INCREASING FERTILITY THREEFOLD WITH DHEA ?

Increasing Fertility Threefold With DHEA?
Israel - A team of researcher from a Tel Aviv University has studied the effect of DHEA (Dehydroepiandrosterone) on women trying to become pregnant.

DHEA is known by consumers as the hormone of youth. Some say it slows the aging of the skin. However, its effectiveness remains controversial. Following rumors, Professor Adrian Shulman and his team focused on its properties in terms of fertility. As part of a program of in vitro fertilization, they found that women who took DHEA in addition to standard treatment had 23% chance of getting pregnant while those who did not follow the usual treatment had only 4% opportunities. In addition, women in the first group lived a pregnancy and childbirth more serene.

These results are nonetheless viewed with caution. In effect , the experiment was performed on only 20 women. It would require a larger study to lead to conclusive results. In addition, researchers have not yet discovered what was the mechanism for DHEA to increase fertility.

Story Source: American Friends of Tel Aviv University.
Link: http://www.aftau.org/site/News2?page=NewsArticle&id=12457

DAILY SEX "HELPS IMPROVE SPERM QUALITY"

Daily Sex "Helps Improve Sperm Quality"

Australian study - Having sex daily increase sperm quality and thus assist men who have fertility problems.

The study was conducted on 118 Australians whose semen showed alterations, the researchers found that daily ejaculation for a week increased significantly reduce the number of DNA damage sperm of patients.

Dr David Greening and colleagues at the private clinic Sydney IVF (Australia), specializes in fertility problems, participants were asked to have sex every day for a week. After seven days, doctors have observed in 81% of subjects a decrease of 12% of the amount of damaged sperm. Sperm quality can also be improved if men do not smoke, do not abuse alcohol, do exercise and ingest more antioxidants.

Although the sperm count has dropped to 180 million per ml to 70 million per ml, men were still in the "range of fertility."

Since he led the study, Dr Greening said now recommend to all couples seeking advice to improve their fertility to begin to love more. One suggestion that seems to contradict the older men but delight the youngest, said the doctor.

Sex frequent help to improve sperm quality by preventing it from staying too long in the body. The sperm DNA was indeed more likely to be damaged when staying long in the body. Also heat can also make sperm less mobile.

Some experts welcomed the study but added that it does not prove that sex daily allows men with fertility problems to have a better chance of producing babies. Dr Greening and colleagues are still analyzing the results of the study to determine how many companions of participants became pregnant.

If confirmed, the discovery could have implications for in vitro fertilization (IVF) as was previously recommended for couples to abstain for two days just to increase sperm count.

"Studying the DNA of sperm is only part of the puzzle" said his side Bill Ledger, professor of obstetrics and gynecology at the University of Sheffield, Great Britain, who has not participated in the study.

"This may improve pregnancy rates, but we still need to study further" Mr. Ledger also believes that apply to couples with fertility problems to have greater love could harm their relationship.

"This could add to the anxiety and do more harm than good." Couples should not feel obliged to change their sexual life to have a baby, he said.
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This work was presented Tuesday, June 30, 2009 in Amsterdam at the Congress of the European Society of Human Reproduction and Embryology. (Website: http://www.eshre.com)
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Sources: BBC News, AP

GENETICS : NEW HOPE OF A SUCCESSFUL IVF

Genetics: New Hope Of A Successful IVF
Researchers at the Oregon Health and Science University in the United States have found a potential means to correct inherited disorders, that affect thousands of women.

Monkeys born using this technique
The authors, worked with monkeys, have transferred genetic material necessary for the birth of a healthy baby from a defective egg originally rendered by sound technique.

This technique of American authors, published in the medical journal Nature, raises the hope that treatment will enable some couples to have a healthy child without having to resort to donor eggs. However, it should be noted that the future child will have a limited number of genes from one - third parent.

The treatment will involve genetic changes that can be transmitted to future generations. The genetic defect is contained in structures called mitochondria. If an egg with faulty mitochondria is fertilized, the resulting child could have any of hundreds of different diseases including anemia, dementia, hypertension and a range of neurological disorders.

The animal research laboratory led by Dr. Shoukhrat Mitalipov, could now be in the author applied in humans within two or three years. According to him, every 30 minutes, a child born carrying one of these diseases could be prevented with this technique is closer to clinical application that everything had been done before.

According to one commentator, Professor Dr. Robin Lovell-Badge, responding to some concerns should not worry about a germline alteration since mitochondria do not provide specific human quality. The technique could be compared to the action of changing the bacteria in the intestines, which should, supposes he upset anyone. In England, however, a law should be amended to allow the use of this technique in patients.

ENDOMETRIOMAS and IN VITRO FERTILISATION

ENDOMETRIOMAS and IN VITRO FERTILIZATION OUTCOMES
This article reports the effects of endometriomas and infertility treatments on their out-come mainly in cases of in vitro fertilization.

The main conclusions are: the absence of any deleterious effects on IVF results in cases of endometriomas, the conservation of the stock oocytes in the ovary after any type of surgery for ovarian endometriomas (Cystectomy or more drainage laser vaporization), the poor out-come of iterative surgical approach of endometriomas, the risk of ovarian abscess after puncture during an IVF procedure.





