November 07, 2011 (New York, NY) —As an alternative to its standard Egg Donation Program, the EcoDEP discount donor egg program offers patients an opportunity to receive donor eggs at a much lower total cycle cost of $14,950. The cost of a standard egg donation cycle is approximately double this cost.

“Because CHR, likely, offers the largest and most diverse pool of carefully selected egg donors in the world, and because of the program’s excellent pregnancy rates, CHR’s standard Egg Donation Program has served a worldwide clientele successfully for years,” explains Norbert Gleicher, MD, Medical Director of CHR. He adds: “The large number and diversity of available egg donors allow CHR, uniquely, to match donors closely to patients, and with practically no waiting period.” However, CHR recognizes fertility patients’ current economic realities. Dr. Gleicher continues: “Traditional egg donation is expensive. Looking for a less costly alternative, we created a radically different low cost donor egg program. EcoDEP, the new frozen donor egg program, utilizes frozen-thawed donor eggs instead of fresh donor eggs, and instead of giving one recipient all of the eggs from a donor, the program splits one donor’s eggs amongst up to three recipients.”

In the EcoDEP donor egg program, donor eggs are frozen after retrieval in batches of at least five. Once a recipient chooses a donor with frozen eggs as her “match,” a batch of five frozen eggs is thawed, fertilized with partner sperm, and resulting embryos are transferred to the recipient’s uterus.

Although a number of recent studies from around the world reported comparable pregnancy rates from fresh and frozen donor eggs, the use of frozen eggs is still widely, including at CHR, considered “experimental.” As such, patients will be required to sign an informed consent, acknowledging the experimental nature of EcoDEP. Like all in vitro fertilization (IVF) outcomes at CHR, EcoDEP outcomes will be closely monitored, serially reported to CDC and SART, but also immediately published to the public on CHR’s website, as soon as statistically valid numbers become available.

“Choosing between standard egg donation and the new lower-cost EcoDEP requires careful consideration of advantages and disadvantages,” says David H. Barad, MD, CHR’s Director of Clinical ART. “If costs were not an issue, traditional egg donation would be the first choice of most patients, since it offers broader donor selection and higher cumulative pregnancy chances.” Dr. Barad continues: “But, only too often, second best choices have to be made in life, because first choices are unaffordable. EcoDEP will give many women their first access to egg donation. This may also be the first chance at pregnancy for these patients – and ultimately, this is what CHR stands for.”

About Center for Human Reproduction

Center for Human Reproduction, or CHR, is a leading fertility center in the United States with a worldwide reputation as a “fertility center of last resort.”  Under the leadership of Drs. Norbert Gleicher and David H. Barad, CHR is now offering the EcoDEP program for finding an affordable egg donor.  For more information, visit http://www.centerforhumanreprod.com.

In the United States pregnancy in older women is becoming progressively more common. For a number of years, US national birth data has demonstrated that women above age 40 now represent the most rapidly growing age group having children.

Different societal developments contribute to this development. More women are in the work force, there are fewer and later marriages, higher divorce rates and, of course, medical progress has allowed older women conceive into their 50s either with their own eggs or via egg donation.

Norbert Gleicher, MD and Medical Director of New York City’s Center for Human Reproduction (CHR) – a leading clinical and research center in infertility – has recently brought attention to the rising number of older women becoming mothers. In a blog published by CHR he notes that a number of media reports recently presented the pros and cons of pregnancy in older women. All reports, however, missed the most important conclusion to this seemingly sudden societal development (which in reality has been growing quietly for over a decade): the developed world is in the midst of a reproductive social revolution in which we will increasingly see older, and often single, women becoming mothers.

So far, the medical profession, academia and government have failed to address potential societal consequences of an increase in older mothers. The public and medical establishments are similarly skeptical and to a degree hostile to what some have derisively called “grandmothers having children.” Yet, Dr. Gleicher notes, “The trend [of pregnancy in older women] is irreversible, and can only be expected to accelerate.”

