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Barry A. Ripps, M.D.
Phone: (850) 857-3733

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Successful IVF Outcome

What are true chances of successful IVF outcome?
Medical science is often a mystery to the lay public but in an effort for honest disclosure about ART (assisted reproductive technologies) statistics, the U.S. government legislated a centralized and standardized CDC reporting system in 1992. ART statistics are confusing for even the educated and for many others, they can be misleading at best. By having fertility practices report outcomes, it was hoped to be a step toward patient advocacy but in retrospect, it has left as many questions as answers.

A new broad-reaching and authoritative textbook, Infertility and Assisted Reproduction, editors: Rizk, Garcia -Velasco, Sallam, Makrigiannakis, was published in 2008. Drs. Ripps and Minhas were asked to contribute a chapter that addresses the evaluation of ART statistics as presented to the public in the CDC database (Chapter 60, pp570-575). Their findings were quite revealing. The following entry offers some pertinent conclusions.

As advances in reproductive laboratories have increased successes, the techniques have become relatively standardized as well, producing little variation in outcomes between lab settings. However, the list of other factors that influence the outcome statistics is diverse and astonishing and these factors are not reported to the CDC.

Perhaps the greatest non-reported influence is patient selection. If a physician at a fertility program encourages the better prognosis couples to complete IVF, and shuns those with poor prognosis, this artificially elevates its pregnancy rates above the average. This deception is apparently widely practiced, particularly in highly competitive metropolitan markets where pressure to achieve pregnancy is an incentive for this and for excess embryo transfer and high multiple pregnancy rates. There are many publicized cases that illustrate what are otherwise invisible phenomena.

There are also, unfortunately economic influences that encourage practices to move quickly to the more expensive ART options when in many cases other less costly and less invasive treatments would suffice. Some patients with less patience go along with such management when dealing with prolonged infertility. So there is public pressure on practices as well.

The authors’ research revealed that even the best intentions for disclosure and consumer advocacy, are trumped by clinical practice patterns leaving patients in search of something more. Those programs that report pregnancy rates far above the national average are likely manipulating their numbers by selecting better patients. Those practices well below the average, likely need improvement. A general recommendation about IVF statistics that may be valuable to consumers is to seek fertility programs with “average” pregnancy rates as they are probably practicing consistent, cost-effective, quality medicine.
 
Male Factor Infertility and ICSI

ImageInfertility is a prevalent condition with significant societal and psychological impact. Thirty percent of couples seeking treatment for infertility are unable to conceive solely due to male related problems. Impaired sperm performance in conjunction with other female factors is noted in an addditional 20 percent of patients.

Normal male fertility requires completion of a daunting sequence of elaborate processes to include spermatogenesis, sperm transport, accessory gland function, along with timely sperm deposition through adequate coitus. Prior to acquiring fertilization ability the sperm undergoes complex morphological and biochemical changes. This process of capacitation allows hyperactivated motion characteristics, zona pellucida binding, acrosome reaction and oocyte penetration. Once within the oocyte, decondensation is necessary for male pronuclear formation; thus completing the most essential goal of spermatozoa: delivery of genetic material to the oocyte. Natural reproduction offers other obstacles requiring adequate sperm function. After vaginal deposition, a fraction of the total ejaculated sperm enters the cervical mucus, potentially extending viability of the male gametes to four days. The fertilizing spermatozoa must traverse the female reproductive tract to reach the distal fallopian tube, the usual site of fertilization. In the absence of patent fallopian tubes or surgically correctable tubal obstruction, couples have to resort to In Vitro Fertilization (IVF) for procreating. During IVF successful gamete interaction becomes dependant upon oocyte quality, sperm count, motility, morphology and ability to capacitate followed by acrosome loss (1,2).
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New research on motivating "lazy" sperm

Using innovative approaches, the clinicians at New LIFE developed a research model to assess the effects of a compound, Platelet Activating Factor (PAF) on sperm motion. Sperm must undergo changes in motility to be able to reach and fertilize an egg. This is part of a process called, sperm capacitation. PAF was known to enhance mechanisms inside of cells that is related to cell motion.

In this study, Drs Ripps, Minhas and colleagues showed that exposure of sperm to PAF at different concentrations resulted in increased sperm motility consistent with the capacitation process. This same treatment may prove useful for treating infertile men with slow sperm.

The full article can be viewed the recent issue of the journal: Early Pregnancy:
 
Natural approach to PCOS found to be effective

While managing the frustrating condition of PCOS remains a challenge, it becomes easier after careful evaluation in the specialty of reprodutive endocrinology. A research study conducted at New LIFE revealed that for patients with irregular periods, facial hair growth, uncontrollable weight gain and sometimes insulin resistance, careful lab evaluation identifies patients for whom natural approaches such as special diets and dietary supplements will allow ongoing weight loss, improved cholesterol levels and return of menstrual periods with pregnancy. This without taking medicines or starvation. These findings were reviewed by world-renowned specialists and accepted for presentation at the annual scientific meeting of the American Society for Reproductive Medicine in San Antonio, TX in October, 2003. Two of the senior authors were Drs Barry Ripps and Brijinder Minhas.
 
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