couple in love

Sex Around The Time of Embryo Transfer Increases The Likelihood of Successful Early Embryo Implantation and Development.

Research has now shown that sex around the time of embryo transfer increases the likelihood of successful early embryo implantation and development.

Intercourse during an IVF cycle has the potential to improve pregnancy rates and there is adequate research to now back this up. We know that in animal studies, exposure to semen is reported to promote embryo development and implantation.

Intercourse may assist implantation

This is actually good news for humans as well as it shows that intercourse may act to assist implantation. Animal studies reveal that exposure to seminal plasma, the fluid component of the ejaculate, is particularly important for achieving normal embryo development and implantation. Animals that become pregnant through artificial insemination or embryo transfer without being exposed to seminal plasma have substantially lower rates of implantation than those exposed to seminal plasma (Pang et al., 1979; Queen et al., 1981; O et al., 1988; Flowers and Esbenshade, 1993), while rodents inseminated with spermatozoa prior to blastocyst transfer also have a higher rate of implantation compared with those not exposed to spermatozoa (Carp et al., 1984).

Intercourse may influence pregnancy success rates

A multicentre prospective randomised controlled trial was conducted through IVF centred around the world, including Australia. The study was conducted to determine if intercourse around the time of embryo transfer, or just before and embryo transfer in an IVF cycle, actually has the potential to have any influence on pregnancy success rates.

Participants in Australian IVF clinics underwent frozen embryo transfer (FET) and participants in Spain IVF clinics did fresh embryo transfer. Participants were randomised to either have intercourse, or to abstain from intercourse around the time of embryo transfer.

The study showed that there was no significant difference in the pregnancy rates between those couples that abstained and those that had intercourse. However, the portion of transferred embryos that made it to 6-8 weeks gestation was significantly higher in the women exposed to semen compared to those who abstained.

This landmark multi-centre international study showed that women who had sex around the time of embryo transfer, and who were exposed to semen around the time of embryo transfer, had increased likelihood of successful early embryo implantation and development.

Couples need to be having more sex during IVF cycles

One of the things that I always promote as part of my fertility program, is that regular sex is so important for our fertility patients, on many levels. Sometimes the obvious eludes some people though.

One of the things we see quite regularly is that couples doing Assisted Reproduction (ART) are abstaining from sex fearing it will affect their chances of conceiving. Actually the opposite is true. By not having sex during ART cycles (IUI, IVF etc) you are affecting your chances of conception.

I have spoken about the importance of sex and orgasm assisting implantation in other posts and there is so much medical research to back this up. This is seen in the research I have talked about above.

Let’s be real and look at the facts

Let ask the question “If you were trying naturally, would you stop having sex for fear that conception has taken place?”

Then why would you stop having sex around an ART cycle?

Let’s face the facts, implantation takes place in the uterus, and not the vagina, and no man is that well endowed to even penetrate the cervix, so…. Let’s get a grip here

The question to ask is “What does an embryo feed off and need to successfully implant?”

The answer is blood!

Think of a tick borrowing into skin to feed off its host.

How do you get blood flow into the uterine lining?

The answer is that sex and climax stimulate blood flow to the lining to assist implantation and also prepare the lining for implantation. Nature has given us all the tools for healthy conception to take place, and yet many of us just aren’t using them.

Sex is more than just and egg and a sperm

Don’t forget that regular sex during this time not only helps assist implantation, but it also helps with the bonding process and physical connection process during this stressful time. Many couples split up because of losing this connection during the ART process and sex is a way of keeping that physical and emotional connection. Sex also tells your body you are also preparing to conceive on another level too.

For those doing IVF etc, next time you are doing an ART cycle maybe it is time to start doing things the way nature intended to give you that boost you so desperately are needing. Go get busy people

Final Word

If you are struggling to fall pregnant, or need advice with preconception care, please give my friendly staff a call and find out how my fertility program, which has helped over 12,500 babies into the world, may be able to assist you too.

Regards

Andrew Orr

– No Stone Left Unturned

-Master of Reproductive Medicine

-Master of Women’s Health Medicine

-The International Fertility Experts

References:

  1. http://humre.oxfordjournals.org/content/15/12/2653.short
  2. Bellinge, B.S., Copeland, C.M., Thomas, T.D. et al. (1986) The influence of patient insemination on the implantation rate in an in vitro fertilization and embryo transfer program. Fertil. Steril. , 46, 252–256.
  3. Carp, H.J.A., Serr, D.M., Mashiach, S. et al. (1984) Influence of insemination on the implantation of transfered rat blastocysts. Gynecol. Obstet. Invest. , 18, 194–198.
  4. Coulam, C.B. and Stern, J.J. (1995) Effect of seminal plasma on implantation rates. Early Pregnancy , 1, 33–36.
  5. Fishel, S., Webster, J., Jackson, P. and Faratian, B. (1989) Evaluation of high vaginal insemination at oocyte recovery in patients undergoing in vitro fertilization. Fertil. Steril. , 51, 135–138.
  6. Franchin, R., Harmas, A., Benaoudia, F. et al. (1998a) Microbial flora of the cervix assessed at the time of embryo transfer adversely affects in vitro fertilization outcome. Fertil. Steril. , 70, 866–870.
  7. Franchin, R., Righini, C., Olivennes, F. et al. (1998b) Uterine contractions at the time of embryo transfer alter pregnancy rates after in-vitro fertilization. Hum. Reprod. , 13, 1968–1974.
  8. Marconi, G., Auge, L., Oses, R. et al. (1989) Does sexual intercourse improve pregnancy rates in gamete intrafallopian transfer? Fertil. Steril. , 51, 357–359.
  9. Pang, S.F., Chow, P.H. and Wong, T.M. (1979) The role of the seminal vesicles, coagulating glands and prostate glands on the fertility and fecundity of mice. J. Reprod. Fertil. , 56, 129–132.
  10. Qasim, S.M., Trias, A., Karacan, M. et al. (1996) Does the absence or presence of seminal fluid matter in patients undergoing ovulation induction with intrauterine insemination? Hum. Reprod. , 11, 1008–1010.

 

Sperm meets an egg

Regular sex found to trigger ovulation in females & make them more fertile.

Regular sex isn’t just beneficial for ones health, physical and mental well being and happiness.  Researchers have now found that regular sex and a protein in seminal fluid actually helps to trigger ovulation in females and make them more fertile to sustain a pregnancy.

