Zygote Intrafallopian Transfer: ZIFT

Posted by on Nov 14, 2014 in Blog Posts

Zygote Intrafallopian Transfer: ZIFT

What is zygote intrafallopian transfer (ZIFT)?

ZIFT is an assisted reproductive procedure similar to in vitro fertilization and embryo transfer, the difference being that the fertilized embryo is transferred into the fallopian tube instead of the uterus. Because the fertilized egg is transferred directly into the tubes, the procedure is also referred to as tubal embryo transfer (TET). This procedure can be more successful than gamete intrafallopian transfer (GIFT) because your physician has a greater chance of insuring that the egg is fertilized. The woman must have healthy tubes for ZIFT to work.

The main difference between ZIFT and GIFT is that ZIFT transfers a fertilized egg directly into the fallopian tubes while GIFT utilizes a mixture of sperm and eggs.

How is ZIFT performed?

ZIFT is an assisted reproductive procedure that involves the following steps:

A woman’s ovaries are stimulated with medications to increase the probability of producing multiple eggs. Eggs are then collected through an aspiration procedure. Those eggs are fertilized in a laboratory in a procedure identical to IVF, with the exception of the time frame. During the ZIFT procedure, fertilized eggs are transferred within 24 hours, versus 3-5 days as used in a regular IVF cycle. The fertilized eggs are then transferred through a laparoscopic procedure where a catheter is placed deep in the fallopian tube and the fertilized eggs injected. The final step is to watch for early pregnancy symptoms. The fertility specialist will probably use a blood test to determine if pregnancy has occurred. Who should be treated with ZIFT?

ZIFT is an assisted reproductive procedure which may be the selected form of treatment for any infertility problems except the following:

Tubal blockage Significant tubal damage An anatomic problem with the uterus, such as severe intrauterine adhesions Sperm that are not able to penetrate an egg ZIFT is commonly chosen by couples who have failed to conceive after at least one year of trying and who have failed five to six cycles of ovarian stimulation with intrauterine insemination (IUI).

What are the similarities and differences between ZIFT and in vitro fertilization (IVF)?

ZIFT and IVF both tend to be favorable treatments for women who have more severe infertility issues such as damaged fallopian tubes. ZIFT and IVF both involve embryo culture. ZIFT and IVF both provide the physician with the opportunity to select only the best quality embryos for transfer. ZIFT transfers the fertilized embryo into the fallopian tube whereas the IVF and embryo transfer procedures result in the fertilized embryo being placed into the uterus. The ZIFT procedure differs from IVF in that the transfer of embryos into the tube requires an extra surgical procedure called laparoscopy.

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Preimplantation Genetic Diagnosis: PGD

Posted by on Nov 14, 2014 in Blog Posts

Preimplantation Genetic Diagnosis: PGD

Preimplantation genetic diagnosis (PGD), also called Preimplantation Genetic Testing (PGT), is a procedure used prior to implantation to help identify genetic defects within embryos created through in vitro fertilization to prevent certain diseases or disorders from being passed on to the child. In most cases, the female, male, or both partners have been genetically screened and identified to be carriers of potential problems.

How is the PGD performed?

The preimplantation genetic diagnosis begins with the normal process of in vitro fertilization that includes: ovary stimulation through medication, egg retrieval, and fertilization in a laboratory. Over the next three days the embryo will divide into 8 cells. The preimplantation genetic diagnosis involves the following steps:

1. First, a one or two cells are removed from the embryo. 2. Next, DNA is retrieved from the cell and copied through a process known as polymerase chain reaction (PCR). 3. Finally, by molecular analysis, the DNA sequence code is evaluated to determine if the inheritance of a problematic gene is present. Once the PGD procedure has been performed and embryos free of genetic problems have been identified, implantation will be attempted through embryo transfer, intracytoplasmic sperm injection (ICSI), or zygote intrafallopian transfer (ZIFT).

Who can benefit from PGD?

Preimplantation genetic diagnosis can benefit any couple at risk for passing on a genetic disease or condition. The following is a list of the type of individuals who are possible candidates for PGD:

Women ages 35 and over Carriers of sex-linked genetic disorders Carriers of single gene defects Those with chromosomal disorders Women experiencing recurring pregnancy loss associated with chromosomal concerns PGD has also been used for the purpose of gender selection. However, discarding embryos based only on gender considerations is an ethical concern for many people.

What does PGD look for?

