Wellness Wednesday: Let’s talk about Dolce and Gabbana

Dr Sonya Kashyap comments on the Dolce and Gabbana IVF scandal

When I first saw the headline “Victoria Beckham supports Sir Elton John and ‘beautiful IVF babies after Dolce & Gabbana criticism,” I was surprised. As I went on to read the entire article, I was shocked. Children born through IVF or other forms of reproductive technology are not fake or “synthetic”—they are human beings, with thoughts and feelings and people who love them, just like any other child.

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Wellness Wednesday: Independently Verified Pregnancy Rates

In 2013, Genesis Fertility Centre became the first and only clinic in Canada to independently verify our clinical results. We did this to improve transparency about our clinic’s pregnancy rates and translate for patients procedural success rates that are often reported in different ways.

In the U.S., reporting of pregnancy rates by fertility clinics is mandatory, audited and identifiable. In Canada, reporting is voluntary, de-identified and unaudited. Websites may contain only biochemical pregnancy rates* and use different denominators, making it virtually impossible for patients to compare the success rates of different fertility clinics.

At Genesis, we ensure validity of our pregnancy rates annually through third-party auditing conducted by two independent, unrelated industry organizations: Fertility Authority, a leading authority in patient advocacy, and IVF Reports, an authority in IVF standards.

At Genesis Fertility Centre, we believe that singleton pregnancies are healthiest for mothers and babies as multiple implantation’s increase the risk of pre-term delivery and obstetrical complications.

Between January 2011 and December 2012, Genesis’s elective and mandatory single embryo transfer rate was 18%.

In 2013, elective day-five single embryo (eSET) utilization increased to 76% for eligible women under age 37 (table 3).

Elective single day-five embryo transfer (eSET) in women under age 37 at Genesis Fertility Centre (independently verified, January 2013 - July 2014).

 

What do these numbers mean?

Pregnancy rates may be reported in several ways due to various definitions of pregnancy (see Table 4). The denominator against which positive pregnancies are measured also vary:

  1. The start of an IVF cycle, i.e. the start of fertility medication
  2. Egg retrieval
  3. Embryo transfer

We report according to fresh embryo transfer.

Independently verified pregnancy rates (%) per fresh embryo transfer for Genesis Fertility Centre (January 2013 - July 2014).

 

Why do we report according to fresh embryo transfer?

Many patients now choose to freeze their embryos for later use rather than proceed with embryo transfer immediately. Also, some patients with poorer prognoses or more challenging histories (e.g. AMH levels of <0.5; multiple previous failed cycles at the same or different fertility clinics) may have poorer progression to transfer, i.e. no embryo to transfer. In the past, these patients may have been denied a chance to try. We take pride in accepting these “challenging cases” provided the patients understand the prognoses. We are honoured to help them build their families.

Not all egg retrievals result in embryo transfer:

  • Fertility preservation for patients with cancer or other medical issues
  •  Cryopreservation of embryos for later use due to:

i. Genetic screening (day-five embryo biopsy and freezing while awaiting results of testing)
ii. Risk of ovarian hyperstimulation
iii. Uterine factor infertility
iv. Other, e.g. personal or health reasons

  • No eggs retrieved (this occurs at a frequency of <1% in a normal responder)
  •  Failed fertilization (occurs in <5% of cases)
  • Failed embryo development (occursin <1% of cases)

We intend to post our pregnancy rates according to age, AMH levels and previous attempts on our website to allow patients to interpret their individual circumstances. Stay tuned!

*Biochemical pregnancy rates are defined as positive blood tests done 17 days after the embryo transfer.

Wellness Wednesday – Success With Egg Freezing

At Genesis, supporting our patients through successful treatment is our top priority. This applies to all the procedures we perform at our centre, including egg freezing.

Egg freezing is a delicate process and its success rates are highly dependent on method and experience. Thanks to our talented and seasoned team we have managed to achieve high success rates (Table 1).

Genesis Fertility Egg Freezing Success Rates

Most women do not return for their frozen eggs for many years, so the number of women who have attempted to become pregnant from these eggs is limited. For this reason, quality assurance in the egg survival process is paramount, and has helped us achieve a thawed egg survival rate of 95%.

Delayed Childbearing

An increasing number of women are interested in having children later in life for a variety of reasons:

  • Meeting the right life partner
  • Focusing on education and career development
  • Seeking financial stability prior t o having a child

When a woman is in her late 30s or older, there is a decreased chance of pregnancy and an increased chance of pregnancy loss and chromosomal abnormalities. Women can now choose to freeze their eggs through vitrification at Genesis.

