BERLIN, August 9, 2013 – Managing Facebook for physicians, protecting doctor reputations online, converting website visitors to patients and protecting a medical practice against computer hackers are just a few of the topics to be presented at the 2013 IVF Worldwide Live Congress: Growing IVF Clinics in the Digital Age.

The Ministry of Health of the Province of Buenos Aires developed a program of diagnosis and treatment for infertile couples based on the recommendations of a multidisciplinary Think-Tank Committee.

On January 7 2011, the Congress of the Province of Buenos Aires signed the law 14208, which assures free ART (Assisted Reproductive Technology ) to all the citizens of the Provincewithout discrimination of socioeconomic status.

It is with pleasure that we announce the launch of the IVF-Worldwide blog. This blog will provide physicians and other professionals in the field of IVF a platform to stay informed, share ideas and is intended to fuel discussions on burning topics and developments in our field.

In addition, the IVF-Worldwide blog will serve as a tool to disseminate new research publications and offer an opportunity to review books and products.

Leading experts in fields such as of IVF, gynecology, technology, internet and marketing will serve as guest bloggers and will lead discussions and address topics that are relevant to all who practice in our field.

Before vitrification, blastocoelic fluid (0.3-0.5 nl) is withdrawn from human blastocysts by microsuction and (usually) discarded. The metabolomic of blastocoele fluid was studied using Rapid Resolution-Reverse Phase (RR-RP) and mass spectrometry coupled to HPLC (RR-RP-HPLC-ESI-MS). The characterization of DNA fragments present in this fluid, and the evaluation of these fragments as potential target for Preimplantation Genetic Diagnosis was performed by using, real-time PCR based on SYBR green chemistry, Whole Genome Amplification techniques and -subsequently- Next Generation Sequencing approaches.

Aneuploidism , monogenic diseases and possibly embryo markers of its own viability could be detected in the blastocoele to improve embryo transfer efficiency.

Data will be presented at the
OVARIAN CLUB III
The Inverse Pyramid: Regulating Follicle Number and Oocyte Quality
Paris, France • November 14 - 17, 2013
http://www.comtecmed.com/oc/2013/pre_program.aspx

Definition of the luteal phase status in ART cycles: can it be described as Luteal phase dysfunction, or luteal phase insufficiency?

I would not readily support the use of ‘luteal phase insufficiency’ for describing what happens in COS and would prefer ‘luteal phase dysfunction’, as it more humbly states what we are dealing with.

Conflict statement

We want to point out to readers of this article that The Center for Human Reproduction (CHR) holds a number of patents, which claim therapeutic benefits from androgen/DHEA supplementation of selected infertile women. CHR and some CHR employees, including this author, receive royalty payments from two companies, which have licensed these patents and, therefore, are entitled to use these claims in their marketing efforts. Moreover, Dr. Gleicher is a shareholder in one of these companies, Fertility Nutraceuticals, LLC.

Background

DHEA is the most abundant steroid hormone in our bodies, and is the precursor hormone for all sex hormones. It, in itself, has very low affinity to the androgen receptor (AR) (and mild affinity to the estrogen receptor) and, therefore, is functionally almost inert as an androgen. Moreover, DHEA within minutes from ingestion is metabolized to DHEAS. Both, DHEA and DHEAS, as storage forms, usually are to a degree in balance in the circulation, constantly changing back and forth. Increasing evidence suggests that this allows different organs to take up sufficient DHEA to produce organ-specific testosterone (T)-levels. It appears that, aside from ovaries and adrenals, other organs, for example, liver, endometrium, etc. also have the apparatus to produce T from DHEA. The overwhelming amount of T in the woman comes, however, almost evenly, from ovaries and adrenals.

The apparatus for adding a sulfate group to DHEA to produce DHEAS, however, exists almost exclusively only in the zona reticularis of the adrenals. This is diagnostically important, and is also important when patient under DHEA supplementation are clinically monitored: Since DHEA and DHEAS should be in reasonable balance, DHEA supplementation should result in quick increases in DHEA as well as DHEAS.

If only DHEA rises, the patient likely suffers from deficiency of sulfotransferase enzymes (SULT1A1 and SULT1E1) in the zona reticularis, and DHEA supplementation will, likely, not lead to adequate increases in T. Such patients then need to be directly supplemented with T.

It is also important to note that the zona reticularis shrinks with advancing age and, therefore, DHEAS levels decline as women (and men) are getting older.

