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August 22, 2016 Blog0

When 45-year-old Cara Lyons found out she was pregnant after undergoing IVF at Barbados Fertility Centre, there were no big hurrahs or grand celebrations. Instead, she and her husband, Mike, remained “cautiously optimistic.”

They had been down this road before. The couple – she is of Afro-Caribbean descent and he is Caucasian American – had suffered a heartbreaking miscarriage in 2014 and had been through cycles of intrauterine insemination and IVF in their home state, California, as well as in Prague, Czech Republic.

In Prague, the couple had a bunch of staggered egg retrievals with the hope that some would be good enough to be fertilized. But the process took the mixed race couple down another rabbit hole; the tests revealed a lot of chromosomal genetic issues with Cara’s eggs. Using donated eggs to start their family was an alternative worth considering.

“Here in the US there are not a whole lot of donors of colour so for every 100 Caucasian donors there were just a few African American or black Caribbean donors. When we began our donor research, I was impressed with the fact that Barbados Fertility Centre (BFC) had such a vast network of donors, people, who look more like me,” said Cara.

Dr Juliet Skinner, Barbados Fertility Centre’s medical director, knows it’s a big jump for a couple like the Lyons to go from recognising they need fertility treatment, to being prepared to use donor gametes but the fact is there a real need among women who cannot become pregnant using their own eggs, and an even a greater one among couples of Afro Caribbean/ American descent or even mixed race couples.

“There are many women, older women, who for a variety of reasons (lack of money, lack of partner, lack of interest, lack of partner’s interest) didn’t have children in their biological prime and there are also many younger women with non functioning ovaries who are unable to get pregnant,” says Dr. Skinner.

“Because of our location and our reputation for rigorous adherence to ethics and the medical protocols associated with egg donation, we are fortunate to have a robust egg donation programme that has afforded many couples of varied ethnicities the ability to become parents.”

After Cara’s and Mike initial consultation with Dr. Skinner, the couple’s resolve was strong. “I felt like BFC did everything with due diligence and extreme care, that they had already pre-screened the donors and had done all the necessary blood work and history checks. I felt confident in their hands because of their reputation.”

Dr. Skinner identified some immune issues and put the couple in touch with the Alan Beer Institute in California, so they were able to tackle some immune issues before heading to Barbados where they underwent a successful cycle of IVF. “Had Dr. Skinner not spotted that and have us tackle the immune issue, I don’t think we would have had success.”

The Lyons’ first trimester were anxious months; hope and fear did a tango in a dance where it was not always clear which would win. “It was only after the first trimester that I felt like I could breathe a little, find release and not be so worried.”

Hope won.

Quincy Lyons was born on July 11th in Berkley, California. “He’s amazing,” gushed the new parents. “It’s like having a unicorn in the room. It’s magical, it’s surreal.”

The Lyons still have three embryos already frozen at Barbados Fertility Centre and the possibility of the future does not escape them. “Right now Quincy is the only unicorn. Whether we have more unicorns or not, we’ll have to see how things go. We’re flexible. “


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August 8, 2016 Blog0

Some month ago we have launched a campaign #startasking but what does asking really mean? What does it involve?

Asking is the first step of a process of understanding why you are not getting pregnant and this process can take many different roads and bring you to totally different conclusions.

When couples first start thinking about seeing a doctor, because they are having difficulties conceiving, often they hesitate about going to a fertility specialist & IVF clinic as this is mostly because they aren’t yet ready to acknowledge they may have a problem and definitely not ready to consider IVF treatment.

To help ease this concern I want to try and explain what is involved in an initial fertility assessment and how the doctor works with you to develop a personal treatment plan that suits your specific case.

Your fertility specialist will take a medical history and based on that will prescribe some tests for both partners to identify the factors that could be affecting your fertility.

The specialist will also advise you on the impact of any other health problems that you have and how they can influence your fertility.  For some couples simple attention to their health and diet may be all that is needed.

