The American Association
of Bioanalysts

The College of
American Pathologists

testing

L. S. Morrison, S. M. Carney, M. P. Portmann, B. A. McGuirk, M. J. Tucker, R. F. Feinberg
Reproductive Associates of Delaware, Newark, DE

Objective:
To determine if days of higher IVF volume due to patient grouping for controlled ovarian hyperstimulation influences implantation rates, ongoing pregnancy rates, and blastocyst formation.

Design:
Outcomes of 561 fresh non-donor cycles from patients of all ages during a 5 year period were analyzed based on the daily number of retrievals performed:  Low Intensity (1–3 retrievals/day), Moderate Intensity (4–6 retrievals/day) and High Intensity (7-8 retrievals/day).  The parameters analyzed for each group were implantation rate, spare embryo blastocyst formation, and ongoing pregnancy rate per retrieval.

Materials and Methods:
Oocytes were retrieved in HTF (InVitrocare – IVC, Frederick, MD) or Fertilization Media (Sage, Cooper Surgical Inc. – Trumbull, CT) hyaluronidased after 2 to 3 hours incubation and ICSI’ed 1 to 3 hours following cumulus-corona removal. Oocytes were placed in IVC-1 (IVC) or Cleavage Media (Sage) after ICSI and cultured individually in this media until Day 3. Embryos were placed into CCM (Vitrolife, Denver, CO) or Blastocyst Media (Sage) on the morning of Day 3 for extended culture. The best embryos were identified and laser hatched prior to transfer using the Zilos laser system from Hamilton Thorne (settings: one pulse; 0.500 milliseconds duration). Morphologic assessment occurred on Day 2, 3, 5, 6 and 7.  Blastocysts were cryopreserved on Day 5, 6 or 7. All transfers occurred on Day 3 or Day 5 using a Wallace 23cm stylet (Irvine Scientific, Irvine, CA) and Cook Echotip Catheter (Cook OB/GYN, Spencer, IN) under abdominal ultrasound guidance and were performed by the same physician (RF).  Three Thermo-Forma water-jacketed CO₂ incubators were used for embryo culture by 2.5 (FTEs) embryologists.  Oil overlay was utilized exclusively throughout the study period.

Results:

* p = N.S.
¹ Group A vs. Group B
    P = 0.03063
² Group B vs. Group C
    P = 0.00007
³ Group A vs. Group C
    P = 0.00327

There were no statistically significant differences between groups A, B and C with regard to implantation rate and ongoing pregnancy rate using Chi Square Analysis.  However, Group C resulted in significantly lower blastocyst formation rates when compared with Groups A and B, based on the total number of embryos.

Conclusions:

Grouping of IVF patients for controlled ovarian stimulation has numerous logistical and economic advantages for smaller clinics, as long as outcomes are not being compromised.  As our facility has grown, so has the volume of IVF clinical and lab procedures during specific days.  Although embryo implantation and ongoing pregnancy rates appear to be remarkably similar between lower and higher intensity work days, there may be other factors that are exerting a negative impact on blastocyst formation rates.  One important factor in the lab may be repeated incubator openings, causing subtle but significant fluctuations in culture temperature and pH.  In this study, our facility had a limited number of Group C (“high intensity” days).  However, as IVF utilization increases, we will continue to evaluate this work volume factor prospectively, and will preemptively enhance workflow efficiency through additional sterile hoods, incubators, and professional personnel. 

M. P. Portmann, L. S. Morrison, S. M. Carney, C. F. Boylan, R. F. Feinberg, G. Kovalevsky

Reproductive Associates of Delaware, Newark, DE

Objective:

To assess the feasibility of transitioning from day three embryo transfers to day five single blastocyst transfers.

Design:

Elective single embryo day 5 transfers (ESET) between January 2006 and March 2007 were retrospectively analyzed. Donor cycles were not included in the study group. Patients were chosen based on good prognosis or on hyperstimulation risk factors.

Materials and Methods:

Oocytes were retrieved in HTF (InVitrocare) or Fertilization Media (Sage-Cooper), hyaluronidased after 2 to 3 hours incubation and ICSI’ed 1 to 3 hours following cumulus-corona removal. Oocytes were placed in IVC-1 (IVC) or Cleavage Media (Sage) after ICSI and cultured individually in this media until Day 3. Embryos were placed into CCM (Vitrolife) or Blastocyst Media (Sage) on the morning of Day 3 for extended culture. The best embryos were identified and laser hatched prior to transfer using the Zilos laser system (Hamilton Thorne). Morphologic assessment occurred on Day 2, 3, 5, 6 and 7. Spare embryos developing to blastocysts were vitrified for future use.

Results:

The mean age, mean eggs retrieved and 2PN blast formation were 32, 24.4 and 49.4% respectively for the study group. Of the 33 transfers analyzed, 25 patients achieved pregnancy with 23 pregnancies ongoing, yielding a 69.7% ongoing pregnancy rate. All patients in this group had blasts vitrified for subsequent use.