Digital communication in the medicine

- Composed for IVF-Worldwide.com Blogby: Julia Rupprecht, Michael Schindler, Medical IT Experts. Connect to MedITEX on Facebook

Communication will be defined as a “social interaction, in which two or several people exchange information with the help of a communicative devices”.

Comments by:
Michael Alper , USA
Sherman Silber, USA
Dominique De Ziegler, France
Norbert Gleicher, USA

The below protocol was developed by Prof. Kuang and his team at the Shanghai Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine, China. The unit performed more than 7,000 IVF cycles a year with 100% of Frozen Thawed Embryo transfer with 55-60% pregnancy rate in women age below 38 y.o..
This protocol is based on double stimulation during the same cycle, using letrozole, clomid, hMG and GnRH-agonist. The unique of this protocol is that there is the second stimulation takes place during the luteal phase, it allows retrieving more oocyte (which suits the poor responder group) with the eradication of OHSS.

Starting fertility treatments can be an exciting yet nerve-raking experience, Dr. IVF's goal is to create an innovative interaction in the doctor-patient relationship and to become part of this important bond.

Dr. IVF, a 3D medical interactive mobile application, creates a new interactive damnation in these relations and gives gynecologists and embryologists the ability to actively illustrate procedures in impressive 3D graphics. Patients will be able to explore, witness and to share with their physician the experience of In Vitro Fertilization. All of those and much more makes the Dr. IVF medical application an important tool in this ultimate one-to-one relationship.

More than 50% of colleagues worldwide are not flushing follicles during egg collection.  The primary reason for this are studies, published in the early nineties, comparing egg retrievals using two needles with the same outer diameter (Single Lumen Needles and Double Lumen Needles). All of the authors concluded that that they harvested the same number of oocytes with either needle, but the duration of egg collection procedure took 2 to 3 times longer using the double lumen needles. 

Posted by  Gerald Schatten, an American stem cell researcher with interests in cell, developmental, and reproductive biology. Posted on IVF-Worldwide.com on 07 Oct, 2012.

Notwithstanding the publication last week of our paper generating haploid round spermatid-like cells in vitro from human induced pluripotent stem cells (iPSCs) and embryonic stem cells (ESCs) [Easley et al.,  Direct Differentiation of Human Pluripotent Stem Cells into Haploid Spermatogenic CellsCell Reports 2, 440–446, September 27,  2012], this week another highly significant breakthrough is reported in the jouirnal SCIENCE.

Practically from incept, ART has been associated with controlled ovarian stimulation (COS) in order to foster multiple oocyte harvests. We all recognize that COS improves ART outcome by the sheer fact that more oocytes are inseminated and thus, more embryos are available to chose from at the time of embryo transfer (ET). Yet, it is also well established that the functionality of the endometrium – its receptivity to embryo implantation – is impaired by the very mechanisms at the core of the COS process itself. The harm caused by COS on endometrial quality is taken as the primary explanation

 Direct Differentiation of Human Pluripotent Stem Cells into Haploid Spermatogenic Cells.The first author is Dr. Charles Easley IV who just accepted a faculty position at Emory University and full authorship is:  Charles A. Easley, Bart T. Phillips, Megan M. McGuire, Jennifer M. Barringer, Hanna Valli, Brian P. Hermann, Calvin R. Simerly, Aleksander Rajkovic, Toshio Miki, Kyle E. Orwig, Gerald P. Schatten It is now available online  in CELL Reports at: http://cellreports.cell.com/ Cell Reports,23 August 2012; 10.1016/j.celrep.2012.07.015

The  in vivoembryo culture device allowing for embryos to be cultured inside the uterine cavity within the intrauterine fluids, effectively enabling crosstalk with the maternal environment. The communication enabled between the maternal environment and the embryos is a fundamental difference between the Anecova method and the other “in-vivo” embryo culture systems using closed vaginal containers filled with artificial medium. 

Various studies using the Anecova method have showed promising results and demonstrated not only the safety and feasibility in a human subject, but also trends of higher implantation potential and higher proportion of euploidy for the embryos cultured  in vivo.A multi-center study is currently underway in Belgium and Denmark on a second-generation device to confirm the trends of higher implantation of  in-vivocultured embryos and gather data on a novel “full  in-vivo” clinical protocol as described below. 

