interesting. They ADDED Viagra to the treatment, & treated all the women differently depending on what their other problems were (so some got prednisone, some got that + IV Ig, etc), so again not reproducible...

But anyway, they conclude:
"The present data shows the effects of vaginal sildenafil on NK-cell activity and endometrial thickness in women with a history of RM. According to our knowledge, these data suggest for the first time that sildenafil might be a useful therapy in RM patients. The data suggest that sildenafil has no detrimental effect on NK-cell activity; on the contrary, NK-cell activity was significantly decreased after vaginal sildenafil therapy in the study women. The mechanism of sildenafil's influence on NK cells is unknown; however, it can not be excluded that improvement in uterine artery flow has efficient influence on the local endometrial NK-cell population, and the diminished NK cell activity may promote successful pregnancy outcome. Additionally, sildenafil significantly improves endometrial thickness, which is especially important in successful implantation. Therefore, sildenafil citrate introduced vaginally might be a novel therapy improving the quality of the endometrium and the immunologic environment in recurrent miscarriage patients."

http://www.ncbi.nlm.nih.gov/pubmed/18440513
"Sildenafil citrate decreased natural killer cell activity and enhanced chance of successful pregnancy in women with a history of recurrent miscarriage" (Jerzak M, Kniotek M, Mrozek J, Gorski A, Baranoswi W )
ABSTRACT
OBJECTIVE: To evaluate the effect of sildenafil on peripheral natural killer (NK) cell activity in women with a history of recurrent miscarriage (RM).
DESIGN: Observational study.
SETTING: University teaching hospital.
PATIENT(S): Thirty-eight nonpregnant women with a history of RM and 37 healthy women with previous successful pregnancy outcomes.
INTERVENTION(S): Patients self-administered sildenafil suppositories (25 mg intravaginally, four times a day) for 36 days.
MAIN OUTCOME MEASURE(S): Peripheral blood NK-cell activity before and after vaginal sildenafil therapy in the RM women was measured using flow cytometry. In addition, the influence of 10 microg and 400 ng sildenafil on NK-cell activity after in vitro culture were determined. Uterine artery blood flow and endometrial thickness were recorded using Doppler ultrasound with an intravaginal probe.
RESULT(S): The NK-cell activity was significantly decreased after vaginal sildenafil therapy. Endometrial thickness was significantly increased after such therapy.
CONCLUSION(S): Vaginal sildenafil might be an interesting therapeutic option before conception in women with histories of reproductive failure.

/links
 

·
Registered
Joined
·
2,244 Posts
I found a recent article where they finally explain: "The sildenafil suppositories were prepared from the oral tablets. The tablets were mashed and dissolved in Hosco S-55 (25 mg sildenafil/1.35 g Hosco S-55)"(from: "Endometrial growth & uterine blood flow: a pilot study for improving endometrial thickness in the patients with a thin endometrium," Fertility & Sterility April 2010, vol 93 issue 6, pages 1851-8.)
So basically a compounding pharmacy could easily do this for you -- they'd just put it in a gel-like base which helps to keep it from going away too fast. That's probably why the pills themselves are supposedly not as useful, they aren't absorbed as well (but there is no proof yet so who knows).

In this study, they used vitamin E, L-arginine, & Viagra for ladies with thin linings & not good blood flow, & all methods were better than doing nothing & much better than placebo. The sample sizes were pretty small so validity of the science is limited, but they were very enthusiastic about vit E treatment & also about Viagra. I'm just wondering what happens if you take them all -- is your blood flow too much? do they cancel each other out?


/links
 

·
Registered
Joined
·
594 Posts
Discussion Starter · #34 ·
1. Exposure to Chemicals in Environment Associated with Onset of Early Menopause

Exposure to perfluorocarbons associated with lower concentrations of the hormone estradiol
A recent study accepted for publication in The Endocrine Society's Journal of Clinical Endocrinology & Metabolism (JCEM) found that higher levels of perfluorocarbons (PFCs) in the body are associated with increased odds of having experienced menopause in women between 42 and 64 years old. Women in this age group with high levels of PFCs also had significantly lower concentrations of estrogen when compared to women who had low levels of PFCs.
PFCs are man-made chemicals used in a variety of household products including food containers, clothing, furniture, carpets and paints. Their broad use has resulted in widespread dissemination in water, air, soil, plant life, animals and humans, eve in remote parts of the world. A probability sample of U.S. adults, found measurable concentrations of PFCs in 98 percent of the participants tested.
"The current study is the largest ever to be done on the endocrine-disrupting effects of perfluorocarbons in human women," said Sarah Knox, PhD, of the West Virginia University School of Medicine in Morgantown and lead author of the study. "Our data shows that after controlling for age, women of perimenopausal and menopausal age in this large population are more likely to have experienced menopause if they have higher serum concentrations of PFCs than their counterparts with lower levels."
In this study of 25,957 women aged 18 to 65 years, researchers ascertained menopausal status of participants and then measured their serum concentration levels of PFCs and estradiol. They found that there was an association between PFC exposure, decreased estradiol and early menopause in women over age 42. There was also an inverse association between PFC levels and estradiol in women of child bearing age but this association was not statistically significant.
"There is no doubt that there is an association between exposure to PFCs and onset of menopause, but the causality is unclear," said Knox. "Part of the explanation could be that women in these age groups have higher PFC levels because they are no longer losing PFCs with menstrual blood anymore, but, it is still clinically disturbing because it would imply that increased PFC exposure is the natural result of menopause."
PFCs are known to have multiple adverse health outcomes including increased cardiovascular risk and impairment of the immune system.
"Our findings suggest that PFCs are associated with endocrine disruption in women and that further research on mechanisms is warranted," said Knox.
Other researchers working on the study include: Timothy Jackson, Beth Javins, Stephanie Frisbee, Anoop Shankar and Alan Ducatman of the West Virginia University School of Medicine in Morgantown.
The article, "Implications of Early Menopause in Women Exposed to Perfluorocarbons," appears in the June 2011 issue of JCEM