Patients with Cancer

Advances in cancer treatment have increased survival rates over the past decades. However, many cancer treatments can permanently affect fertility for both men and women. In women, cancer treatment may deplete the number of eggs in the ovaries and trigger early menopause. If you will be receiving chemotherapy imminently, your doctor may refer you and you will be seen within 24 to 48 hours to discuss your fertility options.

Fertility can be preserved through the freezing of sperm, eggs and embryos. Our team works closely with oncology teams to ensure any fertility treatment is safe.

Genesis Fertility Centre helped Anna freeze her embryos to use after her cancer treatment

 

Steps to Egg Freezing

Women who elect to freeze their eggs undergo the same initial steps as an IVF treatment cycle. Vitrified eggs are then banked and can be stored for many years. Women are encouraged to access this treatment prior to age 38 to increase the chance of pregnancy when their eggs are thawed, fertilized and transferred at a time in their life when pregnancy is desired. We have observed success of frozen eggs up to age 38 but consider patients on a case by case basis up to 42.

Our medical director Dr. Sonya Kashyap recently penned a detailed article for the Huffington Post entitled “Egg Freezing Deserves Serious Consideration.” The article provides detailed background information on the fertility procedure and how it applies to Canadians.

Wellness Wednesday: Comprehensive Chromosomal Screening & Preimplantation Genetic Diagnosis

Genesis Fertility Centre is committed to fertility patient care, and screening for chromosomal abnormalities can help reduce the probability of a failed cycle, miscarriage or abnormal pregnancy from an IVF cycle. At our clinic, we offer both comprehensive chromosomal screening (CCS; Table below) and pre-implantation genetic diagnosis (PGD).

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Genesis pregnancy rate for CCS patients of all ages (2014).

What is Comprehensive Chromosomal Screening?

CCS, also known as preimplantation genetic screening (PGS), allows fertility specialists to identify a chromosomally balanced embryo for transfer with 98% certainty. Screening embryos prior to implantation can help achieve higher success rates and fewer pregnancy losses, particularly for women over 35 years old, patients with multiple-failed IVF cycles, implantation failures or repeated miscarriages.

For women under age 35, more of their embryos will be balanced (euploid). Nevertheless, there are some younger patients who prefer CCS. An example would be unexplained recurrent pregnancy loss or previously chromosomally abnormal pregnancies.

Due to age-related infertility, for women over age 38, most of their embryos will be abnormal (aneuploid) and CCS can help reduce the time needed to successfully conceive by avoiding the transfer of an abnormal embryo.

What is pre-implantation genetic diagnosis and how is it different than CCS?

PGD is a test offered to patients who have a high risk of transmitting a known single-gene defect to their child, such as Tay-Sachs disease, haemophilia and cystic fibrosis.

If you would like to speak with one of our nurses about CCS or PGD, please call us at 604.879.3032

Wellness Wednesday: 3 Reasons Thyroid Imbalance Can Cause Infertility

By Dr. Jeda Boughton, BodaHealth

3 Reasons Thyroid Imbalance Can Cause Infertility

It is estimated that 16% of couples have fertility problems. Thyroid imbalance can contribute to difficulty conceiving a child in several ways, such as:

1)    Menstrual Cycle

The underproduction of thyroid hormones (hypothyroidism) or the overproduction of hormones (hyperthyroidism) can cause irregularities in your menstrual cycle. A cycle that is too long or too short can cause difficulty with conception.

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Wellness Wednesday: Toxin Awareness

By: Dr. Spence Pentland, TCM

Toxins to avoid for fertility health

Environmental toxins are a very passionate topic in my life. My desire to create awareness through strong emphasis on the negative impacts of these substances and products may, at times, create fear and the feeling that major damage has already been done. This could then be followed by a sense of despair, resentment, and not knowing what to do. I apologize if any version of this is your experience, but to some degree if it is, I have done my job! That said, beginning the process of reversing damage caused by toxins is simply a matter of starting to incorporate choices that lead to a cleaner, less toxic personal environment. Start today; it’s easier than you think.

No one is immune to the health ailments that are being caused by environmental factors. Educating yourself is key, not only for conception, but also for parenting. Health challenges like Autism and cancers are rising steadily for children and their causes have been linked to common pesticides. Learn as much as you can and avoid what you can.

