Innovation and Intimacy at Main Line Fertility Center
Interview with Sharon H. Anderson, PhD, HCLD; Michael J. Glassner, MD; and John J. Orris, DO, MBA
Main Line Fertility Center, Bryn Mawr, PA
Main Line Fertility Center has been serving the needs of men and women requiring fertility services in Philadelphia and its surrounding area for more than 20 years, with a commitment to providing the most up-to-date fertility techniques and innovations in patient care and preserving the patient–clinician intimate interaction. Infertility & Reproductive News asked Drs Anderson, Glassner, and Orris to describe their approach to infertility care.
Q: What motivated you to open your fertility center?
We founded our center in November 1998 to pursue our commitment to Continued on page 10 high-quality patient care for people with fertility problems. Our center has become the largest fertility program in Pennsylvania. We emphasize individualized care, without losing the intimacy of the doctor–patient relationship. We have a dedicated team of nurse practitioners who help to maintain the care continuity.
In addition to dealing with the aspects of medical treatment, we also focus on the emotional well-being of the patient throughout the fertility treatment process. In our practice, we never overextend ourselves. We maintain our integrity at the core to stay strong in all aspects. We do not gamble with trying to become something that we are not.
We serve the Main Line area in the greater Philadelphia region, but we are attracting many new patients from outside the area via our website. We pride ourselves on proactively pursuing new and innovative technologies to be the first to introduce them in our region. We are most proud that our center has grown. We have diligently kept up with staffing our center with people who are kind and caring, and who understand the importance of what we do. Patients come because they do not feel like they are a number.
What are some of these technologies and innovations?
We had the first program in the area to do array comparative genomic hybridization (aCGH) testing, which is generating tremendously improved pregnancy rates. Doing the aCGH allows us to study embryos for aneuploidy and improve our success.
We perform a day 5 blastocyst biopsy for aCGH, followed by a day 6 fresh embryo transfer, which has led to excellent pregnancy rates compared with the conventional day 3 embryo biopsy. We also are doing a preimplantation genetic diagnosis (PGD) study to see if PGD of embryos improves pregnancy rates. In addition, we work with the Tay Sachs Foundation and with the Fragile X Foundation to assist people in preventing propagation of genetic diseases through the use of PGD.
As a private institution, we have been able to pioneer certain technologies, such as the egg-freezing program, which now is branching into creating a frozen egg bank, similar to the frozen sperm bank. The frozen egg bank cuts the price of fresh donor egg by almost half. Furthermore, just as fresh sperm insemination using donors is restricted by the US Food and Drug Administra tion, we believe the same restrictions will eventually be applied to the egg bank.
We also take pride in our pro bono work with the Children’s Hospital of Philadelphia (CHOP), where we are actively involved in fertility preservation for young men and women who have cancer.
Could you elaborate on your work with fertility preservation?
We work with oncologists at CHOP, and treat young male patients who are diagnosed with cancer and wish to preserve their sperm. This is done with little or no fee to the patient, with the hope to provide them the ability to procreate later in life, once their cancer treatment is over.
For the boys, we simply freeze their sperm. They have to reach puberty and to be able to generate sperm, which is the one limitation.
As far as fertility preservation for women, if the patient is old enough (again at puberty), we do controlled ovarian hyperstimulation to extract their eggs and freeze them through vitrification. If the patient had at least one period, we can stimulate the ovaries and extract eggs from her.
How do the kids react to the fertility preservation process?
It is a little scary for them, but the hospital offers very good education for fertility preservation. They offer excellent emotional support to the parents and the children to provide them the confidence they need to proceed with the procedures. Our goal is to bring normality to their future, which we hope will allow them to have a genetic child of their own. It is one of the best things one can do to give back to society. The experience they had battling cancer, overcoming it, and then having offspring, is going to make them excellent human beings in the way that they conduct themselves and give back to society.
