RPMG Doctors Publish 2 ND Edition of Book That Helped Many Couples Conceive

Two RPMG physicians who “wrote the book” on in vitro fertilization and other assisted reproduction techniques for patients have just released a second edition of Conceptions and Misconceptions, the book that has helped many infertile couples conceive.

Arthur L. Wisot, M.D., and David Meldrum, M.D. published the first edition of Conceptions and Misconceptions in 1997. The second edition, published by Hartley and Marks Publishers, is a completely updated and revised version that provides clear, concise information on topics ranging from the latest assisted reproduction technologies to consumer issues.

In the latest edition, readers can accompany a patient on a 30-day journey through a cycle of IVF and discover both the physical and emotional impacts of fertility treatment. There is an all-new new chapter on the role of complementary and alternative methods in fertility treatment, including a balanced look at acupuncture, Traditional Chinese Medicine (TCM), nutrition, and the mind-body connection. The authors also delve into newer fertility issues that include pre-implantation genetic diagnosis (PGD), surrogacy, and consumer issues helping the reader avoid pitfalls such as unethical advertising, misleading statistics and outright fraud.

Conceptions and Misconceptions: The Informed Consumer’s Guide Through the Maze of In Vitro Fertilization and Other Assisted Reproduction Techniques is available at most booksellers or at Reproductive Partners’ website at www.2reproduce.com.

Ultrasound Guided Transfer and Embryo Glue

By David R. Meldrum, M. D.

My experience as the guest of a pioneering group in Melbourne, Australia to learn IVF over 20 years ago gave me the very strong feeling that embryo transfer was the least understood and a very important part of IVF. Over the intervening years there have been many excellent studies thoroughly documenting that easy, atraumatic transfers are more likely to be successful, with also a lower risk of tubal pregnancy. Clearly a rehearsal of the transfer (trial transfer) helps to define the ideal conditions for the actual transfer.

Today, ultrasound-guided transfer usually uses abdominal ultrasound to visualize the transfer catheter to verify its position in the uterus. A full bladder allows the uterus to be seen with an abdominal probe and provides the additional advantage of rotating the uterus into alignment with the cervical and vaginal canals, making transfers easier. Some studies have shown an increased pregnancy rate using ultrasound guidance.

“Embryo glue” is a name for a recent refinement of the culture medium used for transfer to increase the viscosity (thickness) to the same as uterine fluid. This allows the culture medium to mix with uterine fluid rather than to be displaced. A recent study using a mechanical model to simulate the uterus documented that such a medium stays more localized. A study yet to be published has shown a significant increase of implantation using “embryo glue.”

Refinements of transfer technique have resulted in higher success rates at Reproductive Partners for many years

RPMG Committed to Goal of Reducing High Order Multiple Pregnancy (HOMP)

Reproductive Partners is committed to the goal of minimizing triplets and higher order multiples resulting from IVF and ovulation induction. At RPMG, the very large majority of women under age 35, and even under 38, are now being advised to have only two good quality embryos transferred. Women over 38 can also have only two embryos transferred by growing the embryos to the blastocyst (5-day) stage, with or without preimplantation genetic diagnosis, which allows selection of the highest quality embryos. Limiting transfer to two embryos has reduced the risk of having more than two embryos implant. In high-quality programs such as Reproductive Partners which utilize an excellent laboratory and refined transfer technique, this policy has resulted in little or no change in the chance of successful pregnancy.

Avoidance of HOMP is a very important national goal, since such pregnancies are fraught with high costs and potential complications for both mother and offspring. Unfortunately not all programs are participating in this endeavor, fearing that their success rates may suffer.

Ovulation induction also contributes to HOMP, partly because there is no absolute follicle diameter below which ovulation will not occur. By using conservative stimulation protocols, the incidence of HOMP can be minimized.