More than 50% of colleagues worldwide are not flushing follicles during egg collection.  The primary reason for this are studies, published in the early nineties, comparing egg retrievals using two needles with the same outer diameter (Single Lumen Needles and Double Lumen Needles). All of the authors concluded that that they harvested the same number of oocytes with either needle, but the duration of egg collection procedure took 2 to 3 times longer using the double lumen needles.

IVF and Multiples

It goes without saying that multiple pregnancies are significantly more common following infertility treatment. However, it is clear that the number of embryos in ART pregnancies is entirely controlled by ET (except for MZ splits after sET).

Thus, it is clear that ART (by producing multiple) directly increases prematurity, low birth weight, cerebral palsy, and anomalies. In this sense, it appears that ART fulfils 5 out of the required 6 Wilson's criteria of being a teratogenic procedure

1. Université Paris Descartes, Paris Sorbonne Cité – Assistance Publique Hôpitaux de Paris, CHU Cochin, Department of Obstetrics and Gynecology, Division of Reproductive Medicine, Paris, France.
2. Department of Obstetrics and Gynecology, Kaplan Medical Center, Rehovot, Israel.
3. Summarry of a presentation made at: The 2nd IVF Worldwide Live Congress: In vitro fertilization clinics growing in the digital age, Oct 31 – Nov 2, 2013. Berlin, Germany.

Thirty years later, neither 0% nor 100%

An enduring characteristic of assisted reproductive technologies (ART) is the fact that its outcome has remained – as it was at outset – neither 0%, nor 100%. Had pregnancy rates (PR) in ART been either 0% or 100%, the issues discussed today wouldn't be issues anymore. With PRs of or nearing 0%, ART wouldn't be an option for treating infertility. At the opposite end if PRs constantly neared 100%, quality assessment would be greatly simplified, needing less discussion. In the latter case, one single failure would be in itself evidence of a problem in a realm where normally all pregnancy tests should be positive. In case of anesthesia for example, awakening the patient after surgery is expected to be 100% effective. In this context, one single failure is by itself evidence of a problem that needs close and immediate attention.

In a study published today in Science Translational Medicine a team of researchers from the Center for Fertility Preservation at Sheba Medical Center in Tel Hashomer, in conjunction with Bar Ilan University, present findings that show the mechanism responsible for the destruction of eggs and infertility that occurs with chemotherapy treatments. Co-treatment with the immunomodulator, AS101, during chemotherapy successfully prevented the damage to fertility. This study was selected by the journal for international media release. The study was conducted at the Center for Fertility Preservation at Sheba Medical Center, headed by Prof. Dror Meirow, in collaboration with Prof. Benjamin Sredni, Director of the Cancer AIDS and Immunology Research Institute at Bar Ilan University.

 Abstract

Three decades of clinical experience with assisted reproductive technologies (ART) led to an intimate intertwining between the responses to controlled ovarian stimulation (COS) and actual ART outcome.  In turn the functional testing that predicts COS responses – dubbed ‘ovarian reserve’ – was mistakenly seen as foretelling the degree of remaining fecundity.  The highly publicized ‘ovarian reserve’ concept has now sparked an emerging business of advanced or ‘provisional’ ART for the purpose of saving cryopreserved oocytes for later use in women whose ovarian reserve is diminished.

      Vitrification has resulted in a watershed in human embryology during the past decade. This approach enabled safe and efficient cryopreservation of human oocytes and blastocysts allowing efficient application of ART procedures such as elective single blastocyst transfer (eSET) and preimplantation genetic screening (PGS), and opening new possibilities for patients including preservation of fertility for both medical and nonmedical reasons, and resolving many logistic problems during oocyte donation. However, the path was not smooth, and continuous concerns are risen re. Safety issues including long term consequences, potentially toxic cryoprotectant components, and first of all, dangers of disease transmission mediated by liquid nitrogen. Vitrification methods are commonly divided in two categories: open systems allow and closed systems eliminate direct contact with liquid nitrogen – consequently open systems are safe, and closed systems are unsafe.

At the IVF Worldwide 2013 Congress in Berlin, I'll be demonstrating how to optimise profiles and pages for Facebook, Twitter and LinkedIn. I'll be speaking on the main stage from 4pm-4:30pm on Thursday, October 31. I'll also be providing hands-on, one-to-one sessions and mini-workshops.

Here we give some comments on a session in the upcoming meeting of BCGIP in Nov. 21 – 24 2013 in Shanghai. An international panel will answer that question.