For women generally the initial step is to have a blood tests to check your egg reserve, hormonal balance, infections and a specialised ultrasound to check the condition of your fallopian tubes, uterus and ovaries (HyCoSy). For men, as well as blood tests to assess infections and fertility hormones, the principal investigation is a semen analysis to check the quantity, motility and morphology of sperm.

Your fertility specialist will then explain your test results and go through the possible reason as to why you are having difficulties conceiving. The specialist will then advise you on the treatment options available for your particular fertility issue as well as your possible chance of achieving a successful pregnancy, either naturally or with each assisted reproductive treatment.

If there is a problem in the uterus such as fibroids or polyps or an ovarian cyst, it may be that surgery will be the right approach and able to solve the problem without requiring any further fertility treatment.

If the problem appears to be a difficulty with ovulation as in PCOS (polycystic ovarian syndrome), taking medication to induce ovulation can increase the chance of conception through timed intercourse and in many patients this can be a very effective treatment. In cases of minor sperm abnormalities Intrauterine insemination (IUI) or artificial insemination, can be the most suitable treatment. IUI involves inserting the male partner’s prepared sperm into the uterus close to the egg at the time of ovulation.

IVF is only offered as the first line of treatment for infertility only in limited and clear cases as severe issues with the male partner’s sperm or the woman has both the tubes blocked or removed or in some cases when the women is over the age of 40.  IVF treatment may also be recommended if you know or suspect a genetic condition or chromosomal abnormality and want to test the embryos and transfer only those embryos without the condition.

The message of this blog I want to be to you is,  “Do not be afraid of asking”, burying your head in the sand does not make the problem disappear and can lead to a long delay in diagnosis, worsen the problem and finally decrease your chances of success.

At BFC, our fertility specialists are here to support patients by giving them all the facts and options, then helping patients to make the right decision for them. We will work with you to develop a treatment plan that you’re comfortable with and this normally means starting with some simple treatments and moving towards the more complex treatments over time, but only if necessary.

And remember that ultimately, the final decision and the best choice about how you proceed is only yours. #startasking

Dr. Roberta Corona


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August 7, 2016 Blog0

Failure after IVF can be devastating for many couple. A cycle of IVF requires work, effort, money, and most of all generate hope, hope for success that results in having a healthy beautiful baby in your arms.

So, when IVF fails, it raises the question of why? Why did not work with me? What I did wrong? Sometimes, there will be a clear reason but often there is no direct answer. And this again can be very frustrating for the couple, and believe me, for the doctor as well.

Let`s try to make things clear. First of all, it`s NOT your fault and, unless you injected your husband instead of yourself (☺), you did not do anything wrong. A successful pregnancy requires 3 main things: a capable embryo, a capable uterus and immune acceptance. And most probable a myriads of small things in between that unfortunately we are not able yet to fully understand.

There are though still many factors that we can identify and in most of the case treat.

In this your fertility specialist`s experience is critical when faced with a failed IVF, to try to determine the reasons. Approaching the answer to this question requires evaluating all the multiple aspects of the IVF process in an attempt to define where something went wrong and how to correct it and personalise a further cycle enhancing the chances of success. An IVF cycle it is obviously a treatment plan but it is also, and that is what most of the couple do not appreciate, a very potent diagnostic tool from which the doctor can gain a variety of data very useful in the process that will lead to a precise diagnosis and finally to a successful cycle.

And then of course, there will also be those sad cases of multiple failed attempts, when the couple but especially the doctor will need to face reality and say “it is time to close the door”.

Dividing the world of IVF into the world of the embryo, the uterus and the immune acceptance offers a starting point and an easy way to approach the problem.

Don’t Judge the embryo by its Cover.

The world of the embryo requires a normal sperm and a normal egg to meet, to mix and then equally separate the genetic material (chromosomes) and then start dividing into a new embryo. These embryos will continue to develop and on day 3 or day 5 will be selected for embryo transfer.

Many human embryos can appear perfectly normal under the light microscope on day five and yet have the wrong number of chromosomes. For example, as many as 90% of all normal looking embryos from a women in her 40s will have the wrong number of chromosomes, while the abnormal embryos will be only 25-30% in a women in her early thirties. The most common cause of this problem is age.

