What’s New in Egg/Embryo Freezing: All About the TMRW Tank

Traditional Storage Tanks- Eggs/Embryos are frozen in a small vial with printed label in a designated cryotank and tracked manually or electronically through a separate system.

TMRW Tank- Eggs/Embryos are frozen in a small vial with their printed label and RFID chip in the TMRW tank, and are tracked through the integrated TMRW software system. Here is our All-star Conceptions Embryology Team with the TMRW Tank!

Egg and embryo freezing/banking have become extremely popular options over the last year. A major factor in this decision is Long Term Storage. Eggs and embryos can safely remain frozen for years until you are ready to use them. It is important to feel confident that your samples are stored at a reputable establishment in a safe, transparent, and accessible location. The TMRW tank is an evolution from our current equipment. The basic foundation is not brand new, since we have used cryotanks safely for years, but the software integration system is state of the art. It paves the way for a future where gamete and embryo data can be tracked remotely from our computers, or an app on your phone. Better still you have the assurance that your eggs and embryos are being monitored 24 hours a day every day of the year. Below is a summary of the TMRW Tank concept!

What is it?

• TMRW Tank is the first and only automated egg/embryo storage platform
• It links frozen egg/embryos to traceable RFID chips to completely prevent errors of identification
• It facilitates labeling, tracking & locating samples
• It gathers data to ensure cryogenic temperatures & egg/embryo wellness
• It integrates all data into a software system monitored on our computers
• It replaces old-fashioned liquid nitrogen storage tanks and manual labeling/monitoring

Why is it necessary?

• Safer and more secure identification system- 100% digital chain of custody tracking
• Easier monitoring in real-time with integrated software system on computer
• Integrates embryology storage with the most up-to-date software technology

Who is using it?

• The TMRW tank was rolled out to 30 leading fertility clinics in the US, including Conceptions
• It was created by TMRW Life Sciences

When/where will it be in use?

• Commercial launch was in December of 2020
• The TMRW Tank is already at Conceptions Reproductive Associates of Colorado!

You can read more about this at https://www.tmrw.org/

Omega-3 Fatty Acids: another tool for ovarian rejuvenation

One of the most frustrating questions for women trying to conceive is “what can I do to improve my chances?” Given that women are born with every egg that they will ever have, there are a limited number of ways to optimize the health of the remaining eggs. But for those that are motivated, I have described steps like the use of Acai berry extract and CoQ10 as well as improved sleep and Vitamin D. Now for the first time, there is evidence that some women may be able to improve the responsiveness of their ovaries in as little as one month!

The typical diet of people living in the USA has changed dramatically over the last century. One glaring example has been in the type of fats that we consume on a daily basis. Essential dietary fats—those that we must get from foods because our bodies can’t make them—are typically classified as Omega-6 and as Omega-3 and serve many important physiologic functions. The ideal ratio of Omega-6 to Omega-3 is 1-to-1. However, the typical Western diet—popular amongst most Americans—has a ratio as high as 25-to-1. The result of this unhealthy shift is that many people are eating foods that promote inflammation. This unhealthy shift is associated with a higher risk of heart disease, diabetes, cancer and infertility.

Given that it’s not easy to encourage people to make lasting dietary changes, a recent study looked at the effects of starting a high potency omega-3 fatty acid supplement upon ovarian function and hormone balance. For this study, they put 27 women on a 4 gram supplement and measured their FSH levels before and 30 days after starting this program. Even within this short time frame—effectively one menstrual cycle—they found a dramatic improvement in the omega-6 to omega-3 ratio. Their inflammatory markers improved and their FSH levels dropped. Given that FSH level is considered a marker of ovarian sensitivity; this result is interpreted to mean that their ovaries were more sensitive and thus more fertile.

A cautionary note; they did not find an improved ovarian sensitivity in the women in the study that were obese. It is possible that with longer time and with weight loss, obese women might also experience improved fertility. Obesity has been linked to worsening infertility as well as resistance to some of the treatments offered to normal weight women. It is theorized that obesity itself produces inflammatory chemicals in the body which in turn trigger a state of hormone imbalance. In act, it was discovered that all of the women in the study—including the women that were obese—had improved markers of glucose metabolism. That suggests that the omega-3 fatty acids could help reduce the risk of diabetes and maybe make it easier to lose weight as well.