See: http://www.bcgip.com/china/topics.aspx

In preimplantation genetic diagnosis (PGD) we have to differentiate between classical PGD and preimplantation genetic screening (PGS). The indication of the first is hereditary disease in the parents which they want to avoid in their offspring. In Germany e. g. 100 clinical cases per year are expected. From these epidemiological few cases we have to differentiate the indication for the second which is sterility of the parents in the absence of known hereditary disease.

Embryology has been again in the focus of news with the birth of a child after genome sequencing from a biopsied embryo was born. The birth was announced at the ESHRE, London, July 2013 as last minute, unpublished achievement, and has become a major sensation, breaking news in TVs, front page reports in leading journals all over the world.

Although achievement was respectable, the reported priority was not entirely justified. Just in the previous abstract in the conference proceedings (that was available in printed form at the time of announcement; Li et al, Clinical application of massively parallel sequencing on chromosomal abnormalities detection of human blastocysts. Hum Reprod 2013, 28 (Suppl. 1): i26) BGI Shenzhen, China, in collaboration with CITIC Xiangya Hospital, Changsha, China has reported 7 babies after PGS with whole genome sequencing, and the number of births is growing exponentially. Maybe China is still far away for the Western world, but - getting closer...

The small amount of progesterone (P) released by human follicles at their very final stage of maturation plays a central role in the human reproduction. It may anticipate the expansion of the cumulus even before the LH peak and, once the oocyte-cumulus complex has been released into the fallopian tube, it attracts the sperms toward the oocyte ¹allowing its fecundation. While facilitating the fecundation process, follicular P also plays as the main trigger of the mid-cycle gonadotropin surge. Indeed, under raising estradiol concentration, hypothalamic cells expose P receptors (PR). These P receptors are extremely sensitive and may react to the very small amounts of hormone, either synthesized within the brain or released from the end stage follicle. The activation of hypothalamic PR triggers the release of a peak of GnRH, which in turn triggers the midcycle gonadotropin surge ².

Menopause is related to lifespan in all species. When they begin to undergo menopause, B6J mice deteriorate in physical activity at 525 days approximately, and die at 636 days approximately. That is, after their ovaries are depleted of follicles, the mice themselves become less active and frail. When we transplanted ovaries from young B6J mice who were only 70-140 days old, the old mice began to cycle again and were truly rejuvenated. They now lived to 915 days approximately, a 44 per cent increase in lifespan approximately (Kagawa et al).

(1)Université Paris Descartes, Paris Sorbonne Cité – Assistance Publique Hôpitaux de Paris, CHU Cochin, Department of Obstetrics and Gynecology, Division of Reproductive Medicine, Paris, France. (3)Department of Obstetrics and Gynecology, Division of Reproductive Medicine, Hopitaux Universitaires de Genève, Genève Switzerland. (4)Department of Biomedicine, Research Group on Gynecological Endocrinology, University Hospital, University of Basel, Basel, Switzerland
Address for correspondence: Dom de Ziegler, MD This email address is being protected from spambots. You need JavaScript enabled to view it.

Summary

     It has become commonplace to proffer that medicine lags behind other industries when it comes to safety records. These are indeed deplorable in medicine worldwide, even if significant efforts have been deployed for curbing the mega-mistakes – wrong patient, wrong side, wrong organ – notably, by implementing checklists and other aviation-derived products.

This was a unique gathering of East and West of the greatest scientists and clinicians working on fertility preservation and stem cell biology to produce eggs and sperm (gametes),  This field of reproduction is looming as the major solution to the moderation of the explosive world wide infertility epidemic, as a method to maintain fertility into the later years when nowadays most people are ready to have a child, but cant because of the aging oocyte, or the absence of spermatogenesis.  It is perhaps the most difficult aspect of infertility medicine, but also the most promising.  The results of this very successful meeting indicate just how much progress we have made in pursuing this holy grail, of extending the reproductive lifespan, and of creating sperm and eggs from ordinary skin cells.

This was a unique gathering in Europe of the leading scientists and clinicians working on cryopreservation for fertility preservation, stem cell biology to produce eggs and sperm (gametes) and tissue freezing and transplantation. This field of reproduction is looming as the major solution to the moderation of the explosive world wide infertility epidemic, as a method to maintain fertility into the later years when nowadays most people are ready to have a child, but can't because of the aging oocyte, or the absence of spermatogenesis. The results of this very successful meeting indicate just how much progress we have made in pursuing this holy grail, of extending the reproductive lifespan, creating sperm and eggs from ordinary skin cells, freezing and freeze drying of tissue and cells, ovarian tissue freezing, and egg freezing.

