CHR is proud to announce a research collaboration agreement with University of Rochester School of Medicine and Dentistry (URSMD), to better understand how dehydroepiandrosterone (DHEA) improves female fertility.

The team plans to explore the process of follicle maturation, and especially the role of androgens in female reproduction.

Lead investigators are Aritro Sen, PhD, Research Assistant Professor, and Stephen R. Hammes, MD, PhD, Professor, both in the Division of Endocrinology and Metabolism at URSMD, who have published pioneering work on the subject in a rodent model.

They are joined by two other lead investigators: Norbert Gleicher, MD, CHR’s Chief Scientist, and David H. Barad, MD, MS, Senior Scientist at CHR, who revolutionized infertility treatment for women with low ovarian reserve worldwide through the introduction of DHEA.

“The goal of this research collaboration is to combine complementary animal and laboratory expertise at URSMD with clinical expertise at CHR,” explains Dr. Gleicher. “By combining research in URSMD’s unique animal model and CHR’s large clinical human experience, we aim to better understand how DHEA, as well as other androgens, improve female fertility.”

“This is a very exciting development,” adds Dr. Barad. “We have known for years now that DHEA improves pregnancy chances but only very recently learned that this very likely occurs through conversion of DHEA to testosterone. For all practical purposes, this means that the process very likely involves the androgen receptor (AR) on granulosa cells.” Dr. Barad continues: “For this kind of work our colleagues at URSMD have the ideal mouse model.”

Dr. Sen, who will become a Visiting Assistant Scientist at CHR, adds: “we are very much looking forward to this collaboration, which should be very beneficial for both institutions.”

The Center for Human Reproduction is pleased to announce the recruitment of Vitaly A. Kushnir, MD.

Dr. Kushnir will begin his employment with us on the traditional academic starting date of July 1. Dr. Kushnir will be joining the almost decade-long duo of Norbert Gleicher, MD and David H. Barad, MD in providing medical services and furthering the research horizons at CHR.

“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.”

Born in the former Soviet Union, Dr. Kushnir emigrated with his parents as a child to the U.S., where the family settled in Salt Lake City, Utah. After college he pursued medical school at the New York Program of Sackler School of Medicine at Tel-Aviv University in Israel (which is also the alma mater of CHR’s Founder and Medical Director, Norbert Gleicher, MD). After graduation, he returned to the U.S. for a residency in the Department of Obstetrics, Gynecology and Women’s Health at UMDNJ – New Jersey Medical School. The next step was a 3-year fellowship in Reproductive Endocrinology and Infertility at Emory University in Atlanta, GA, his last educational experience before joining CHR.

Dr. Kushnir comes highly recommended for his clinical knowledge and the skills he acquired during his lengthy training. In addition he has demonstrated a keen interest in research, having at young age published a number of peer reviews with primary research interest in ovarian physiology and aging.

The fit could not be any better. We welcome Dr. Kushnir to CHR, and look forward to a fruitful relationship for many years to come.

You may have seen the media hype over an Australian study that supposedly showed that “common fertility treatments ( like IVF )  raise the risk of birth defects.”  Although headlines of this type appear to dominate the reports on the Australian study, if you read the study itself, what the researchers found is exactly the opposite: fertility treatments do NOT raise birth defect risk. Babies born after fertility treatments do have a slightly higher rate of birth defects, but it is because of the underlying medical issues involved in the parents’ infertility, NOT due to fertility treatments themselves.

It is rather disappointing to note how little has changed in over 30 years in how the media present the technique of in vitro fertilization (IVF) to the public. When the first IVF baby was born in the UK in May of 1979, some media predicted an epidemic of “monsters.” Ever since, no opportunity has been lost to exaggerate the negative and to ignore the positive of IVF treatment.

