Midwest Reproductive Symposium

Me with Elizabeth Brown, the first “Test Tube Baby”

Midwest Reproductive Symposium International, June 6-9.

My goals in attending this conference were to:

  • Gather information helpful to my patients.
  • Meet attendee Elizabeth Brown, who was the first IVF baby (born in 1978).
  • Learn about Dr. Ali Domar’s latest research.
  • Pick up cool give always from vendors and exhibits.

THE PEARLS

Fertility Apps: Although I often feel that my patients are too reliant on fertility apps and on-line “support” groups, Dr. Ali Domar’s new apps for self-help fertility support are awesome. They are based on her many years of experience using Cognitive Behavioral Therapy (a form of talk therapy) with couples struggling with infertility. The app for women is called FertiCalm and the one for men is FertiStrong. They are fee and can be downloaded at www.FertiCalmApp.com. I tend to favor in person counseling, but these apps are truly impressive.

Genes and genetic testing: While science is racing ahead in this arena, there are differing views on the value of and indications for pre-implantation screening of embryos, based not so much on conflicting data, but interpretation of the data. Reproductive endocrinologists Dr. Richard Paulson and Dr. Richard Scott had a lively debate that included a discussion of the so called “mosaic embryos”, which have a mixture of normal and abnormal cells. If I understood them correctly, the decision to transfer a mosaic embryo should probably be done on a case by case basis.

Genetic Counselors: There were several “shout outs” to genetic counselors and how important they are in view of the increase in testing. For anyone looking for a career, as one doctor stated, “We don’t have enough genetic counselors”.

Interesting dessert!

Sperm quality and miscarriage: Research shows that sperm quality can adversely affect miscarriage rate, and sperm quality does decrease starting at age 45 or 50. A tool on the wish list for RE’s would be a microscope that could visualize the DNA in a sperm without having to open it up and therefore render it unusable. It was one speaker’s opinion that sometime in the future this microscope will be invented.

QUESTIONS I GOT ANSWERED

I often ambush speakers after their presentations to ask them questions that are related to their area of expertise and involve information I often discuss with my patients.

Can endocrine disruptors such as BPA which we are exposed to through plastics, influence the development of endometrioses ? Is there any point in trying to avoid exposure ?

For this question, I ambushed Dr. David Adamson, a reproductive endocrinologist from Stanford who has special expertise and experience in treating endometrioses. He was totally on board with the idea that the endocrine disruption of plastics could be a contributing factor in endometrioses for some individuals. It was good to hear his answer, since as my patients know, I have been preaching for years about the importance of cooking with and eating from glass and stainless steel, as well as avoiding personal care items that contain harmful chemicals.

Why aren’t more of my male patients with varicoceles referred for corrective surgery since it has been shown that many men go on to father children after the problem is corrected? (A varicocele is like a varicose vein in the scrotum that can negatively affect sperm quality)

I didn’t have to ambush Dr. Rodrigo Pagani for this answer as I attended his workshop which was a small group. As a urologist at the University of Chicago and team member at INVIOS, he indicated that he has the same question. He is supportive of “working up” the man when there are male issues rather than going straight to IVF. He said that there probably are men who should be evaluated for surgery if there is a varicocele, and are not being referred. There is even some evidence that correcting the varicocele could positively affect a man’s future health. But he added that unless the varicocele is palpable on exam or painful, surgical correction is not suggested. I also asked him:

Does marijuana have a negative effect on sperm health ?

Dr. Pagani was quick to say YES. Marijuana can cause DNA fragmentation in sperm. It also converts a man’s testosterone to estradiol, which can disrupt endocrine function. With the increasing legalization of marijuana, it will be interesting to see if fertility rates are indeed impacted in users.

Another interesting dessert!

Is CoEnzyme Q10 helpful for enhancing egg quality ?

Dr. Doody said “yes”, probably because this body enzyme increases “ATP” which facilitates the movement of chromosomes between cells as they divide. He said that women under age 36 probably do not need this help. A 400-600 mg dose per day is good, although divide it, because only 200mg can be absorbed at once. Sperm parameters seem to improve with the CoQ10 as well. I was impressed with one of the CoQ10 vendors at the meeting if anyone wants to contact me about that info.

It was nice to hear again that:

Anti-depressants in the SSRI category seem to be generally safe in pregnancy, although some data show there may be some issues. However, Paxil was an exception however and is considered unsafe in pregnancy so it is best to talk with your doctor about switching to a different medication before conceiving if you are taking Paxil (Dr. Marcelle Cedars, UCSF).

Vitamin D levels, pre-conception Vitamin D levels, of greater than 30ng/ml may help to increase pregnancy rates and decrease miscarriage rates. (Dr. William Kutteh)

The National Fertility Support Center, which seeks to educate people about donation of embryos currently has a grant to help with some of the costs of adopting an embryo. Debra Peters, the executive director, said that they are unsure about how long the money will last.

Summary

I left the conference with the same feeling I always leave these conferences with—a sense of sadness at the huge industry that has grown up around the need for fertility services. The large hall of exhibitors and vendors offering eggs, sperm, medications, options for genetic testing, financing, equipment needed for IVF, etc. is overwhelming. I am sad because I think of how my patients grew up assuming when they were ready to start a family it would not be this hard, expensive, and complicated. But given the reality of fertility challenges, I am happy that knowledge and options are increasing.