Semen isn’t just a vehicle for carrying sperm

Semen isn’t just a vehicle for carrying sperm and studies actual now show that it also plays a crucial role in triggering ovulation. Researchers have discovered the protein in the seminal fluid acts as a hormonal signal on the female brain. This triggers the release of other hormones that signal the ovaries to release an egg.

The international team of researchers at the University of Saskatchewan, found this protein in a variety of mammals and say it plays an important role in reproduction in all mammals.

Male mammals have accessory sex glands that contribute seminal fluid to semen, but the role of this fluid and the glands that produce it are not well understood. From the results of the research, it is now understood that these glands produce large amounts of a protein that has a direct effect on the female brain and reproductive organs.

Ovulation Inducing Factor (OIF)

The protein, which was dubbed the ‘ovulation-inducing factor’ (OIF), works through the hypothalamus of the female brain. This part of the brain links the nervous system to the endocrine system (a system of glands that secrete hormones into the blood stream) via the pituitary gland.

The idea that a substance in mammalian semen has a direct effect on the female brain is not a new one, but now there is research to back these theories up. The scientists also discovered it is the same molecule that regulates the growth, maintenance, and survival of nerve cells.

OIF affects ovulation and fertility

In this study, they also looked at how OIF not only affected ovulation in females, but how it also affected their fertility and chances of a pregnancy.

For the purposes of the study, the research team looked at two species of mammals, that being llamas and cattle. They did this because Llamas are ‘induced ovulators, meaning that they ovulate only when they have been inseminated. Cows and humans on the other hand are ‘spontaneous ovulators,’ meaning that a regular build up of hormones stimulates the release of an egg.

Using a variety of techniques, the researchers found OIF present in semen samples taken from both animals. However, when they injected the llamas with this protein it caused them to ovulate. The same effect wasn’t seen in cattle.

While OIF didn’t appear to induce ovulation in spontaneous ovulators, such as cows and human, it did affect fertility in different ways. The protein was found to effect the timing of when cattle developed follicles (fluid-filled sacs in the ovary which carry the eggs). The researcher also found that OIF promoted the development of a temporary endocrine structure needed to sustain pregnancy.

Research has broaden our understanding of ovulation and fertility

This research definitely helps to broaden our understanding of the mechanisms that regulate ovulation and also helps to raises some interesting insights into fertility. More research is needed to see what role OIF plays in human fertility, as the researchers suspect it will be exactly the same. The study appeared in the Proceedings of the National Academy of Sciences.

It is great to see this research getting out there and this is something that I have promoted and taught for ages. It is great to see actual research to back up what I have teaching for years. Let’s face it, many of our advancements in fertility have actually come from veterinary science through use of IVF in cattle.

Couples undergoing IVF need to be having more sex

This is also great research that showed why couples trying to have a baby, or undergoing fertility treatments (IVF etc) need to still be having sex. It isn’t rocket science, yet so many people forget basic biology and that we are actually still an animal.

The problem is that so many couples actually stop having sex when doing assisted reproduction such as IVF. While I can totally understand the whole emotional aspect of why, it is still hindering their chances of conception and having a successful pregnancy. It is a truth that must be talked about and also get couples to understand.

Regular sex also helps with connection for the couple

I am always telling them how important it is to still have an active sex life, for the benefit of a happy, healthy relationship. It is also about the connection and not just about having sex. We do see so many couples split up while undergoing IVF and assisted reproduction, and some of this is purely due to lack of bonding and connection with their partner.

But even so, regular sex and intercourse also gives the chance of a natural pregnancy too, no matter how slim the chance for some couples. We still see couples that have done multiple cycles of IVF still conceiving naturally, but you actually have to have sex for this to happen.

Now we have research, which shows that a protein in seminal fluid actually acts as a hormonal signal that actually triggers ovulation, improves egg quality and may in fact make a woman more fertile for a pregnancy to take place. Again, when you look at this logically, it really is not rocket science and really is easy to understand.

Regular sex while doing IVF improves pregnancy rates.

This is why it is so important for all our couples using ART (Assisted Reproduction Therapy) and IVF to still keep having sex. Regular sex and more importantly regular climax, increases your sex hormones, helps regulate hormones, increases blood flow to the uterine lining, helps with libido, helps with egg quality, helps for better ovulation and most of all improves your fertility and the chance of sustaining a pregnancy. There is also research to show that regular sex before and after IVF transfer, improves pregnancy rates and I will talk about this research in another article on it’s own.

Final Word

If you are struggling to have a baby, and need help with fertility issues, then talk to my friendly staff about how our fertility program might be able to assist you. It has helped over 12,500 babies into the world… and counting.

Regards

Andrew Orr

-No Stone Left Unturned

-Master of Reproductive Medicine

-Master of Women’s Health Medicine

-The International Fertility Experts

 

 

fertility 1

Fertility- Before you go any further, you are forgetting one thing…….. The Male

In this video blog I explains how I often get emails from patients and practitioners, needing assistance with fertility issues. The only thing is, it is often only from the female perspective and I have to then explain this to people, or these practitioners. So often, as I am hearing their case study, or patients telling their story, I have to politely stop them and explain “Fertility Before you go any further, I can see what the issue is, you are forgetting one thing…… The Male”

Being completely honest, 95% of the time it is the full female history I am hearing and absolutely no mention of the male. The male is always 50% of the fertility picture, unless there is absolute infertility with the female (medically diagnosed infertility)

Fertility issues require proper evaluation of both the male and female, otherwise crucial things get overlooked. It takes a sperm and an egg to make a baby, not just an egg. Besides that it is a legal and ethical requirement to investigate the female and male. You cannot just investigate and treat the female. Have a listen to the latest video (below) of this very important subject.

If you do need assistance with fertility and reproductive issues, please give my staff a call and find out how my fertility program may be able to assist you and your partner.

Regards

Andrew Orr

-No Stone Left Unturned

-Master of Reproductive Medicine

-The International Fertility Experts

 

genetics and fertility

Understanding How Genetics Play a Major Part in Fertility & Reproduction

Understanding how genetics plays a major part in fertility and reproduction is very important. Many couples are completely unaware that their fertility issues and inability to conceive may in fact be from genetic, or hereditary issues that have not been screened for.