Preimplantation genetic diagnosis looks for genetic and chromosomal problems that place the couple at risk for birth defects or spontaneous misscarriage. Research shows that PGD identifies the presence of the following disorders and the list continues to grow as technology improves:

Recessive sex-linked disorders such as hemophilia, fragile X syndrome, and most neuromuscular

dystrophies

Dominant sex-linked disorders

such as Rett syndrome, incontinentia pigmenti, pseudohypererp arathydroidism, and vitamin D-resistant rickets Single gene disorders such as cystic fibrosis, Tay-sachs, Huntington disease, and sickle cell anemia

Chromosomal rearrangements such as translocation, inversion, deletions and Aneuploidy What are the benefits of PGD?

The following are considered benefits or advantages of PGD:

The procedure is performed before implantation thus reducing the need for amniocentesis later in pregnancy. The procedure is performed before implantation thus allowing the couple to decide if they wish to continue with the pregnancy. The procedure enables couples to pursue biological children who might not have done so otherwise. The procedure may help reduce the costs normally associated with birth defects. What are the concerns of PGD?

The following are considered concerns or disadvantages associated with the use of PGD:

Many people believe that because life begins at conception and that the destruction of an embryo is the destruction of a person. In practice, the PGD procedure usually results in a small number of discarded embryos. In some cases, a genetically defective fertilized egg will mature without the presence of disorder or disease. The probability of disorder development should be a topic of discussion with the healthcare provider. While PGD helps reduce the chance of conceiving a child with a genetic factor, it can not completely eliminate this risk. In some cases, further testing done during pregnancy is needed to ascertain if a genetic factor is still possible. Although genetically present, some resulting diseases only generate symptoms when carriers reach middle age.

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Intracytoplasmic Sperm Injection:

Posted by on Nov 14, 2014 in Blog Posts, Houston Midwife

Intracytoplasmic Sperm Injection:
ICSI

Intracytoplasmic sperm injection (ICSI) involves the direct injection of sperm
into eggs obtained from in vitro fertilization (IVF).

How is ICSI performed?

There are basically five simple steps to ICSI which include the following:

1. The mature egg is held with a specialized pipette.
2. A very delicate, sharp, and hollow needle is used to immobilize and
pick up a single sperm.
3. The needle is then carefully inserted through the shell of the egg and
into the cytoplasm of the egg.
4. The sperm is injected into the cytoplasm, and the needle is carefully
removed.
5. The eggs are checked the following day for evidence of normal

fertilization.

Once the steps of ICSI are complete and fertilization is successful, the
embrto transfer procedure is used to physically place the embryo in the
woman’s uterus. Then it is a matter of watching for early pregnancy
symptoms. The fertility specialist may use a blood test or ultrasound to
determine if implantation and pregnancy has occurred.

Are there specific situations where ICSI might be recommended?

ICSI may be recommended when there is a reason to suspect that achieving
fertilization may be difficult. ICSI is most often used with couples who are
dealing with male infertility factors. Male infertility factors can include any of
the following: low sperm counts, poor motility or movement of the sperm,
poor sperm quality, sperm that lack the ability to penetrate
an egg or azoospermia.

Azoospermia is a condition where there is no sperm in the male’s
ejaculation. There are two types of azoospermia: obstructive and non-
obstructive. Obstructive azoospermia may be caused by any of the following:

Previous vasectomy
Congenital absence of vas
Scarring from prior infections
Non-obstructive azoospermia occurs when a defective testicle is not
producing
sperm.

How is sperm retrieved for use in ICSI?

For men who have low sperm count or sperm with low mobility, the sperm
may be collected through normal ejaculation. If the man has had a
vasectomy, the microsurgical vasectomy reversal is the most cost-effective
option for restoring fertility.

Needle aspiration or microsurgical sperm retrieval are good alternatives
when a competent microsurgical vasectomy reversal has failed, or when the
man refuses surgery. Needle aspiration allows physicians to easily and
quickly obtain adequate numbers of sperm for the ICSI procedure. A tiny
needle is used to extract sperm directly from the testis.

Needle aspiration is a simple procedure performed under sedation with
minimal discomfort; however, there is the potential for pain and swelling
afterwards. The sperm obtained from testis is only appropriate for ICSI
procedures when testicular sperm is not able to penetrate an egg by itself.

What health concerns are there when considering ICSI?