INTRODUCTION
The presence of endometriomas in the course of a cycle of in vitro fertilization (IVF) raises several concerns among practitioners

1. The risk of poor ovarian response,
2. The low chance of pregnancy,
3. The risk of an "outbreak" of the endometriomas by hormonal stimulation, and
4. The risk of infection after follicular puncture.

Most of these concerns about endometriomas and IVF date from a study in 1989 Dlugi become obsolete since the advent of analogues of Gn-RH [1]. This study suggested a deleterious effect of endometriomas and called for their removal prior to IVF.

On the other hand, surgery for endometriomas has often been accused of being "destructive" for the ovarian reserve.

Endometriotic Lesions - Endoscopic Image

Endometriosis Human Ovary

Endometriomas AND RISKS OF IVF
Most of the fears reported in the introduction are quite imaginary. Indeed, no cases have been reported endometriosis cyst rupture after IVF or any outbreak of endometriosis or endometriomas after ovarian stimulation. Only one case of endometriosis cyst rupture during pregnancy IVF is found in the literature.

However, there are a dozen publications reporting cases of infection of endometriomas. Team Clermont-Ferrand reported a case of bilateral endometriomas abscess in early pregnancy with birth of twins. This case (unpublished) was instructive in many respects.

1.The germ of 2 identical sides, which proves that the good seed punctures IVF follicles and, despite aseptic precautions and antibiotic prophylaxis, as the authors emphasize.
2. Drainage percoelioscopique these endometriomas proved as ineffective in many publications.
3. This is a vaginal drainage that resulted in the healing of the patient.
4. Nevertheless, the pregnancy continued.

Thus, it is necessary to avoid a drain on endometriomas during IVF to avoid the risk of abcedation. This is not to drain through a endometriomas is not always easy or even feasible. The antibiotic appears to be ineffective.

IMPACT OF SURGERY ON endometriomas ovarian response in IVF
As we have seen, there is no scientific evidence that proves the need for the endometriomas to improve the outcome of IVF.

In contrast, the surgical treatment of endometriomas can achieve spontaneous pregnancy in many cases, but it has also been accused of having a negative impact on ovarian reserve and thereby to risk compromising the chances of IVF.

CONCLUSION
Our conclusion were made in the form of FAQ:

Should we make the endometriomas before IVF?
1. Yes, because the intervention results in spontaneous pregnancies and surgery and not well made does not iterative any future IVF.
2. No, if one considers that the surgery has been very fortunate to achieve a pregnancy and that IVF is indicated. This is particularly the case of recurrence or in the case of endometriosis ultrasound and clinically very severe.

Should reoperer a recurrent endometriomas before switching to IVF?
1. No, because this will not impact either positive or negative effect on IVF.
2. Similarly, the discovery of a endometriomas during stimulation for IVF is not an indication to stop IVF.
3. However, if very large endometriomas, drainage preventif could facilitate the puncture. The best technique is the drainage under ultrasound.

Which surgical technique should be used?
1. Finally, there is no big difference between the drainage and kystectomie LASER vaporization with respect to the alteration of the oocyte stock.
2. The first is the more accessible material and appears to have a lower recidivism rate.
3. However, all endometriosis cysts are not readily clivables and in this case, the technique of coagulation drainage is preferable.

Should drains an endometriomas during IVF puncture?
1. No, because this is not enough to make and increase the risk of abcedation.
2. Yes, it is with pain, but with caution and under antibiotic coverage.

Can we drain follicles by passing through a endometriomas?
1. Clearly, it is best to avoid in order not to risk a abcedation.
2. However, this complication is not frequent and if it is sometimes impossible to do otherwise. The presence of liquid chocolate in the sample did not affect the outcome of IVF when the oocytes were treated immediately by the biologist.

What is the best treatment for endometriomas on ovarian abscess after oocyte aspiration?
1. The drainage vaginally, if possible, is the technique most effective and least aggressive.
2. The approach coelioscopique is a second-best, because there is often a pelvic armor that makes the start of the ovary very difficult.

IN VITRO FERTILIZATION (IVF)

Definition
IVF literally means "fertilization in a test tube." IVF (in vitro fertilization) is a method to achieve fertilization outside the human body by combining laboratory oocytes of women and the man's sperm. The fertilized eggs that result (embryos) are then placed in the woman's uterus.

The conduct of an IVF cycle involves several stages:

1. Ovarian stimulation
2. The timing of ovulation
3. The follicular puncture
4. The collection and preparation of semen
5. Fertilization
6. The development and transfer of embryos
7. Cryopreservation of supernumerary embryos

Ovarian stimulation
Oocytes grow within ovarian follicles in. In the natural menstrual cycle, several follicles are growing at the beginning of menstruation. Only one or two of these follicles will mature about 2 weeks later and will be released during the follicular rupture (ovulation). Follicles that are not mature stop growing and degenerate. Thus, very few oocytes reach the final stage of ovulation in a woman's life.