When it comes to fertility and being able to conceive more and more couples are now struggling. Some of this is due to increased stress levels, poor diet and lifestyle, increase alcohol consumption, lack of preconception care and many other factors. However, one key area that is not often talked about, or even known to many is genetic factors, chromosomal factors and DNA issues passed on through our sperm and eggs.

Fertility and reproduction is one of the hardest areas of medicine to understand. I am sure many people think that they understand it, but even with years of study and clinical experience, some questions just cannot be answered at this present time. No amount of “Dr Google” searching is going to bring answers for many couples and this is something that needs to be discussed more. Unless you have done years of study and clinical research into fertility and reproduction, you cannot understand the finer details and intricacies of conception. Even then, some answers are just not available to anyone at this present time.

The Reality of Fertility and Reproduction

The reality of fertility and reproduction is that just because an egg and sperm are put together, it does not mean that an embryo will be formed. Even if an embryo is formed, it does not mean that it will become a baby. Even if an embryo meets scientific grading categories (grade 1-4 etc), it still does not mean that the inner make up of that embryo is chromosomally viable. Even if the embryo is tested to be chromosomally viable (via PGD/PGS testing), it still does not mean that the embryo will go on to become a baby. This is the hardest thing for people to get their heads around and why we need to discuss this more. Quite simply, something that is supposed to seem easy really isn’t that easy at all. Reproduction and having babies is not as easy as many have led us to believe.

Chromosomal Errors

One of the biggest factors in embryos not developing, or IVF cycles failing, or even natural conception not working is chromosomal errors at the embryo stage. Even if both parents have normal karyoptype (46XX and 46XY) it does not mean that they cannot produce random chromosomal and genetic errors in their sperm and eggs. The thing is, the older we get, the more these errors occur and the harder it is to fall pregnant. An abnormal embryo with and abnormal number is cells is called aneuploidy. When an embryo has the correct number of cells it is called euploidy. Unfortunately, many couples are producing high numbers of aneuploidy embryos and this is why they are struggling to conceive. As mentioned before, just because the outer features of the embryo look fine, it does not mean the inner workings (chromosomes and DNA) are fine.

The Important of Genetic Screening

Speaking about chromosomal and genetics, when couples are struggling with fertility and being able to conceive, one of the biggest factors I see is that couples are not being screened properly. This is screening on all aspects, not just the standard blood tests and fertility investigations. Many couples that come to see me for help for fertility often believe that they have had everything done, yet most times I am finding that they have only had the basics done. Many couples have not even had basic genetic screening for karyoptype and genetic issues such as cystic fibrosis.

Understanding the Coding on DNA

Understanding the coding on the DNA is now having a profound practical impact on the practice of medicine today. This is particularly important in the area of infertility. There is increasing knowledge that there is frequently a major genetic component both from nuclear and mitochondrial DNA in couples with infertility or subfertility.

Significant examples include:

  • The demonstration of microdeletions on the Y chromosome in men with low sperm count (oligozoospermia)
  • The identifications of mutations in the Cystic Fibriosis gene in those with congenital bilateral absence of the vas deferens
  • The high rate of aneuploidy in normally dividing embryos after fertilisation in older infertile couples
  • The presence of an expanded triplet repeat in the androgen receptor in some men with low sperm counts.

Without seeing someone who has all this  knowledge of the molecular and genetic basis  of fertility many couples will continually have troubles trying to fall pregnant and may possible end up with repeated failed cycles in IVF too. There is so much to genetics and it is often overlooked in all areas of fertility these days. No amount of “Dr Google” is going to give you this information, nor will it give you understanding, unless you have a degree in reproductive medicine, or genetics. I do understand that people get desperate for answers, but unfortunately, sometimes these answers cannot be found by an internet search.

Other Genetic Factors Affecting Fertility

There are also other genetic conditions and chromosomal errors such as balanced translocations, reciprocal translocations, Robertsonian translocations, Turner’s syndrome, Kleinfelter’s syndrome, fragile X syndrome and many more. Again, many who are struggling with fertility issues and struggling to have a baby may not have even had some of these genetic screening done.

When I see couples, I also recommend advanced genetic carrier screening which tests for several hundred more genetically inherited mutations. Many fertility clinics do not recommend couples to do advanced carrier screening. Given that 1 in 22 couples are at risk of a hereditary gene mutation, it is really important to screen couples properly and not just do the basics.

Mutations in Genes

A mutation is a change in the information encoded in the DNA sequence. Such a change may result in the production of an abnormal protein, produce a truncated protein, reduce the levels of that protein, or cause it not to be made at all.

A single gene genetic disorder is one where an alteration in the DNA sequence of only one of the genomes 40,000 genes has resulted in significant pathology and disorders that affect the human body.

Such disorders include cystic fibrosis, Duchenne muscular dystrophy, Huntington disease and familial breast cancer. Although individually these disorders are rare, as a group, they are numerous and therefore important.

Cystic fibrosis, one of the most common autosomal recessive conditions affecting people of Northern European decent has a population incidence of 1 in 2,500.

To date up to 6,000 single gene disorders have been characterized and it is estimated that 14 per 1,000 people suffer from one of these conditions. A person who inherits a mutation in a single gene will carry that mutation in every cell of their body.

Mutations occur when a cell is dividing. The task of correctly copying 6 billion “bits” of information, the number of base pairs in the human genome, is huge and mistakes do occur. It has been established experimentally that these mistakes occur and are uncorrected in one in one billion base-pairs copied (or about 6 errors per cell division).

When a mutation occurs in the coding DNA sequence of a gene it may be a polymorphism with no effect or it may significantly impair the gene function. All mutations are thereafter inherited. Inherited or germ line mutations must be present in the egg or sperm. They are twice as common in sperm as eggs.

 Male Sperm Quality is a Big Part of Fertility Issues

Before everyone jumps to the conclusion that all failed cycles are related to women’s egg quality, I need to make it absolutely clear that men are half of the fertility equation. They are not exempt when conception does not take place, or an IVF cycle fails. As mentioned above many genetic mutations are twice more likely to be present in sperm than eggs. Up to 85% of miscarriage and chromosomally defective embryos are related to chromosomal errors that men have passed through their sperm.

Women’s eggs do have more errors as they get older, and eggs are not as viable as they get older, but men’s sperm are exactly the same. If men are not having their sperm quality managed while trying to fall pregnant, there is half your problem then and there. This is why all men are treated and managed on all levels of their health when doing my fertility program.