There have been studies indicating that developing babies from pregnancies
achieved through artificial insemination, and particularly ICSI, may face an
increased risk for some birth defects, such as imprinting defects. Imprinting
refers to the phenomenon in which certain genes function differently
depending on whether they involve a particular chromosome passed on by
the father or by the mother. Reproductive researchers are concerned that
manipulation of either gametes or zygotes may affect the imprinting process
or the subsequent release. Other researchers believe that the incidence of
these birth defects occurring is similar to those achieving pregnancy without
ART procedures and therefore should not be a deterrent in using them. The
potential risks or complications from doing ICSI is something that you should
discuss with your reproductive specialist at length about.

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Gamete Intrafallopian Transfer: GIFT

Posted by on Nov 14, 2014 in Blog Posts, Houston Midwife

Gamete Intrafallopian Transfer:
GIFT

What is gamete intrafallopian tube transfer (GIFT)?

GIFT is an assisted reproductive procedure which involves removing a
woman’s eggs, mixing them with sperm and immediately placing them into a
fallopian tube. One of the main differences between this procedure and the
in vitro fertilization (IVF) and zygote intrafallopian transfer (ZIFT) procedures
is that the fertilization process takes place inside the fallopian tube rather
than in a laboratory. However, healthy tubes are necessary for GIFT to work.

How is GIFT performed?

GIFT is an assisted reproductive procedure that involves the following:

A woman’s ovaries are stimulated with medications to increase the
probability of producing multiple eggs.
Eggs are collected through an aspiration procedure.
The best quality eggs are immediately mixed with mobile sperm and
placed in a special catheter.
The mixture of eggs and sperm are transferred to the woman through a
laparoscopic procedure by placing a catheter in the fallopian tube and
injecting the egg/sperm mixture.

The last step is to watch for early pregnancy symptoms. Your fertility
specialist will probably use a blood test to determine if pregnancy has
occurred.
Who should be treated with GIFT?

GIFT is an assisted reproductive procedure that is a possible solution for any
infertility problem except the following:

Tubal blockage
Significant tubal damage
An anatomic problem with the uterus, such as severe intrauterine
adhesions.
In general, in vitro fertilization (IVF) is preferable for couples with male factor
infertility.

GIFT is commonly chosen by couples who have failed to conceive after
trying at least one year and who have failed five to six cycles of ovarian
stimulation with intrauterine insemination.

What are the differences between GIFT and in vitro fertilization
(IVF)?

GIFT tends to be favored by women who have tried getting pregnant
through other means but have not been successful, whereas IVF is
preferable for women with more severe infertility concerns.
Since GIFT does not involve embryo culture, patients are able to
pursue additional fertility treatments without having to address ethical
concerns related to the creation or transfer of embryos.
IVF provides the physician with the opportunity to select the best
quality embryos on day 3 or day 5 for transfer. In contrast, GIFT places
unfertilized eggs and sperm in the tubes.
In the GIFT procedure, the transfer of gametes into the tube requires
an extra surgical procedure called laparoscopy.

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Using Illegal Drugs DuringPregnancy

Posted by on Nov 14, 2014 in Blog Posts, Houston Midwife

Using Illegal Drugs DuringPregnancy

When you are pregnant, it is important that you watch what you put into your body. Consumption of illegal drugs is not safe for the unborn baby or for the mother. Studies have shown that consumption of illegal drugs during pregnancy can result in miscarriage, low birth weight, premature labor, placental abruption, fetal death, and even maternal death. The following information can help you understand these drugs and their effects.

Marijuana:

Common slang names: pot, weed, grass and reefer What happens when a pregnant woman smokes marijuana?

Marijuana crosses the placenta to your baby. Marijuana, like cigarette smoke, contains toxins that keep your baby from getting the proper supply of oxygen that he or she needs to grow. How can marijuana affect the baby? Studies of marijuana in pregnancy are inconclusive because many women who smoke marijuana also use tobacco and alcohol. Smoking marijuana increases the levels of carbon monoxide and carbon dioxide in the blood, which reduces the oxygen supply to the baby. Smoking marijuana during pregnancy can increase the chance of miscarriage, low birth weight, premature births, developmental delays, and behavioral and learning

problems.

What if I smoked marijuana before I knew I was pregnant? According to Dr. Richard S. Abram, author of Will it Hurt the Baby, “occasional use of marijuana during the first trimester is unlikely to cause birth defects.” Once you are aware you are pregnant, you should stop smoking. Doing this will decrease the chance of harming your baby.