Dr. Gleicher further points out that at CHR the median patient age, which a decade ago was around 35 years, passed 40 in 2011. Egg donation, mostly utilized by older women who no longer have use of their own eggs, is CHR’s most rapidly growing in vitro fertilization (IVF) program. Trends also can be seen nationally based on Center for Disease Control and Prevention data. Between 2004 and 2008 percentages of IVF cycles as a proportion of all IVF more than doubled above the age of 42. By 2008, egg donation cycles already represented 12.3% of all IVF cycles in the US.

“Medicine is not ready to manage pregnancy in older women safely and society is not ready to help them cope with older motherhood,” warns Dr. Gleicher. “Affected medical specialties have to develop the necessary expertise, whether they agree with patients’ decisions to be pregnant at advanced ages or not.” Feeling strongly about the subject, he concludes, “As we do not withhold care from smokers with lung cancer or from overly obese diabetics, it would be unethical to withhold care from older women desirous of motherhood.”

About CHR
Center for Human Reproduction (http://www.centerforhumanreprod.com) is a leading infertility center in New York City treating patients worldwide.  CHR is well-recognized for its major clinical research program, which has contributed a number of essential breakthroughs to the IVF process. Dr. Gleicher is available for further comments.

August 23, 2011 (New York, NY) – Androgens (male hormones), contrary to popular belief, play a crucial role in women’s fertility. Some androgens and follicle-stimulating hormone (FSH) may work together to encourage development of eggs in the ovary in the early stages of oocyte (egg) maturation, investigators from a New York fertility center suggested in a recent article.

In a paper just published in the journal Reproductive Biology and Endocrinology¹, researchers from the Center for Human Reproduction (CHR) reached these conclusions combining results from human and recent mouse research. Some androgens, such as testosterone and dehydroepiandrosterone (DHEA), may make essential contributions to the normal maturation of follicles that contain eggs in the ovary.

Androgen’s role in female fertility has been controversial at best. Some researchers have even insisted that androgens are the principal enemy of follicle maturation, especially given observations in patients with polycystic ovarian syndrome (PCOS), who often present with excess androgens and tend to struggle with infertility.

“Recent research data suggests that androgens and FSH, likely at specific, balanced concentrations, work together in promoting follicle development,” explains Norbert Gleicher, MD, lead author of the paper, and Medical Director of CHR. “Investigations of such intricacies of ovarian function cannot be done in humans, at least initially, and requires integration of animal data, which is exactly what we did.”

The synergism between androgens and FSH appears most pronounced in the pre-antral and early antral stages of follicle maturation, at least 2-3 months before an egg is ready for ovulation. “This may open new avenues for treatment, especially for women with ‘older’ ovaries,” says David H Barad, MD, another author of the study. “Instead of focusing only on the last two weeks of oocyte maturation, as we currently do with infertility treatments, we may be able to offer treatments that benefit follicle development from much earlier maturation stages.”

Dr. Gleicher notes in the publication that doctors at CHR have preliminary evidence that longer-term exposure to DHEA in combination with FSH may positively affect oocyte development, though more definite conclusions require further studies.

¹Gleicher N, Weghofer A, Barad DH. The role of androgens in follicle maturation and ovulation induction: friend or foe of infertility treatment? Reprod Biol Endocrinol 2011;9(1):116.

Original article: Study Suggests Androgens Crucial to Female Fertility

About Center for Human Reproduction
Center for Human Reproduction (http://www.centerforhumanreprod.com) is a leading IVF center in New York City with world-wide clientele, well recognized for its major clinical research program, which over the years contributed a number of essential breakthroughs to the IVF process. Dr. Gleicher and Dr. Barad are available for further comments.

This last weekend the WSJ.com ran a heart-wrenching essay written by Holly Finn titled “My Fertility Crisis” detailing this 40-something year old woman’s journey through multiple failed IVF treatments.