Sperm quality is variable and each time a man ejaculates the quality of that sperm can vary by as much as 20% at a given time. This is why men need to be continually looking after their health and sperm health while trying to conceive. Men are actually the bigger part of conception not taking place and we need to talk about this more. Men are not exempt when it comes to making babies.

Creating Life

Life does not begin with conception, but is simply a continuum from living cell to living cell with genetic information being transmitted through the genome from one generation to the next. A failure to achieve this is recognised as infertility.

At conception we are a single fertilized cell resulting from the fertilization of the egg by the sperm. The sperm contributes one copy of nuclear DNA, the egg the other copy and the mitochondrial DNA. That cell proceeds to divide, and over the course of 9 months (32 cell divisions) billions of cells are created, with specialized functions, forming complex tissues and organs that constitute the working human body. That first cell therefore must contain all the information necessary for embryological development, growth from fetus and then growth through to adult life. Without all the right coding and necessary information, life does not get created. This is also the answer to why so many couples are having problems trying to conceive.

The Importance of Seeing a Reproductive Medicine Expert

There are many factors to fertility and reproduction and why it is important that couples see someone who is a fertility expert. The fertility profession is largely unregulated and many who are now practicing in that profession are not experts at all. Many actually do not have further training and qualifications in reproductive medicine and are some of the reason why people are struggling to fall pregnant.

Final Word

Lastly, while we cannot change our chromosomes, or change genetic mutations, we can do things to change and improve our cellular DNA. This is why proper preconception care and preconception programs are so important. Everything we do, we ingest, we think etc, can be passed on to our future offspring via sperm and eggs. Health parents produce healthy sperm and eggs, thus producing healthy babies.

If you need help with being able to conceive, give my friendly staff a call and find out how my fertility program may be able to assist you. I use a ‘No Stone Left Unturned’ approach to assisting couples with fertility issues and will look at every aspect of a couples lives, including genetic and hereditary issues, to help them have the best chance of having a baby.

Regards

Andrew Orr

-No Stone Left Unturned

-Master of Reproductive Medicine

-The International Fertility Experts

IVF cover image

Let’s Talk About Why IVF Cycles Fail

Let’s talk about why IVF cycles fail because it is a very common question that is asked when a cycle fails. Often there will be no conclusive answer and often when I am asked this, I have to say the old saying “How long is piece of string?”

The reason I say this is that there are so many factors involved with a cycle failing. It could be from following

  • poor egg quality
  • poor sperm quality
  • age of the couple
  • genetic factors (diagnosed, or undiagnosed)
  • hereditary issues
  • DNA and chromosomal issues
  • a non-receptive endometrium
  • dietary and lifestyle factors
  • weight factors (excess or too little weight)
  • emotional factors, or mood disorders
  • stress
  • incorrect hormone therapy
  • medications
  • human error
  • lab errors
  • many other factors in the IVF process.

I wish it was as easy as putting a sperm and an egg together and it just happening. I know many couples do look at it this way, but there is so much more to the whole process of conception. I know it is often hard to understand, but no google search is going to tell you all of this and you would need years of study to completely understand the whole process. Plus IVF is still only a young form of medicine and it still evolving.

This is why IVFsuccess rates are still relatively low. We just do not have the technology yet to tell us which embryo will go on to become a baby. If we had that, then there would be a much higher, if not near 100% success rate. The reality is that type of technology may never be available, or would be many many years off. We can only hope.

The other thing I explain to couple is that sometimes it is literally the IVF process hindering a couples chances of success, by not having the right protocol, or right team helping them.  I could go on and on because there are so many factors that could affect a cycle and someones chances of conceiving. This is why I use the term “How long is a piece of string?”

This is why I do what I do and explain all of this and more to all my patients as part of my fertility program. I am literally there to hold their hands every step of the way and explain everything in detail each step of the way as well. I will always make sure everything is done properly and even go into bat for them and step on toes if I have too. My patient’s come first always.

What is required for a successful pregnancy?

At least three things are required for a successful pregnancy during in an vitro fertilization (IVF) cycle:

  • a healthy embryo
  • a receptive endometrium
  • careful transfer at the proper time in the cycle

There are things other things such as the right diet and right nutrients and right emotional state for the couples and proper preconception care, but for now I am just talking about a successful embryo transfer on a medical level. Firstly I will discuss the IVF process.

IVF has improved significantly in its almost 40-year history. Different types of hormone and fertility drugs have been developed that are easier to administer and are associated with an improved safety profile. In addition, numerous stimulation protocols are available that allow us to individually tailor treatments. For example, ultrasound-guided embryo transfer using soft catheters and embryo glue (enzyme to assist implantation) has also helped with ensuring better placement of the embryo, without trauma to the endometrium, but very few clinics are actually doing this. Tests can also be used to evaluate the receptivity of the endometrium in order to determine the best time to schedule the transfer.

Despite all these improvements, however, implantation and pregnancy rates with IVF only slowly increase year after year.

Achieving Implantation-The hardest step

The rate-limiting step of IVF is implantation. It requires the proper interaction of a healthy embryo and a receptive endometrium. It often fails due to problems with the embryos. The genetic health of the embryo depends on both its inherited genetic material and on the errors and repairs during the cell divisions.

A chromosomally abnormal (anuploidy) embryo is unlikely to implant, and when it does it is likely to be lost early on. Many embryos that are transferred have chromosomal abnormalities, even if they look fine on the outside, or are classified as being the best grade prior to transfer. We need people to understand that just because and embryo has reached Blastocyst, or Morella stage and it looks like a good quality embryo from the outside, it does not mean that the inside and the chromosomes inside the embryo are OK. Not every fertilised egg will result in a genetically sound embryo that will go on to become a baby.

DNA & Chromosomal When Sperm and Egg Combine

We also need people to realise that an embryo is made up the genetic material of two people and that requires the sperm to be healthy both outwardly, but also chromosomally, and this can change with each batch of sperm ejaculated. Sperm quality and the viability of sperm changes and just because something was “OK” last cycle, or two years ago, or last month, or last week, does not mean that it is OK now.

