Paraplegic Man Conceives Twin Girls After Sperm Extraction

April 24, 2013
ABC News

Raul Rodriguez of Camarillo, Calif., has been paralyzed since a 1997 car accident when he tried to pass a truck on a canyon road. His car spun out of control, slammed into a large tree and landed upside down in a creek. An athlete before he became wheelchair-bound, Rodriguez, then 24, bounced back quickly. Six months out of the hospital, he was water skiing, and in 2004, he found love and got married.

Because the injury in his spine was low, on the T-5 vertebra, Rodriguez can get an erection but cannot ejaculate. So his doctor told the couple they could never have children. Rodriguez said he was told, “Sorry, your best bet is to look into adoption or a donor — that’s it.”

That doctor was wrong. Today, at 39, Rodriguez and his wife, Maria Angelica Rodriguez, or “Angie,” are expecting twin girls. It’s all because of a procedure called testicular sperm extraction, or TESE.

Rodriguez said he feels as if he has been “reborn.”

“They are having twins — It’s a miracle,” said Dr. Philip Werthman, director of the Center for Male Reproductive Medicine and Vasectomy Reversal in Los Angeles, who performed the procedure. “Here is a guy who lost everything, and for whatever reason, he was told the wrong thing,” he said. “They took away all his hope.” During this week of National Infertility Awareness, Rodriguez’s story should bring hope to many couples who may have thought they could never have children.
“I have spent my career dedicated to … countering misinformation and rumors and old wives’ tales about fertility,” said Werthman. “Many people are denied the hope of reproduction, even though it’s technically feasible.”

Rodriguez was diagnosed with anejaculation, meaning he wasn’t producing enough ejaculate because of nerve damage, and nonobstructive azoospermia, meaning he had no measurable levels of sperm.

“He had sperm, they just weren’t very good,” said Werthman.

In a 30-minute office procedure, Werthman removed a piece of testicular tissue through a 2-inch skin incision, which requires nothing more than a small Band-Aid afterward. The tissue is placed in culture and morseled into tiny pieces, which liberates the sperm so that it can be extracted. The sperm can be used for insemination right away or frozen for later use. Despite Rodriguez’s paralysis, erection is still possible because it is controlled by a separate division of the central nervous system than his leg movement. “No one is exactly sure why in many men who have a spinal cord injury the sperm quality deteriorates after the injury,” said Werthman. “It may well be, sitting in a wheelchair, the heat builds up — that’s one theory,” he said. “Many also develop chronic urinary tract infections, and that affects their reproductive tissues.”

For three years, Rodriguez and his wife tried to get pregnant, even spending $800 on a lab stimulator. Then they consulted that first Los Angeles doctor, who did some cursory lab tests and took their hope for children away. “It was a long drive home, and Angie said she was OK with getting donor sperm,” said Rodriguez. “We tried that three or four times, and it never took. “Angie became depressed, and we decided it was taking an emotional toll, so we decided to take a break,” he said. Costs had been adding up, but by 2012 they explored insurance coverage and learned that in vitro fertilization was covered.

In June, the couple found a nearby fertility clinic and Dr. Richard Buylos, who was instrumental in the pregnancy. Rodriguez said Buylos was stunned by the advice Rodriguez and his wife had previously received and referred the couple to Werthman. “[Werthman] did a physical exam and felt normal testicle size and didn’t think it would be a problem. We were already off to a good start,” said Rodriguez.

Rodriguez’s sperm production was also deemed normal. “I just wanted to cry,” he said. “I couldn’t believe it. My wife was even happier than me.” The sperm extraction was set for a Thursday, and the first step in the IVF was scheduled for Saturday. Biopsy results showed Rodriguez had a good number of sperm, but on Friday, the lab called to say the quality of the sperm was not good enough and the number was decreasing.

With the clock ticking, Werthman recommended the couple try extraction a second time, on Saturday, the same day as Angie Rodriguez’s egg retrieval. “Dr. Werthman showed up whistling and singing and all happy,” said Rodriguez. “He said, ‘We’re going to get some more babies out — don’t worry.'” As soon as Werthman looked under the microscope he grew optimistic. The sperm were stronger and better-looking than the first batch.