Conclusions:

This data is meant to be used by others contemplating ESET in their clinics. ESET has conferred a number of beneficial aspects to our practice. For example, the application of less subjective embryo/blastocyst grading has resulted in better selection for transfer. Also, the additional two days provides our clinical staff with more time to assess Ovarian Hyperstimulation Syndrome risk – transfer on day 5 becomes clearly advisable or inadvisable if clinical symptoms do not resolve. The future challenge will be application of ESET more liberally and across a broader patient population.

Reproductive Associates of Delaware (RAD) Team Uses Frozen Donated Eggs, Opening Doors for New Fertility Treatments

NEWARK, DE – August 08, 2008 – A patient of Reproductive Associates of Delaware (RAD) is in the second trimester of a healthy pregnancy, following the region’s first successful use of thawed, frozen donated eggs.

In May, frozen donor eggs were shipped to the Delaware-based infertility clinic. Soon after, the eggs were successfully thawed and fertilized. An ongoing pregnancy occurred following the first attempt at transferring the embryos to the patient’s uterus.

Dr. Ronald F. Feinberg, IVF Medical Director at RAD, notes that the availability of frozen eggs has opened a new era in fertility care, with new options for women. “Frozen sperm banks have been available for over thirty years. Egg freezing and thawing has been much more technically challenging. Nevertheless, research has progressed and various options for egg freezing and banking have now arrived.”

“Frozen eggs offer women options in deciding when they wish to conceive, whether with their own eggs or with donor eggs,” notes Dr. Barbara A. McGuirk, Medical Director for Reproductive Surgery at RAD. “Some women have diseases such as cancer earlier in life, and must delay childbearing. In addition, cancer treatments can destroy eggs. Around the world, many women have chosen to bank their eggs and/or ovarian tissue for future use. Others have opted to use donor eggs.”

Women’s aging has particularly negative effects on their eggs. RAD clinicians care for hundreds of women each year who have this problem. “Many of our patients who use donor eggs are only in their thirties,” notes Dr. Feinberg. “They are often upset because no one informed them previously that ovarian aging is a serious and common problem.”

Dr. McGuirk explained, “Freezing eggs give women and couples the time and convenience of using their eggs when they are ready to get pregnant, liberated from the financial, personal, and ethical dilemma presented with frozen embryos.”

Dr. McGuirk added, “Egg donation is a highly successful treatment option for women who may not be able to get pregnant with their own eggs, but are still able to carry a pregnancy. However, the process of selecting the right women’s eggs often presents challenges.”

Achieving a pregnancy with frozen donor eggs may circumvent issues of time, money, and emotion. A representative of the supplier of the frozen eggs used in the Delaware pregnancy, Cryo Egg International, notes, “Patients frustrated by years of tests and failures greatly value the speed and convenience of frozen eggs and will seek the procedure in greater percentages.”

Worldwide, it is estimated that over 1,000 healthy babies have been born following the use of frozen eggs. So far, it is believed that the incidence of birth defects and genetic abnormalities in those babies is no greater than that seen in babies born within the general population.

For more information, please contact Sonya R. Feinberg or visit www.reproductiveassociates.org.

Reproductive Associates of Delaware is an infertility treatment practice with offices in Newark (on the campus of Christiana Care Hospital), Dover (in the new Eden Hill Medical Center) and North Wilmington (on Silverside Road).

Contact:
Sonya R. Feinberg, MPH
Phone: (302) 623-4234
Fax: (302) 623-4269

PROMINENT DELAWARE FERTILITY DOCTOR TO SPEAK AT MARCH OF DIMES ANNUAL PREMATURITY SUMMIT

Dr. Ronald Feinberg to Address New Fertility Care Strategies For Achieving Healthier Pregnancy Outcomes

NEWARK, DE – October 20, 2006 – Reproductive Associates of Delaware (RAD), a leading fertility care center in the U.S., today announced that their IVF Medical Director, Ronald F. Feinberg MD, PhD will be a plenary speaker at the Third Annual Prematurity Summit hosted by the March of Dimes Delaware Chapter on November, 8th at 10:30 AM. The entire event runs from 8:30 a.m. to 2:45 p.m. at the Chase Center on the Riverfront, and is being offered as a continuing education opportunity for all healthcare professionals.

The focus of the Summit, entitled, “Nature vs. Nurture: The Problem, The Research and the Consequences of Premature Birth,” is to bring people together across the state to address the escalating problem of premature birth in Delaware, and the impact it has on the local community.

“Fertility care has been traditionally blamed as a major contributor to the worldwide prematurity problem,” stated Dr. Feinberg, “But I hope to show that effective, strategic fertility care can actually reduce the risk. Newer techniques such as single embryo transfer, focused pre-conception care, and diligent minimally-invasive restorative surgery are the keys to healthier pregnancy outcomes. I applaud the March of Dimes for promoting this vital dialog.”