With publication of a new study in the May 5, 2012 issue of the New England Journal of Medicine, the pattern continues. In this paper, researchers from Australia, in an effort to offer a long-term outcome control study, did what every drug and medical device manufacturer should do for their medical products (and, unfortunately, only rarely does!): they followed up on the outcome of babies born after IVF treatment. Since the inception of IVF, professionals in this field all over the world have been doing this routinely in innumerable studies, small and big, and have found ABSOLUTELY NO SIGNIFICANT INCREASES IN ABNORMALITIES attributable to IVF procedures!

In contrast to how this study was, unfortunately, once again presented in the media, this Australian study, in essence, reconfirmed this age-old finding. There is absolutely nothing in this study that was not known before, based on many such follow up studies performed on different patient populations (such divergence is important because medical consequences can differ in different populations) all over the world.

It has been known for many years that children born after any form of infertility treatment will demonstrate a small increase in birth defects. However, as the authors of this Australian study also noted in their comments, this increase has repeatedly been shown NOT to be the consequence of IVF itself, but overwhelmingly due to the fact that infertile women and men have underlying medical conditions, which, once they are overcome by IVF, converting an infertile couple into a fertile one, will increase certain parental birth defect risks for the offspring. Probably quantitatively the most significant is the association of an increased risk of urogenital birth defects, mainly in male offspring, after intracytoplasmic sperm injection (ICSI) to overcome severe male infertility.

Not only has CHR informed our patients in our informed consent process about these small risks ever since they became apparent in follow up studies, but CHR physicians have in scientific publications (Gleicher N. Modern obstetrical and infertility care may increase the prevalence of disease: an evolutionary concept. Fertil Steril 2003; 79:249-52) repeatedly pointed out that this principle about “increased risks” to offspring also applies to many medical diseases.

For example, diabetic women until only a few decades ago almost never had children because uncontrolled diabetes usually resulted in infertility or, if women did conceive, resulted in miscarriages. With the advent of insulin therapy, this started to change, and over the last two to three decades the chance of fertility of a diabetic woman is basically the same as that of a non-diabetic female. But the risk of the child of a diabetic woman to become diabetic is, of course, much higher! Moreover, the poorer a diabetic woman’s blood sugar is controlled during the first few weeks of her pregnancy, the higher her risk for birth defects.

The same applies to women with autoimmune diseases and practically all other medical diseases (Gleicher et al., The impact of abnormal autoimmune function on reproduction: maternal and fetal consequences. J Autoimmun 2006;27:161-5).

In an evolutionary sense, infertility can, in many ways, be viewed as nature’s way to prevent inheritance of genetic risks into the next generation. By overcoming infertility, we overcome this nature’s block, and, inadvertently increase certain risks of diseases (and birth defects) for the next generation. Fortunately, these increases in risk are relatively small, because, while genetic in nature, these diseases and defects are usually multifactorial and not related to just one gene. Such multifactorial risks are assumed to be the consequence of multigenetic combinations, in association with environmental factors and usually hover in the single digit range.

We hope that all of these examples point out the media presentation of this most recent IVF paper was, once again, sensationalism at its best. The study, once more, confirmed what now has been known for many years: IVF, in itself, with absolutely minimal exceptions, does not increase risks for birth defects. Having said this, IVF, of course, indirectly, does increase risks to offspring because IVF allows infertile women (and their male partners) with genetic predispositions towards certain risks to become genetic parents, and that automatically means increased risks for their offspring.

After over four million IVF births worldwide, we, however, can state with a high level of confidence that IVF is, likely, much safer a treatment than most other major medical treatments administered about which you never hear in the media. One wonders why!

If you thought this blog was quieter than usual in the past week or so, it was because we were in a crunch time for abstract preparations for the annual ASRM meeting. Now, after all the hard work of our clinical and research staff members, 14 abstracts have gone out ahead of the looming submission deadline, and we are breathing a sigh of relief.

