CHR Update February 2009

Despite all the bad economic news, we hope that all of our readers experienced a good transition into the New Year 2009. We, here at CHR, have been keeping very busy over the holiday season, and into the new year, and are pleased to offer some details.

CHR Founder Gives Patrick Steptoe Lecture

On January 7, 2009, Norbert Gleicher, MD, CHR’s Founder and Medical Director, gave the prestigious Patrick Steptoe Memorial Lecture before members of the British Fertility Society and two other British societies in Edinburgh, Scotland, UK. Asked to offer an opinion about the state-of-the-arts in IVF, he addressed two main issues: (1) the infertility patient’s right to maximal pregnancy chances; and (2) why there still exists so much disagreement on some of the most fundamental issues in reproductive medicine.

Dr. Gleicher pointed out that infertility patients enter treatments with the principal goal of conceiving, and as quickly as possible. In contrast to its earlier years, IVF is now a mature procedure, giving infertility patients valid expectations of success. It, therefore, behooves the specialty, first and foremost, to meet these expectations. The specialty must avoid compromises in pregnancy rates, based on speculative assumptions of secondary gains, which may or may not pan out. He noted in his controversial but very well received lecture that recent experiences with preimplantation genetic screening (PGS), single embryo transfer (SET) and, most recently, the concept of so-called “patient friendly” or “low intensity” IVF, all have one thing in common: they significantly decrease pregnancy chances without any proven compensatory gain.

CHR’s IVF Pregnancy Rate

Addressing the possible consequences of what he called “momentary fashions in medical practice,” he warned that resulting decreases in pregnancy rates may very soon be reflected in changes in nationally and internationally reported pregnancy outcomes after IVF. IVF pregnancy rates, whether in the US or Europe, have, in the past, consistently improved year after year. Seeing the potential consequences of widespread and uncontrolled utilization of these new technologies in routine IVF practice, Dr. Gleicher warned that this trend towards continuous outcome improvement now appears threatened for the first time in the history of IVF. He strongly urged the professional community to introduce changes in routine IVF practice only in controlled ways, under study conditions, and only with appropriate informed consents, which advise infertility patients of potential adverse consequences to pregnancy chances.

As the second main topic of his presentation, Dr. Gleicher suggested the specialty’s fixation on absolutes or, as he called it, “the absolute truth,” as major reason for many of the still prevailing differences of opinion. Pointing out that, since medical knowledge, as everybody knows, changes very rapidly, he emphasized that it should never be considered “absolute,” whether in the prevailing understanding of physiological processes or what is considered to represent normal physiological values of tests or laboratory assays. Instead, he suggested that knowledge within a clinical or scientific framework should always be considered as “relative” and pointed towards the work done at CHR under the leadership of David Barad, MD, MS, in regards to age-specific, rather than universal, ovarian reserve testing.

Our age-specific treatments for “older ovaries”

In a timely coincidence, the prestigious ESHRE medical journal, Human Reproduction, in its January 2009 issue, published a paper by Andrea Weghofer MD, Ph.D and Norbert Gleicher, MD, in which this idea, for the interested reader, is described in very much more detail.

Master Class

Immediately following the meeting of the British Fertility Society, a master class was held in Edinburgh, with the principal topic of the event being diagnosis and management of diminished ovarian reserve (DOR). The two visiting professors for the master class were Prof. Richard Fleming from the Division of Developmental Medicine at the University of Glasgow in Scotland and Norbert Gleicher, MD. The presentations of both professors were taped and are being prepared by the organizers for publication. Dr. Gleicher lectured on CHR’s DHEA experience and presented recent research conducted at CHR in regards to the regulatory function of the FMR1 (fragile X) gene on ovarian reserve.

CHR Welcomes New Senior Embryologist

CHR founder fertility expertWe are very pleased to report the recruitment of a new senior embryologist, who, as of the new year, has assumed supervisory responsibility for all laboratory operations at CHR. Alka Goyal, Ph.D., H.C.L.D. is, as the latter acronym following her name indicates, licensed as a High Complexity Laboratory Director by the American Board of Bioanalysis. She has joined us after serving as IVF laboratory director and Clinical Scientist at two excellent IVF programs in Canada.

She was awarded her Ph.D. from Bombay University, India, with a thesis on follicular fluid. After serving for many years as laboratory director in one of India’s leading IVF programs, she trained at a number of leading IVF centers world-wide, including the Institut Universiari Dexeus, Barcelona, Spain, before moving full-time to Canada. Her extensive research and clinical experiences include benchmark work in molecular biology and expertise in all aspects of IVF, including vitrification and stem cells.

Based on her broad experience, Dr. Goyal was recruited with three very specific goals in mind: (1) To maintain, and possibly even further improve CHR’s outstanding clinical pregnancy rates in IVF from the laboratory side; (2) To expand in-house laboratory operations by, for example, bringing anti-M-llerian hormone (AMH) testing in-house and transforming vitrification from an experimental procedure into clinical routine; and (3) To expand laboratory-driven research. The latter has in recent years somewhat lagged behind clinical research at CHR, as the embryology staff has been busy in handling a growing procedure volume. Dr. Goyal’s strong interest in research should now allow us to add the laboratory in a much more aggressive way to rapidly expanding research efforts at CHR.

We are confident Dr. Goyal will be very quickly successful in achieving all three goals and are looking forward to a long-lasting relationship.

Learn more about the IVF program at CHR

CHR Publications 2008

As previously noted during 2008, research activities at CHR broke all prior records, with an average of two publications appearing per month. Because of space restraints, we cannot list all the invited talks, meeting abstracts and other academic activities CHR staff members participated during the year. We will, however, list all published papers by CHR staff that appeared during 2008 electronically or on paper, to give interested readers the opportunity to request reprints from our office at [email protected]; Tel: 312-876-1506. The listing is in alphabetical order of first authors and not by date of publication during the year 2008.