Dr. Feinberg was a previous research grant recipient from the March of Dimes while on faculty at the University of Pennsylvania. He was the co-discoverer of a protein produced by placental cells — oncofetal fibronectin — which now forms the basis of a clinical test used to identify and minimize risk of premature birth. This unique protein is also produced by early embryos prior to implantation.

Registration is $50 and includes breakfast, lunch and continuing education credits. To register for the Summit, visit March of Dimes, Delaware Chapter or call 302.225.1020. Registration deadline is November 3rd. For directions to the Chase Center on the Riverfront, located at 800 South Madison Street in Wilmington, DE, visit www.centerontheriverfront.com.

About the March of Dimes

The March of Dimes is a national voluntary health agency whose mission is to improve the health of babies by preventing birth defects, premature birth, and infant mortality. Founded in 1938, the March of Dimes funds programs of research, community services, education, and advocacy to save babies and in 2003 launched a campaign to address the increasing rate of premature birth. For more information, visit the March of Dimes Web site, www.marchofdimes.com or its Spanish language Web site at www.nacersano.org.

About Reproductive Associates of Delaware:

With centers in Newark, DE (on the main campus of Christiana Care) and Dover, DE, Reproductive Associates is home to a world-class team of fertility care professionals. Working with Dr. Feinberg are Drs. Barbara McGuirk and George Kovalevksy, all Board-certified physicians. With specialized credentials, vast experience, and advanced technologies, Reproductive Associates has helped grow thousands of families since 1995. The Center offers a unique and comprehensive array of the most advanced treatments available today, such as outpatient laparoscopy, hysteroscopy, and IVF, resulting in successful pregnancy outcomes that are among the best in the country. For more information, visit www.ivf-de.org or call 302-623-4242.

Media Contact:
Chris Faust
973.906-5553
chris.faust @ paragon-design.net

DR. BARBARA McGUIRK NAMED ‘TOP DOC’ IN REPRODUCTIVE ENDOCRINOLOGY & INFERTILITY BY DELAWARE TODAY MAGAZINE

Second Consecutive Year a Doctor from Reproductive Associates of Delaware Has Been Recognized as a Delaware Today ‘Top Doc’

NEWARK, DE – September 8, 2006 – Reproductive Associates of Delaware (RAD), a leading infertility practice dedicated to excellence in patient care and increasing fertility success rates, today announced that Barbara McGuirk, M.D., has been named the Top Reproductive Endocrinology & Infertility Doctor by Delaware Today. A feature article about Dr. McGuirk will appear in the magazine’s October issue. This recognition marks the second consecutive year a doctor from RAD has been named a Top Doctor by Delaware Today. IVF Medical Director, Ronald F. Feinberg, MD, PhD, was given this honor last year.

With over 15 years experience, Dr. McGuirk has devoted her career to learning, developing and practicing proven techniques for improving the lives of women and parents who are experiencing difficulty conceiving a child. Her specialty is in reproductive endocrinology, the branch of science and medicine that deals with the endocrine glands, metabolism and hormones and their many effects in reproduction, fertility, and healthy pregnancies.

“I’m pleased and honored to have been selected by Delaware Today,” said Dr. McGuirk, who serves as RAD’s director for minimally-invasive reproductive surgery. “I have a real passion for what I do and receive a great amount of satisfaction collaborating with my peers and helping my patients become proud parents.”

Dr. McGuirk is Board-certified in Reproductive Endocrinology / Infertility and Obstetrics and Gynecology, by the American Board of Obstetrics and Gynecology. She is also a Fellow of the American College of Obstetricians and Gynecologists, and completed a Fellowship in Reproductive Endocrinology at the University of Pennsylvania Medical Center in Philadelphia in 1995. She is the Founding Partner of RAD, which was also established in 1995.

Dr. McGuirk completed an Obstetrics and Gynecology residency at the Medical Center of Delaware (now Christiana Care Health System). She received her M.D. from St. Georges University School of Medicine in St. Georges, Grenada and her B.S. in Biology from Pennsylvania State University in University Park, PA. She is also an attending staff physician within the Department of Obstetrics and Gynecology at Christiana Care.

About Reproductive Associates of Delaware:

Joining Drs. McGuirk and Feinberg at RAD is Dr. George Kovalevsky, Director of Academic Affairs, as well as a team of thirty dedicated fertility specialists, IVF lab technicians, specialized nurse practitioners and other fertility care support personnel.

With centers in Newark, DE (on the main campus of Christiana Care) and Dover, DE, Reproductive Associates is home to a world-class team of fertility care professionals who are passionate about making dreams come true. With specialized credentials, vast experience, and advanced technologies, Reproductive Associates has helped grow thousands of families since 1995. The Center offers a unique and comprehensive array of the most advanced treatments available today, such as outpatient laparoscopy, hysteroscopy, and IVF, resulting in successful pregnancy outcomes that are among the best in the country. For more information, visit www.ivf-de.org or call 302-623-4242.

Media Contact:
Chris Faust
973.906-5553
chris.faust @ paragon-design.net

Fertility Care is an uncommon problem

It never affects men

Polycystic Ovarian Syndrome