CHR VOICE is a physician newsletter published by the Center for Human Reproduction, a leading fertility center in New York City. CHR VOICE provides ob/gyn physicians a quarterly update on the new developments in the subspecialty of reproductive endocrinology and infertility.
In 2011, Improvements in CHR's Pregnancy Rates
We are pleased to offer CHR's IVF clinical pregnancy rates for 2011, which show considerable further progress, demonstrating that CHR's "fighting for every egg and embryo" has become even more effective!
What makes CHR's pregnancy rates so remarkable is the patient population in which these rates were achieved as the "center of last resort" for fertility patients with difficult cases, including severly diminished ovarian reserve. As noted below, there, likely, is no IVF program in the world with less favorably selected patients than CHR. An overwhelming majority of patients contacting CHR for advice and treatment has previously been in treatment at other fertility centers, and has failed. In addition, they probably represent the oldest patient population any center is serving!
Please remember that the rates reported here, as in past years, represent ongoing pregnancy rates, signed out into obstetrical care. Delivery rates are, of course, not yet available for the year 2011, and will, as always, be reported to and through the national CDC and SART databases. Clinical pregnancy rates for fresh IVF cycles are reported here with reference point embryo transfer (pregnancy rate/embryo transfer) and not cycle start, meaning that only the patients who reach embryo transfer are counted. For pregnancy rates in other types of cycles (FET, Eco-IVF and donor egg cycles), please see our website.
Delivery rates can be anticipated to be somewhat lower than ongoing pregnancy rates, since additional pregnancy losses can be expected. As we repeatedly reported in peer-reviewed medical journals, CHR's miscarriage rate is unusually low, especially given the center's very adversely selected patient population, a finding attributable to CHR's use of DHEA supplementation in all women with diminished ovarian reserve (DOR), whether young or older. Calculated per cycle start, pregnancy rates would also be lower.
Fresh IVF Cycles
Above noted 2011 pregnancy rates are so extraordinary that they deserve a number of detailed comments. Not only do CHR's 2011 results demonstrate continuous significant improvement in pregnancy rates over preceding years but they were achieved with a significantly more challenging patient population than in preceding years, and in approximately 30% more cycles than in 2010.
In addition, in 2011 the center's mean age of new patients for the first time exceeded 40 years. Even that, however, does not tell the whole story: an overwhelming majority of the center's younger patients are women with significant degrees of premature ovarian aging (POA). In other words, the mean "ovarian age" of CHR's patients is even higher than 40+ years!
As the figure on the right shows, only 6% of IVF cycles were performed in women under age 30, 22.2% in women between 30-35 years, 25.0% at ages 36-39, 28.7% in women between 40-43 and a full 18% in women of age 44 or older (up to age 49).
Considering that over 90% of CHR's patients demonstrate DOR by objective parameters, clinical pregnancy rates in the high 30% range up to, and inclusive of, age 40 years; a pregnancy rate of 25.0% at age 41; pregnancy rates around 15.0% at ages 42 and 43; and a pregnancy rate in excess of 10% in women ages 44-49; is almost incredible!
Without comparing CHR's pregnancy rates to other centers, above noted data demonstrate quite obviously that, likely, no other IVF center in the world serves a more adversely selected patient population, yet CHR's pregnancy rates are highly competitive at all ages! What we, however, are even more proud of is that our center's pregnancy rates continue to improve at a time when European data suggest that, in general IVF populations, IVF pregnancy rates have plateaued. And CHR accomplished all of this with continuously low cycle cancellation rates, and thanks to DHEA supplementation in women with DOR, with very low miscarriage rates.
In summary, 2011 was another great year at CHR!
So, approximately eight years ago, a patient walked smiling into Dr. Gleicher's office, revealing that over five preceding back-to-back IVF cycle, she, unbeknownst to CHR's medical staff, had been supplementing with DHEA. She was then 43 years old, and, up to that point everybody at CHR had been wondering why she produced progressively more eggs and embryos cycle after cycle.
