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By Angela Ipsen

What is an Endometrial Receptivity Array (ERA)?

Problems with the endometrial lining are one of the leading causes of infertility in women. The uterus is the organ in which pregnancy takes place. The interior is lined with a tissue called endometrium, which is prepared each month for the arrival on an embryo and is the place where the embryo implants and resides during gestation. Sometimes embryo implantation in the endometrium does not develop successfully. This failure can occur for different reasons. A particularly important factor is endometrial receptivity. Endometrium is receptive when it is ready for embryo implantation to occur, which usually takes place between days 19-21 of the menstrual cycle (5-7 days post-ovulation). This period of receptivity is called the “Window of Implantation”.
An Endometrial Receptivity Array (ERA) is a novel diagnostic technique that allows us to evaluate the endometrial receptivity status of a woman, from a molecular point of view. A biopsy of endometrial tissue is performed on a specific day of a woman’s cycle.  This biopsy is performed by an ICRM physician here in the office, and is an easy and quick procedure. The biopsy is sent to the testing facility and the expression of 238 genes involved in endometrial receptivity is analyzed. An ERA predictor analyzes the data collected and classifies the endometrium as “receptive” or “non-receptive”.
The results of the analysis determine whether or not the patient will be responsive to embryo implantation at the time of sampling. If “receptive”, then the window of implantation is defined as the day on which the biopsy was taken, meaning the embryo is capable of implanting in the uterus during this period. A state of “non-receptivity” means that the window of implantation is displaced. In this case, the process will be repeated according to data from the ERA predictor, which will give a new estimation of your window of implantation.
At ICRM, we typically recommend an ERA to patients that meet certain criteria. If you are 37 years of age or older, with at least 2 failed implantations (not biochemical pregnancies), we highly recommend ERA testing to provide more information and to hopefully increase the chance of success of a future embryo transfer. However, if you do not meet this criteria but would like to learn more about an ERA and
 how it may be a useful tool for you, please feel free to speak with a nurse or physician at ICRM. Also, more information is available from IGENOMIX.  (Information courtesy of IGENOMIX.)

News from ICRM’s Embryology Lab

The laboratory at the Idaho Center for Reproductive Medicine has increased our number of incubators. We are excited to bring this new technology into our lab! In the past, incubators have had a very large culture chamber. The culture area in the new Minc incubators is very small. This small area for culturing adds some very big benefits to the quality of embryos grown.
The warmed gas mixture is constantly flowing through the humidification flask and into the chambers. This leads to a very quick return to the desired culture environment after the lid has been opened and closed. Equilibration is said to occur in one minute. The older style incubators took more than 30 minutes to bring the temperature, humidity, and gas concentrations back to desired levels.
The Minc incubators offer a heated base and lid to ensure that temperatures stabilize quickly. There are impressions in the metal of the base which fit the three main types of dishes used for culture. These impressions allow for the heated base to be in direct contact with the bottom of the dish.
The culture environment will now be one of reduced oxygen tension. What does that mean? That means the embryos will be exposed to less oxygen. In the presence of high (atmospheric) levels of oxygen, production of reactive oxygen species is possible. These reactive oxygen species, or free radicals, can lead to poor development of the embryos.
The older style incubators received a known concentration of CO2 in the chamber, which was mixed with room air. The Minc incubators require a triple gas mixture (CO2, O2, and Nitrogen) that flows into the culture chamber. The final concentration of oxygen in this culture system drops from just over 20% down to 5%. This will greatly reduce the potential for free radical production in the culture media.
These new Minc incubators have been thoroughly checked and quality controlled. We are very excited to use them for our November 2011 IVF cycle!

There’s an App for That

Attain Fertility® Centers has announced the launch of the Attain Fertility Predictor, a free iPhone app designed for women that will help them determine their chances of becoming pregnant on their own. And for women who are unable to get pregnant on their own and need assisted reproductive technology (ART), the predictor then shows her chances of having a baby through in vitro fertilization (IVF). The first of its kind, the Attain Fertility Predictor is filled with vital information, from when to see a specialist, to how many IVF cycles may provide her the best chance of becoming a parent.
Based on a woman’s age and how long she’s been trying to get pregnant without fertility assistance, the Attain Fertility Predictor helps a woman understand her options, including when she may want to consider seeing a fertility specialist. The Attain Fertility Predictor includes other interactive features and information, including:

– Fertility Center Finder: Helps locate the nearest clinic that’s a part of the Attain Fertility network, request an appointment and get directions.
–  BMI calculator: Suggests whether or not a woman is at her optimal weight.
–  Fertility loan calculator: Calculates payments for fertility loans that can make paying for treatment more manageable and can be used for programs like Attain IVF.
–  Fertility information: Users can learn about causes of infertility, different treatment options, IVF costs and information about the Attain IVF Programs.

