in this issue
Sonja Kristiansen, MD
Medical Director & founder
of
the Houston
Infertility Clinic, Dr. Kristiansen is double board
certified
in
Reproductive
Endocrinology and Obstetrics & Gynecology and
specializes in surgical and IVF procedures.
She has
advanced training in hysteroscopy, laparoscopy, and
microtubal reconstruction. She also works with
female endocrine abnormalities relating to
menstrual and reproductive development.
Quick Links...
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Greetings,
It's easy to describe some assisted reproductive
technologies with glowing superlatives -- "miraculous"
treatments with "the best" outcomes. After all, much of
the science involved in reproductive medicine is
nothing short of amazing and getting more so every
year. Still, the educated patient knows that usable
science doesn't pop out of nowhere like a rabbit out of
a magician's hat. The technology that we use every
day in our work results from the accumulation of many
pieces of meticulously gathered information.
Reproductive research aims at taking minute details
and combining them to form one big picture:
successful conception, pregnancy, and healthy babies.
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Presenting parts of the puzzle
At Houston Infertility Clinic, both our clinical and
laboratory staff explore the different facets of assisted
conception. At this year's annual meeting of the
American Society for Reproductive Medicine, we will
be presenting results of a study that looks at a
woman's age and IVF outcome. In the interest of
building a strong foundation of knowledge, we
examined one specific detail -- the cavitation rate of
embryos created with in vitro fertilization (IVF).
Cavitation is an event that should occur in a
developing embryo around the 4th or 5th day following
egg retrieval. It refers to the formation of what is called
the blastocoelic cavity, which will later go on to
become the primary yolk sac after the embryo has
implanted in the mother's uterus.
Patients undergoing IVF may read that different clinics
transfer their embryos back to the uterus on different
days. Here at HIC, we use what is called Extended
Embryo Culture (EEC). More than half of HIC's embryo
transfers are performed on Day 5 after retrieval.
Another related puzzle piece is that rates of aneuploidy
in IVF embryos increase with the mother's age.
Aneuploidy is the situation in which there are either
too many or too few chromosomes in a cell, leading to
any number of chromosomal-based disorders.
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Putting the pieces together
Our study found that as women patients' ages go up,
the rate of successful cavitation in Day 5 embryos
goes down. We believe that this clear finding might
also indicate that "advanced maternal age" is related
to the rise in aneuploidy of their embryos.
So what does all of this mean to patients considering
IVF?
For one thing, it's another flag that waiting to seek
treatment is possibly the most self-defeating choice
an infertile woman can make. No matter what detail is
studied, virtually every component of the getting-
pregnant process appears to function better when
women are younger than mid-30's.
Additionally, this study points to choices that treatment
providers can make to increase the likelihood of
successful conception with IVF. For example,
clinicians who routinely transfer embryos at Day 3 for
reasons of efficiency may find that their patients
benefit from waiting another two days. Assuming an
IVF patient has a good number of healthy looking
embryos, waiting until Day 5 to see how well they
continue developing may result in a higher percentage
of healthy pregnancies per number of embryos
transferred (ET). At HIC, our policy is to perform Day 5
ET so long as a patient has at least four embryos with
no more than 20 percent fragmentation on Day 2.
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Narrowing down the mystery
Our work is about combining what is known with what
is apparent and helping people resolve what often
starts out as the biggest mystery of their lives. To do
that, we piece together seemingly unconnected
details to come up with as firm a foundation as
science and technology will allow. That foundation
gets firmer with each additional study conclusion.
Our patients are educated and curious to learn more.
As always, I hope that you will bring your questions in
for consultation. My staff and I are happy to explain
how unfolding science relates to your personal
infertility situation.
Sincerely,
Sonja B. Kristiansen, MD
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