Of the 12 eggs retrieved, eight formed into blastocysts, embryos that had advanced to the five-day stage. Two were implanted and both took. The couple has frozen the rest for future use. Eleven days after the implantation, Angie Rodriguez had a blood test that revealed she was pregnant. And now, with the twins due in May, “She’s pretty big,” said Rodriguez. “I am buying things like double strollers and infant seats and looking into cribs.

“I just want other guys in my situation to be informed,” he said. “I wish I had known sooner, to find that your sperm can be good.

“It has already changed my life, and I feel like I’ve got more life in me,” said Rodriguez, who hasn’t ruled out siblings for the twins “It’s just made me whole again.”

Researchers Conduct Study On Age Related Fertility Decline

Researchers in Southampton are conducting the largest survey of its kind to find out what men and women know about age-related fertility decline and the impact it has on planning a family.

The University of Southampton together with Princess Anne Hospital in Southampton, are looking to recruit more than 2000 people from all over the country to the online study.

Researchers hope to gain insight into the attitudes of people towards egg freezing, their intentions regarding having children and what people think ovarian awareness is.

The number of women having IVF treatment to conceive is rising. In 2010 45,264 women had IVF treatment in the UK compared to the 36,861 women who had the treatment in 2007 and now around 1.5 per cent of all babies born in the UK are the result of IVF and donor insemination.

Professor Nicholas Macklon, Professor of Obstetrics and Gynaecology at the University of Southampton and Director of the Complete Fertility Centre at the Princess Anne Hospital, comments: “Until recently, most women wishing to conceive after the age of 37 either faced failure or opted for IVF, often without success. In recent years however, new technology has become available which may allow women to freeze their eggs, for use later in life. This offers women the possibility of waiting to have a family until they have found a partner with whom they wish to have children or until a suitable moment in their career.

“Many people know that age has a significant impact on a women’s ability to have a baby. But we want to find out more about what people really understand about age-related fertility decline, the reasons why women, men and couples make the conscious decision to postpone having a family, and the options available to make that happen.”

Researchers hope that a better understanding of the reasons behind delaying having a family will help in the provision of relevant information to enable women and couples to make informed fertility decisions in the future. It will also allow for better service provision, not only for women and couples wishing to postpone childbearing, but also for those women wishing to plan a family.

Fertility Rates and Ectopic Pregnancy

WEDNESDAY, March 13 (HealthDay News) — Fertility rates are about the same for women who undergo different types of treatments for ectopic pregnancy, according to a new study.

In an ectopic pregnancy, the fertilized egg grows outside the uterus, usually in the fallopian tubes. This typically leads to a miscarriage.

This study looked at pregnancies among more than 400 women in France two years after their ectopic pregnancy had been treated using one of three methods: methotrexate injection to halt the pregnancy; conservative surgery, which preserves the fallopian tube; and radical surgery, which removes the fallopian tube.

The first part of the study compared drug treatment and conservative surgery, while the second part compared conservative and radical surgery. The researchers did not directly compare drug treatment and radical surgery, because some women must be treated by surgery.

Pregnancy rates two years after treatment were 67 percent among women who received methotrexate, about 70 percent among those who had conservative surgery and 64 percent among those who had radical surgery.

The study was published online March 13 in the journal Human Reproduction.

“This is the first randomized study to be able to compare fertility after the three treatments for ectopic pregnancies,” Dr. Perrine Capmas, a gynecology surgeon and obstetrician at the University Paris Sud, said in a journal news release. “We found that two years after treatment, there was no significant difference in fertility among the women who received medical treatment or conservative surgery in the first arm of the study, or women who received conservative or radical surgery in the second arm.”

Experts welcomed the findings.

“This is good news, as it reaffirms our experience that [nonsurgical] medical treatment is sufficient in most cases of ectopic pregnancy that are picked out early enough,” said Dr. Avner Hershlag, chief of the Center for Human Reproduction at North Shore University Hospital, in Manhasset, N.Y.

And Dr. Jennifer Kulp Makarov, a fertility specialist at Maimonides Medical Center in New York City, said the statistics on fertility were strong, no matter what treatment was used.

“This … is good news for women who have had an ectopic pregnancy. It gives confidence that women treated for ectopic pregnancy, whether with surgery or with medication, have high rates of fertility after treatment,” Makarov said. “The majority of women who desired to become pregnant after treatment for an ectopic pregnancy were able to do so, and most of these pregnancies were located in the uterus.”

