Issue Contents:
SCIENCE PULSE: Pregnancy Rates for 2007 and 2008 CRITICAL REVIEW: Conception at 40 and Beyond – Does IVF help?
WHAT'S NEW @ PFC?: Our New State-of-the-Art Laboratory 2009 EDUCATIONAL SERIES: Approaches to Sex and Relationship Therapy
IN THE NEWS: Octuplets Born Using IVF PFC Passes the CAP Laboratory Accreditation Inspection


Pacific Fertility Center


55 Francisco Street,
Suite 500
San Francisco,
CA 94133
TEL: 888-834-3095
FAX: 415-834-3080
pacificfertilitycenter.com
info@pacificfertilitycenter.com



Our Promise

As a unified team,
guided by the highest
ethical standards, we
provide our patients with
the best quality,
individualized,
compassionate fertility
care.





Top 5 Reasons to Choose Pacific Fertility

1. All of our physicians
are subspecialty
board certified as
Infertility Specialists.

2. Our laboratory has
certified embryologists
and Ph.D. educated
scientists.

3. Our clinical and
administrative team
provides quality,
individualized and
compassionate care.

4. Our excellent
success rates rank us
among the best
programs in the nation.

5. We offer the most
technologically
advanced and innovative services.



Pacific Fertility Center is pleased to share our delivered pregnancy rates for 2007 and our preliminary clinical pregnancy rates for 2008. These outstanding pregnancy rates are made possible thanks to our team of board certified Reproductive Endocrinology and Infertility specialists, as well as, our highly trained embryologists.

Clinical pregnancy reflects the finding of a pregnancy sac in the uterus following transfer. Delivered pregnancy rate will be lower after accounting for miscarriage and pregnancy loss, particularly in older age groups.

 

Pacific Fertility Center Preliminary Clinical Pregnancy Rates for 2008

Oocyte Donation
    Fresh Frozen
  Number of Cycles 191 153
  Pregnancy Rate per transfer 66% 34%

IVF - Own Egg
  Age <35 35-37 38-40 41-42 >42
  Number of Cycles 180 166 174 119 58
  Pregnancy Rate per transfer 51% 46% 42% 31% 15%

PGS/PGD - Own Egg, < 40 years of age
  Number of Cycles 32
  Clinical Pregnancy Rate per transfer 56.3%

Elective Single Embryo Transfer (eSET)
Oocyte Donation
  Number of Cycles 73
  Clinical Pregnancy Rate per transfer 68.5%
  Multiple pregnancy (identical twins) 2
IVF - Own Egg, < 40 years of age
  Number of cycles 41
  Clinical Pregnancy Rate per transfer 51.2%
  Multiple Pregnancy (identical twins) 1


Delivered Pregnancy Rates 2007 (as reported to SART and CDC)

Oocyte Donation - All
    Fresh Frozen
  Number of Cycles 161 180
  Delivered Pregnancy Rate per transfer 61.5% 31.1%

IVF - Own Egg
  Age <35 35-37 38-40 41-42 >42
  Number of Cycles 190 165 199 109 78
  Delivered Pregnancy Rate per transfer 44.1% 42.4% 23.5% 22.2% 10.9%



In October of 2008, after many months of planning, PFC began construction on our new lab. The design called for an environmentally friendly facility that was bright, open, and efficient for our 8 embryologists and the many thousands of embryos that we care for each year. The size of the lab was doubled to allow for the addition of more embryo incubators and ensure room for future growth.

Traditionally the embryology lab is an area that is not accessible to patients or visitors, but our new design utilizes glass walls in key areas and makes our activities more transparent to the outside world. While the lab remains a secure area with limited access, the activities inside can be observed from the outside by anyone passing through our facility. This openness is important to all of us at PFC; we want to remove any mystery associated with the IVF lab, and allow patients free “visual” access. Large TV monitors are installed above several of the microscopes to further open up the world of IVF. We are proud of the work we do at PFC and we want to share.

While the glass walls are largely a cosmetic change, almost every other part of the new lab was designed with the health of our embryos in mind. The installation of a specialized and custom-designed air filtering unit consumed over 20% of the budget for the project. Our goal is to have highly purified air circulating in the lab. The new air handler achieves this goal with the use of a series of filters that remove all particles and chemicals from the air. The lab is further protected from the outside by two separate air lock doors that use positive pressure from the inside to the outside to keep unclean air out.