There are over 80,000 manmade chemicals existing in the marketplace today. Many were introduced after World War II when petro-chemical companies no longer had a market for chemical weapons and found uses for their products other forms, consisting of home and agricultural pesticides and fertilizers, food preservatives, household cleaners, and personal care products. Current estimates place the existence of over 200 of these industrially produced chemicals in the human body at any given time. The time when a human is at greatest risk of the effects of these toxins is during fetal development, hence the added relevance for this post. Many of these chemicals are known toxins that disrupt hormonal balance and are contributing factors in infertility, PMS, irregular menstrual cycles, polycystic ovary syndrome, endometriosis, premature ovarian failure, recurrent pregnancy loss, anxiety and cancer of all kinds.

I recently heard a statistic that one half of all Americans will have cancer at some point in their life.

We are all in this together…

Everything is connected. A great example of this can be seen in Theo Colborn’s book, ‘Our Stolen Future’, in which he tells the tale of a single PCB molecule (a cancer causing chemical found in coolants and banned in 1979) travelling from a factory in Texas, to the bottom of a Great Lake, to a Polar bear in Norway twenty years later.

Drastic changes in the reproductive health, patterns and behaviors of species living around heavily polluted areas (sewage, garbage, agricultural and pharmaceutical run off, PCB’s, etc) is no secret and we are adding more chemicals each day. We are told by industry leaders and government that all are individually tested but the real danger, and something that can never be studied in totality, is how these chemicals interact when they are in our water, food and air.

But you’re on your own…

The food and drug industry is big business and you really have to look out for yourself. Be sure to read labels and go organic when possible. Some women have had success by going vegan but if that seems too extreme try your best to eat only free-range, organic fed animal products. When you can buy locally, by all means do. Not only are you getting fresher, less processed food, you are supporting the local economy and sending a message to the large corporations that care more about their bottom line than your health.

Top products to avoid:

  • Non-organic animal products ( i.e. meat, eggs and dairy)
  • Non-organic foods due to pesticide use and genetic modification
  • Water that has been stored in a plastic container and possibly exposed to temperature extremes
  • Cleaning agents that contain fragrance (laundry, body, hair, dish, household)
  • Food that has been microwaved– especially in plastic containers
  • Artificial and manmade sweeteners
  • Domestic home and garden pesticides
  • Canned foods (unless specified non-BPA lining)
  • Phthalates (used in cosmetics and to soften plastic)
  • For new homes and office building environments (full of paint, new furniture and flooring, mattresses, photocopiers, etc) please consider purchasing an air filtration system that reduces Volatile Organic Compounds.

Childless for the Holidays: Tips for Coping While Trying to Conceive

By Holly Yager, M.Ed., RCC, CCC, Well Woman Counselling, Vancouver BC

tips for coping with the holidays when trying to conceive

Sentimental movies. Sappy TV commercials. Holiday greetings cards with family updates and photos. Work parties where the conversations revolve around the latest toy to buy for kids. Family dinners where everyone is gushing about your cousin’s or sister’s baby news. These are usually happy occasions, but can be highly triggering when you’re dealing with infertility.

The holidays can be difficult for anyone trying to conceive and experiencing infertility. Here are some tips to survive the holidays when you’re trying to conceive:

Set Your Boundaries

It is perfectly acceptable to turn down invitations to events that you know will be triggering. Give yourself permission to look after your needs. If you worry about others’ reactions, remember that if they were going through infertility, they would likely do the same. This year try focusing your time and energy on the people and experiences that make you feel good.

Look For Alternatives

Many couples trying to conceive find that children and family events bring up intense emotions. If you find child-centric events difficult, this may be a good year to try other types of activities. If you have friends or family who do not have children, plan to spend some time with them. Or go away for the holidays and spend time away from all the holiday activity. If you don’t have the time or funds for a vacation right now, try having a “staycation” and telling everyone you’re out of town. If you can’t skip out on events that make you uncomfortable, do your best to manage the situation by putting in the minimum amount of time – arrive late, leave early, say you have another engagement to get to.

 Advance Preparation

Avoid sitting next to those who like to ask all of those “when are you having kids?” questions. Find out in advance who will be there. If any “allies” are present who know about your experience, make plans to sit next to them. It can also help to anticipate the conversations and questions and have some scripts prepared in advance (i.e., some good come-backs or ways to deflect the questions).

 Self-Care

Spend time doing things that lift you up. This is the time of year where it is essential to recharge the batteries and regenerate for the New Year. Try booking a massage or pedicure or spending time in nature. Read that book you’ve been coveting. Tackle your “bucket list” of things you’ve always wanted to try. And make sure you are paying attention to getting enough sleep to keep your energy up.