Unfortunately people need to face the reality of what happens with the body and reproduction. The health of the sperm is also reflected in the health and lifestyle and age of the male too. Unhealthy males produce unhealthy sperm and higher levels or sperm with chromosomal abnormalities and damage to the DNA. Unless you are testing every batch of sperm for DNA and chromosomal abnormalities, you aren’t going to see this and even then, testing can only see so much.

A healthy embryo (Euploidy embryo) also requires a female to be healthy and her eggs to be health chromosomally and on a DNA level. It also requires a healthy male for his sperm quality to be healthy on a DNA levels as well. Egg and sperm quality is also related to age, diet, lifestyle, environment, and exposure to environmental disruptors, weight, body fat, stress and so many other factors.

We need people to be aware of this. Then when you put two unhealthy people’s genetic and reproductive material together, there is a high likelihood that it will produce higher numbers of abnormal embryos, and sometimes it can be all of them. It all depends on the health of the sperm and health of the eggs at time of fertilisation. Even then we can still have random errors in chromosomes and DNA and this then produces faulty embryos. Again this is a hard process to explain and again Dr Google isn’t going to tell you this.

Pre-implantation Genetic Diagnosis/Screening (PGD/PGS)

Various methods of genetic testing of embryos have been evaluated in past decades. During the early days of PGD/PGD many embryos were lost in this form of screening. Today it is more routine and more perfected.  One can test the chromosome content of the polar bodies, but a cleavage-stage embryo (day 3 of development) or a blastocyst-stage embryo can be evaluated as well. In addition, various techniques  are available for assessing the chromosomes.  There are also new testing and new technologies that have addressed the shortcomings of these earlier tests.

The authors of a recent systematic review concluded that comprehensive genetic screening of embryos using day 5 blastocyst biopsy is associated with increased implantation and pregnancy rates. In addition, this technology appears to be a good tool to limit the number of embryos transferred. But embryos can still be tested early on in their development, with good results, too.

Most experts recommend genetic testing of embryos in women with advanced reproductive age, recurrent implantation failure, recurrent pregnancy loss, or severe male factor infertility/DNA issues. This then gives a greater probability of transferring a chromosomally normal embryo and having a higher chance of implantation and pregnancy occurring. But even a chromosomally normal embryos doesn’t ensure a pregnancy. This is often the hardest thing for people to get their heads around. To be honest, much of this comes down to luck and is really in the hands of the gods. Again this is often not told to people and no google search is going to tell you this either.

Preconception care increases chances of conceiving

But what you can do to ensure healthy egg quality, healthy sperm quality, healthy embryo quality, healthy uterine lining, decreases stress levels, optimal health at time of transfer etc, is doing proper preconception care as part of proper fertility program.  There is now growing evidence that the health of both parents before and at the time of conception influences the chances of conceiving and the short and long term health of the future offspring. (9,10,11,12,13,14,15)

This is why I offer couples a program to go over everything they need to know and everything the need to do prior to trying to conceive or trying to embark on the next IVF cycle. It is about getting the couple as healthy as possible and their bodies as ready as possible to give them the best chances of success. I always explain to people that preparing for an IVF cycle is like preparing for a marathon. If you do the work and get the body ready, it gives you a better chance of making it to the finish line.

If you are having trouble falling pregnant, or are having failed IVF cycle, then give my clinic a call and find out more about how my fertility program may be able to assist you achieving success of having a baby. So far my program has helped over 12,500 plus babies into the world and counting. It doesn’t matter if you are starting the journey, or well on your way into the journey or trying to have a baby. You can also do a meet and greet appointment to find out more about the fertility program before you commit to the whole program.

Take care

Regards

Andrew Orr

-No Stone Left Unturned

-Master of Reproductive Medicine and Women’s Health Medicine

-Women’s and Men’s Health Advocate

01 Dr Andrew Orr 1

References

  1. Mains L, Van Voorhis BJ. Optimizing the technique of embryo transfer. Fertil Steril. 2010;94:785-790. Abstract
  2. Society for Assisted Reproductive Technology. Clinic Summary Report. https://www.sartcorsonline.com/rptCSR_PublicMultYear.aspx?ClinicPKID=0Accessed April 27, 2015.
  3. Staessen C, Platteau P, Van Assche E, et al. Comparison of blastocyst transfer with or without preimplantation genetic diagnosis for aneuploidy screening in couples with advanced maternal age: a prospective randomized controlled trial. Hum Reprod. 2004;19:2849-2858. Abstract
  4. Mastenbroek S, Twisk M, van Echten-Arends J, et al. In vitro fertilization with preimplantation genetic screening. N Engl J Med. 2007;357:9-17. Abstract
  5. Yang Z, Liu J, Collins GS, et al. Selection of single blastocysts for fresh transfer via standard morphology assessment alone and with array CGH for good prognosis IVF patients: results from a randomized pilot study. Mol Cytogenet. 2012;5:24.
  6. Scott RT Jr, Upham KM, Forman EJ, et al. Blastocyst biopsy with comprehensive chromosome screening and fresh embryo transfer significantly increases in vitro fertilization implantation and delivery rates: a randomized controlled trial. Fertil Steril. 2013;100:697-703. Abstract
  7. Forman EJ, Tao X, Ferry KM, et al. Single embryo transfer with comprehensive chromosome screening results in improved ongoing pregnancy rates and decreased miscarriage rates. Hum Reprod. 2012;27:1217-1222. Abstract
  8. Scott RT Jr, Upham KM, Forman EJ, et al. Cleavage-stage biopsy significantly impairs human embryonic implantation potential while blastocyst biopsy does not: a randomized and paired clinical trial. Fertil Steril. 2013;100:624-630. Abstract
  9. Buck Louis, G. M., et al. (2016). Lifestyle and pregnancy loss in a contemporary cohort of women recruited before conception: The LIFE Study. Fertility and Sterility, 106(1), 180-188. doi: 10.1016/j.fertnstert.2016.03.009
  10. Chiu, Y.-H., Chavarro, J. E., & Souter, I. (2018). Diet and female fertility: doctor, what should I eat? Fertility and Sterility, 110(4), 560-569. https://doi.org/10.1016/j.fertnstert.2018.05.027
  11. Day, J., et al. (2016). Influence of paternal preconception exposures on their offspring: through epigenetics to phenotype. American Journal of Stem Cells, 5(1), 11-18
  12. Homan, G. F., Davies, M. J., & Norman, R. J. (2007). The impact of lifestyle factors on reproductive performance in the general population and those undergoing infertility treatment: a review. Human Reproduction Update, 13(3), 209-223.
  13. Nassan, F. L., et al. (2018). Diet and men’s fertility: does diet affect sperm quality? Fertility and Sterility, 110(4), 570-577. https://doi.org/10.1016/j.fertnstert.2018.05.025
  14. Salas-Huetos, A., et al. (2017). Dietary patterns, foods and nutrients in male fertility parameters and fecundability: a systematic review of observational studies. Human Reproduction Update, 23(4), 371-389. doi: 10.1093/humupd/dmx006
  15. Sharma, R., et al. (2013). Lifestyle factors and reproductive health: taking control of your fertility. [Review]. Reprod Biol Endocrinol, 11(66), 1477-7827.
Endometriosis Facts Endometriosis does not always cause infertility 1