CHR’s research activities have been expanding steadily in the past year or two, and this expansion is reflected in the breadth of the topics we covered in the 14 abstracts:

• Androgen dynamics after DHEA supplementation
• Hormone ratios for prognostication
• BRCA-FMR1 interaction
• FMR1 and ovarian aging patterns per race
• Donor FMR1 and recipient success
• Immunoglobulins for prognostication
• Immunoglobulins and FMR1
• FMR1 and menarche
• Oocyte quality for prognostication
• FMR1 and menopause
• BRCA-FMR1 interplay in reproductive lifespan
• FMR1 for prognostication
• Case report on abnormally high AMH levels
• G-CSF update

Most notably, we reported on the surprisingly robust relationship between certain genotypes of BRCA gene and of the FMR1 gene, going beyond our medical specialty into oncology and genetics. In fact, apparent interplay of BRCA1/2 genes and FMR1 gene was one of the major focuses of this year’s CHR abstracts. Abstracts in this area included some interesting findings on these genes’ influence on women’s reproductive lifespan, as well as the effect of egg donors’ FMR1 genotype on recipients’ pregnancy success.

Building on our previous DHEA work, we also reported on how DHEA may actually “work,” and how balances between hormones—instead of absolute values of individual hormones, can be used as prognostic tools for patients in fertility treatment. This includes androgens.

Other abstracts refine our understanding of autoimmunity in reproduction, bring some new insight about how to evaluate oocyte quality, and update our previous report of G-CSF use to treat chronically thin endometrium.

Look forward to a good number of full length papers on these subjects in the near future!

National Infertility Awareness Week® (NIAW) began in 1989 with a goal to raise awareness about infertility and to encourage the public to understand their reproductive health. During the week tell the world (or Facebook and Twitter) that people with infertility matter and ask them to help you spread the word. To guide you through a few ins and outs, here are some easy facts to get you started.

What is infertility?


Infertility is the inability to conceive or maintain a pregnancy within a certain period of time. For couples under the age of 35, infertility is diagnosed when they fail to conceive after 1 year of regular unprotected sexual intercourse. In addition, couples who are able to conceive but experience repeat miscarriages may also be considered having infertility. If she is over 35 years old, it is diagnosed after 6 months of unprotected, well-timed intercourse. After a diagnosis many couples begin infertility treatments.

Who is affected by infertility?


Infertility is a medical problem. Approximately 30% of infertility is due to a female factor and 30% is due to a male factor. In the rest of the cases, infertility results from problems in both partners or the cause of the infertility is not identified (unexplained infertility).

What are the risk factors?

Weight, age, sexually transmitted diseases (STDs), tubal disease, endometriosis, DES exposure, smoking, alcohol and even autoimmunity are some of the major risk factors for infertility.

What are the signs and symptoms?


Often there are no signs or symptoms associated with infertility, other than the inability to conceive. Listen to your body and get regular checkups. Early detection and treatment are critical to achieve successful pregnancies.

How is infertility treated?


Medical technology offer more answers and treatment options to men and women trying to conceive a child, from hormonal treatments, ovulation induction and intrauterine insemination to more advanced technologies like in vitro fertilization, ICSI to surrogacy, egg/sperm donation and even embryo donation.

What medications are used?


There are a variety of medications used to treat infertility. It is important to understand the medications and what their purpose is and to speak with your physician about the medications that will be used in your specific treatment plan.

What is artificial insemination?


Artificial insemination, or intrauterine insemination (IUI) is a procedure used for couples with minimal male infertility, and women with cervical mucus problems. (Some physicians use IUI in couples with “unexplained infertility,” but since we don’t believe in the concept of “unexplained infertility,” we don’t routinely use IUI for this indication. Instead, we try, and usually are able, to get down to the root of the problem before trying random treatment.) In IUI, the husband’s or donor’s sperm is washed and prepared, then injected it into the partner’s uterus during the time of ovulation. At CHR, IUI is usually combined with ovulation induction to achieve maximum pregnancy chances.

What is In Vitro or IVF?


In vitro fertilization (IVF) gets its name from the fact that fertilization occurs outside of the woman’s body, in a lab dish instead of a woman’s fallopian tubes. Typically, a woman undergoes ovarian simulation to produce multiple mature eggs. These eggs are micro-surgically retrieved from the ovaries and fertilized in dish with sperm. If fertilization takes place, the physician transfers the embryo(s) into the women’s uterus.