Another important benefit of omega-3 fatty acids is that they can reduce oxidative stress. That means that consuming these healthy dietary fats can reduce the risk of DNA damage to a woman’s eggs—another important fertility promoting benefit. So although this was a small study and needs to be confirmed in a longer time period, you don’t need to wait. Make this health promoting change in your fertility promoting plan now. Here are a few practical suggestions:

• Switch to a low-fat diet plan taking care to avoid animal fats when possible
• Use products at home that include healthy omega-3 fatty acids instead of butter
• Incorporate more olive oil, Flax seeds and tree nuts into your daily diet
• Start taking a daily supplement—preferably a plant based one (rather than fish oil) like those made by Life’s DHA
• IMPORTANT NOTE TO MEN: Emerging evidence suggests that increasing your omega-3 fatty acid consumption can improve sperm shape (teratospermia) as well!!

IVF with hGH: time to reconsider an under-used treatment option

One of the greatest challenges that we face in treating couples with infertility, is what options to offer beyond the typical treatment protocols. Clearly, most of our patients are well served with the basic ovarian stimulation methods but in some patients that may exacerbate or simply ignore an underlying hormone imbalance that’s compromising success rates. Therefore, one of the greatest challenges is to figure out how and when to tweak the typical combination of meds in order to shift the hormone balance back to a more favorable outcome. This is the reason that we should now reconsider the use of human growth hormone (hGH) for patients that have failed previous IVF treatment.

I trained under Dr. David Meldrum at UCLA-Harbor Medical Center in Los Angeles. Back in the early 1990’s he was advocating the consideration of adding hGH to the protocol of certain patients. His reasoning was good. First of all, we know from previous research [u1] that healthy developing eggs produce a growth hormone analogue known as IGF-2.  Better still, other studies [u2] have demonstrated that hGH could possibly increase the ability of eggs to repair damaged DNA. Finally, several studies have found that growth hormone can improve the response of the ovaries to stimulation during an IVF cycle. Given that all of this information has been available for quite some time, it may be surprising to a patient that there hasn’t been wider use of hGH during IVF treatment. Recently, Dr. Meldrum and several other experts [u3] suggested that this was because there remained too much confusion amongst specialists on which patients would benefit from the use of this somewhat expensive but also possibly game-changing hormone.

The good news is that recent studies [u4] have more carefully defined the characteristics of the patients that were receiving hGH. As a result, we have some new data to better guide us as to which women may be most likely to benefit from hGH. Here is a summary of what they found:

• In women >40 years of age, they found a higher implantation rate and better on-going pregnancy rate in women treated with hGH during ovarian stimulation.
• In women that are poor responders to ovarian stimulation—defined as three or fewer eggs produced per IVF cycle—there was a marked improvement in pregnancy rate with growth hormone supplementation. They also found an improved outcome in FET cycles from embryos created during these cycles.
• In women that have poor embryo quality and low pregnancy rate in otherwise encouraging ART cycles, there is not be a clear benefit of using growth hormone. Instead, other causes of poor embryo quality should be explored. Once those have all been addressed, reconsideration of hGH is worthwhile.

Robert Greene, MD, FACOG

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 [u1]Link to http://humupd.oxfordjournals.org/content/14/2/143.abstract

 [u2]Link to http://endo.endojournals.org/content/141/11/4321.abstract?sid=4c52af1c-a53d-4529-8c92-4fc71dff7b76

 [u3]Link to http://www.fertstert.org/article/S0015-0282(09)00751-1/abstract

 [u4]Link to http://www.fertstert.org/article/S0015-0282(11)02624-0/abstract

Sleeping well? Insomnia may be contributing to your infertility.

I’ve long been fascinated by how symptoms provide insight into underlying hormonal disturbances. A great example is the emerging research on sleep. Your body has a circadian rhythm or a daily cycle of when specific physiologic events are to occur. This process organizes everything from growth, digestion and repair to consolidation of memories and production of chemicals to regulate your mood. It also coordinates the growth and development of sperm and eggs. The hormone that regulates your circadian rhythm is called melatonin.