The Attain Fertility Predictor is now available at Apple’s iTunes App Store and can be used with iPhones and iPads.

IUI Explained

Intrauterine insemination (IUI) is the placing of sperm into a woman’s uterus when she is ovulating. This procedure is used for couples with unexplained infertility, minimal male factor infertility, and women with cervical mucus problems. IUI is often done in conjunction with ovulation-stimulating drugs. IUI can be performed using the husband’s sperm or donor sperm. Before IUI, the woman should be evaluated for any hormonal imbalance, infection or any structural problems.

Insemination is performed at the time of ovulation, usually within 24-36 hours after the LH surge is detected, or after the “trigger” injection of hCG is administered. Ovulation is predicted by a urine test kit or blood test and ultrasound.

In the case of husband inseminination, the male partner produces a specimen, at home or at the clinic or doctor’s office. The sperm is then prepared for IUI. Sperm from the male partner or third-party donor are “washed” or separated. Separation selects out motile sperm from the man’s ejaculate and concentrates them into a small volume. Sperm washing cleanses the sperm of potentially toxic chemicals which may cause adverse reactions in the uterus. The doctor uses a soft catheter that is passed through a speculum directly into the woman’s uterus to deposit the semen at the time of ovulation.

IUI may be used in conjunction with ovulatory medications, such as clomophine citrate, gonadotropins, or urofollitropins. If injectable ovulation stimulating drugs are used in an IUI cycle, careful monitoring is essential. Monitoring includes periodic blood tests and ultrasounds beginning around day 6 of the woman’s cycle. Results of these tests will indicate when eggs are mature, prompting the hCG shot.

IUI is also used with specially prepared donor sperm. The sperm bank sends the doctor’s office sperm that is already prepared for IUI.

IUI is a relatively quick procedure and is performed in the doctor’s office without any anesthesia. It should not be painful, although some women report mild discomfort.

(From www.Resolve.org)

Success Rates – Just a Part of the Whole Puzzle

Before you begin treatment, it’s a good idea to be informed and comfortable about the clinic that will be directing your care. In addition to discussiongs with your healthcare provider, you can do research on the success rates and policies of individual clinics. The website for the CDC is a good resource. You can find reports on past success rates for individual clinics, as well as information on patient diagnoses, average number of embryos transferred per cycle, and other factors.

Success rates for a facility can help you understand what to expect from ART (assisted reproductive technology), but the CDC cautions against using statistic to compare one clinic to another. This is because a clinic’s patient selection process and treatment procedures can significantly affect its success rates. For instance, a clinic that refuses or discourages patients with challenging cases may appear to have a high success rate, while one that accepts these patients may appear to have a lower success rate when, in fact, its success with challenging cases is relatively high. In other cases, a clinic may achieve a promising success rate by transferring a high number of embryos per cycle but, in doing so, may create a high risk for multiple births.

A good strategy for selecting a clinic is to look for one that treats a high number of patients who have the same diagnosis you have. And of course, it always makes sense to talk to a physician or nurse directly to ask about a clinic’s policies and make sure you are comfortable with the people who will be treating you.

Fertility Preservation for Cancer Patients = HOPE

Due to recent advances in oncology, the diagnosis and treatment of several types of cancer have drastically improved, leading to increases in survival rates through the years. With these advances, more patients are living longer, more productive lives with cancer, and are oftentimes in remission. Although the prognosis for patients with cancer is positive, physicians currently face new challenges in treating younger patients with cancer who wish to maintain the ability to have children later in life.

Until now, not much thought had been given to being able to have children once cancer treatment is completed and the cancer is in remission. For example, in female patients with cancer, freezing a woman’s eggs, or embryos created with sperm from her partner or an anonymous donor allows her the chance to have a genetic child in the future. For male patients, sperm banking and cryopreservation is a highly successful option.

Physicians making a cancer diagnosis are beginning to offer their patients fertility preservation options through subspecialty, board certified reproductive and infertility (REI) specialists, such as the Idaho Center for Reproductive Medicine.