All this week help spread the word about infertility through social media platforms like Facebook and Twitter. There are many infertility treatments available for hopeful parents struggling with this condition and it’s important for them to know that they’re not alone.

April is National Minority Health Month, with the aim of reducing health disparities among different ethnic groups. Ethnic and racial health disparities exist in many areas of medicine, and infertility treatment is no exception.

CHR, as a principle, is committed to providing a diversity of options for all hopeful parents. One of the challenges minority patients face in our area of medicine is the often very limited choice of “ethnic” egg donors. This is, however, one area where CHR differentiates itself from most other infertility centers, and where we have been able to achieve significant diversity of choice.

CHR’s egg donor program makes steady efforts to maintain a highly diverse egg donor pool to reflect the diversity of the center’s patient population. The center’s egg donor pool, therefore, very likely, is the most ethnically diverse pool anywhere in the world, including donors of many different minorities, donors of mixed racial backgrounds and of all major and many less frequently encountered religions. Not surprisingly, CHR, therefore, serves recipients from all over the world.

Nowadays, most infertility centers try to avoid the large investment that is required to maintain such a diverse egg donor pool. They, therefore, increasingly have abandoned maintaining their own eggs donor pools, and refer their patients to egg donor agencies.

For what we believe to be very good reasons, CHR has chosen the opposite track, and has consistently expanded the size and diversity of its egg donor pool. This in our opinion allows us to carefully select only well suited donors, screened in a carefully designed, multi-step, in-house screening process. Without wanting to denigrate the donor selection process at agencies (because some agencies do offer excellent services), we, not infrequently, see donors from agencies, which never would have qualified under our center’s selection process. By offering patients donor selection in house, we also save them thousands of dollars in agency fees.

Finally, by having such a large and diverse egg donor pool in house, our center, usually, can offer patients of practically all races, ethnicities and religions an immediate donor matching opportunity, without the usual lengthy waiting periods, customary at most fertility centers. And our efforts don’t end with the National Minority Health Month; we are proud of setting the standard all year long!

A Belgian study found that donating eggs does not hurt egg donors’ long-term fertility prospects. This is an interesting study that confirms, one more time, what has been known for a long time. Although many women considering donating eggs do rightly wonder about any effects of egg donation to their future fertility, we have known that to donate eggs do not hurt a woman’s long-term fertility prospects.

Barring unforeseen (and fortunately very rare) complications, based on our understanding of a woman’s egg pool, even repeat egg donations should not affect the donor’s fertility. All eggs removed in an egg donation cycle would have been lost to the donor, anyhow. By donating eggs, the donor does not lose additional eggs from her egg reserve, which would not have been used up otherwise. Had she not donated these eggs, they would have undergone degeneration and apoptosis, anyway.

A young woman constantly recruits a large number of eggs from her egg pool with which she was born. These recruited eggs go through a months-long process of maturation, during which the vast majority degenerate and get absorbed back into the body. In natural cycles, only one follicle (egg) amongst hundreds usually makes it to ovulation. All others degenerate before reaching that point.

In an IVF cycle, many of these eggs that otherwise would have degenerated are rescued and retrieved. Their retrieval, however, leaves the remaining egg reserve of the donor unaffected. Since a woman’s fertility potential is represented by her remaining egg pool, therefore, no decline in a woman’s fertility should be expected from egg donation.

Many years ago, CHR investigators reported on a group of CHR’s egg donors who had undergone repeat egg donation cycles, in a study presented at an Annual ASRM Meeting. The study demonstrated that over up to 4 consecutive donation cycles analyzed, the number of eggs obtained from the donors remained practically the same, confirming that donating eggs, even multiple times, do not hurt the donors’ fertility.

A new study by CHR casts doubt on the effectiveness of low intensity IVF (LI-IVF) programs, also known as “mini IVF,” “natural IVF” and various other names.