/links
 

·
Registered
Joined
·
594 Posts
Discussion Starter · #35 ·
The Bright Side of PCOS - PCOS may make fertility last longer

An extraction from the article below, full article at

http://www.smh.com.au/lifestyle/diet-and-fitness/bright-side-to-pcos-paradox-20111017-1lt1w.html

"There is perhaps a evolutionary twist to the prevalence of PCOS among women. Since the condition causes women to ovulate less regularly, they tend to have better fertility than other women later on in their reproductive years. In a manner of speaking, their bodies hold on to their eggs, so they last for longer. One evolutionary explanation is that female bodies adapted to times of famine by increasing insulin resistance to save calories and extend the reproductive years.

"PCOS might have been a good thing to have in times of food scarcity because it allowed the window of fertility to be extended and it allowed women to survive and preproduce in low fuel environments. Today we have calories all around us, and yet the body's possible adaptation to another time still remains for some women. One way to look at PCOS is as a past adaptation gone astray." Dr. Sarah Berga says, speaking on PCOS at a recent conference."
---------------------------
FYI - a lot of fertility clinics prescribe Glucosophage for women with PCOS which helps control blood sugars allowing them to fall pg more easily.

/links
 

·
Registered
Joined
·
480 Posts

·
Registered
Joined
·
480 Posts

·
Registered
Joined
·
594 Posts
Discussion Starter · #38 ·
For all those with POF and very low AMH this is interesting research. It's a small study, that shows something we have long suspected. Just because a woman has POF doesn't mean she doesn't have ovarian activity from time to time. In this study in shows 24% of the women with POF showed ovarian activity - I'm guessing in order to predict "when" they must have used some kind of regular ultrasounds. By the way, a recent UK study now believes the number of woman under 40 affected by POF is more likely to be around 7 or 8%, not the 1% previously thought.

http://www.menopausematters.co.uk/newsitem.php?recordID=125/Intermittent-Ovarian-Activity-May-Follow-Premature-Ovarian-Failure

/links
 

·
Registered
Joined
·
594 Posts
Discussion Starter · #39 ·
A very very interesting breakthrough. Maybe women are not born with a limited number of eggs after all. Human stem cells generate new eggs in human ovarian tissue.

http://www.nature.com/news/egg-making-stem-cells-found-in-adult-ovaries-1.10121

http://gma.yahoo.com/stem-cell-finding-could-expand-womens-lifetime-supply-190304876.html

This post contains an unconfirmed link/information and readers are reminded that FertilityFriends.co.uk or its owners are not responsible for the content of external internet sites
 

·
Registered
Joined
·
490 Posts
Apple Orchard
Just come across this thread and saw your post about the "Flexible GnRH antagonist versus flare-up GnRH agonist protocol in poor responders treated by IVF: a randomized controlled trial" by Lainas et al.

I looked at the statistics they report in the abstract, and it doesn't actually show very promising results (at least not in terms of statistically significant terms). Their results show that the outcomes weren't much better than chance...

They say that "Ongoing pregnancy rate, the primary outcome measure, was significantly higher in the antagonist group compared with the agonist group (12.2 versus 4.4%, P< 0.048; difference 7.8%, 95% CI: 0.2 to 14.0)". What the numbers mean is that, yes it was a bit higher, but when you do stats tests on the numbers, it isn't much better than chance. the P value should be 0.05 or less... so, it is just on the brink of statistical significance. The CI numbers refer to the 'confidence interval'.... ideally here you don't want a very big range and 0.2 - 14.0 is really big (basically they are saying 95% of their sample scored within that range. really you'd want 95% scoring within a range of one or two points for this kind of outcome measure).

The second bit of findings they report: "Estradiol levels on the day of hCG administration were lower in the antagonist protocol [median (interquartile range): 572 (325-839) versus 727 (439-1029) pg/ml, P = 0.018]. " is also not terribly promising

Sorry if its diappointing news... i guess i'd rather know myself (boring old realist when it comes to chances of sucess).
x

/links
 
21 - 40 of 54 Posts
Top