Thousands Protest In Moscow Against Ban On Adoptions To US

By Kirit Radia
Jan 13, 2013
ABC World News

MOSCOW — Thousands of Russians took to the streets on Sunday to protest Russia’s new ban on adoptions to the United States.
In what organizers called the “March Against Scoundrels” they paraded down a tree-lined boulevard in central Moscow chanting “Hands off our children” and “Russia will be free.” They also carried signs with the faces of Russian politicians who approved the ban and the word “Shame” written on them.
“I am not an apologist for the U.S. I am a patriot of this country. But this monstrous law must be canceled,” leftist protest leader Sergei Udaltsov told the crowd before the march began, according to the Interfax news agency.
As usual, organizers and police disagreed on the size of the crowd. Organizers estimated between 20,000 and 50,000 people turned out. Police put the figure much lower at about 7,000, but overhead photos of the protest appear to show a crowd larger than that.
Significantly smaller protests, some consisting of just a few dozen people, took place in other cities around the country, according to Interfax. A nationwide poll taken in December by the Public Opinion Foundation found 56 percent support for the ban.
But participants in Sunday’s protests accused the ban’s proponents of playing politics with the lives of children.
The adoption ban was a late amendment to a bill retaliating for a set of human rights sanctions that President Obama signed into law in December. It cut off adoptions to the United States, one of the most popular destinations for international adoptions from Russia, starting Jan. 1.
More than 60,000 Russian orphans have been adopted by Americans since the end of the Soviet Union, according to the State Department. Many of them are sick or suffer from disabilities.
But Russian officials have pointed to the cases of 19 children who died after being adopted by Americans. They also noted cases in which American parents accused of abusing their adopted children received, in their view, lenient sentences.
Since the law went into effect, Russian officials have struggled to explain whether the ban would cancel 52 adoption cases that had already received court approval and were within weeks of completion. Kremlin spokesman Dmitri Peskov said Thursday that at least some of those adoptions which had cleared the courts would be allowed to proceed, but did to say how many.
The ban was controversial even before it became law. Even though it received nearly unanimous approval from Russia’s rubber stamp parliament, prominent cabinet officials, including Russia’s Foreign Minister Sergei Lavrov, came out against the ban. Even President Vladimir Putin himself evaded questions about it when asked during an end of year press conference.
Since the ban was approved, top Russian officials have pledged to devote more resources to reforming the country’s dilapidated orphanages and to encourage more Russians to adopt.
Sunday’s protest was organized by some of the same opposition leaders who organized last year’s anti-Putin rallies. The last such protest, held without city approval and under heavy police presence, drew relatively few people in December, suggesting the protest movement had fizzled. Protest leader and anti-corruption blogger Alexy Navalny, however, told Interfax today that he hopes the adoption ban could rally more Russians to continue protesting.

Infertility Rates Haven’t Changed Much In 20 Years

By Eryn Brown
December 19, 2012
Los Angeles Times

It can seem like infertility is on the rise, especially in developed countries as women wait longer to start families. But according to a new analysis of 277 surveys, conducted by researchers at the World Health Organization and other institutions, infertility trends around the world stayed largely the same from 1990 to 2010.

Worldwide in 2010, 1.9% of women ages 20 to 44 who wanted to have babies were unable to give birth to a first child, wrote Gretchen Stevens of the World Health Organization and coauthors in a study in the journal PLOS Medicine. Among women who had already given birth, 10.5% were unable to have another child, the group reported.

Those numbers were only slightly changed from 20 years earlier, when so-called primary infertility (inability to have a first child) was 2.0% worldwide and secondary infertility (inability to have a subsequent child) was 10.2%.

“Independent from population growth and worldwide declines in the preferred number of children, we found little evidence of changes in infertility over two decades,” the authors wrote.

The two exceptions were sub-Saharan Africa and South Asia, where infertility declined significantly. Stevens and her collaborators suggested that may be linked to reductions in rates of sexually transmitted diseases such as gonorrhea and chlamydia, which can cause infertility when left untreated.

Central and Eastern Europe and Central Asia, on the other hand, had relatively high rates of secondary infertility, which the coauthors suggested might be associated with the region’s higher incidence of abortion and the persistence of unsafe abortion practices that can cause complications that affect fertility.