Repeated attempts at IVF will not correct this problem but of course multiple cycles and embryo transfers will increase the chance to find the “good one”. Fortunately, recent advances in technology can be used to reduce the number of embryos transferred with the wrong number of chromosomes. The use of preimplantation genetic screening (PGS) allows us to determine with very high reliability the actual chromosome number of an embryo which has developed to the stage of blastocyst.

Using data from the literature, we see that transferring an embryo with the correct number of chromosomes result in delivery rates as high as 60%, and may actually go higher. However, still not all transfers result in a live birth. So the question remains – WHY?

The problem must be then somewhere else, although it is important to understand that is possible that there are other genetic issues with the embryo that are not detected by PGS, and for the time being, these abnormalities will remain undetectable.

The Uterus and Recurrent Implantation Failure

The uterus is the place where the pregnancy start and is kept until the delivery. It is therefore  fundamental that the uterus is functioning properly so that the embryos could implant and develop. Uterine malformation, presence of fibroids in the muscle of the uterus or presence of fibroids and or polyps in the endometrial cavity can affect uterine functionality and impair implantation. For the same reasons implantation may occur but the pregnancy may end in miscarriage. A full evaluation of the uterus and the uterine cavity by SIS, HyCoSy orHSG is mandatory before proceeding to IVF. And in case of failure a diagnostic hysteroscopy (looking inside the uterus with a scope) may be indicated.

The endometrium is the tissue lining the uterus, which gets thicker during the cycle until it reaches the optimum thickness for implantation following ovulation. While shape and thickness are very important, the receptivity of the endometrium is a crucial factor in determining the success of IVF treatment.

The endometrial receptivity is the status in which the endometrium is ready for embryo implantation to take place and it is also called window of implantation. This occurs normally around days 19-21 in each menstrual cycle of a fertile woman.

In some couples who have recurrent implantation failure, it may be that the window of implantation is displaced either back or forward a few days.

Again advancement of science can help us to diagnose a receptivity problem thanks to the development of a specific test called ERA (Endometrial Receptivity Array). The ERA test involves taking a biopsy of the womb-lining and analysing the genes of this tissue taken on the day of “normal” receptivity”. The biopsy procedure is simple, fast and performed in clinic in a similar procedure to an embryo transfer.

“My uterus is perfect and the embryos are genetically normal, so WHY am I not pregnant yet?”

When recurrent miscarriage occurs after natural conception, or for patients who undergo IVF with a capable uterus and repeated excellent quality embryos transferred and yet have no success, other factors must play a part.

Reproductive immunology is a field of medicine which studies the interaction between the immune system and reproductive organs. Research has suggested that during a normal pregnancy, a unique type of immunity occurs that stops the body rejecting an embryo as a foreign body and aids the growth and development of the foetus. If this immunity does not work properly, embryos may not implant or may be rejected early after implantation. A number of important components of the immune system have been recognised as key players to successful pregnancy.

Those women at high risk of more profound immune factors such as women who have an autoimmune disease or who have a history of repeated failed IVF, recurrent implantation failure or pregnancy loss, should undergo to a comprehensive investigation panel including antibodies, cytokines and Immunophenotype assay. The results of the immunological panel are careful analysed and interpreted to choose a personalised therapeutic protocol that more efficiently targets the underlying immune component.

In conclusion…

Infertility is not a curse but a disease and many times, a cause can be determined. A failed cycle, that it seems a tragedy at first can sometimes be the key to understand the real problem. Based upon the findings, recommendations can be made as to how best approach the diagnosed problem and reach our goal.

DO NOT GIVE UP!


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August 6, 2016 Blog0

Today I made the decision to give it another try.

I am signing up for another half marathon.

As the months have ticked on in 2016, I knew the day was going to come when a decision would need to be made. I have really struggled with this over the past few months and intentionally abandoned all training that would be associated with a goal of this nature. I haven’t even been back to my running group since the last race. I was a rebel with no cause.