Endometriosis DOES NOT Always Cause Infertility

Many women are led to believe that if they are diagnosed with endometriosis, that they will be infertile. The one thing I do want all women to know is that Endometriosis DOES NOT always cause infertility.

Over the years I have helped over 12,500 plus babies into the world and many of the women who went on to have these babies had endometriosis.

I have had women who have been diagnosed with endometriosis being told that they cannot fall pregnant, based on the diagnosis and AMH (Anti-Mullerean Hormone) levels alone, and no other fertility investigations. This is disgusting and should never happen. It is so sad hearing things like this and women believing they are infertile and cannot have a baby, when it fact they actually may be able to.

Endometriosis can make it harder to fall pregnant

While having endometriosis can increase your chances of having fertility issues (about 50%), it does not mean you are infertile. To be honest the word infertility is often wrongly uses. Unless you have absolutely infertility and have been diagnosed with a condition that would render you infertile, then we should really be using the word subfertility. Subfertility is a better word to use for those that may be experiencing difficulty falling pregnant, but may need assistance of some come.

Biology 101 tells us that it takes two people to make a baby

Let’s not forget that just because you have endometriosis, it does not mean that the fertility issue falls solely with you. Men are just as big an issue when it comes to fertility issues and could be the bigger part in you not being able to fall. The problem is that many fertility clinics will solely focus on the women because she has a diagnosed condition and this is wrong. Many times I have seen a women with endometriosis blamed as the main cause of the fertility issue, when in fact it is actually the man’s sperm that is at fault. Please remember this. Biology 101 tells us that it takes a sperm and an egg to have a baby, not just an egg.

Endometriosis can make it harder to fall pregnant and can affect egg quality, fertilisation and implantation, due to the resulting inflammation from the disease. But this is where it gets a bit tricky.

Pregnancy rates are not necessarily related to the extent of the disease

It isn’t always about the amount of the disease either. We know that pain levels and the associated symptoms of endometriosis are not related to the extent of the disease. I will address this in one of the other facts posts sometime in the future. The hard thing is that sometimes stage 4 endometriosis sufferers, with lots of the active disease, will have not issues falling pregnant at all. Meanwhile a woman with stage 1, or minimal disease, may have lots of issues falling.

Then we have the women who are having issues falling pregnant and will not even know that they have endometriosis and then it is found as part of fertility investigations, via a laparoscopy. Just remember that a significant portion of women with endometriosis are asymptomatic (meaning no symptoms).

Like I always say to my patients, Endometriosis can make it harder to fall, but having the disease does not mean that you are automatically infertile, or will have trouble conceiving. This is why it is important to see someone who specialises in Fertility, not just a regular OB/GYN or a GP, and also specialises in the area of endometriosis.

Fertility Program

If you are having issues falling pregnant, please give my clinic a call and find out how my fertility program may be able to assist you. I can help you and assist you in receiving the proper fertility evaluation and investigations you should be getting. This is for the couple, not just the woman. Like I mentioned before, my multi-modality fertility program has helped and assisted over 12,500 babies into the world and it may be able to help you too.

Take care

Regards

Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate

-The International Fertility Experts

-The Endometriosis Experts

Dr Andrew Orr Header Slider 03

Let’s Talk About Fertility

Dr Andrew Orr has an honest and open chat about his years of experience dealing with couples with fertility issues.

Much of it gets back to couples not having the proper testing and investigations, being on the same page, preconception planning, getting healthy, doing the work and the expectations versus reality.

Have a listen to Andrew’s open and honest discussion about a very serious topic.

If you do need help and are struggling with fertility and not having a baby, Andrew can assist you in your journey to becoming parents.

To find out how Dr Andrew Orr’s fertility program, please call his friendly staff to find out more.

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The Myth of The Barren Woman Runs Deep

The word “Barren” comes originates from the French word ‘Brehaigne’, which means not producing, incapable of producing offspring, infertility, infertile; sterile.

Sounds terrible doesn’t it?

Fortunately very few women are ‘sterile’ and the word “infertility” is often misused in our modern society. Nobody is truly infertile, unless they actually have reproductive organs missing, or have genetic abnormalities that will actually prevent conception from happening etc. When a couple is having trouble conceiving, we should really use the word “sub-fertility” instead of “infertility”

The problem with talking fertility, sub-fertility, or infertility is that we often reference, target, or even blame the woman. Yes, women are often the blame of not being able to conceive a child and therefore the myth of the barren woman still runs deep and is very much in existence and kept alive by all concerned today in our modern world.

But is conception and the ability to conceive a child inherently the fault, or responsibility of the woman?

The answer to that is “No!”, but there is still this expectation, or focus, that not being able to conceive all falls back on a woman. Sometimes women actually wrongly blame themselves, or wrongly take on that responsibility too. Some women will even take on that burden, to protect a partner, who may actually be the main issue.

Then we now have an area of medicine that has its focus as being the woman, because women are the primary driving force for wanting to have a child.  Hence the vicious cycle continues in this terrible loop and then many, practitioners included, buy into the myth of the barren woman and so the cycle continues over and over again.

Well, I am here to tell you that women are not the only part of having a child and that men play just as big a part when it comes to fertility issues and not being able to conceive.

No matter what you get sold, or what BS (bullshit) you are sold, while pulling on your ‘I need a baby heartstrings’, to make you part with your hard earned money, the fact remains, and will always remain, that it takes a sperm and an egg to make a baby. That is basic biology 101 and no matter what someone tries to tell you, sperm quality is just as important as egg quality in this equation.