Cocaine:

Common slang names: bump, toot, C, coke, crack, flake, snow, and candy What happens when a pregnant woman consumes cocaine? Cocaine crosses the placenta and enters your baby’s circulation. The elimination of cocaine is slower in a fetus than in an adult. This means that cocaine remains in the baby’s body much longer than it does in your body. How can cocaine affect my baby? According to the Organization of Teratology Information Services (OTIS), during the early months of pregnancy cocaine exposure may increase the risk of miscarriage. Later in pregnancy, cocaine use can cause placental abruption. Placental abruption can lead to severe bleeding, preterm birth, and fetal death. OTIS also states that the risk of birth defects appears to be greater when the mother has used cocaine frequently during pregnancy. According to the American Congress of Obstetricians and Gynecology (ACOG), women who use cocaine during their pregnancy have a 25 % increased chance of premature labor. Babies born to mothers who use cocaine throughout their pregnancy may also have a smaller head and be growth restricted. Babies who are exposed to cocaine later in pregnancy may be born dependent and suffer from withdrawal symptoms such as tremors, sleeplessness, muscle spasms, and feeding difficulties. Some experts believe that learning difficulties may result as the child gets older. Defects of the genitals, kidneys, and brain are also possible.

What if I consumed cocaine before I knew I was pregnant? There have not been any conclusive studies done on single doses of cocaine during pregnancy. Birth defects and other side effects are usually a result of prolonged use, but because studies are inconclusive, it is best to avoid cocaine altogether. Cocaine is a very addictive drug and experimentation often leads to abuse of the drug.

Heroin:

Common slang names: horse, smack, junk, and H-stuff What happens when a pregnant woman uses heroin? Heroin is a very addictive drug that crosses the placenta to the baby. Because this drug is so addictive, the unborn baby can become dependent on the drug. How can heroin affect my baby? Using heroin during pregnancy increases the chance of premature birth, low birth weight, breathing difficulties, low blood sugar (hypoglycemia), bleeding within the brain (intracranial hemorrhage), and infant death. Babies can also be born addicted to heroin and can suffer from withdrawal symptoms. Withdrawal symptoms include irritability, convulsions, diarrhea, fever, sleep abnormalities, and joint stiffness. Mothers who inject narcotics are more susceptible to HIV , which can be passed to their unborn children. What if I am addicted to heroin and I am pregnant? Treating an addiction to heroin can be complicated, especially when you are pregnant. Your health care provider may prescribe methadone as a form of treatment. It is best that you communicate with your health care provider, so he or she can provide the best treatment for you and your baby. PCP & LSD:

What happens when a pregnant woman takes PCP and LSD? PCP and LSD are hallucinogens. Both PCP and LSD users can behave violently, which may harm the baby if the mother hurts herself. How can PCP and LSD affect my baby? PCP use during pregnancy can lead to low birth weight, poor muscle control, brain damage, and withdrawal syndrome if used frequently. Withdrawal symptoms include lethargy, alternating with tremors. LSD can lead to birth defects if used frequently. What if I experimented with LSD or PCP before I knew I was pregnant? No conclusive studies have been done on one time use effects of these drugs on the fetus. It is best not to experiment if you are trying to get pregnant or think you might be pregnant.

Methamphetamine:

Common slang names: meth, speed, crystal, glass, and crank What happens when a pregnant woman takes methamphetamine? Methamphetamine is chemically related to amphetamine, which causes the heart rate of the mother and baby to increase. How can methamphetamine affect my baby: Taking methamphetamine during pregnancy can result in problems similar to those seen with the use of cocaine in pregnancy. The use of speed can cause the baby to get less oxygen, which can lead to low birth weight. Methamphetamine can also increase the likelihood of premature labor, miscarriage, and placental abruption. Babies can be born addicted to methamphetamine and suffer withdrawal symptoms that include tremors, sleeplessness, muscle spasms, and feeding difficulties. Some experts believe that learning difficulties may result as the child gets older.

What if I experimented with methamphetamine before I knew I was pregnant? There have not been any significant studies done on the effect of one time use of methamphetamine during pregnancy. It is best not to experiment if you are trying to get pregnant or think you might be pregnant. What does the law say?

Currently there are no states that holds prenatal substance abuse as a criminal act of child abuse and neglect. But many have expanded their civil child-welfare requirements to include substance abuse during pregnancy as grounds for terminating parental rights in relation to child abuse and neglect.

