New fertility treatment for PCOS without hormone injections

For millions of women suffering from polycystic ovarian syndrome (PCOS), trying to conceive can be a heart-breaking experience. But a new procedure is making it easier for patients to get pregnant without hormone injections, meaning a decreased risk for certain complications. “PCOS is an endocrine disorder where women don’t ovulate on a regular basis,” Dr. Jesse Hade, medical director at Neway Fertility in New York City told FoxNews.com. “It's usually characterized by having multiple little follicles in the ovaries that appear on ultrasound, or having irregular periods, coupled with elevated male hormone levels, or elevated androgen levels.” Manpreet Sangari, 32, was diagnosed with PCOS after months of trying to get pregnant proved unsuccessful. “Basically it will be very hard for me to ovulate on my own and have kids … It would be, not a miracle, but it would just, it would take a long time, and that's when [my obstetrician] told me I should go to a fertility doctor,” Sangari told FoxNews.com. “And hearing all that was just crazy because now you're adding more people into the process of baby making, which should have been so simple.” Sangari went to see Hade, who suggested she try a less-invasive procedure like intrauterine insemination (IUI) before jumping into in vitro fertilization (IVF). But the IUI procedure did not produce a pregnancy, so Sangari tried a round of IVF. The procedure was a success and Sangari and her husband, 36-year-old Sarbdeep Mokha, were overjoyed to learn she was pregnant with twins. But their excitement was short lived when, not long after, the unthinkable happened. “I ended up [having a] preterm delivery on the 23rd week and the babies didn't survive,” said Sangari. “The procedure itself was successful, the IVF was successful -- the carrying of the babies was not successful.” Three months later, when Sangari was ready to try again, Hade suggested a different kind of fertility treatment called in vitro maturation (IVM). “Usually women with … PCOS are the primary candidates for this procedure because they have lots of little immature follicles which lead to lots of little immature eggs. We then go ahead and harvest all these immature eggs, remove them, and then mature them in the petri dish,” Hade said. With traditional IVF, patients typically inject themselves with hormone medications for eight to 10 days to stimulate the ovaries into producing multiple eggs for fertilization. This increases the chances of creating healthy embryos for transfer into the uterus. But hormone injections can be dangerous for PCOS patients because they have an increased risk for ovarian hyperstimulation syndrome (OHSS) – a condition that causes the ovaries to become swollen and painful. Sangari developed OHSS during her IVF trial, making her the perfect candidate for IVM. “In in-vitro maturation, little to none of these [hormone] drugs are given initially, so what we're doing is preparing the endometrium for implantation with hormones to … prime the lining,” Hade said. “And in this process, we wait until the endometrial receptivity gets to its best point, and that's when we trigger the ovulation and remove the immature eggs out.” The treatment is still considered experimental, so it’s not covered by insurance. But Hade hopes to change that with an ongoing IVM study he is conducting that has shown success rates of 80 percent so far. Sangari had the procedure, and in October 2013 she and her husband welcomed a daughter, Zoya. They plan on trying for another child. “We're hoping Dr. Hade helps us get the second baby,” said Sangari. “We had thought of having two kids, and after the first time we got one back, and we need one more.” Article: 20th February 2014 www.foxnews.com

