Reproductive Partners Worldwide
Because of the overwhelming response to our website, we are introducing Reproductive Partners Worldwide (RPWW). The purpose of RPWW is to make the programs and facilities of Reproductive Partners available to couples throughout the United States and around the globe.
Our interactive bulletin board and e-mail communications show that there are unmet needs for couples in many parts of the U. S. as well as in the rest of the world. Until now we have tried to meet some of the educational needs through our website and books. In addition to consultations and telephone consultations, we can now also make IVF cycles more accessible for couples from other locations.
The key to success of this effort is good communications. By utilizing modern communications technology such as e-mail, faxes and the Internet, we will be able to share information with a couple's physician close to home. That will minimize the time required for the couple to be present in one of Reproductive Partners' nationally recognized centers in Los Angeles or San Diego.
Travel arrangements can be made through the patient's travel agent or a special travel consultant to take advantage of specially priced accommodations. An IVF cycle would require female partner to be near one of our facilities from twelve to fifteen days, while the male partner would have to be present for one to two days at the time of egg retrieval.
Although telephone consultations are available, we feel it would be best that the couple have an in-person consultation in order that we may meet face-to-face and perform the pre-cycle semen analysis, semen culture and trial transfer at the time of the initial consultation. The remainder of the pre-cycle testing can be done close to one's home. We will work with the couple's physician to perform these vital tests. If a couple chooses, we can offer a telephone consultation and arrange to have the semen analysis, culture and trial transfer done in the couple's home city.
We will instruct the patient's local physician in monitoring the initial portion of the preparation and stimulation phase and request the female partner arrive at a Reproductive Partners facility starting with the sixth day of stimulation. She should plan to stay until the completion of two days of bed rest following the transfer.
ASRM 2000 Selected Abstracts
By David R. Meldrum, M. D., Reproductive Partners Medical Group, Inc., Beverly Hills and Redondo Beach, California
This summary of selected abstracts and comments from the 56th Annual Meeting of the American Society for Reproductive Medicine (October 21-26, 2000) was prepared for educational purposes only and constitutes neither an endorsement of any of the procedures discussed nor a recommendation of any particular treatment or protocol. Most of the following studies are in the experimental phase and are not yet clinically available.
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0-004
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The group at Cornell has been doing extensive work on nuclear transfer in the mouse model. In this study they have demonstrated that transfer into a normal egg can rescue a nucleus from an egg with damaged cytoplasm (thus simulating aging) with the nucleus removed. Comment: This area is progressing but extensive further work will be necessary to demonstrate normal maturation of the immature eggs, fertilization and normal fetal development. |
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0-036
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The presence of endometrial fluid correlated with a reduced pregnancy rate (26 vs. 42%) and with a poor response to stimulation. Clearly endometrial fluid was not associated with any dramatic decrease in pregnancy outcome and the decrease that was observed may have been due to reduced ovarian response. Comment: It is not clear that in the absence of hydrosalpinx whether freezing of embryos and later transfer should be advised for these patients. |
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0-044
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A group of 77 gonadotropin-IUI cycles converted to IVF yielded an ongoing pregnancy rate of 47%, which was significantly higher than IVF controls. Comment: For selected patients, this does appear to be a reasonable option. |
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0-084
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A significantly lower pregnancy rate was noted with Crinone versus intramuscular progesterone in oil for IVF cycles in this prospective randomized study. The progesterone was started the day after egg retrieval. Comment: It is possible that if Crinone was started later, this deleterious effect might not be seen. |
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0-196
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A controlled study was done of metformin, 500 mg. three times a day for IVF in PCO patients. Estradiol rose more slowly and to a lower peak level, and improved fertilization and pregnancy rates were achieved with metformin. Comment: This study suggests metformin should be routinely used for PCO patients for IVF. |
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0-203
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A meta-analysis of published studies with IVF in women with endometriosis showed fewer eggs, lower fertilization and lower implantation rates than in women with tubal factor. Comment: The finding of decreased endometrial integrin in some women with endometriosis suggests that treatment before IVF may play a role in improving outcome. A biopsy for integrin could be considered in women with endometriosis before starting into IVF. |