All supplies and consumables for the lab are handled by the embryologists only, who also take responsibility for all cleaning and other custodial functions. We empty our own trash and wash our own floors. These precautions are in place not only to keep custodians and other building staff out, but also to control the chemicals and cleaners that might con- taminate our clean environment. All com- pressed gases (which feed our incubators) and liquid nitrogen (for our frozen embryo tanks) is piped in from outside the lab, so that it is not necessary for delivery people to enter the lab.

Our incubators in which the embryos develop are fundamentally the most important pieces of equipment in the lab. These incubators are monitored, serviced, and maintained by the embryologists, who have specific training in the use of all of our equipment. Quality control checks are exhaustive and performed daily to make sure that all equipment is functioning exactly as specified. A change of even a half degree in temperature could cause problems in an incubator, so monitoring is continuous and detailed. The gases that are piped into the incubators (carbon dioxide and nitrogen) are filtered as they enter the lab to make sure that they are pure.

The laboratory is supplied with emergency power from a large dedicated back-up generator located at the side of our building. Should there be a major power outage this generator produces power for at least 36 hours before it needs additional diesel. Our generator has proved itself many times over during the years of rolling black outs and other power failures.

We continue to upgrade our facility and maintain the standards of excellence that makes PFC the choice of patients. At the time of writing, we are working toward installing a second back-up system in the event that there is a power outage and our back-up generator fails. We are also always examining new equipment that will allow us to offer new technologies to patients. As we move forward, we will report our latest developments at PFC in the Fertility Flash. In the meantime, come by and visit with the embryologists through the glass. We won’t wave at you, but we’re happy to see you checking up on us. We want you to know that your embryos are in good hands.

To schedule a tour contact one of our New Patient Coordinators at 888-834-3095.

—Joe Conaghan, Ph. D., HCLD

 

Joe Conaghan, Ph.D., HCLD, is PFC’s laboratory director. Dr. Conaghan is internationally recognized for his work on improving embryo culture conditions. His interests include developing programs for the treatment of severe male factor infertility; diagnosis of genetic disease in embryos; and improved embryo culture.



In southern California last month, a set of octuplets were born via Cesarean section. The mother, Ms. Nadya Suleman, recently divulged that this pregnancy resulted after undergoing in vitro fertilization (IVF) treatment. Most previous cases of high-order multiple births have occurred after treatment with injectable fertility drugs combined with intrauterine insemination (IUI). This case is unusual in that the treatment was IVF, where the number of embryos transferred back to the patient is a conscious decision on the part the patient and her physician. We are reassured to hear that Ms. Suleman and the octuplets are thus far doing well, but certainly the potential complications of premature birth may not present themselves until much later in each of these octuplets’ coming days, months, or even years.

We are very concerned that such an event of a high-order multiple pregnancy has occurred, and would like to reiterate that PFC takes the issue of multiple gestation very seriously. PFC has been taking steps to minimize the risk of multiple pregnancy for several years. Balancing high pregnancy rates with low pregnancy risk improves pregnancy outcomes. Achieving that balance and reducing the risk of multiple pregnancy is our goal. In all treatment cycles that we perform here at PFC, our ultimate aim, and any recommendations we provide, are with the hope of achieving a singleton pregnancy- the safest pregnancy.

Fertility physicians are very aware that one of the most important side effects of fertility treatment is multiple gestation. Our governing organization, the American Society of Reproductive Medicine (ASRM), as well as the Society for Assisted Reproductive Technology (SART) have worked steadily to formulate evidence-based guidelines for the number of embryos to be transferred in assisted reproductive technology (ART) cycles. These guidelines were first established in 1996 and were updated in 2006 to reflect improved success rates with ART. Over the past decade we have seen a significant decrease in the number of high-order multiples in the US.

We at PFC adhere to the ASRM and SART guidelines. These guidelines provide the flexibility to give each patient treatment individualized to her needs, and her best chance to become pregnant; while minimizing the risks of a high-order multiple pregnancy.

SART member clinics are committed to following these guidelines, although it would appear that the guidelines were not followed in Ms. Suleman’s case.