We do a great deal for women undergoing treatment for breast cancer, such as the removal of their ovaries. When they are scheduled for chemotherapy or radiation, we make every effort to get the patient in to our clinic the next day to set up a treatment plan to optimize their chances of fertility preservation. We are not freezing ovarian or testicular tissue. We are on the front-lines of retrieving the oocytes and the sperm, so that they can be used at a later date.
What have you learned from your work with young people with cancer?
It has made us realize the importance of fertility awareness for youth. It is our thought that young people should take the time to have a reproductive health physical. Having this information about one’s personal health has an advantage down the road when they want to achieve pregnancy. Understanding their reproductive health today will allow young people to proactively address any potential problems in the future. Most insurance companies will cover a reproductive health physical to validate one’s fertility capacity.
We recommend that young men and women in their late 20s or 30s do a reproductive health physical, because the majority of people we know that would contemplate getting pregnant are in that age range. We also see a second tier coming in their late 30s, but it is beneficial to get a reproductive physical in the mid- to late-20s.
What does a reproductive physical include?
In men, we would look at the use of anabolic steroids and the use of medications that could compromise sperm function. Men are taking medications to reduce androgens, treat hair loss, or men who have had trauma to their testicles, and those who have had inguinal hernia repairs or have had undescended testicle surgery as a child.
We see many problems with kids, who had undescended testicles or inguinal hernias when they were infants and had surgery, with compromised semen parameters. This can be identified, proactively, through a simple semen analysis. Having chronic diseases later in life, including diabetes, hypertension, or being overweight, could affect their fertility. So, a man may want to find out if he has low sperm count in his 20s, and this is all covered by insurance.
For women, it will be helpful to see evidence of endometriosis in a woman who is 25 years old, or a uterine fibroid that is small. She will eventually need more surveillance than a manual examination. Anyone with a tubal occlusion should undergo a laparoscopy to find the reason for that and not be surprised when she is 36 and wants to have a child.
A good history and physical examination, as well as a few cost-effective blood tests, will give them insight into their reproductive potential and if needed, do things that will preserve their reproductive potential.
Your center is also involved in clinical trials. What do you hope to achieve by that?
The state of the economy and our desire to be academically competitive has led us to partner with many organizations and companies with meaningful clinical trials that will afford patients the ability to participate in trials and undergo procedures that are more advanced and often prohibitive from a cost perspective for many individuals. This is a win–win situation. We serve to advance science, accumulate knowledge, and improve our field. At the same time, it opens the door for patients who could not afford assisted reproductive technologies on their own.
We are involved in several clinical trials, which also help us to reach success in pregnancies that would have otherwise not been possible. We are currently participating in an international, multicenter trial in which we are looking at substances found in follicular fluid, substances secreted by the embryos or the cells around the eggs to see if they are associated with embryo quality.
Some of our current studies offer free or highly discounted fertility medications which, in turn, helps the patient and is also an incentive to participate in the trial. All studies at Main Line Fertility Center are approved by an Institutional Review Board and patients have given their consent voluntarily knowing that they may withdraw at any time. We have been awarded a grant to study the effect of egg vitrification on embryo development. We are also involved with a national multicenter PGD study. The study is looking at the impact of PGD on implantation rates and pregnancy rates after selecting the genetically normal embryos for transfer.
We have published many articles and studies. In a competitive marketplace, one is either a leader or a follower. Being a follower can lead to losing sight on what is new and exciting in the field. And the pregnancy rates suffer from that. In addition, patients are quite knowledgeable these days, and they know who is at the top of the field.
We believe it is our duty to know what is right and good, as well as to be able to answer any patient who asks, “Why do you not offer this service?” and explain our reason. If we believe a technique or a procedure is beneficial, we offer it.
Is IVF your primary focus?
Yes, our main focus is on in vitro fertilization (IVF) technologies. We do the standard IVF and intracytoplasmic sperm injection (ICSI). What sets our program apart is our active egg vitrification program. We also do blastocyst biopsy with aCGH, which is a form of PGD. After we biopsy or remove cells from a blastocyst-staged embryo, the biopsy is tested for aneuploidy, which helps us to select the normal embryos for transfer. In addition, we have a special laser at our center and the highly trained embryologists needed to perform blastocyst biopsy.