The goal of ovarian stimulation in IVF is to prevent the degeneration of the follicles by exposure to a sufficient dose of FSH. Administering of FSH by injection, you get higher circulating levels that support the development of multiple follicles and maturation of several oocytes. This proliferation of follicular recruitment, also known as controlled ovarian hyperstimulation, improves the chances of success of IVF by increasing the number of embryos available

Of ovulation (the timing of ovulation)
When the follicles have reached the desired size and estrogen levels are sufficient, the final phase of maturation of oocytes is induced by an injection of hCG (Choriomon ® Ovitrelle ®, Pregnyl ®). Follicular aspiration (oocyte collection) is scheduled approximately 35 hours after injection.

Follicular puncture
Under light general anesthesia, an ultrasound probe with a guide is inserted into the vagina and the follicles are identified. A thin needle is inserted through the guide in the vaginal wall and the ovary and the follicles are punctures one by one. The follicular fluid containing the egg is sucked and collected in a tube. The intervention is short (15-20 minutes). During surgery, the tubes containing the follicular fluid are kept at body temperature in an incubator. They are then immediately transported to the laboratory where the biologist determines the number of oocytes harvested. After ovarian stimulation, we get an average of 8 to 10 oocytes. The patient is then transferred into a room where the result of the drain will be communicated in one hour. After 3 to 4 hours of observation, it can go home.

The collection and preparation of semen
On the day of oocyte aspiration, the spouse takes a sample by masturbation semen to be used for fertilization.

In the event of major difficulty of sampling, it is possible to arrange in advance, a cryopreservation of sperm, which can be used for fertilization.

In cases where semen was collected at surgery or testicular excretory channels before the treatment cycle is generally the cryo sperm to be used.

Whatever its origin, the sperm is analyzed and prepared in the same way. Seminal plasma that limits the power of the fertilizing sperm is eliminated and the most mobile sperm, which are a priori most pollinators are selected.

The oocyte insemination is performed. Depending on the type of infertility, fertilization is left to chance (IVF) or to run (ICSI).

Fertilization
There are two ways to fertilize ova:

1. in vitro fertilization "classic" (IVF) and
2. intra-cytoplasmic injection of sperm (ICSI).

IVF is used as the origin of infertility is female and the sperm quality is normal or slightly altered. A few hours after follicular puncture, the oocytes are reunited with sperm in a culture medium conducive to their survival. They are placed at 37 º C for a period of 4 to 20 hours. Only one spermatozoon - the most active - will cross the zona pellucida and the plasma membrane of the egg and achieve fertilization.

After 18-20 hours of incubation, the biologist look under a microscope if fertilization has occurred. The fertilized ovum (or "impregnated") comes in the form of a cell with two nuclei (pronuclei), one of paternal origin, the other of maternal origin. This stage is called the zygote.

The zygote is not yet an embryo because the genetic heritage maternal and paternal have not yet merged.

At this point, the biologist for the custody transfer 2 or 3 zygotes. The supernumerary zygotes were frozen (cryopreserved) and may be used at a future attempt.

There is sometimes fertilization anomalies that make it impossible to transfer or freezing that these zygotes.

The development and transfer of embryos
Two to three days after the collection of oocytes, embryos are transferred into the uterus. On Day 2, embryos were divided into 2 to 4 cells, the 3rd day, they reached 6 to 8 cells.

The transfer is a painless process. The embryos are placed in a thin flexible catheter. After explaining the cervix with a speculum, the doctor inserts the catheter gently into the uterine cavity. In some cases, the transfer is performed under ultrasound to guide the establishment of the catheter within the uterus and to ensure that the embryos have been tabled in the right place.

Two or three embryos are usually transferred. The number of embryos was decided after discussion with the doctor, depending on the age of the woman and the couple's choice.

Approximately 12 days after the transfer, a pregnancy test performed on a blood test will know the outcome. If the test is positive, an ultrasound will be scheduled approximately 4 weeks after transfer to verify the proper development of the pregnancy.

Cryopreservation of supernumerary zygotes
It is not uncommon that we get more zygotes than the desired number for the transfer. The supernumerary zygotes can be kept at very low temperatures in liquid nitrogen (freezing or cryopreservation).

The aim of cryopreservation of zygotes is to give the couple the best chance to achieve pregnancy, while limiting the occurrence of multiple pregnancy and its complications. The zygote can be thawed and transferred if no pregnancy in the first round. In this case, the stages of the ovarian stimulation and follicle puncture need not be repeated.

The five stages of IVF treatment: (short way of explanation)

1. Hormonal Stimulation of the Ovaries
The woman receives 10 to 14 days, a natural hormone preparations by injection, in order to develop more eggs. In a traditional cycle, one egg is released, but thanks to the hormonal preparation, there are several.

2. Grab or Ovum Pick Up
Puncture or ovum pick up takes place just before ovulation. In this way, the follicles are punctured and sucked so that eggs can be gathered. Around the same time, the man must give a semen sample.

3. Insemination
The insemination is to collect the eggs and sperm.

4. Fertilization
After 16 hours, we can examine whether fertilization took place. Two days later, we can see if the embryos are formed.

5. Transfer of Embryos
Finally, we introduce the (s) best (s) embryo (s) in the uterus.