The laws that address prenatal substance abuse are as follows:

Iowa, Minnesota, and North Dakota’s health care providers are required to test for and report prenatal drug exposure. Kentucky health

care providers are only required to test. Alaska, Arizona, Illinois, Louisiana, Massachusetts, Michigan, Montana, Oklahoma, Utah, Rhode Island and Virginia’s, health care providers are required to report prenatal drug exposure. Reporting and testing can be evidence used in child welfare proceedings. Some states consider prenatal substance abuse as part of their child welfare laws. Therefore prenatal drug exposure can provide grounds for terminating parental rights because of child abuse or neglect. These states include: Arkansas, Colorado, Florida, Illinois, Indiana, Iowa, Louisiana, Minnesota, Nevada, Rhode Island, South Carolina, South Dakota, Texas, Virginia, and Wisconsin. Some states have policies that enforce admission to an inpatient treatment program for pregnant women who use drugs. These states include: Minnesota, South Dakota, and Wisconsin. In 2004, Texas made it a felony to smoke marijuana while pregnant, resulting in a prison sentence of 2-20 years.

How can I get help?

You can get help from counseling, support groups, and treatment programs. Popular groups include the 12 step program. Numbers that can help you locate a treatment center include:

National Drug Help Hotline 1-800-662-4357 National Alcohol and Drug Dependence Hopeline 1-800-622-2255

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Breast Changes During Pregnancy

Posted by on Nov 14, 2014 in Blog Posts

Breast Changes During Pregnancy

From the beginning of your pregnancy, there are breasts changes you
should expect. These breast changes are normal because they are evolving
and preparing for the arrival of your baby.

What breast changes during pregnancy can I expect?

There are a number of breasts changes during pregnancy that you should
expect. These pregnancy related breast changes include the following:

Growth and enlargement
Tenderness and hypersensitivity
Darkening of nipples and areolas (the skin around your nipples), due to
hormones that affect pigmentation of the skin
Darkened veins along your breasts (due to increased blood supply to
your breasts)
Your breasts may start leaking a yellowish, thick substance known as
colostrum
Nipples stick out more; the areolas and nipples will grow larger
Small glands on the surface of the areolas called Montgomery’s
tubercles become raised bumps
Your hormones are the cause of these changes and you may experience some effects more than others.

How can I handle pregnancy and breast changes?

Here are some helpful suggestions you can do to make some of these changes more comfortable and easier to manage.

Growth and enlargement: For some women this may be something to look
forward to, as you are excited about your breasts getting bigger. For women
with large breasts there may be less enthusiasm. Buying a good supportive
bra can help. If your breast size increases greatly, you may want to sleep in
a cotton supportive sports bra at night.

What to look for in a bra:

Good support
Deep band beneath the cups
Wide shoulder straps
Adjustable closure (back-fastening bras give you more
flexibility to adjust than front-fastening bras)
Avoid underwire bras
Sensitive and tender breasts:Hormones in your body are preparing your
breasts for lactation.The milk ducts are growing and being stretched as they
fill with milk early in pregnancy. All this causes your breasts to be more
sensitive, particularly your nipples.This can be a bonus for your sex life or
can cause you discomfort.

Colostrum:This is known as pre-milk, which is a sweet and watery fluid that
is easy to digest.During your second trimester your breasts will begin to
produce colostrum. Colostrum appears thick and yellow at first, and as birth
draws near, it becomes pale and almost colorless. Colostrum will provide
your baby with his first few meals before your milk comes in. Discharge may
occur at any time, when your breasts are massaged, or when sexually

stimulated. There is no need to be alarmed when this happens, and there is
no need to worry if it does not happen. Women who do not experience
discharge in pregnancy still produce and provide milk for their baby.

What about breast cancer?

Continuing with self-breast exams during pregnancy is important.
Unfortunately, during pregnancy it is more difficult to accomplish because of
all the changes your breasts are going through. Your breasts are growing in
size, are tender, and sometimes may even be lumpy due to all the
preparations for your baby. It is still important for you to examine your
breasts during pregnancy every 4-5 weeks.

Very common lumps found among women during pregnancy are clogged
milk ducts. These are red, tender-to-the-touch, hard lumps in your breasts.
Warm compresses (running warm water over your breasts in the shower or
applying a warm wash cloth) and massage will probably clear the duct in a
few days. If you are unsure of any new lump, tell your doctor on your next
visit. Keep in mind breast cancer is rare among women younger than 35.

If you are planning on having a baby and are over the age of 35, you may
want to consider asking your doctor about a mammogram before you get
pregnant.

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