Every day I see practitioners, both medical and in complementary medicine, focussing in on women as the primary focus of fertility and actually feeding the myth of the barren women by their very actions.

Many times the men are overlooked, or ignored, or completely disregarded in the fertility equation. Not only is this unethical, to just treat and focus on the women when it comes to fertility treatment, but it is highly negligent as well. Men are not born with an inherent right to automatically be able to conceive and worse still, the male sperm levels have fallen by as much as 60% in the last 70 years, with sperm quality levels said to be dropping at an alarming rate.

So why is the focus, the burden, the guilt and the whole emotional baby roller coaster left solely to women?

Well, I have explained that practitioners are to blame, the fertility profession is to blame, society is to blame, guilt is to blame and last of all men are a big part of the issue too.

Men are often to reluctant passengers in the fertility journey and are often very happy to bury their heads in the sand and pass the responsibility of not being able to conceive onto a woman. Then many men are told their sperm is fine, when in fact it is far from being fine.

Over 50% of fertility issues are related to male factors and up to 85% of miscarriage issues may be related to male chromosomal, or DNA issues related to sperm. As I said before, research has now shown that the male sperm quality has fallen by up to 60% over the last 70 years and is actually on the decline. Men are often the bigger part of the fertility picture and it isn’t just the woman at all.

Semen analysis parameters are based on what is needed for Assisted Reproduction (IVF, IUI, ICSI) , not based on what is needed for natural conception and this is where some of the biggest issues lay.

Misinterpretation of semen analysis and misinterpretation of parameters have many men believing they have OK sperm, when in fact it is far from being OK. With modern procedures such as ICSI, we only need a few single sperm to be able to fertilise eggs and this can still be considered ok, because at least there was some sperm to fertilise the egg in the first place.

A few single sperm, or a few hundred sperm, or even a few thousand sperm is not OK when it comes to natural conception. We actually need a few hundred million sperm for it to be OK and even then they need to be motile and they need to be swimming properly (rapid progressive) and actually be of good shape (morphology)

While a semen analysis is often the first part of male fertility evaluation, it is also very limited. While we can look at morphology, motility, concentration, count etc, it does not tell us about the actual quality of the sperm inside. Many sperm may look ‘OK’ via a semen analysis, but inside their DNA integrity is poor and there are high amounts of DNA fragmentation and this can only be measured by a DNA fragmentation analysis. Even then, each time a man ejaculates, the quality of the sperm will be different and can differ by up to 20% in each ejaculate.

We also know that what a man eats, drinks and even his physical and emotional health will affect his sperm quality and that a man’s physical, dietary and emotional health can be passed onto his offspring through the sperm. This is why it is important for a man to get his physical and dietary and emotional health in check way before he tries to conceive a child with his partner.

We always say that the healthier a man is, the healthier his sperm is and the healthier the woman is, the healthier her eggs will be also. A healthy man and a health woman produce healthy babies.

I have been assisting couples with fertility and pregnancy for over 20 plus years now, and helped over 12,500 plus babies into the world,  and I can tell you that conception is not just about the woman. It gets back to basic biology 101 that it takes a sperm and an egg to have a baby.

Even when couples are having issues trying to conceive, or doing IVF, or however they are trying to conceive, there will be some issue on the man’s side and the woman’s side. Unless there is absolute infertility on one side, or the other, there will always be a bit of both the man and woman to work on to assist in being able to conceive.

While the myth of the barren woman runs deep in society, fertility clinics and through the guilt handed down from their fellow sisters and mothers, fertility issues and the right to be able to conceive ‘does not’ fall solely into the hands of a woman, far from it.

Men are an equal part in the fertility equation and men need be held just as accountable when it comes to trying to have a baby, or if there are difficulties in conceiving.

No matter what anyone tells you, a man needs to be part of treatment, management and support of the journey to have a baby.  This is a big part in my multi-modality fertility program.

Fertility isn’t just the responsibility of the woman, it is the responsibility of the man as well and I make sure both the man and the woman are properly investigated, clinically managed and helped with treatments as well.

If you do need help with having a baby, then please give my friendly staff a call and find out how my fertility program may be able to assist you

Regards

Andrew Orr

-Master of Reproductive Medicine (MRepMed)

-No Stone Left Unturned

-The International Fertility Experts

Fertility Diet for website

Mediterranean Style Diet May Help to Improve Pregnancy Rates for Couples Undergoing IVF and Assisted Reproduction.

New research published in Human Reproduction, has found that those who follow a “Mediterranean” style diet at least six months before assisted reproductive treatment have a significantly better chance of becoming pregnant and giving birth to a live baby than women who did not.

As part of my Fertility Program, one of the first things I talk to couples about is the importance of a healthy diet that has adequate protein, lots of vegetables, seeds and nuts, healthy oils, adequate water intake, electrolytes and cutting out all the refined carbohydrates that cause inflammation.

The hard thing is that I hardly see a couple following those health food principles, with many not even really knowing what a health diet is. The diet that I promote is based on my specially formulated PACE diet.

Previous studies have shown that when refined carbohydrates are cut out and replaced with proteins, essential fats and good carbohydrates, such as fruit and vegetables, that the clinical pregnancy rates shot up by 80%. (Fertility & Sterility 2012 Volume 98 issues 3 Page S47)

In this new study, researchers focussed in dietary patterns rather than individual nutrients, food, or food groups. They found that those who ate lean protein, more fresh vegetables, fruit, fish and olive oil, had a 70% greater likelihood of achieving a successful pregnancy and birth compared to women who didn’t follow this style of diet.

The research outcomes found that out of the 244 women in the study, 229 women (93.9%) had at least one embryo transferred to their wombs; 138 (56%) had a successful implantation; 104 (42.6%) achieved a clinical pregnancy (one that can be confirmed by ultrasound); and 99 (40.5%) gave birth to a live baby.

The most important message to come from the study is that women attempting to have a baby should be encouraged to eat a healthy diet, such as a Mediterranean style diet, because it may help increase the chances of successful pregnancy and successful live birth.

The researchers did note that when it comes to conceiving a baby, diet and lifestyle are just as important for men as for women. Previous studies from the same research group showed that male partners that adhered to the same sort had better semen quality.

A healthy diet is important for all couples prior to trying to conceive and should be a part of any preconception planning by all healthcare practitioners assisting couples with fertility.