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P-149
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Use of birth control pills prior to IVF for more than 28 days reduces ovarian response. Comment: Routine pre-treatment in non-PCO patients should be limited to 21 days. |
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P-176
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Of 194 women receiving gonadotropins with IUI, 38 did not show ovulation 60 hours after hCG, and none of these women conceived (29% subsequently conceived with intrafollicular insemination). Comment: Until a generally accepted and effective treatment for such women is defined, IVF may be the most logical solution. Routine ultrasound 60 hours after hCG could detect a significant group of women for whom IVF is a preferred treatment. |
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P-191
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Luteal phase E2 levels over 150 pg/ml 7 days after embryo transfer predicted a higher chance of pregnancy in women receiving 2 mg. per day of oral E2. Comment: Presuming that the blood sample was taken prior to the single daily dose, this study 1) provides further support for the role of adequate luteal E2 levels for IVF success, 2) since E2 levels are maintained only for several hours after a single oral dose, the study suggests that a divided oral dose or better yet, transdermal E2 may give optimal results. |
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P-235
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A favorable pregnancy rate was observed in women reaching criteria for hCG before day 10 of stimulation who were arbitrarily given hCG on day 10. Comment: This study suggests that women who develop follicles rapidly may do equally well by delaying hCG to day 10. In such women, follicular size, which is a very indirect indicator of oocyte maturity, may be a less reliable criterion than duration of gonadotropin exposure to the eggs. |
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P-364
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Significant discrepancies were noted between uterine measurements by sounding versus ultrasound. Comment: Ultrasound guided ET may therefore provide a more precise deposition of the embryos. |
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P-370
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Women with a poor rate of blastocyst development tend to have this repeat in subsequent IVF cycles. Comment: This suggests inherent reduced oocyte quality. |
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P-373
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Hysteroscopy (with saline distention) with or without polypectomy in the birth control pill pretreatment phase of the IVF stimulation did not adversely impact on IVF outcome. |
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P-378
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A good rate of success was observed with frozen blastocysts in the natural cycle by giving hCG at 17 mm follicle size and micronized vaginal progesterone 200 mg. twice daily starting 4 days after hCG. Transfers were done 7 days after hCG. Ongoing pregnancy rates with day 5 blastocyst were 36% and 29% with day 6 blastocyst. |
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P-436
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Vaginal E2 and luteal Crinone improved endometrial biopsies (100% were in-phase) in PCO patients on clomiphene citrate. Without hormone supplementation, 5/12 biopsies were out of phase and the pregnancy rate was lower. Comment: Another randomized study of ethinyl estradiol showed improved pregnancy outcome in PCO (Fertil Steril 2000;73:85-9), suggesting that routine estrogen treatment maximizes success with cc for PCO. |
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P-438
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A new protocol of birth control pills/very low dose Lupron (.25 mg. reducing to .125 mg.) produced equal results to microflare, with significantly fewer days of stimulation, less gonadotropin and a trend toward a higher implantation rate. Comment: This was not a randomized trial but suggests that very low dose Lupron is at least as effective as the microdose flare and may be considered as an alternative for poor responders. |
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P-511
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A randomized study of 5% O2 for blastocyst culture showed a higher rate of supernumerary blastocysts for freezing and trends toward higher pregnancy (51 vs. 40%) and implantation (37 vs. 30%) rates with 5% O2 for embryo culture. |
Reproductive Partners, 90210
It's actually Beverly Hills 90211. That's where the newest office of RPMG has recently opened. "Reproductive Partners 90210" just sounds better because of the hit TV show, "Beverly Hills 90210." The new office is located in the heart of Beverly Hills at 150 N. Robertson, Suite 150. It will be a convenient location for not only our Beverly Hills patients, but also for Westside and Valley couples as well. Just call (310) 855-2229.
Drs. Meldrum, Yee, Rosen and Wisot will work at this new location, providing the full range of diagnostic and therapeutic fertility options such as evaluations, ovulation induction, fertility drug stimulation, inseminations and preparation for GIFT and IVF. Patients prepared at this location will have the advantage of having their GIFT or IVF done at one of RPMG's nationally known reproductive facilities.
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