The deeply personal piece brings to light the struggle that many couples face when the infertility treatment that they poor their emotional, physical, and financial resources into – fails.

The reality is that most IVF treatments do not result in a child. The average age of women seeking infertility treatment is 39 years of age, and by 40 a woman’s chance of the treatment actually resulting in a live birth is around 20%. Once she reaches 41 this drops to on 12%. Even more disheartening is that once a woman has failed a treatment, her likelihood the next time is even less.

In Ms. Finns story she reminisces how after several failed IVF treatments Ms. Finn asked her doctor, “Would a sane person bother trying again?”

Thankfully, she had a wonderful doctor who told her that there is nothing insane about hanging onto a thread of hope. Despite sinking chances of a baby her doctor is willing to support helping her pursue her dream of a family – while staying honest about the mere chances which he told her was only 5%.

Dr. Norber Gleicher, Medical Director of the Center for Human Reproduction, President of the Foundation for Reproductive Medicine, and Visiting Professor at Yale University came across Ms. Finn’s article and was moved by her message. As an infertility expert who specializes in “older women” he was particularly touched by the hopelessness that Ms. Finn conveyed in her essay.

“As a gynecologist and infertility expert, I – like most of my colleagues, of course – constantly try to create awareness about the importance of female age for successful reproduction,” he said. “The younger the better! But, increasingly, every time I make this point to an ‘older’ patient, I am uncomfortable about unwittingly aggravating her already unwarranted and excessive sense of guilt that is so well depicted in Ms. Finn’s essay.”

According to Dr. Gleicher there is no clear answer to how many infertility treatments are too many. He says that this depends wholly upon the individual circumstances of each woman. He does say, that this woman’s chances could be much greater should she choose to go with a donated egg.

“While genetic inheritance very clearly represents one of the primary purposes of reproduction, biological maternity is also of crucial importance to maternal-child bonding,” explained Gleicher. “Women today are no longer limited by their own reproductive lifespan (i.e. their ovaries’ ability to produce viable eggs) because (anonymous) egg donation has become widely available. In the United States, egg donation now represents the most rapidly growing fertility treatment within IVF.”

I strongly suggest reading Dr. Gleicher’s full response to Ms. Finn’s essay. It reminds us that in the booming infertility medical business there are still doctors, such as him, who really do care about creating miracles for patients who have lost all hope.

Further reading: Pregnancy after 40: Risk for Complications

July 12, 2011 (New York, NY) – A leading IVF center in NY has announced research suggesting that genetic control over the mother’s immunologic tolerance of embryos is behind some IVF failures.  According to the Center for Human Reproduction, genetics can have an effect on the implantation of embryos.  After over four million IVF babies worldwide and a Nobel Prize in Medicine and Physiology to recognize the accomplishment, the reality of IVF is that more IVF cycles still fail than succeed.

A majority of failed IVF cases (and miscarriages) are considered to be a result of chromosomal abnormalities in embryos. In a smaller number of cases—estimated by some authorities to represent approximately 15% of failed IVF cycles—implantation fails because the process of implantation itself malfunctions. “Implantation is an immunologic process,” explains Norbert Gleicher, MD, Medical Director at the IVF NY center CHR and an international expert in the immunology of reproduction. “Because the genetic material of the implanting embryo is half paternal, for the mother’s immune system, the embryo is analogous to an organ transplant. Under normal circumstances, however, this ‘transplant’ is not rejected.”