The article in January’s issue of Fertility Flash, Conception at 40 and Beyond – Does IVF Help? contained some errors in the table. The following is a reprint of the article with corrections.

We all know that fertility declines with female age but what is not certain is how much does in vitro fertilization improve one’s chances of conception if a woman/couple is having problems conceiving on their own?

The table below is one I often use when counseling patients 40 and over about their chances of conception with in vitro fertilization.

This table represents pregnancy outcomes with PFC patients from January 2003 to March 2008, so most of the viable pregnancies tabulated here have been delivered.

One thing to note is that over half of the patients that get a positive beta-hCG result do not end up delivering a baby. This is consistent with the observation that most embryos from women 40 and over have abnormal numbers of chromosomes.

Another thing to note is that pregnancies after age 43 are exceedingly rare, even with IVF. We encourage most women over age 43 to strongly consider ovum donation.
World-wide, over half the babies born from assisted reproduction to women over age
40 are born from ovum donation, not from their own eggs.

Stats for Age 40-47   % of Cycles Cancelled #Egg Retrievals (ER) Total # Positive Pregnancy Test # Pregnancies Lost % Loss (Viable Pregnancy/Egg Retrievals)
Age # Initiated Cycles (prior to ER, mostly due to poor response)   (percentage of pts with a positive beta hCG) (includes miscarriages, ectopics and terminations) (# Lost/ Total Positive beta hCG)  
40
41
42
43
44
45
46
47
370
354
240
199
125
55
25
4
15%
17%
21%
21%
23%
18%
32%
25%
315
294
190
157
96
45
17
3
43%
23%
29%
27%
16%
9%
35%
35%
79
37
31
26
14
4
5
1
58%
54%
55%
61%
93%
100%
83%
100%
18%
11%
13%
11%
1%
0%
6%
0%

—Carolyn Givens, M.D.

 

Carolyn Givens, M.D. was the first in San Francisco to successfully initiate a pregnancy using intracytoplasmic sperm injection (ICSI). She currently co-directs the Bay Area Pre-Implantation Genetic Diagnosis Program (PGD) and is director of PFC’s PGD program.



Cutting Edge Approaches to Sex and Relationship Therapy

Presented by: Dr. Naomi O’Keefe,
Licensed Clinical Psychologist

Thursday, March 26, 2009
Time: 4:00 – 5:00 p.m.

Program will be held at the
PFC Education Center
55 Francisco St., Fifth Floor
San Francisco, CA 94133
Parking in garage will be validated.

The Educational Series is a complimentary service provided by PFC to health care professionals specializing in the field of reproductive medicine, obstetrics and/or gynecology. Please watch for future talks on a variety of topics within the field.




The IVF Lab at PFC recently received and passed an inspection by the College of American Pathologists (CAP) Laboratory Accreditation Program. This extensive inspection is held on-site and occurs every two years.

The CAP Laboratory Accreditation Program is an internationally recognized program and the only one of its kind that utilizes teams of practicing laboratory professionals as inspectors. This program is designed to help laboratories achieve the highest standards of excellence to positively impact patient care.

The accreditation program is based on rigorous accreditation standards that are translated into detailed checklist questions. The checklists provide a quality practice guideline for laboratories to follow and are used by inspection teams to assess the overall management and operation of the laboratory. Inspections take place every two years and on the off years, the PFC laboratory conducts our own self inspection, utilizing the same checklists.

The overall goal of the CAP Laboratory Accreditation Program is to improve patient safety by advancing the quality of laboratory services through education, establishing a “standard”, and ensuring laboratories meet
or exceed regulatory requirements. Upon successful completion of the inspection process, the laboratory is awarded CAP accreditation and becomes part of an exclusive group of more than 6,000 labs worldwide that have met the highest standards of excellence.

Congratulations to Dr. Joe Conaghan and the embryology staff!


 
Free Seminar

Overcoming Infertility:
The Next Step to Parenthood


Ask • Meet • Learn

Led by PFC’s Infertility Specialists

Dates:
April 15, 2009

Location:
Pacific Fertility Center
55 Francisco Street, 5th Floor
San Francisco, CA 94133

Contact:
Please call for reservations,
directions and parking information:
888-834-3095

Sign Up Now



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-- Best regards from all of us at Pacific Fertility Center.


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