This is when CHR's research on DHEA started! Since then, we have learned a huge amount about DHEA, have published what we have learned, and have, worldwide, convinced colleagues of the benefits of DHEA (at least those who read the published literature). More importantly, we have also learned that DHEA reduces chromosomal abnormalities in embryos (i.e., aneuploidy) and, therefore, reduces miscarriages. In recognition, we were awarded two U.S. patents, supporting our DHEA claims.
We learned that DHEA improves what we have come to call functional ovarian reserve (FOR) because it improves anti-Müllerian hormone (AMH) levels. Indeed, we also learned that a rise in AMH levels was predictive of good pregnancy chances in a subsequent IVF cycles.
The one question we were unable to answer, for all these years, was how DHEA does all these things.
And now we know!
Thanks to published work with animals, and especially due to a study by Aritro Sen , PhD, and associates (now at Rochester University School of Medicine and Dentistry, and future research collaborators of CHR starting on July 1st), we have been suspecting for some time that DHEA works through androgen receptors (AR).
These ARs are only present in very small growing follicles. Once follicles reach the so-called pre-antral stage, ARs, as well as AMH receptors, disappear. Therefore, if DHEA indeed works through ARs, it must happen at those early stages, weeks to months before a follicle is ovulated.
Since we just submitted our paper on the subject for publication, we are not yet at liberty to divulge more details. Therefore, only so much: We now have convincing evidence that our hypothesis was correct: Women with severely diminished ovarian reserve (DOR) usually have very low androgen levels. Most of DHEA is quickly converted to androgens, once a woman with DOR ingests it. Indeed, the best pregnancy rates occur in women who start out with the lowest androgen levels and end up with highest after DHEA supplementation.
We, furthermore, found out that the ability to convert DHEA well to other androgens appears genetically controlled, and is, at least partially, related to each woman's FMR1 genotype. Stay tuned; there is much more to come!
FERTINATALTM, the first (and so far only) high-quality DHEA supplement for female fertility that we have endorsed, finally hit the market in early April, after much anticipation. FERTINATALTM is now available through its website (www.fertinatal.com) and will become available in select physician's offices throughout the United States.
We have been told that the response has been quite robust, and a customer even wrote in to report her first positive experience with DHEA supplements:
According to her account, prior to FERTIANTALTM, she had tried many DHEA supplements from various health food stores. All induced moderate insomnia and made her skin rashy. She was thrilled that FERTINATALTM did not induce these side effects in her, and we are also happy to hear such a positive feedback!
Conflict Statement: CHR, Drs. Gleicher and Barad have been awarded two U.S. patents, claiming therapeutic benefits from DHEA supplementation in women with diminished ovarian reserve (DOR), improving pregnancy chances and diminishing embryo aneuploidy. Those patents have been licensed to Fertility Nutraceuticals, LLC, which produces an over-the-counter DHEA supplement, called FERTINATAL™. Dr. Gleicher is a share holder in this company. CHR, Drs. Gleicher and Barad also are co-inventors on pending patent applications regarding use of FMR1 testing in infertility.
Dr. Kushnir Joins CHR
We are very pleased to announce the recruitment of Vitaly A. Kushnir, MD, to join the CHR family, starting on July 1st, the traditional academic starting date. After a lengthy search, CHR's recruitment team was unanimous in recommending Dr. Kushnir for his strong clinical and research background as the best fit with CHR.
Born in the former Soviet Union, Dr. Kushnir emigrated to the U.S. as a child. He pursued medical school at the New York Program of Sackler School of Medicine at Tel-Aviv University in Israel (also the alma mater of CHR's Founder and Medical Director, Norbert Gleicher, MD). After graduation, Dr. Kushnir returned to the U.S. for a residency in the Department of Obstetrics, Gynecology and Women's Health at UMDNJ – New Jersey Medical School, followed by a 3-year fellowship in Reproductive Endocrinology and Infertility at Emory University in Atlanta, GA.
"We have been looking for a 'good fit' candidate for a very long time," notes Dr. Gleicher, who headed up the recruitment team. "Once we had the opportunity to meet Vitaly, everybody involved in the recruitment process was of the unanimous opinion that we had found exactly the person we were looking for."