Why the maternal immune system tolerates this “transplant” is also not well understood. However, recent research at CHR suggests a genetic component. Investigators at CHR recently closely linked a gene on the X-chromosome, the so-called FMR1 gene, with ovarian aging and chances of conceiving with IVF:  women with so-called normal genotype had almost double the pregnancy chance with IVF as women with so-called heterozygous-normal/low genotype.¹

A follow-up study, also in the medical journal PLoS ONE, suggested that FMR1 differences are also likely responsible for variations in IVF pregnancy rates in different races/ethnicities.²

David H. Barad, MD, the Center’s Clinical Director of IVF explains: “We now have evidence that IVF outcome differences associated with FMR1 affect implantation. They are likely immunologic in nature.” These are the first reported genetic controls for IVF outcomes. “This genetic component to embryo implantation may lead to prognostications, based on IVF patients’ genetic profiles,” adds Dr. Gleicher. “Potentially, then, these prognostications may open up revolutionary new avenues to therapies to improve implantation and IVF pregnancy chances through immunologic treatments.”

¹Gleicher et al., PLoS ONE 2010; 5(12): e15303; ²Gleicher et al., PLoS ONE 2011; 6(4): e18781

Center for Human Reproduction (http://www.centerforhumanreprod.com/) is a leading IVF center in New York City with world-wide clientele, well recognized for its major clinical research program, which over the years contributed a number of essential breakthroughs to the IVF process. Dr. Gleicher and Dr. Barad are available for further comments.

June 14, 2011 (New York, NY) – Infertile women all over the world are falling victim to a widespread misunderstanding of Premature Ovarian Failure (POF), a medical condition in which a woman’s ovarian function is lost prematurely ,warns a New York infertility expert. This misunderstanding, in some cases, results in women resorting to egg donation even when they still have a significant chance of pregnancy without donor eggs.

Premature Ovarian Failure (POF) is also called early menopause or Primary Ovarian Insufficiency (POI), a recently coined medical term. Current diagnostic criteria for POF are Follicle Stimulating Hormone (FSH) levels above 40.0 mIU/mL before age 40 – a condition known as High FSH. True POF affects only approximately 1% of all women. However, approximately 10% of all women experience a premature decline of ovarian function, which is milder than outright POF. This milder decline in ovarian function is called Premature Ovarian Aging (POA) or Occult Primary Ovarian Insufficiency (OPOI).

This multitude of medical terminologies for similar or identical medical conditions has led to serious problems for affected patients. “Correct diagnosis is crucial in advising patients about prognosis and treatment choices, because women with POA, especially if under age 42, still have excellent pregnancy chances with correct treatments,” explains Norbert Gleicher, MD, Founder and Medical Director of the Center for Human Reproduction (CHR) in New York City. “In contrast, women with true POF have much poorer pregnancy chances with the use of their own eggs, and usually require experimental treatments.”

While women with POF and POA represent only a small minority of all women, they are a significant presence in infertility setting. “The percentages amongst patients vary between fertility centers, but have been reported to reach 50-60% in centers like CHR that specialize in women with diminished ovarian function,” notes David H. Barad, MD, MS, the center’s Clinical Director of Assisted Reproduction. “Incorrect diagnoses and treatments can, therefore, negatively affect a rather large number of infertility patients.”

“We see an increasing number of POA patients who have been given a POF diagnosis,” adds Dr. Gleicher. “They are advised to pursue egg donation very prematurely, in our opinion. A significant minority of those who consult our center after such advice end up conceiving without egg donation!”

Dr. Gleicher discusses High FSH and its implications in female fertility. This video on High FSH can be viewed here: http://www.youtube.com/watch?v=7xYkGeTZQ6U

About Center for Human Reproduction
Center for Human Reproduction (http://www.centerforhumanreprod.com) is a leading IVF center in New York City with world-wide clientele, well recognized for its major clinical research program, which over the years contributed a number of essential breakthroughs to the IVF process. Dr. Gleicher and Dr. Barad are available for further comments.

May 31, 2011 (New York, NY) – A New York IVF center warns against simplistic interpretation of a recent report on IVF pregnancy rates, published online in the medical journal Human Reproduction. The paper¹ reported that maximal birth rates were achieved when 15 to 20 oocytes (eggs) were retrieved in an IVF cycle. A press release² by the European Society for Human Reproduction and Embryology (ESHRE), which publishes the journal, summarized the study as demonstrating that “15 [eggs] is the perfect number” to strive for in every IVF cycle, and many media outlets have followed. However, according to the fertility researchers at Center for Human Reproduction (CHR) in New York, NY, this conclusion is an oversimplification of reported data on IVF success rates.