In the past month, I have viewed this decision like a Fabergé egg on the shelf. I have picked it up, turned it around and mused the thoughts associated with it – every time I put it back on the shelf.  Each time I went to that place, I remembered the struggles of last year. I remembered the physical struggle, the needles needed to release the muscles in my calves, the weekly physio appointments, the 4 am wake up calls and all the decisions that come when you lock in a goal like this impacting your physical, emotional and social life. Did I really want to do this again?? There was a fight going. It was my head vs my heart… then I read the following quote…

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Last year I grew as a person in those training months. I went through some tough person moments but I came out the other end stronger and more dedicated to my personal growth than ever before.

As I remembered those training days I realized I was focusing on the negative on the experience and not the amazing positive one. It was time to flip the coin over. On Saturday morning I decided to try a 10k, the longest distance I have done in months. As I opened my eyes that morning I saw a text from a friend encouraging me that I could achieve anything I put my mind to. I took his advice and when it got tough I pushed forward. Finishing that run on Saturday I went back to the shelf and looked back at the decision of not running these long distances anymore. I picked it up and there was no more fear- it was time. I could do this.

The crazy thing is that sometimes the unknown can be a blessing because you really have no idea what you are getting yourself into. The second time around, the battle loses some of its shine and is a bit more daunting, the hope glass is cautioned full to the mid-point. You know the highs and you know the lows but somewhere in your heart there is that little voice that whispers to try again against all reason, because this time, this time you just might get what you have been waiting for.

So the decision is made and I am dedicating this race to all of my patients to whom this is not your first round of IVF and you know, just as I do, that it is the possibility of success that is pulling us forward. Will it be easy, no, will it be worth it – absolutely!

Join me for the next few months as I start my training and we will run this race together side by side -we got this! Time to lace up!

Rachel


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May 27, 2016 Blog0

Her voice quieted, her tone turned serious, she leaned in and she asked three words I had not been in the presence of for a very long time… “How are you?” she asked. I took a long deep breath and the gates opened.


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April 26, 2016 Blog0

“Let’s do a hike!” she enthusiastically said. “Hmm….a what??” I thought. We were supposed to go for a run but my running partner was changing the game plan at the last minute


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April 26, 2016 Blog0

This week is National Infertility Awareness Week and we encourage our patients to ask questions. Here are some questions that should be answered by your Embryologist and clinic when going through IVF.


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April 24, 2016 BlogNews0

#StartAsking is the theme for this year’s National Infertility Awareness week, which runs from April 24th to April 30th 2016. In support of all of our patients that are suffering with infertility, we encourage you to watch these amazing video’s from our previous patients who were brave enough to ask questions and leave their home country for successful IVF in Barbados.

https://youtu.be/YyVrz00WqUw
https://youtu.be/cQHqYohfiME
https://youtu.be/rPJ1JVh1wEE
https://youtu.be/VQNrPo6x3Y0


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March 16, 2016 Blog0

Dr. Juliet Skinner, Medical Director at Barbados Fertility Centre blogs about Endometriosis

Endometriosis is a common condition, affecting over 7 million women in the USA. It is a common cause of pelvic pain, and unfortunately a medical condition which is associated with huge implications for fertility. While clinically diverse, it is generally progressive and over time significantly reduces ovarian reserve for women. This reduction in ovarian reserve can be even at a young age. For the majority of women diagnosed with endometriosis they are likely to need in-vitro fertilisation (IVF) to conceive. Even with IVF, women with endometriosis will produce fewer eggs due to the reduced ovarian reserve, and may make fewer good quality embryos. This may lead to lower success rates compared to other women with different causes of infertility, at the same age.

Time is crucial for women with endometriosis, particularly if the severity is high, such as stage 3 or 4. Interestingly pregnancy itself is very helpful and actually often improves the level of endometriosis!

However, in event a woman with endometriosis is not ready to be pregnant and have a baby at that point in her life, the latest medical advice is that she should consider elective egg freezing. This treatment is now being done by many women, as freezing eggs at a younger age offers security against lower fertility due to egg number or quality, which occurs as a woman ages. For a woman with endometriosis and a markedly accelerated impact of age, the benefits are even greater.


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