Melatonin is a hormone produced by an area of the brain called the pineal gland. Blood levels typically between midnight and about 4 am. Maybe more interesting is the fact that exposing your eyes to light can abruptly interrupt the production and release of this hormone that helps you sleep through the second half of the night. That’s also the time of night when various physiologic functions peak including testosterone production and ovulation.

This is just one of the many facts linking your sleep pattern with your fertility.

Most fertility clinics may not inquire about what role your circadian rhythm may be playing your chance of conception, a recent publication in Fertility & Sterility summarized over 200 studies on how melatonin may be influencing your reproductive function. Here are just a few key points:

• Melatonin is a potent anti-oxidant. Studies show that the process of ovulation produces free radicals which can damage an egg. This hormone is concentrated in the fluid that surrounds mature eggs and likely serves to protect them from harm.
• Melatonin influences the production of estradiol, progesterone and testosterone differently during varying stages of the menstrual cycle.
• Melatonin regulates the maturation capacity of an egg. One study demonstrated that women with a history of failed IVF cycles experienced improved fertilization rates after melatonin supplementation.
• Melatonin modulates the immune system. It is estimated that 30% of women with premature ovarian failure have an autoimmune component. Additionally, many women with recurrent early pregnancy loss also have an immunologic disorder. These situations offer potential intervention to improve outcome through normalization of the circadian rhythm.
• Various fertility problems may be influenced by a melatonin deficiency. For instance, women with PCOS tend to have lower than normal levels of melatonin in their follicular fluid and melatonin may influence endometriosis growth.

The best way to optimize melatonin production is to establish and maintain a normal sleep pattern. In some situations melatonin supplements or the use of long acting melatonin-like medications may be of benefit. If you haven’t considered the role that a good night sleep can play in your successful conception check out this sleep assessment tool.

PCOS Paradox; the most common and yet often overlooked problem

Over 5 million women in the USA have polycystic ovarian syndrome (PCOS) and yet many, don’t even know it. Estimates are that the cost of this manageable condition exceeds $4.4 Billion per year. Less than a quarter of the money is spent providing fertility related treatment. Ironically, earlier diagnosis and management could result in a tremendous potential for reducing cost and improving outcome as well as boosting pregnancy rates for women with this condition. So why is it so difficult to identify and diagnose this problem? It all comes down the diversity of the women that have PCOS.

The term “syndrome” refers to a group of signs or symptoms that occur together and are typically triggered by the same underlying condition. There is no single diagnostic finding that defines a syndrome but instead a necessary combination of concomitant features. PCOS, like any syndrome, represents a spectrum of clinical problems that can be very different depending upon each woman’s unique combination of findings. The result of this diversity has created a diagnostic dilemma.

To date, there are at least three different sets of guidelines that are used to define PCOS; National Institutes of Health (1990), Rotterdam Consensus Group (2003) and the Androgen Excess Society (2006). Each is well recognized and has its merits. The problem is that a patient may be defined as having PCOS by one doctor but not another depending upon which criteria they embrace. Personally, I feel that the Rotterdam Consensus Group represents the most organized attempt to define the vast number of presentations of PCOS. Using the Rotterdam Consensus Criteria, over 90% of the women whose infertility is impacted by this hormonal imbalance can be properly diagnosed and treated.

Better still, for women that want to get a quick estimate of their risk of having PCOS, I encourage you to review your symptoms by taking the PCOS quiz. Then check out the recent ACOG Practice Bulletin on PCOS. This publication will empower you with a summary of the latest information on the diagnosis and management of this common condition. In fact, it should even serve as the basis for a thoughtful discussion with your doctor on the treatment options available to improve your health, your quality of life and your fertility. Here are just a few key topics addressed in this bulletin:

• Suggested evaluation including ultrasound criteria to confirm PCOS (p 938)
• Who should be screened for Congenital Adrenal Hyperplasia (p 940)
• There is no need for specific tests to justify the use of insulin sensitizing medications like metformin (pp 940-2) and the dose most commonly used is 1500 to 2000 mg/day.
• Shaving does not increase hair follicle density or size of the hair shaft for women with hirsutism (p 944)