  1. Azim AA, Oktay K, et al. Safety of fertility preservation by ovarian stimulation with letrozole and gonadotropins in patients with breast cancer: a prospective controlled study. J Clin Oncol 2008;26:2630-5
  2. Gleicher N, et al. Preimplantation genetic screening: “established” and ready for prime time? Fertil Steril 2008;89:780-8
  3. Gleicher N, et al. A pilot study of premature ovarian senescence: I. Correlation of triple CGG repeats on the FMR1 gene to ovarian reserve parameters FSH and anti-M-llerian hormone. Fertil Steril 2008; April 1.[Epub ahead of print]
  4. Gleicher N, et al. A pilot study of premature ovarian senescence: II. Different genotype and phenotype for genetic and autoimmune etiologies. Fertil Steril 2008; April. 1 [Epub ahead of print]
  5. Gleicher N and Barad D. Twin pregnancy, contrary to consensus, is a desirable outcome in infertility. Fertil Steril 2008; April 24 [Epub ahead of print]
  6. Gleicher N and Barad DH. Androgen priming before ovarian stimulation for IVF. Hum Reprod 2008;23:2868-70
  7. Gleicher N and Elkayam U. Peripartum cardiomyopathy, an autoimmune manifestation of allograft rejection? Autoimmune Rev 2008; December 30 [Epub ahead of print]
  8. Gleicher N, et al. Can the FMR1 (Fragile X) gene serve as predictor of response to ovarian stimulation? Reprod Sci 2008′ December 30 [Epub ahead of print]
  9. Oktay K and S’nmezer M. Fertility issues and options in young women with cancer. Recent Results Cancer Res 2008;178:203-24
  10. Oktay K, et al, The c-Jun N-terminal kinase JNK functions upstream of Aurora B to promote entry into mitosis. Cell Cycle 2008;7:533-41
  11. Oktay K, et al. Who is the best candidate for oocytes cryopreservation research? Fertil Steril 2008; April 26 [Epub ahead of print]
  12. Oktay K and S-nmezer M. Gonadotropin-releasing hormone analoges in fertility preservation – lack of biological basis? Nat Clin Pract Endocrinol Metab 2008;4:489-9
  13. Oktay K and S-nmezer M. Chemotherapy and amenorrhea: risks and treatment options. Curr Opin Obstet Gynecol 2008;20:408-15
  14. Oktay K and Oktem O. Ovarian cryopreservation and transplantation for fertility preservation for medical indications: report of an ongoing experience. Fertil Steril 2008; November 13 [Epub ahead of print]
  15. Oktem O and Oktay K. The ovary: anatomy and function throughout human life. Ann NY Acad Sci 200;1127:1-9
  16. Oktem O and Oktay K. Stem cells: a perspective on oocytes. Ann NY Acad Sci 2008;1127:20-6
  17. Oktem O and Oktay K. Preservation of menstrual function in adolescent and young females. NY Acad Sci 2008;1135:237-43
  18. Reh A, Oktay K, et al. Impact of breast cancer chemotherapy on ovarian reserve: a prospective observational analysis by menstrual history and ovarian reserve markers. Fertil Steril 2008;90:1635-9
  19. Roberts JE, Oktay K, et al. Integrin beta-4 signaling plays a key role in mouse embryogenesis. Reprod Sci 2008; December 15 [Epub ahead of print]
  20. Singer T, Barad DH, et al. Correlation of antim-llerian hormone and baseline follicle-stimulating hormone levels. Fertil Steril 2008; June 12 [Epub ahead of print]
  21. S-nmezer M and Oktay K. Assisted reproduction and fertility preservation techniques in cancer patients. Curr Opin Endocrinol Diabetes Obes 2008;15:514-22
  22. Weghofer A, et al. The impact of L-containing gonadotropins on diploidy rates in preimplantation embryos: long protocol stimulation. Hum Reprod 2008;23:499-503
  23. Weghofer A, et al. Does autoimmunity play a role in the pathophysiology of premature ovarian aging? Reprod Biomed Online 2008;16:830-4
  24. Weghofer A, et al. The impact of LH-containing gonadotropin stimulation on euploidy rates in preimplantation embryos: antagonist cycles. Fertil Steril 2008; September 5 [Epub ahead of print]

The new year 2009, in addition, has already seen a number of CHR manuscripts in print.

  1. Gleicher N and Weghofer A. Why depression is associated with increased risk towards premature labor. Hum Reprod 2009; January 3 [Epub ahead of print]
  2. Oktay K, et al. Trying to reduce ovarian damage in patients with Hodgkin lymphoma, using GnRH agonists? Fertil Steril 2009;91:298-9
  3. Weghofer A and Gleicher N. Ovarian function: a theory of relativity. Hum Reprod 2009; 24:17-19
  4. Stanley Young S, Oktay K, et al. Cereal-induced gender selection? Most likely a multiple testing false positive. Proc Biol Sci 2009; January 13 [Epub ahead of print]

We will provide further information on CHR activities in next month’s CHR Update. Until then, we encourage our readers to contact us with any question they may have. We are always available by phone (212-994 4400) or here at our website.

– The CHR Staff

Norbert Gleicher, MD, leads CHR’s clinical and research efforts as Medical Director and Chief Scientist. A world-renowned reproductive endocrinologist, Dr. Gleicher has published hundreds of peer-reviewed papers and lectured globally while keeping an active clinical career focused on ovarian aging, immunological issues and other difficult cases of infertility.