Get Support

Spend time with those who are supportive, or at least not draining. Focus on connecting with your partner or with someone else close to you, even if you haven’t told them of your difficulties. If you aren’t able to share your situation with others, you can access online support networks such as Resolve.org or IAAC.ca. The support of a professional therapist who is experienced with infertility can also be helpful when coping with the holidays.

Meet yourself where you’re at and trust that you know what you need to get through it. With a little preparation and a lot of self-compassion, you can get through the holidays.

Wellness Wednesday: Goal Setting

By: Dr. Spence Pentland

Goal Setting for fertility

“Change is never a matter of ability, it is always a matter of motivation born from a compelling ‘why’. Once you are clear on your ‘why’ setting goals is the first step in turning the invisible into the visible” ~ Tony Robbins

_________________

The goal of anyone experiencing infertility is to have a child. When times are trying, and you are adapting your life style in what might be challenging ways, that is the goal that needs to be kept in mind. Sometimes when you’ve been trying for a while, this ultimate goal can seem frustratingly unreachable so breaking it down into more manageable steps is key.

It is my belief that the most important step in achieving anything is the process of goal setting. Without a target, how can one hit it? With clear goals and vision, each choice you make throughout each day can be evaluated by asking yourself, is this choice bringing me closer to my dream?

As a doctor I determine my goals for treatment from the initial intake and the first appointment. By diagnosing the prominent signs and symptoms I feel are important to work on combined with our joint decisions about larger aspects of life and your family vision, we provide the framework for setting goals. These goals become a guide to ensure we are staying on the path that we have created together.

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Wellness Wednesday: Breast Self-Exam

how to conduct a breast exam

 

October is Breast Cancer Awareness month. Fertility treatment does not increase the risk of breast cancer; however, scientific literature suggests that women who are experiencing infertility are at increased risk of breast cancer.

What can you do?

The best way for early detection of breast cancer is by conducting breast self-exams. In fact, up to 40 per cent of breast cancers are initially detected by women who have felt a lump in their own breasts. Mammograms can help detect cancer before you can feel a lump, breast self-exams help you to be familiar with how your breasts look and feel so you can alert your healthcare professional if there are any changes.

The Canadian Breast Cancer Foundation states:

There is no right way or proper technique to being breast aware. You find a way or ways that are comfortable for you.

There is also no time schedule for being breast aware. You do it at a time and in a place that works for you.

Breast awareness is an important part of proactive and preventive health care but it does not claim to save lives or reduce deaths from breast cancer.

For more information on breast self-exams click here.

I can personally attest to the importance of breast self-exam. I found a breast lump during a self-exam that led to early diagnosis and treatment. And now, 18 years later, I can very gratefully call myself a breast cancer survivor. Please take the time to learn and do your own breast self-exam!

Susan Lockhart, PhD, MBA, BScN

Director of Clinical Operations

Genesis Fertility Centre

Wellness Wednesday: Easy Ways to Fit Exercise into Your Busy Schedule

By: Jennifer Deane

exercising for fertility health

From stress management to activating your feel-good endorphins, there are numerous benefits to adding exercise to your daily routine. For those trying to conceive, exercise is a great way to keep healthy and happy during a stressful time, though it is important to consult with your doctor before beginning a fitness regimen.  As for those who have recently given birth, you will be stronger when your baby arrives and you’ll have a smoother postpartum recovery when you incorporate exercise into your daily routine.

I think of the 2,500-year-old legend of Milo when I see parents carrying babies and sleeping toddlers back to their car after a long day in the park.  “The Tale of Milo and the Bull” encapsulates the core principles of strength training.

It is said that Milo built his incredible strength through a simple, but profound strategy.  One day, a newborn calf was born near Milo’s home. Milo decided to lift the small animal up and carry it on his shoulders. The next day, he returned and did the same. Milo continued this strategy for the next four years, hoisting the calf onto his shoulders each day as it grew, until he was no longer lifting a calf, but a four-year-old bull.

As a new parent, you will be re-living Milo’s tale.  Why not start your strength journey today in preparation!

8 simple tips to help you add fitness to your daily routine:

1. Make it fun!  

Think of your exercise sessions as treat time for yourself. Your inner thoughts about activity makes all the difference for staying on track.  If you approach your fitness as a chore, it will be a chore. If you approach it with the attitude that you are going to have fun, it will be fun!

2. Keep a Fitness Journal

Studies show that people who keep a fitness journal are more likely to reach their health and wellness goals.  Pick up a journal and start recording your daily activities. Write down everything you do, include walking, cycling and even staircases at work.  If you ever feel discouraged on your progress, you can look back and see what you have done and how much you have improved!

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