Mother speaks out about her pioneering drug-free fertility treatment

The mother of the first babies born in Britain using a pioneering drug-free fertility treatment has spoken exclusively to The Independent on Sunday to urge others to follow in her footsteps. Tina Milkovic, 34, a project manager from Oxford, lifted a media blackout on her family to offer hope to thousands of women who may have abandoned their dream of having a child. Mrs Milkovic and her husband, Joe, 48, an administrator at Oxford University, became the first Britons to conceive using IVM – in vitro maturation – a technique that involves removing eggs from a mother's ovaries and maturing them in a laboratory. The family initially wished the twins to remain anonymous, only releasing pictures of the boy and girl, but not their names. But as Ilya and Isabella celebrated their fifth birthday last week, their parents decided to talk about their treatment and encourage others to use IVM, a safer alternative to IVF for the millions of women with polycystic ovary syndrome (PCOS). IVF can be fatal for these women if they react badly to the drugs used during IVF treatment to stimulate the ovaries. The couple's decision to speak out, and the success their twins represent, will provide a big boost for IVM. Rachel Hawkes, chair of the PCOS charity Verity, said: "A safer treatment could be a help to many women with PCOS. It could be a viable option for thousands of women. One in 10 women have PCOS and around 40 per cent will need assisted conception." IVF uses high does of fertility drugs to mature eggs within the ovaries' follicles, later taking them out to be fertilised with sperm. In IVM, immature eggs are collected from unstimulated ovaries and then matured in a laboratory for up to 48 hours before being fertilised. Mrs Milkovic said: "We were trying [to have children] for two years, but, with me having PCOS, we always knew there was a slim chance of falling pregnant naturally. I was already going down the IVF route. We'd bought the drugs and were all set to start treatment, but in the back of our minds was always the risk with IVF for women with polycystic ovaries. I had read about IVM, but it was new and, I thought, not available in the UK. "The night before we were due to start IVF, we just Googled IVM and, by chance, our consultant's name, Tim Child, came up saying he'd just been licensed for it. We decided to call him the next morning to see if it was an option. It feels like fate. I just happened to Google it that night and there in front of me it said the UK had just been granted its licence. "I don't think any of us expected the pregnancy to happen because it was the first cycle. Two weeks afterwards, I was asked to go back in. I had some bleeding so I was convinced it hadn't worked. Then, when he checked the scan, I could see he was excited and he said we had twins. We were in shock. I remember sitting in the car in the car park and thinking, 'My God, it's worked'. "When the twins were born, I asked to remain anonymous so I could bond with them. The pregnancy went fantastically and the babies were a really good weight." Last month, the pair started at school. "I'm so proud of them," she said. "They have an amazing bond together. Ilya is very sporty, he loves football and tennis; and Isabella is a very girly girl, she does ballet and likes fairies and things like that." Though they don't appear any different, the twins do have an inkling of their special status. "On the internet, if you type 'IVM twins' on Google, a photo of them that comes up," their mother explains. "They love seeing themselves and say, 'Oh, that's me'." Mrs Milkovic said she feels lucky she didn't try IVF, "I'm so glad I didn't have to take that risk. I imagine there are lots of women out there who don't know that IVM is available in the UK. It's really important for this to get out so women can know." According to the Human Fertilisation and Embryology Authority, a relatively small number of patients have had IVM because the treatment is still in its early stages and is not offered widely. Dr Child, the Milkovics's gynaecologist at the John Radcliffe Hospital in Oxford, who pioneered the treatment in the UK after it had been used only a handful of times in countries such as South Korea and Canada, said IVF is risky for those with PCOS. "Women who have ovaries that look polycystic on a scan, which is about 25 per cent of women at reproductive age, are at a greater risk from ovarian hyperstimulation. It has been fatal. It's hard to say how many [have died] because it's under-reported, but in general, women who undergo ovarian hyperstimulation can develop abdominal pain and bloating and are at increased risk of blood clotting. About 1 per cent who use IVF could end up in hospital because of it." Many women with PCOS still take the risk with IVF because the chances of becoming pregnant are higher. "We've done 180 IVM cycles since we started five years ago and we've really been the only clinic doing it," said Dr Child. "In that same time we've done about 8,000 IVF cycles, which is driven by the patients. From their point of view, because their main driver is getting pregnant, they tend to choose IVF as the chances of conceiving are higher." IVM costs around £2,100 per cycle compared with around £4,000 for IVF, but it is only half as effective. How IVM offers hope In vitro maturation (IVM) is a safer fertility treatment for women who have polycystic ovary syndrome (PCOS). When undergoing other fertility treatments, women with PCOS are at an increased risk of their ovaries becoming hyperstimulated by the drugs used to help eggs reach maturity before fertilisation. IVM takes eggs from the ovaries earlier than IVF and matures them in a laboratory, thus cutting out the need for fertility drugs. Ovarian hyperstimulation syndrome, a side effect of IVF for some patients with PCOS, can cause bloating, blood-clotting and, in some cases, it can be fatal. IVM is most suitable for women under 38 with polycystic ovary syndrome. IVM is cheaper than IVF because it does not require drugs, but its success rate is currently a little over half that of IVF. Article: 21st October 2012 www.independent.co.uk