The findings, published in the journal Reproductive Biomedicine Online, revealed that LI-IVF programs, which use lower doses of fertility medications to reduce costs, do not measure up to claims of pregnancy rates comparable to those in conventional IVF.

Many LI-IVF proponents claim that the procedure is more economical and “patient-friendly.” Researchers at CHR decided to evaluate this claim, and matched patients in LI-IVF cycles to comparable patients undergoing traditional IVF cycles. What they found was that patients in LI-IVF cycles produced significantly fewer oocytes and embryos, and demonstrated lower pregnancy rates.

Cost savings with LI-IVF were also unverifiable, as patients took longer to conceive, and needed more treatment cycles to get pregnant than patients in the traditional IVF program.

“LI-IVF appears to reduce pregnancy chances and prolongs time to conception without offering any appreciable compensatory financial benefits,” summarizes Norbert Gleicher, MD, the study’s lead author and medical director of CHR.

Dr. Gleicher adds that while CHR offers the procedure to patients, the center has always explained to patients that LI-IVF is experimental. “As the results of our study well demonstrate, doing otherwise would have been rather unethical.”

David Barad, MD, and co-author of the study added, “We must caution patients against resorting to ‘mini IVF’ or ‘natural IVF’ without carefully weighing their options. Until more data becomes available, physicians should offer LI-IVF only as an experimental procedure.”

According to a new research study, only a few percent of women in reproductive age with breast cancer take steps to preserve their eggs before going through chemotherapy and radiation treatments. These cancer treatments pose a significant risk of infertility if appropriate steps for fertility preservation are not taken in advance.

“Patients are understandably overwhelmed by the diagnosis, and might want to focus on the immediate treatment for cancer,” explains Norbert Gleicher, MD, Medical Director of CHR and the Director of the center’s Fertility Preservation Program. “Furthermore, the counseling cancer patients receive may not be timely enough.”

Dr. Gleicher continues: “Cancer patients who do not have timely access to a properly equipped fertility center may lose the chance for fertility preservation before their cancer treatments start. At CHR, all fertility preservation patients are given priority as medical emergencies, and receive same-day or next-day appointments.”

Egg freezing remains the predominant method of fertility preservation for cancer patients, but freezing of embryos can also be an infertility treatment option. Worldwide experience with embryo freezing is much larger than with egg freezing, and available data are, therefore, more extensive and reliable. However, embryo freezing may not be an option for patients without a partner. The only additional alternative to egg and embryo freezing is the freezing of whole ovaries.

“At CHR, we see a considerable increase in ‘social’ fertility preservation in women who are not ready to have children yet, but want to extend their fertility into the future,” adds Dr. Gleicher. “Fertility preservation for cancer patients remains, as the study suggests, a medical service with quite limited demand.”

According to a recent USA Today report by Michelle Chabin, a U.S. citizen from Chicago, who gave birth to twins in Israel, entered “regulatory hell” when she applied for U.S. citizenship for her twins at the U. S. embassy in Tel Aviv.

The first question she was asked, apparently, was whether she conceived through infertility treatment. (What an invasion of privacy!) When she honestly responded yes, she was informed that her two children would not receive U.S. citizenship unless she could prove that the egg or sperm came from an American citizen!

Chabin pointed out in her report the very obvious and “glaring inequity” in citizenship requirements between overseas adoptions and overseas infertility treatments, demonstrated by this case. While children adopted overseas are granted U.S. citizenship, children born overseas to U.S. parents from donor eggs and/or sperm from non-U.S. citizens may not be.

This Chicago citizen, a single woman of advanced age, has given up on seeking U.S. citizenships for her twins, according to Chabin’s piece. Had she given birth in the U.S., both of her children would, of course, have had citizenship automatically.

What an absolutely stupid rule! Outrage aside, however, this case should serve as a serious warning to patients who travel overseas for fertility treatments. If the U.S. embassy in Israel follows these rules, it is reasonable to assume that U.S. embassies in other countries will as well.