SUCCESSFUL IVF!

GEOFFREY SHER M.D.GEOFFREY SHER M.D.

Sher Institute for Reproductive Sher Institute for Reproductive Medicine (SIRM)-St. LouisMedicine (SIRM)-St. Louis

Find Us Online!(See Sheet in Your Packet)

Website:www.haveababy.com

Discussion Boards: forums.haveababy.com

IVF Authority Blog:www.IVFauthority.com

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

Jan-Dec 2012 Feb-Aug 2013

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

% Positive Beta hCG

Average Positive 1st Beta hCGPrior to and After Feb 2013

n=410

n=190

57%

77%

"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

Bir

th R

ate

1-CGH Normal Blast1-Untested Blastocyst1-Untested Cleaved Embryo

"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

Birt

h R

ate

2-Blastocysts

2-Cleaved Embryos

INFLUENCING IVF SUCCESS

1. OPTIMIZING EMBRYO QUALITY

2. OPTIMIZING EMBRYO IMPLANTATION

3. OPTIMIZING THE EMBRYO TRANSFER

Establishing an ideal “Soil”/”Seed” relationship!

SOIL / SEEDSOIL / SEED ENDOMETRIUM / EMBRYOENDOMETRIUM / EMBRYO

75%75%25%25%

MATURE EGG (M-2)

It is primarily the chromosomal integrity of the egg, rather than the sperm that determines embryo Chromosomal

integrity or “competence”!

MeiosisMeiosisMeiosis – Dividing the Egg’s

Chromosomes

FERTILIZATION

INTRACYTOPLASMIC SPERM INJECTION (ICSI)

3-Day-Old Embryo

5-6 Day Embryo (blastocyst)

A “competent” embryo has 46 chromosomes present in its cells!

“EUPLOID”

EMBRYO ANEUPLOIDY -

THE RATE LIMITING FACTOR IN HUMAN REPRODUCTION!

THE BREAKTHROUGH: Comparative Genomic

Hybridization (CGH)

“A genetic test that identifies all the chromosomes in the egg or embryo!”

Which Embryos are chromosomally normal/abnormal?

Embryo Competency

Both Abnormal

Embryo Competency

Both Normal

2. IMPLANTATION POTENTIAL

Immunol. Uterine Lesions

LiningThickness

IMPLANTATIONUTERINE

RECEPTIVITY

Uterine Receptivity Factors

a. Uterine Pathology

SONOHYSTEROGRAM

Endometrial PolypEndometrial Polyp

HYSTEROSCOPYHYSTEROSCOPY

Large, pedunculated endometrial polyp

b. Endometrial Thickness

END 2B

A Thin EndometriaL Lining

A Viagra- Restored Endometrium

““Tri-Laminar” AppearanceTri-Laminar” Appearance

Causes of a Thin Uterine Lining

Uterine scarring • Inflamation• Surgery

Reduced blood flow• Age• Diffuse adenomyosis• Multiple fibroid tumors• Over-use of clomiphene

Viagra Improves Blood Flow

Dilates vascular smooth muscleDilates vascular smooth muscle

Can improve uterine blood flowCan improve uterine blood flow

Increased EIncreased E22 delivery delivery

c. Immunologic Factors

UTERINE IMMUNE TOLERANCEUTERINE IMMUNE TOLERANCE

EMBRYO

GENETIC SIGNALLING

NKcell

STABILITY CYTOKINES

TH-1 ++

CYTOKINES

TH-2

Immunologic Implantation Immunologic Implantation DysfunctionDysfunction

Autoimmune IDAutoimmune ID(85%)(85%)

Alloimmune IDAlloimmune ID((15%)15%)

NK CELLS

Implantation Implantation ImmunotherapyImmunotherapy

Heparin/Lovenox/Clexane IVIG - Replaced by… Intralipid (IL)Dexamethasone/Prednisone Aspirin ?? Other (LIT, Humera)??

3. EMBRYO TRANSFER

Ultrasound-guided Placement of Embryo(s)

Day 3 vs. Day 5?

How Many embryos to transfer?

Full bladder

Ultrasound guidance

Cntd.

THANK YOU!!THANK YOU!!