Seminar Presentation Geoffrey Sher MD 9-13
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Transcript of Seminar Presentation Geoffrey Sher MD 9-13
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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
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Find Us Online!(See Sheet in Your Packet)
Website:www.haveababy.com
Discussion Boards: forums.haveababy.com
IVF Authority Blog:www.IVFauthority.com
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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
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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%
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"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
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"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
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INFLUENCING IVF SUCCESS
1. OPTIMIZING EMBRYO QUALITY
2. OPTIMIZING EMBRYO IMPLANTATION
3. OPTIMIZING THE EMBRYO TRANSFER
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Establishing an ideal “Soil”/”Seed” relationship!
SOIL / SEEDSOIL / SEED ENDOMETRIUM / EMBRYOENDOMETRIUM / EMBRYO
75%75%25%25%
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MATURE EGG (M-2)
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It is primarily the chromosomal integrity of the egg, rather than the sperm that determines embryo Chromosomal
integrity or “competence”!
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MeiosisMeiosisMeiosis – Dividing the Egg’s
Chromosomes
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FERTILIZATION
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INTRACYTOPLASMIC SPERM INJECTION (ICSI)
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3-Day-Old Embryo
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5-6 Day Embryo (blastocyst)
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A “competent” embryo has 46 chromosomes present in its cells!
“EUPLOID”
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EMBRYO ANEUPLOIDY -
THE RATE LIMITING FACTOR IN HUMAN REPRODUCTION!
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THE BREAKTHROUGH: Comparative Genomic
Hybridization (CGH)
“A genetic test that identifies all the chromosomes in the egg or embryo!”
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Which Embryos are chromosomally normal/abnormal?
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Embryo Competency
Both Abnormal
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Embryo Competency
Both Normal
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2. IMPLANTATION POTENTIAL
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Immunol. Uterine Lesions
LiningThickness
IMPLANTATIONUTERINE
RECEPTIVITY
Uterine Receptivity Factors
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a. Uterine Pathology
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SONOHYSTEROGRAM
Endometrial PolypEndometrial Polyp
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HYSTEROSCOPYHYSTEROSCOPY
Large, pedunculated endometrial polyp
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b. Endometrial Thickness
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END 2B
A Thin EndometriaL Lining
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A Viagra- Restored Endometrium
““Tri-Laminar” AppearanceTri-Laminar” Appearance
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Causes of a Thin Uterine Lining
Uterine scarring • Inflamation• Surgery
Reduced blood flow• Age• Diffuse adenomyosis• Multiple fibroid tumors• Over-use of clomiphene
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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
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c. Immunologic Factors
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UTERINE IMMUNE TOLERANCEUTERINE IMMUNE TOLERANCE
EMBRYO
GENETIC SIGNALLING
NKcell
STABILITY CYTOKINES
TH-1 ++
CYTOKINES
TH-2
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Immunologic Implantation Immunologic Implantation DysfunctionDysfunction
Autoimmune IDAutoimmune ID(85%)(85%)
Alloimmune IDAlloimmune ID((15%)15%)
NK CELLS
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Implantation Implantation ImmunotherapyImmunotherapy
Heparin/Lovenox/Clexane IVIG - Replaced by… Intralipid (IL)Dexamethasone/Prednisone Aspirin ?? Other (LIT, Humera)??
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3. EMBRYO TRANSFER
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Ultrasound-guided Placement of Embryo(s)
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Day 3 vs. Day 5?
How Many embryos to transfer?
Full bladder
Ultrasound guidance
Cntd.
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THANK YOU!!THANK YOU!!