“Assuming that patients receive reasonable ovarian stimulation for IVF,” explains Norbert Gleicher, MD, Medical Director of CHR, “the number of retrieved eggs is only a reflection of the patients’ ovarian reserve.” Ovarian reserve is a medical term that describes a woman’s current level of ovarian function. The study, showing that live birth rates plateaued between 15 and 20 eggs, only demonstrates that retrieval of 15 to 20 eggs reflects the maximal ovarian reserve at all ages.   According to research at CHR, ovarian reserve is also reflected in anti-Müllerian hormone (AMH) levels. In a paper³ published in the medical journal Fertility & Sterility, CHR’s IVF specialists reported last year that AMH above 1.05 ng/mL offers best live birth chances at all ages.

The Human Reproduction study confirms the previous CHR finding that threshold levels of ovarian reserve, offering best IVF live birth rates, remains constant at all ages.   “Technically, ovaries cannot be stimulated toward production of a specific number of eggs,” adds David H. Barad, MD, Clinical Director of IVF at CHR. “If the number of eggs, instead of ovarian reserve, were the true determinant of live birth chances, we could simply stop retrieving eggs when we reach that specified number. This, however, would only increase risks to patients. Perfect oocyte numbers, therefore, cannot really be acted upon.”

Dr. Gleicher also warns that patients should not be misled into believing that every patient undergoing IVF can or should be stimulated toward the production of 15 to 20 eggs. Very few women above age 40, for example, can ever reach this range, even with maximal ovarian stimulation. Young women with polycystic ovary syndrome (PCOS), on the other hand, will often exceed this range, even with the mildest stimulation. “It is not the number of eggs we worry about,” says Dr. Gleicher. “It’s the patient’s ovarian reserve!”

About Center for Human Reproduction
Center for Human Reproduction (www.centerforhumanreprod.com) is a leading IVF center in New York City with world-wide clientele, well recognized for its major clinical research program, which over the years contributed a number of essential breakthroughs to the IVF process. Dr. Gleicher and Dr. Barad are available for further comments.

¹Sunkara et al., Association between the number of eggs and live birth in IVF treatment: an analysis of 400,135 treatment cycles ²http://www.eshre.eu/ESHRE/English/Press-Room/Press-Releases/2011-Press-Releases/Eggs-and-live-birth/page.aspx/1337 3 Gleicher et al., Anti-Müllerian hormone (AMH) defines, independent of age, low versus good live-birth chances in women with severely diminished ovarian reserve. Fertil Steril 2010;94:2824-7

A new study suggests that genes located in the part of cells that creates energy, are a large contributor to male infertility.

Dr. Damian Dowling from Monash University in Melbourne and his colleagues conducted genetic studies on fruit flies to determine how genetics affect male infertility. Fruit flies have a surprisingly similar genome to humans, making them an appropriate subject of study.

In looking at the power-center for cells, known as the mitochondria, the researchers realized that the genetics that make up this part of the cell don’t go through rigorous quality control checks like other genes do. The result is high levels of genetic mutations that go unchecked and get passed along to male offspring.

“What our results suggest is that the mitochondria have inadvertently evolved to be bad for males, but good for females, as a by-product of their maternal transmission,” said Dowling. “While medical practitioners have a fairly good idea that certain mitochondrial mutations can bring about male infertility, the evolutionary process that we uncover actually suggests that the mitochondria might well harbor very many unidentified mutations, all of which could contribute to the problem of male infertility.”

Although this study does not necessarily explain all male infertility, it is a breakthrough in how researchers may study this condition going forward. Dowling concludes, “At the very least, our results should therefore provide a road-map of where we should be looking for these mutations.”

