Research program

New Study Shows Improved Pregnancy Rates with Treatment Protocol Changes in Cases of High Progesterone Levels

A retrospective study conducted by physicians at Shady Grove Fertility revealed that a recent change in treatment protocol resulted in higher pregnancy rates. This study of more than 4,000 Assisted Reproductive Technology (ART) cycles showed that frozen embryo transfers (FET) of embryos derived from IVF cycles where progesterone levels were elevated were as successful as FET of embryos derived from IVF cycles with normal progesterone levels.  This stands in contrast to previous work done at Shady Grove fertility that showed that progesterone elevation had a significant negative effect on pregnancy rates when embryo(s) were transferred in the same cycle that the progesterone elevation occurred.

What’s the take home message? — The negative impact of high progesterone elevation on IVF outcomes derives from its impact on the endometrium, not on the embryo. By delaying transfer of high quality embryos until a time where the uterus is not impacted by high progesterone levels, outcomes are improved.

Why Progesterone Levels Increase

Throughout the stimulation phase of IVF treatment, medications are given to patients to encourage several follicles in the ovaries to develop in the hopes of retrieving multiple eggs for fertilization. Progesterone levels can rise in response to medications given during this stimulation phase treatment – sometimes to a level that’s higher than ideal.

At Shady Grove Fertility, our teams of fertility specialists monitor progesterone levels closely throughout the stimulation phase of IVF treatment. This study found that among patients whose progesterone levels were elevated during their IVF cycle, those who waited to have a frozen embryo transfer after their progesterone level had returned to normal had better success than patients who continued with a fresh transfer while progesterone levels were still elevated.

Timing is Key to Success

To achieve the best chances of pregnancy during an IVF cycle with a fresh transfer, there are several elements that have to be timed exactly right.

In cases where progesterone hormone levels are too high, the delicate synchronization of the embryo and the uterine lining (a.k.a. endometrium) is disturbed. This study suggests that increased levels of progesterone can result in ‘advancement’ of the uterine lining, such that the uterus is no longer optimally receptive when the embryo is ready to implant.

However, in an FET cycle, some of these crucial timing factors are eliminated. The patient and medical team can focus on preparing the uterine lining and will thaw the embryos when the patient’s lining is most likely to allow for implantation.

Improving the Standard of Care for Patients

Armed with data from this study, patients and physicians can feel confident that when progesterone is elevated, chances of having a baby will be improved by forgoing  fresh transfer of high quality embryos in favor of transferring them in a later FET cycle. Taking a 1 to 2 month break between cycles allows the progesterone levels to return to a normal level and can increase pregnancy rates as much as 50 percent. While the delay in treatment can be viewed as a setback, this option gives patients and their embryos the best chance of success.

About the American Society for Reproductive Medicine (ASRM) Annual Meeting

ASRM 2015 is the premier National education and research meeting for the field of Reproductive Endocrinology and Infertility. Plenary lectures will address state-of-the-art issues in reproductive medicine and science.

The outlook for patients with infertility continues to brighten year after year, thanks to the thousands of professionals who dedicate their lives to improving outcomes for fertility treatment.  The range of ASRM’s expertise and influence draws from doctors, nurses, and researchers to business experts, pharmaceutical companies, advocacy organizations, and, of course, patients themselves. Shady Grove Fertility continues to play a leading role in clinical research and practice policy at the national level.

 If you would like to schedule an appointment with a fertility specialist, please speak with one of our New Patient Liaisons at 877-971-7755.

New Study Provides Better Predictions for Intrauterine Insemination (IUI) Pregnancy Rates Based on the Number of Moving Sperm

Intrauterine insemination (IUI) is one of the most basic forms of fertility treatment and has provided many women and men who have struggled to conceive with the ability to build their families. Compared with more intensive treatments such as in vitro fertilization (IVF), IUI comes at a lower financial cost but, in general, is associated with lower pregnancy rates. Couples with infertility, in whom tubal and severe male factor have been excluded, generally face the decision of whether to start with IUI or IVF.  While some factors, such as female age, have been known to influence IUI outcomes, clinicians have  had few tools at their disposal to tailor counseling regarding chances of success with IUI. Shady Grove Fertility has recently completed a study to help couples decide whether IUI is the right initial fertility treatment for them and will present key findings at the American Society for Reproductive Medicine (ASRM) Annual Meeting (Baltimore, MD, October 17–21, 2015).