Problem statement and background data
Embryo vitrification – first described 25 years ago – was recently adapted to general use in ART. Practically, vitrification has enabled to cryopreserve and de-vitrify zygotes (day-1) and blastocyst-stage embryos with nearly no losses. These outstanding results have triggered enthusiasm and outlined several immediate clinical indications for vitrifyingembryos and differing ET:

Syndrome (PCOS) – Discussion of the Three Diagnostic Criteria.

PCOS was considered to be a poorly understood reproductive disorder characterized by hyperandrogenism, anovulatory infertility, and polycystic ovarian morphology (PCO) until the 1980s when it was discovered that the syndrome was also associated with insulin resistance and an increased risk for type 2 diabetes mellitus. It became apparent that the effective study of PCOS required standardized diagnostic criteria, an issue of that was addressed in 1990 at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Conference on PCOS. This conference was a meeting of experts who discussed various features of the syndrome. Participants were asked to vote on potential diagnostic features, including androgen excess, menstrual dysfunction, disordered gonadotropin secretion, and insulin resistance. Those features receiving the most votes, hyperandrogenism and chronic anovulation, with the exclusion of secondary causes, became what are known as the NICHD or NIH criteria and are inaccurately referred to as consensus criteria.

The premier reference resource for the whole team at any IVF clinicnow returns in a new format for an entirely revised fourth edition. This edition comes more conveniently as a set of two separate volumes, one for laboratory aspects and the other for clinical applications.

Like any other syndrome, PCOS is a complex of symptoms of unknown etiology. Such conditions are heterogeneous by nature, and the identification of useful diagnostic criteria poses a major challenge. A novel test aiming to identify a disease is usually assessed by its capacity to ascertain the absence or presence of this illness. In any syndrome, a gold standard for the condition to be identified is absent, rendering the usual assessment of sensitivity and specificity of clinical tests elusive. Hence, the debate regarding criteria for PCOS diagnosis seems to come down to which end point of the syndrome is considered most relevant and whether to be inclusive or exclusive. 

I had the pleasure of being one of the Congress Chairpersons at the 2nd IVF Worldwide Live Congress: Growing IVF Clinics in the Digital Age that took place from October 31 through November 2, 2013 in Berlin, Germany.
The Conference was focused on providing knowledge, practical guidance and experience-proven tips geared towards increasing an IVF clinic's online footprint and lead generation across a variety of digital marketing disciplines.
The sessions and speakers picked for the Conference seemed to be highly appreciated by the audience of just under 100 fortunate attendees. After the event, one of the written feedbacks I received from a Founder of an IVF clinic was: "We are really working hard on doing better and with all the ideas I got in Berlin.... I feel like I should give up medicine and focus on marketing!

The II Ovarian Club meeting on  ' The fertilization process of the oocyte and embryo development in relation to various clinical conditions', in  Prague , Czech Republic on  November 8-11, 2012 ,is a unique event that will create synergies between basic science, research and daily clinical practice to benefit patient care.More information on:  http://comtecmed.com/oc/2012

The " Ovarian Club" forum aims to help clinicians to reach reliable solutions that can be implemented in their daily practices, and will allow researchers to present their new studies and findings in their fields of expertise creating an inter-active platform for discussions with the leading experts who will attend the Meeting.

The Internet has revolutionized our society and is now in the process of revolutionizing the way we deliver healthcare.  I attended a conference in Berlin on the subject.  What an eye opener! Experts in the field of internet marketing and social networkingdemonstrated how rapidly things are changing in patients’ desires to communicate with each other about their healthcare delivery.  This was the first formal meeting where IVF Clinicians and Internet experts share information to understand the ways to improve communication.

Nowadays, human oocytes/embryos are cryopreserved via slow freezing (SF) or vitrification (VIT). Due to the high survival rate guaranteed by VIT, this procedure is increasingly applied worldwide. Nevertheless, to date, perhaps millions of SF oocytes/embryos have already been stored in IVF cryobanks. The aim of this study was to evaluate a rapid warming protocol for SF human oocytes based on the standard warming procedure for VIT in order to optimize the SF survival rate and reduce costs by using the same solutions for both SF and VIT warming. Between December 2012 and January 2013, 216 SF oocytes donated for research were randomized for the rapid thawing (RT) conventionally used for SF oocytes, or rapid warming (RW) as for VIT protocols.