Male infertility can be related to issues of low semen count, low semen volume, or abnormal sperm. This research study was published in the May 13, 2011 edition of the journal Science.

Male Infertility Got You Down? 5 Ways to Boost Your Swimmers

May 20 2011 (New York, NY) – An antitrust lawsuit regarding egg donor compensation, filed in U.S. District Court for the Northern District of California, named the American Society for Reproductive Medicine (ASRM), Society for Assisted Reproductive Technologies (SART) and a San Francisco-based fertility center as defendant, according to an email that ASRM sent to its membership on May 9, 2011.

The plaintiff, Lindsay Kamakahi, alleged in a class action suit that ASRM has been price-fixing compensations for egg donors, violating the Sherman Antitrust Act, since the organization issued Ethics Committee Guideline on compensation for oocyte donors in 2007.

The Center for Human Reproduction (CHR), a leading fertility center in New York, NY, with one of the largest and most diverse egg donor programs in the U.S., points out that there are a number of crucially important issues in regards to egg donation, often misunderstood by the public:

1. When egg donors receive payments, they are not paid for their eggs; they are paid for time and efforts given to egg donation.
2. This distinction is crucial: just like it would be unethical and, likely, illegal to make payments for human organs (to be transplanted), so is it unethical, and, likely, illegal, to pay for eggs.
3. The principal issue to be addressed in this lawsuit, therefore, is not whether defendants potentially price-fixed what should be paid for donor eggs but whether they illegally restricted what can be paid in fair reimbursement for time and efforts extended as an egg donor.
4. Whether recommendations as to what constitutes appropriate reimbursement for time and efforts qualify as “price fixing” under the Sherman Antitrust Act would appear questionable. Similar authoritative reimbursement recommendations also exist for organ donors, blood donors, participants in clinical trials, etc.

As CHR’s Medical Director, Norbert Gleicher, MD, already pointed out in 1984, there are biological and legal analogies between gamete/embryo donation and organ transplantation (Gleicher N. The fetus is a graft, both biologically and legally, Fertility & Sterility 1984;42:824-5). “One has to wonder whether, hidden behind this lawsuit about compensation for egg donors is not the much larger issue of creating an open marketplace for organ donations, widely discussed in legal circles,” comments Dr. Gleicher. “The egg donation process, which serves thousands of infertile women so well every year, should not be abused for such purposes.

About CHR

Center for Human Reproduction (http://www.centerforhumanreprod.com/) is a leading infertility center in New York City with world-wide clientele, well recognized for its major clinical research program, which over the years contributed a number of essential breakthroughs to the IVF process. Dr. Gleicher is available for further comments.

For further information please contact:

Communications Manager
Center for Human Reproduction
21 E 69th St
New York NY USA 10021
212-994-4400 phone
webadmin@thechr.com
http://www.centerforhumanreprod.com

Last month egg donor, Ms. Lindsay Kamakahi filed an antitrust lawsuit against the American Society of Reproductive Medicine (ASRM). The lawsuit claims that their ethical guidelines regarding egg donor compensation is creating a price-fixing of the market which would be in violation of the Sherman Antitrust Act.

The Center for Human Reproduction (CHR), who has one of the largest egg donation program in the United States was not named in the lawsuit, however, they released a formal statement regarding the issue today. They state that the statement is for clarification purposes, as there are many public misconceptions about compensation for egg donations.

First, they clarify that egg donors are not compensated for the eggs themselves, but for their time and efforts that goes into the donation process. “This distinction is crucial: just like it would be unethical and, likely, illegal to make payments for human organs (to be transplanted), so is it unethical, and, likely, illegal, to pay for eggs,” reads the press release statement.

Therefore, the lawsuit is not about price-fixing the price of human eggs, but of compensation and reimbursement efforts. The CHR also points out that there are similar compensation guidelines for organ and blood donors.