Do it Once, Do it Right Craig Reisser Andrea Speck-Zulak Families Through Surrogacy 2016
Founded in 1989 - more than 25 years building families patients from 40 countries One of the largest IVF clinics in the US State-of-the art clean-room embryo laboratory designed by engineers who have also designed the fabrication plants at Intel in Oregon Consistently high live birth rates top 1-3% of all US clinics in every reported category In-house egg donor program Leader in surrogacy IVF In-house genetics team and laboratory
Advice from Someone Who Was Sat in Your Chair There can be nothing more costly financially and emotionally for you, your donor, and/or your surrogate than a failed cycle Give yourself the best opportunity for success and a healthy baby on the first attempt
Clinically 4 Things to Focus On 1 2 3 4 IVF success rates Egg donor medical indicators Surrogate medical screening Reproductive genomics
US IVF Clinics Report Their Results Since 1992 by law all US IVF clinics to report their outcomes to the Centers for Disease Control (CDC) You can compare the live birth rates achieved by IVF clinics through the CDC and SART CDS websites: www.cdc.gov/art/ www.sart.org Live birth rates depend on many factors: Age of the woman s eggs Medical background of the woman receiving the embryo Number of embryos transferred Type of procedure, quality of embryology lab, genetic testing of embryos There is a time lag in the reporting CDC / SART does not track: Egg donor / surrogacy success statistics (which should be the highest of all treatments) Outcomes achieved with genetic testing of embryos Consistency in success rates over time can be indicative of IVF clinic and laboratory quality
Achieving Success in IVF is a Cumulative Process Each Step in the IVF Process Builds Upon the Prior Step Optimising Egg Quality Embryology Laboratory Selecting Normal Embryos Optimising the Transfer and Pregnancy Surrogate Screening
Choosing an Egg Donor Not Just a Pretty Face Personal background e.g. education, interests Photos Physical and ethnic characteristics Medical background Genetic testing Donor medical AMH, BAF Prior donation outcomes Reasons for donating Anonymous v. known Costs
Medical Factors for a Successful Donation Age Peak fertility during a woman s 20s Above 35 the rate of abnormal embryo formation increases substantially BMI (Body Mass Index) Can impact the effectiveness of fertility medications BAF (Baseline Follicle Count) The number of follicles in the donor ovary that will create an egg ORM minimum is 20 AMH ( Anti-mullerian Hormone) Provides an indication of a donor s egg reserve ORM minimum is 2.0 Prior Donation Information- if applicable Important to view cycle as a whole number of eggs retrieved, fertilization rate, blastocyst embryros, normal embryo rate Ongoing pregnancy / live birth outcomes Medication dosages ASRM guidelines are for no more than 6 egg donations
Surrogate Medical Screening- ORM Requirements BMI At least 19 but equal or less than 32 Number of Prior Pregnancies At least one uncomplicated pregnancy and delivery- no more than 5 deliveries (physician discretion)] Number of Cesarean Deliveries No more than 3 caesarean sections Location to Hospital Does not live in a remote area distance to NICU must be acceptable Medical Requirements No obstetrical or medical history concerns (extensive list) No psychiatric issues or medications Non smoker, non drinker, no drug history Immune to varicella and rubella Negative for infectious diseases Not on any Category C or above medications
Reproductive Genomics Pre- Embryo Creation Genetic History Evaluation Assessment of the genetic family history for each provider of each egg and sperm to identify any areas that merit particular attention Recessive Carrier Gene Screening Screening for recessive genetic disease genes that could result in a unhealthy baby if both egg and sperm providers are carriers Post- Embryo Creation Pre-implantation Genetic Screening (PGS) Testing embryos to determine normality - the correct number of chromosomes to develop into a healthy pregnancy and baby Pre-implantation Genetic Diagnosis (PGD) Testing embryos to determine whether a patient-specific genetic disorder is present
Recessive Carrier Screening Carriers of a genetic disorder have one gene copy that is not working correctly - as the other copy is working fine carriers are usually healthy and have no signs of the disorder If each provider of sperm and egg for the creation of an embryo are carriers of mutations in the same gene, they will have a 25% chance to have a baby with that disorder - this is called recessive inheritance Being a carrier is common - about 30% of Intended Parents / Donors who undergo screening are a carrier of one or more disorders, even when there are no genetic conditions in their family history Recessive Carrier Screening involves a simple saliva or blood sample Allows Intended Parents to choose an alternative Donor before getting started if there is an increased risk
Latest PGS Technology: Comprehensive Chromosome Screening (CCS) with Next Generation Sequencing (NGS) Removal of 5-10 trophectoderm cells from 5 to 6 day old embryos (blastocyst) Next Generation Sequencing - attachment of 500,000 genetic probes to the amplified DNA of the biopsied cells Detects embryos with abnormal number of chromosomes Most would block embryo s development into fetus Will identify embryos that can lead to abnormal fetus (e.g. Down Syndrome) Embryos generally frozen after testing for later transfer in some cases CCS testing can be performed on embryos for a fresh transfer
% of Embryos that will be Chromosomally Abnormal
Final Words of Advice Be informed Interrogate your providers Be optimistic it absolutely can work the first time It did for me, twice
Thank You