Dr. Kushnir not only comes recommended for his clinical knowledge and skills, but also demonstrated a keen interest in research, best documented by a number of peer reviewed publications already at his young age.
"It is impossible to feel 'at home' at CHR if you are not interested in research," notes Dr. Barad. "At CHR, clinical care and research, simply, go hand-in-hand."
There are not many such candidates because most academic physicians are either clinicians or researchers. Dr. Kushnir not only met this requirement with flying colors but his primary research interests are ovarian physiology and aging, exactly the principal areas of research CHR has been pursuing for years.
Though having studied in Israel, Dr. Kushnir does not consider his Hebrew "good enough." His Russian, however, is perfect, further expanding CHR's status as the United Nations amongst fertility centers. The fit, indeed, could not have been any better. Welcome to CHR, Dr. Kushnir, and we are looking forward to a fruitful relationship for many years to come!
New Faces in the Laboratories
CHR has been proactively rebuilding its laboratory division with a goal to increase the scientific research output. We are now very pleased to report that we have reached our long-searched-for goals. CHR's Division of Laboratories has now three full-time staff members with Ph.D. degrees, one full time member currently working on her M.S., and one laboratory technologist. The division is further backed up by a part-time senior embryologist with an M.S.
This represents more than a doubling of the center's laboratory staff from only a year ago, and a tripling of the number of Ph.D.-level scientists.
The Director of the Division, with academic title of Senior Scientist, is Ho-Joon Lee, Ph.D., who recently joined CHR, after working for a number of years as a research scientist at Massachusetts General Hospital of Harvard Medical School in Boston, MA. Before coming to Boston, Dr. Lee was the laboratory director of South Korea's largest and most prominent IVF program.
Dr. Lee is extensively published in the field, and his research interests over the last years very well match with the direction CHR's research has taken.
Also new to the division is Tamar Michaeli, Ph.D., who joined CHR as an Associate Scientist from a position as Associate Professor of Developmental and Molecular Physiology at Albert Einstein College of Medicine. Dr. Michaeli, who originally is from Israel, was brought on board because of her well-recognized expertise in molecular biology.
Aya Shohat-Tal, Ph.D., also originally from Israel, is a recent graduate of City University of New York Graduate Center, and joined CHR as a Junior Scientist. Despite her young age, she already has a published paper under her belt, pointing towards a sharp and inquisitive research mind.
Emanuela Lazzaroni, B.S., joined CHR in late 2011 from another NYC-based IVF program. As a highly competent clinical embryologist, she has been striving to advance her academic career, and has been enrolled in a master's program in embryology and clinical andrology at Eastern Virginia Medical School in Norfolk, VA. She is currently in the process of completing her master's thesis at CHR.
CHR in the Media
CHR continued to have a flurry of media appearances in the last couple of months:
In February, for a Quebec newspaper Le Devoir, Dr. Gleicher weighed in on the negative side of Quebec's mandatory single embryo transfer (SET) policy, regardless of patients' individual circumstances. The paper also reported that the mandatory SET policy significantly reduced the region's IVF pregnancy rates, as CHR researchers had predicted.
Then, in March, a publisher of college psychology textbook "The Developing Person through the Life Span" visited our Manhattan facility to film an educational clip with Dr. Gleicher. Topics included the psychological aspects of infertility and treatments, as well as a number of current medical ethics topics surrounding ART.
Also in March, FertilityAuthority.com interviewed Dr. Gleicher on "unexplained infertility," in which Dr. Gleicher explained why such a diagnosis is really a "non-diagnosis" arrived simply because something important has been overlooked during the investigation phase.
A list of CHR's press releases and media appearances is available here.
Letter from a Patient
Penelope was born on March 31, 2012.
-D. S. from New York City
If you have any questions or comments, please contact us.
- The CHR
CHR VOICE Archive
To read previous issues of CHR VOICE, please go to the VOICE archive page.
Last Updated: May 31, 2012