Sperm Count Predicts IUI Pregnancy Rates

In addition to maternal age, sperm count has been known to have an impact on pregnancy rates with IUI treatment; however, precise predictions based on sperm count were not possible, as limited data were available.

Based on a retrospective study of over 47,500 IUI cycles, Shady Grove Fertility has developed a model to predict IUI success based on total motile sperm count in the sample used for IUI.

Before an IUI cycle, most patients will have a sperm wash to prepare the sample for insemination. At this time, the total motile sperm collected are counted. The sperm count can range from nearly zero to tens of millions. It seems obvious that the higher the sperm count, the higher the chances of pregnancy—but just how high, or low, are the chances?

For the average couple in this study who underwent IUI with a post-wash total motile sperm count of at least 9 million, the chances of a clinical pregnancy with one IUI cycle using “washed sperm” was 16.9 percent. If the count was above 9 million the same chances of success were observed.  In other words, it didn’t matter if the sample used for insemination had 9 million, 10 million, or 20 million moving sperm, success rates didn’t increase further.

However, for patients with sperm counts on the lower end of the spectrum, success rates steadily fell as the sperm count decreases from 9 million.

Total Motile Sperm Count (millions)	Number of Insemination Cycles	Number of Clinical Pregnancies	Clinical Pregnancy per Cycle
<0.25	123	3	2.40%
0.25-0.49	180	5	2.80%
0.50-0.99	355	17	4.80%
1.00-1.99	904	62	6.90%
2.00-3.99	2463	249	10.10%
4.00-4.99	1465	166	11.30%
5.00-5.99	1499	186	12.40%
6.00-6.99	1676	230	13.70%
7.00-8.99	3257	479	14.70%
9.00-9.99	1621	274	16.90%
> 10.00	34010	5649	16.60%

Determining Total Motile Sperm Count

At Shady Grove Fertility, a semen analysis is part of any couple’s initial fertility work-up. This helps determine if male factor infertility may be playing a role in the couple’s inability to conceive, as well as providing insight into which treatment option may provide the best chance of pregnancy. When considering expected total motile sperm count for an IUI, two important variables need to be accounted for: 1) total motile sperm count from the baseline semen analysis, and 2) the impact that sperm washing (a procedure in which a sperm sample is concentrated that is necessary for IUI) will have on that number.

What This Means for Patients

Based on the largest study of its kind, physicians can now counsel patients about their potential success rates with IUI and whether it is the right treatment option for them. When a semen analysis shows a borderline or low sperm count, patients can undergo a diagnostic semen wash to give a more accurate expectation of total motile sperm count expected to be obtained for IUI treatment, and thereby obtain a refined understanding of their chances of success. Another SGF study being presented at the 2015 ASRM meeting looked at factors that may be able to predict post-wash total motile sperm count and found that baseline sperm morphology is likely the most important predictor.

Together, these studies demonstrated that post-wash total motile sperm count can provide valuable decision making information to couples deciding between IUI and IVF treatment.

With more accurate, individualized expectations, patients can make informed decisions about treatment, which was the Shady Grove Fertility Research team’s primary goal in conducting this study

About the American Society for Reproductive Medicine (ASRM) Annual Meeting

ASRM 2015 is the premier National education and research meeting for the field of Reproductive Endocrinology and Infertility. Plenary lectures will address state-of-the-art issues in reproductive medicine and science.

The outlook for patients with infertility continues to brighten year after year, thanks to the thousands of professionals who dedicate their lives to improving outcomes for fertility treatment.  The range of their expertise and influence draws from doctors, nurses, and researchers to business experts, pharmaceutical companies, advocacy organizations, and, of course, patients themselves. Shady Grove Fertility continues to play a leading role in clinical research and leadership in practice policy at the national level.

If you would like to schedule an appointment with a fertility specialist, please speak with one of our New Patient Liaisons at 877-971-7755.