Seminar Presentation Geoffrey Sher MD 9-13

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The factors that influence IVF success. Presented by Geoffrey Sher, MD, of Sher Institute for Reproductive Medicine

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Seminar Presentation Geoffrey Sher MD 9-13

  1. 1. SUCCESSFUL IVF! GEOFFREY SHER M.D.GEOFFREY SHER M.D. Sher Institute for ReproductiveSher Institute for Reproductive Medicine (SIRM)-St. LouisMedicine (SIRM)-St. Louis
  2. 2. Find Us Online! (See Sheet in Your Packet) Website: www.haveababy.com Discussion Boards: forums.haveababy.com IVF Authority Blog: www.IVFauthority.com
  3. 3. Positive 1st Betas by Cycle Date 66% 62% 48% 62% 52% 60% 52% 52% 47% 61% 68% 69% 67% 78% 69% 88% 79% 81% 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Jan- 12 Feb- 12 Mar- 12 Apr- 12 May- 12 Jun- 12 Jul-12 Aug- 12 Sep- 12 Oct- 12 Nov- 12 Dec- 12 Jan- 13 Feb- 13 Mar- 13 Apr- 13 May- 13 Jun- 13 Jul-13 Aug- 13 Cycle Date
  4. 4. Jan-Dec 2012 Feb-Aug 2013 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% % Positive Beta hCG Average Positive 1st Beta hCG Prior to and After Feb 2013 n=410 n=190 57% 77%
  5. 5. "Maximum" Birth Rate Per Single Embryo Transferred Blastocyst vs. Cleaved Day-3 Embryo 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% <35 35-39 40-42 43-44 Age BirthRate 1-CGH Normal Blast 1-Untested Blastocyst 1-Untested Cleaved Embryo
  6. 6. "Maximum" Birth Rate Per Transfer of Two (2) Embryos [Blastocyst vs. Cleaved Day-3 Embryo] 0% 10% 20% 30% 40% 50% 60% 70% <35 35-39 40-42 43-44 Age BirthRate 2-Blastocysts 2-Cleaved Embryos
  7. 7. INFLUENCING IVF SUCCESS 1. OPTIMIZING EMBRYO QUALITY 2. OPTIMIZING EMBRYO IMPLANTATION 3. OPTIMIZING THE EMBRYO TRANSFER
  8. 8. Establishing an ideal “Soil”/”Seed” relationship! SOIL / SEEDSOIL / SEED ENDOMETRIUM / EMBRYOENDOMETRIUM / EMBRYO 75%75%25%25%
  9. 9. MATURE EGG (M-2)
  10. 10. It is primarily the chromosomal integrity of the egg, rather than the sperm that determines embryo Chromosomal integrity or “competence”!
  11. 11. MeiosisMeiosis Meiosis – Dividing the Egg’s Chromosomes
  12. 12. FERTILIZATION
  13. 13. INTRACYTOPLASMIC SPERM INJECTION (ICSI)
  14. 14. 3-Day-Old Embryo
  15. 15. 5-6 Day Embryo (blastocyst)
  16. 16. A “competent” embryo has 46 chromosomes present in its cells! “EUPLOID”
  17. 17. EMBRYO ANEUPLOIDY - THE RATE LIMITING FACTOR IN HUMAN REPRODUCTION!
  18. 18. THE BREAKTHROUGH: Comparative Genomic Hybridization (CGH) “A genetic test that identifies all the chromosomes in the egg or embryo!”
  19. 19. Which Embryos are chromosomally normal/abnormal?
  20. 20. Embryo Competency Both Abnormal
  21. 21. Embryo Competency Both Normal
  22. 22. 2. IMPLANTATION POTENTIAL
  23. 23. Immunol. Uterine Lesions Lining Thickness IMPLANTATION UTERINE RECEPTIVITY Uterine Receptivity Factors
  24. 24. a. Uterine Pathology
  25. 25. SONOHYSTEROGRAM Endometrial PolypEndometrial Polyp
  26. 26. HYSTEROSCOPYHYSTEROSCOPY Large, pedunculated endometrial polyp
  27. 27. b. Endometrial Thickness
  28. 28. END 2B A Thin EndometriaL Lining
  29. 29. A Viagra- Restored Endometrium ““Tri-Laminar” AppearanceTri-Laminar” Appearance
  30. 30. Causes of a Thin Uterine Lining Uterine scarring • Inflamation • Surgery Reduced blood flow • Age • Diffuse adenomyosis • Multiple fibroid tumors • Over-use of clomiphene
  31. 31. Viagra Improves Blood Flow  Dilates vascular smooth muscleDilates vascular smooth muscle  Can improve uterine blood flowCan improve uterine blood flow  Increased EIncreased E22 deliverydelivery
  32. 32. c. Immunologic Factors
  33. 33. UTERINE IMMUNE TOLERANCEUTERINE IMMUNE TOLERANCE EMBRYO GENETIC SIGNALLING NKcell STABILITY CYTOKINES TH-1 + + CYTOKINES TH-2
  34. 34. Immunologic ImplantationImmunologic Implantation DysfunctionDysfunction Autoimmune IDAutoimmune ID (85%)(85%) Alloimmune IDAlloimmune ID ((15%)15%) NK CELLS
  35. 35. ImplantationImplantation ImmunotherapyImmunotherapy Heparin/Lovenox/Clexane IVIG - Replaced by… Intralipid (IL) Dexamethasone/Prednisone  Aspirin ?? Other (LIT, Humera)??
  36. 36. 3. EMBRYO TRANSFER
  37. 37. Ultrasound-guided Placement of Embryo(s)
  38. 38. Day 3 vs. Day 5? How Many embryos to transfer? Full bladder Ultrasound guidance Cntd.
  39. 39. THANK YOU!!THANK YOU!!

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