The advantages of the blastocyst biopsy are that we can biopsy more cells and it is less stressful to the embryo. We have seen a very significant increase in our pregnancy rates with the use of blastocyst biopsy and aCGH.
Blastocyst biopsy and aCGH allow us to select the chromosomally normal embryo for transfer, and thereby minimize the chance of multiple gestations. We have been using this procedure for about 1 year now. Many clinics are not able to offer this cutting-edge technology, because of the high cost of the equipment and the lack of fully trained embryologists on staff who can properly perform blastocyst biopsy.
In addition, if we have several highquality blastocyst embryos that are chromosomally normal, we have a blastocyst vitrification protocol with very high survival rates. They can remain cryopreserved just about indefinitely.
Another thing that is new at our center is the impending launch of an egg bank. We can freeze or vitrify eggs from screened donors. Then we have an immediate availability of frozen donor eggs for infertile couples. With an egg bank there is no need to synchronize the recipient cycle with the egg donor’s cycle. We simply prepare the recipient’s lining, thaw the donor eggs, perform ICSI to fertilize them, and then perform an embryo transfer. This reduces the wait time for the recipient couple, which could be up to 1 or 2 months at other centers.
What is your pregnancy success rate?
Our current success rate is significantly higher than the national average. It has increased as a result of the new technologies and the dedication of our entire team. One thing we do differently is individual embryo culture, as opposed to group culture. We culture each embryo in individual drops of culture medium and then evaluate each one daily. When we select embryos for embryo transfer, our decision is based on each embryo’s individual developmental progression during the 3 or 5 days in culture.
Your center is involved with the Puah Institute. What is it and how is it linked to infertility?
There are certain halachic (ie, Jewish law) restrictions based on the Torah on what can and cannot be done in terms of reproduction. For many observant Jews, certain levels of technology were unavailable, because it was breaking halachic law. Puah is centered in Jerusalem.
We were the 13th center in North and South America to be approved by the Puah Institute in Israel. This required certain adjustments in the laboratory, such as having someone trained by Puah at the laboratory when a sperm sample is given, to make sure that the sperm is carefully labeled, and that no other sperm sample is processed concurrently. These trained personnel also have to be present in the embryology laboratory during egg retrieval to ensure that the eggs are the patient’s eggs, and to make sure the husband’s sperm is used.
Next, we have to place the embryos in special lockboxes in the incubator. The next morning the Puah representative comes and makes sure the lockbox was not disturbed, so that no embryos were mistakenly put in there. It in volves much education of the staff, and it cannot be done on Saturday. This has allowed us to provide treatment for rabbis from the Chabad community in the United States, Canada, and Europe. We have also had some non-Jewish couples ask for the Puah supervision, for an extra set of eyes making sure that everything goes well.
What are the biggest challenges and rewards for your center?
In terms of challenges, it is upsetting that we cannot help everybody. We try to treat anyone we can, especially in this tough economy. Pennsylvania does not have a mandate for infertility treatment. We have to be creative with ways to help people who could otherwise not afford fertility treatment. We must pay attention to the psychological disposition of our patients to do a good job.
The biggest rewards are seen in our community. Although the community is very spread out, there are not many degrees of separation between people who know a doctor from Main Line Fertility Center, because there is somebody who has a friend or a family member that we have treated. We know our community. We meet people at our kids’ schools, and we know we are responsible for helping many of those parents and teachers achieve pregnancy. That is very rewarding.
To see the impact we had on patients’ lives makes us more driven to keep putting out not only a good technological product, but also a good people product, where we are emotionally invested in each individual’s treatment. Valuing family puts an intrinsic pressure on us to create families. If you love family, you are going to go that extra mile to deliver for your patients.