While this study focussed on improving assisted reproduction pregnancy rates, this style of diet should be adopted by any couple wanting to have a baby and should be implemented at least 6 months prior to conceiving. This is why it is essential for all couples to receive counselling and guidance on the importance of a healthy diet and having a healthy lifestyle as well.

This is a foundation of my fertility program that has helped over 12,500 babies into the world and continues to assist many more couples reach their goal of becoming parents. If you would like to find out more about my fertility program and how it may assist you, please give my friendly clinic staff a call to find out more.

Regards

Andrew Orr

-No Stone Left Unturned

-The International Fertility Experts

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Stressed Uterine Cells & Inflammation Cause Miscarriage, Not Natural Killer Cells

It is stressed uterine cells and inflammation causing miscarriage and causing the embryo not to implant, not Uterine Natural Killer cells.

For the first time the functions of natural killer cells in the womb have been identified by Researchers at the University of Warwick and University Hospitals Coventry

Although it has long been known that the lining of the womb harbours dynamic uterine natural killer cells, no functions have so far been given to these cells outside of pregnancy.

The researchers have discovered that the uterine natural killer cells remodel and refresh the lining of the womb at the time of embryo implantation. This is the first time a role for uterine natural killer cells in the lining of the womb has been identified outside of pregnancy. The research was published on December 14, 2017.

In addition they discovered that this process isn’t always balanced in each cycle. The natural killer cells perform the role of targeting and clearing inflammatory stressed cells, thereby making space for the implanting embryo. However sometimes not enough of these cells are cleared away and sometimes too many are targeted and removed. Excessive inflammation or insufficient clearance by uterine natural killer cells makes miscarriage more likely.

For many years I have been trying to tell people that they need to stop trying to get rid of the natural killer cells, or reduce their numbers. I have long known that natural killer cells are meant to be in the body and their job is to protect us from infections, bacteria, cancers, tumours and inflammation.

If killer cells are in high numbers, it means that there is something wrong and that is what needs to be treated, not the killer cells. But unfortunately, many clinics play on couples emotions and the use of the word “Killer”. So then we get this war on killer cells and people wanting to kill the killer cells because they think it is killing their babies.

No matter how hard I have tried to explain it, people just don’t listen and now it is finally great to have the research to back up what I knew all along, plus additional knowledge of how Killer cells actually help with implantation and reducing miscarriage.

The researchers have explained what happens if the natural killer cells cannot do their job properly, or there is inflammation that they haven’t been able to target. They said that a good analogy is Swiss cheese: without holes, the embryo has nowhere to go which will cause implantation failure; but if the holes are too large, the tissue will physically collapse and lead to miscarriage.

This imbalance, which may be short-lived or last for multiple cycles, explains the high rate of early pregnancy failure. It really can be a numbers game on how long that cycle could last and why it is important to make sure there are enough natural killer cells there to do their job properly. Without the natural killer cells, there is more chance of inflammation and stressed uterine cells being left behind, which will then lead to higher pregnancy loss and reduced implantation.

The researchers conducted an analysis of 2,111 endometrial biopsies, which is more than had ever been conducted previously. The research team examined the acutely stressed cells in the lining of the womb which generate tissue inflammation. They found that the natural killer cells which are in the womb perform the important function of selectively targeting and eliminating acutely stressed cells.

When there are high acutely stressed cells in the lining of the uterus, the lining of the uterus fails to sense the chemical signals from the fertilised egg and it then silences many of the genes involved in allowing the embryo to implant and embed into the uterus.

One of the chemicals needed for this process to take place is Trysin, which is a common enzyme the embryos gives off. If trysin isn’t detected the embryo is not accepted and left to disintegrate and then the cycle is reset once again. The lack of Trysin signal appears to indicate to the endometrium that the quality of the embryo is not very high and initiates a reduction of receptivity to implantation. These findings could help to improve the success rates of IVF, because one of the biggest problems with IVF is getting the embryo to implant

The research team also found that high numbers of Natural Killer cells in the endometrium are not only a sign of high inflammation and acutely stressed uterine cells, but also indicate a insufficient production of steroids, which in turn leads to reduced formation of fats and vitamins that are essential for pregnancy nutrition.

Again, this is exactly what I have been trying to say for years and why when I treat women who are having implantation issues and recurrent miscarriage I look at treating the cause of the issue, rather than masking it.

To treat miscarriage and help with embryo implantation you need to do the following

  1. Reduce inflammation in the uterine environment and pelvic cavity
  2. Make sure the pelvis, tubes and uterus have been surgically evaluated properly prior to conception, or assisted reproduction (IVF, IUI, ICSI etc)
  3. Increase blood flow and nutrients into the uterine lining
  4. Ensure adequate essential fats and nutrients are given prior to conception
  5. Reduce stress levels
  6. Increase protein and reduce inflammatory refined carbohydrates
  7. Make sure the couple in are optimum health (healthy sperm + healthy eggs=health baby)
  8. Make sure the man is being treated at the same time the woman is (up to 85% of miscarriage issues are related to chromosomal and DNA factors related to poor quality sperm, which cannot be measured by a normal semen analysis)

We need to stop blaming high NK cells as being the cause of miscarriage and embryos not implanting. We need to look at the real cause, which is inflammation, stressed uterine cells ( due to stress in the person), lack of nutrients and blood flow in the uterus and lifestyle factors that is also leading to increase miscarriage rates and reduced embryo implantation.

Let’s not forget that faulty sperm and DNA damage and chromosomal issues with sperm are also a big part of miscarriage too. Miscarriage is not just a woman’s issue. To be honest, statistically it is more likely to be on the male side of the equation and often gets overlooked. But that is a whole other post in itself.

Couples who are part of my fertility program are educated on issues such as this and all the things they need to do to assist them in having a child.  The program has assisted over 12,500 babies into the world and my motto is “No Stone Left Unturned.”

Hopefully in the future this new information will be used to screen women at risk of reproductive failure and help with new treatment options for women suffering recurrent miscarriages or recurrent IVF failure.

If you are having trouble conceiving my fertility program may be able to assist you in getting the answers that you need. If you would like to find out more about my fertility program, please call my friendly staff to find out more.

Regards

Dr Andrew Orr

-No Stone Left Unturned

-Women’s and Men’s Health Advocate

-The International Fertility Experts