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The factors that influence IVF success. Presented by Geoffrey Sher, MD, of Sher Institute for Reproductive Medicine
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SUCCESSFUL IVF!
GEOFFREY SHER M.D.GEOFFREY SHER M.D.
Sher Institute for Reproductive Sher Institute for Reproductive Medicine (SIRM)-St. LouisMedicine (SIRM)-St. Louis
Find Us Online!(See Sheet in Your Packet)
Website:www.haveababy.com
Discussion Boards: forums.haveababy.com
IVF Authority Blog:www.IVFauthority.com
Positive 1st Betas by Cycle Date
66%62%
48%
62%
52%
60%
52%
52%
47%
61%
68% 69%
67%
78%
69%
88%
79%
81%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Jan-12
Feb-12
Mar-12
Apr-12
May-12
Jun-12
Jul-12 Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Jan-13
Feb-13
Mar-13
Apr-13
May-13
Jun-13
Jul-13 Aug-13
Cycle Date
Jan-Dec 2012 Feb-Aug 2013
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% Positive Beta hCG
Average Positive 1st Beta hCGPrior to and After Feb 2013
n=410
n=190
57%
77%
"Maximum" Birth Rate Per Single Embryo Transferred
Blastocyst vs. Cleaved Day-3 Embryo
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
<35 35-39 40-42 43-44
Age
Bir
th R
ate
1-CGH Normal Blast1-Untested Blastocyst1-Untested Cleaved Embryo
"Maximum" Birth Rate Per Transfer of Two (2) Embryos
[Blastocyst vs. Cleaved Day-3 Embryo]
0%
10%
20%
30%
40%
50%
60%
70%
<35 35-39 40-42 43-44
Age
Birt
h R
ate
2-Blastocysts
2-Cleaved Embryos
INFLUENCING IVF SUCCESS
1. OPTIMIZING EMBRYO QUALITY
2. OPTIMIZING EMBRYO IMPLANTATION
3. OPTIMIZING THE EMBRYO TRANSFER
Establishing an ideal “Soil”/”Seed” relationship!
SOIL / SEEDSOIL / SEED ENDOMETRIUM / EMBRYOENDOMETRIUM / EMBRYO
75%75%25%25%
MATURE EGG (M-2)
It is primarily the chromosomal integrity of the egg, rather than the sperm that determines embryo Chromosomal
integrity or “competence”!
MeiosisMeiosisMeiosis – Dividing the Egg’s
Chromosomes
FERTILIZATION
INTRACYTOPLASMIC SPERM INJECTION (ICSI)
3-Day-Old Embryo
5-6 Day Embryo (blastocyst)
A “competent” embryo has 46 chromosomes present in its cells!
“EUPLOID”
EMBRYO ANEUPLOIDY -
THE RATE LIMITING FACTOR IN HUMAN REPRODUCTION!
THE BREAKTHROUGH: Comparative Genomic
Hybridization (CGH)
“A genetic test that identifies all the chromosomes in the egg or embryo!”
Which Embryos are chromosomally normal/abnormal?
Embryo Competency
Both Abnormal
Embryo Competency
Both Normal
2. IMPLANTATION POTENTIAL
Immunol. Uterine Lesions
LiningThickness
IMPLANTATIONUTERINE
RECEPTIVITY
Uterine Receptivity Factors
a. Uterine Pathology
SONOHYSTEROGRAM
Endometrial PolypEndometrial Polyp
HYSTEROSCOPYHYSTEROSCOPY
Large, pedunculated endometrial polyp
b. Endometrial Thickness
END 2B
A Thin EndometriaL Lining
A Viagra- Restored Endometrium
““Tri-Laminar” AppearanceTri-Laminar” Appearance
Causes of a Thin Uterine Lining
Uterine scarring • Inflamation• Surgery
Reduced blood flow• Age• Diffuse adenomyosis• Multiple fibroid tumors• Over-use of clomiphene
Viagra Improves Blood Flow
Dilates vascular smooth muscleDilates vascular smooth muscle
Can improve uterine blood flowCan improve uterine blood flow
Increased EIncreased E22 delivery delivery
c. Immunologic Factors
UTERINE IMMUNE TOLERANCEUTERINE IMMUNE TOLERANCE
EMBRYO
GENETIC SIGNALLING
NKcell
STABILITY CYTOKINES
TH-1 ++
CYTOKINES
TH-2
Immunologic Implantation Immunologic Implantation DysfunctionDysfunction
Autoimmune IDAutoimmune ID(85%)(85%)
Alloimmune IDAlloimmune ID((15%)15%)
NK CELLS
Implantation Implantation ImmunotherapyImmunotherapy
Heparin/Lovenox/Clexane IVIG - Replaced by… Intralipid (IL)Dexamethasone/Prednisone Aspirin ?? Other (LIT, Humera)??
3. EMBRYO TRANSFER
Ultrasound-guided Placement of Embryo(s)
Day 3 vs. Day 5?
How Many embryos to transfer?
Full bladder
Ultrasound guidance
Cntd.
THANK YOU!!THANK YOU!!