Vitalab - Q & A - Q & A Page 4

DAY 3 Tests

Measuring Unit

Lab Reference range

Average value in normal population

Average value in infertile population

Considered Very Low in infertile population

Considered Very High in infertile population

17B Oestriadol

TOPIC: ZIFT/GIFT

When is GIFT or ZIFT the better treatment option as opposed to normal IVF? I always thought that GIFT / ZIFT was 'old fashioned' but I see some doctors still seem to prefer doing it as first option rather than IVF. Why would a doctor choose to do a GIFT vs an IVF?

GIFT and ZIFT were how artificial reproduction got off the ground many years ago. It was done purely because in those days, the quality of the laboratories were poor and did not match the intra uterine environment, i.e. embryos did poorly in that environment. However, as the years went on, the laboratory environment improved substantially in leaps and bounds to the point that today, there is very little difference between the uterine and laboratory environment in the first 5 days of embryo life. For that reason GIFT and ZIFT fell out of favour, and unfortunately the art of performing the procedures as well. There are however, still circumstances where GIFT or ZIFT might be a better option for the couple than routine IVF. These would be couples who have had multiple IVF failures for no apparent reason, couples whose embryos repeatedly fragment in the incubator due to the stress of being handled on a daily basis and older women over the age of 41. It is therefore indicated mainly in the poor prognostic group of patients.

TOPIC: ENDOMETRIOSIS RELAPSE

I had stage 2 endo removed last year aug. I had 2 IUI's done. 2nd one succesful but ended in m/c. My AF has arrived but my timing regarding work is really bad at the moment. Will my chances of falling pregnant decrease if I wait until May to try again? Will endo have grown back by then?

The recurrence rate of endometriosis is largely dependent on the quality of the surgery. If excised completely, the recurrence rate of stage 1-2 endometriosis is less than 20% over a period of 5 years. Therefore, if your endometriosis was excised completely, you should not have to worry about recurrence until approximately 18 months post surgery.

TOPIC: INTERCOURSE AFTER TREATMENT

Should couples abstain from intercourse during their 2ww after any treatment (while waiting for a beta) or does this only apply to IVF and if so, what is the reasoning behind abstaining?

There are no hard and fast rules regarding abstinence or intercourse during these time periods, and definitely not during intercourse or insemination cycles � in fact the more often in these cases the better. During IVF however, we prefer abstinence during the 2 weeks following the embryo transfer in order to theoretically give the attempt the best chance of success. There is however no scientific evidence that this makes any difference at all to the ultimate outcome and is possibly more psychological the scientific.

TOPIC: EMBRYOLOGISTS

I am interested to know How important the role of the laboratory and embryologist during an ivf are, would it differ from clinic to clinic, or is the training the same and laboratory conditions due to strict law regulations all of the same standard?? (basically can you have a semi-crap lab and we all blissfully unaware?)

Unfortunately, unlike the U.K. and other developed countries, there are no set standards in South Africa and no body to enforce such requirements. It is therefore very possible to have a substandard laboratory and be unaware of it. Theoretically all embryologists must be trained and there is a very steep learning curve. Studies from the USA have shown that in order to be current and up to scratch, embryologists need to do in the vicinity of around 120 cases per year. Furthermore, there are very definite requirements for the laboratory in order to function at an optimum level. Things like air quality, airflow and management, incubators, temperature, lighting etc are all very important factors when it comes to embryo quality and pregnancy and take home baby rates.

TOPIC: IMPACT OF SEPTUM IN UTERUS

I�ve had a large number of recurrent miscarriages, which I was told to be due to genetic issues, a recent HSG at Vitalab revealed the presence of a septum in my uterus. Can a partial septum really play such a huge roll in recurrent mc's and what is the proximate success rate of pregnancy's (and live births) after the septum is removed?

Uterine septae are a documented reason for recurrent miscarriages and preterm labour. way In order to manage recurrent miscarriages successfully, one has to exclude ALL possible causes systematically , one by one and correct any abnormality that might be pregnant. The prevalence of uterine septae is around 3 % in the general population and there are many patients, unaware about the fact that they have a septum in the uterus that go on and have one successful pregnancy after another. However, there is also the group the have one bad outcome after another, and after having the septum resected and all other causes excluded that then go on and have a successful pregnancy - difficult to put an approximate number to this though. I guess that what I am trying to get across is the fact that ALL possible reasons should be dealt with BEFORE attempting another pregnancy.

TOPIC: BED REST AFTER ET

Is there a benefit to bed rest after embryo transfer?

Unlike popular belief, there is absolutely no evidence that bed rest after embryo transfer makes any difference to the outcome at all and is a myth. There are in fact a few studies proving the contrary.

TOPIC: INFERTLITY BLOOD TESTS

Every woman in infertility treatment eventually gets tested for:

17B Oestriadol
FSH
LH
Prolactin

AMH

The reference range of the mentioned tests do differ from lab to lab, depending on the assays used and units used to express the findings. When looking at results, one therefore has to see the complete picture. Hormone profiles, from an infertility point of view , only have meaning when done on day 2 or 3 of the menstrual cycle. Outside of this window period, the results have no significance at all. From that point of view the following is of significance:

1) 17B Oestradiol - Less than 200

2) FSH - Less than 10

3) LH - Less than 10

4) Prolactin and thyroid within the normal range of the laboratory used

5) In our clinic AMH levels of 1.1 and above would be in keeping with a fair to good chance of success.

Very little information is available on these results, especially from South African sources. We understand that values can differ from lab to lab, but could you possibly give us reference values according to your own lab (Lancet - Vitalab) to help us understand our results better?

TOPIC: PCOS - FREE TESTOSTERONE

Many sources that I have studied mention free testosterone as a measurement tool for PCOS. As a patient at Vitalab, why is this hormone not tested? Is it not regarded as useful indicator? Could it not be a useful tool for monitoring progress in diet and exercise programmes for the improvement of PCOS?

When assessing a PCOS patient, the aim is not to perform as many blood tests as possible at an astronomical cost, but to rather perform a blood test that will help with diagnosis and management. The uniform impression is that current available direct assays for testosterone have limited value in the evaluation of the PCOS patient, and that there are better ways of evaluation e.g. the free androgen index. The only area that testosterone measurement might be of value is the monitoring of testosterone producing tumours. There is no place for the measuring of this hormone level in diet and exercise programs. The best way of monitoring is the measurement of body mass index. ( BMI )

TOPIC: EXERCISE & TREATMENT

Exercise is recommended for the improvement of PCOS. During infertility treatment, how do I know that I�m not overtraining? Can I jeopardise my treatment by pushing too hard? Could 1hr 3 times per week have a greater negative than positive impact? How do I monitor my training for best outcome?

1 Hour 3 times a week is perfect. Overtraining is highly unlikely as long as one remembers that anything in EXCESS is usually bad.( i.e.� pushing too hard� can be bad) Different people have different thresholds and the best way to ensure that you are not overtraining is to have professional supervision in the form of a fitness coach. The best way of monitoring is to strive to reach the appropriate BMI and then to keep it there.

TOPIC: BICARB RECIPE

The question on Bicarb for the improvement of Hostile Cervical mucus has been asked before. How would one go about preparing the mixture? 10ml on 200ml water? Recipe please?

2 teaspoons of bicarb in 200ml of luke warm water douched 3-4 hours before intercourse, around the time of ovulation.