The factors that influence IVF success. Presented by Geoffrey Sher, MD, of Sher Institute for Reproductive Medicine

1. SUCCESSFUL IVF!
GEOFFREY SHER M.D.GEOFFREY SHER M.D.
Sher Institute for ReproductiveSher Institute for Reproductive
Medicine (SIRM)-St. LouisMedicine (SIRM)-St. Louis

2. Find Us Online!
(See Sheet in Your Packet)
Website:
www.haveababy.com
Discussion Boards:
forums.haveababy.com
IVF Authority Blog:
www.IVFauthority.com

3. Positive 1st Betas by Cycle Date
66%
62%
48%
62%
52%
60%
52%
52%
47%
61%
68% 69%
67%
78%
69%
88%
79%
81%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Jan-
12
Feb-
12
Mar-
12
Apr-
12
May-
12
Jun-
12
Jul-12 Aug-
12
Sep-
12
Oct-
12
Nov-
12
Dec-
12
Jan-
13
Feb-
13
Mar-
13
Apr-
13
May-
13
Jun-
13
Jul-13 Aug-
13
Cycle Date

4. Jan-Dec 2012 Feb-Aug 2013
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
% Positive
Beta hCG
Average Positive 1st Beta hCG
Prior to and After Feb 2013
n=410
n=190
57%
77%

5. "Maximum" Birth Rate
Per Single Embryo Transferred
Blastocyst vs. Cleaved Day-3 Embryo
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
<35 35-39 40-42 43-44
Age
BirthRate
1-CGH Normal Blast
1-Untested Blastocyst
1-Untested Cleaved Embryo

6. "Maximum" Birth Rate
Per Transfer of Two (2) Embryos
[Blastocyst vs. Cleaved Day-3 Embryo]
0%
10%
20%
30%
40%
50%
60%
70%
<35 35-39 40-42 43-44
Age
BirthRate
2-Blastocysts
2-Cleaved Embryos

7. INFLUENCING IVF SUCCESS
1. OPTIMIZING EMBRYO QUALITY
2. OPTIMIZING EMBRYO IMPLANTATION
3. OPTIMIZING THE EMBRYO TRANSFER

8. Establishing an ideal “Soil”/”Seed” relationship!
SOIL / SEEDSOIL / SEED ENDOMETRIUM / EMBRYOENDOMETRIUM / EMBRYO
75%75%25%25%

9. MATURE EGG (M-2)

10. It is primarily the
chromosomal integrity of
the egg, rather than the
sperm that determines
embryo Chromosomal
integrity or “competence”!

11. MeiosisMeiosis
Meiosis – Dividing the Egg’s
Chromosomes

12. FERTILIZATION

13. INTRACYTOPLASMIC SPERM INJECTION (ICSI)

14. 3-Day-Old Embryo

15. 5-6 Day Embryo (blastocyst)

16. A “competent” embryo has 46
chromosomes present in its cells!
“EUPLOID”

17. EMBRYO ANEUPLOIDY -
THE RATE LIMITING
FACTOR IN HUMAN
REPRODUCTION!

18. THE BREAKTHROUGH:
Comparative Genomic
Hybridization (CGH)
“A genetic test that identifies all the
chromosomes in the egg or embryo!”

19. Which Embryos are chromosomally
normal/abnormal?

20. Embryo Competency
Both
Abnormal

21. Embryo Competency
Both
Normal

22. 2. IMPLANTATION POTENTIAL

23. Immunol.
Uterine
Lesions
Lining
Thickness
IMPLANTATION
UTERINE
RECEPTIVITY
Uterine Receptivity Factors

24. a. Uterine Pathology

25. SONOHYSTEROGRAM
Endometrial PolypEndometrial Polyp

26. HYSTEROSCOPYHYSTEROSCOPY
Large, pedunculated endometrial polyp

27. b. Endometrial Thickness

28. END 2B
A Thin EndometriaL Lining

29. A Viagra- Restored Endometrium
““Tri-Laminar” AppearanceTri-Laminar” Appearance

30. Causes of a Thin Uterine Lining
Uterine scarring
• Inflamation
• Surgery
Reduced blood flow
• Age
• Diffuse adenomyosis
• Multiple fibroid tumors
• Over-use of clomiphene

31. Viagra Improves Blood Flow
 Dilates vascular smooth muscleDilates vascular smooth muscle
 Can improve uterine blood flowCan improve uterine blood flow
 Increased EIncreased E22 deliverydelivery

32. c. Immunologic Factors

33. UTERINE IMMUNE TOLERANCEUTERINE IMMUNE TOLERANCE
EMBRYO
GENETIC SIGNALLING
NKcell
STABILITY
CYTOKINES
TH-1 +
+
CYTOKINES
TH-2

34. Immunologic ImplantationImmunologic Implantation
DysfunctionDysfunction
Autoimmune IDAutoimmune ID
(85%)(85%)
Alloimmune IDAlloimmune ID
((15%)15%)
NK CELLS

35. ImplantationImplantation
ImmunotherapyImmunotherapy
Heparin/Lovenox/Clexane
IVIG - Replaced by…
Intralipid (IL)
Dexamethasone/Prednisone
 Aspirin ??
Other (LIT, Humera)??

36. 3. EMBRYO TRANSFER

37. Ultrasound-guided Placement of
Embryo(s)

38. Day 3 vs. Day 5?
How Many embryos to transfer?
Full bladder
Ultrasound guidance
Cntd.

39. THANK YOU!!THANK YOU!!