Estimating infertility is tricky, the team wrote, because few researchers have attempted to do comparative analysis of different countries’ health survey data in the past, and no one has applied a consistent method to all the sources of data. This group collected data from demographic and reproductive health surveys that had collected women’s ages, whether women were part of a couple, whether they were using contraception, time since first and last births, time since first union and desire to have a child. U.S. data came from the National Survey of Family and Growth, conducted by the U.S. Centers for Disease Control and Prevention.

In all, they said, 48.5 million couples around the world are unable to have a child, up 6.5 million from 1990. They attributed the rise in absolute numbers to population growth.

Badly Wounded Veterans Lobby For Fertility Treatment

By Alexandra Zavis
December 14, 2012
Los Angeles Times

Army Staff Sgt. Matt Kiel was shot while on patrol in Iraq just six weeks after his wedding. Doctors said he would be on a ventilator for the rest of his life and would never again move his arms or legs — dashing his hopes of raising a family.

But within months of his injuries five years ago, Kiel was breathing on his own and had regained enough function in his left arm to operate a motorized wheelchair. Doctors said he and his wife, Tracy, could start a family through in vitro fertilization.
The couple were overjoyed, until they discovered that the Department of Veterans Affairs does not cover the costly procedure.

“The war takes away so many things from us,” Matt Kiel said. “I don’t think it should take away our ability to have a family.”

Kiel, 31, of Parker, Colo., is among a growing population of veterans whose war wounds make it difficult for them to have children. Advances in battlefield medicine mean troops are surviving catastrophic wounds in Iraq and Afghanistan that might have killed their predecessors in earlier wars. The use of homemade bombs to target foot patrols has left them particularly vulnerable to injuries that can damage their reproductive systems.

More than 1,900 service members have suffered such injuries since 2003, according to Pentagon data provided to U.S. Sen. Patty Murray ( D-Wash.). Most are men, but they include a growing number of women. Many could benefit from in vitro fertilization, which is why Murray is pushing for the VA to cover the procedure.

“Providing this service is a cost of war,” Murray said. “There is absolutely no reason we should make these veterans, who have sacrificed so much, wait any longer to be able to realize their dreams of starting or growing their families.”

The VA does cover fertility counseling, diagnostic tests and some procedures for veterans with service-connected injuries. For men, that can include the retrieval of sperm, and for women, intrauterine insemination, in which semen is inserted into the uterine cavity through a catheter. Those treatments do help some veterans conceive, although the VA generally won’t cover the care provided to veterans’ spouses or surrogates.

But for the most severely wounded, more advanced treatments are needed, said Dr. Lori Marshall, medical director at Seattle-based Pacific Northwest Fertility and IVF Specialists. The sperm retrieved from injured men may be of too poor quality for successful intrauterine insemination.

In IVF, egg and sperm are combined in a laboratory, and the resulting embryo is transferred into a woman’s uterus. The procedure bypasses the fallopian tubes and is the treatment of choice for many women with badly damaged or missing tubes, Marshall said. If the uterus is incapable of sustaining a pregnancy, the woman may need a surrogate.

“Most of the men and women who suffer these injuries are young and should have very high success rates,” Marshall said. But the cost can be prohibitive. A complete cycle of IVF typically costs between $12,000 and $20,000, and it can take several attempts to achieve a successful pregnancy.

Murray, chairwoman of the Veterans’ Affairs Committee, introduced legislation that passed the Senate by unanimous consent Thursday directing the VA to make advanced fertility techniques like IVF available to disabled veterans, their spouses or surrogates. But prospects for similar legislation are uncertain in the House, where spending cuts to avoid the fiscal cliff are dominating discussion.

Sperm Count Low Among Couch Potatoes, Study Finds

By Monte Morin
February 4, 2013
Los Angeles Times

For those men who are looking to boost their sperm count, researchers at the Harvard School of Public Health have some simple advice: drop the TV remote control and get to the gym.

A study published Monday in the British Journal of Sports Medicine found that men who watched more than 20 hours of television a week had 44% lower sperm count than men who watched almost no television.

Researchers found too that men who engaged in moderate to vigorous exercise for 15 or more hours a week had 73% higher sperm count than men who exercised less than five hours per week.

The findings come amid claims from some scientists that sperm quality has declined among Western men in the last decades. Some say it may be due in part to a rise in sedentary lifestyles.

“We know very little about how lifestyle may impact semen quality and male fertility in general, so identifying two potentially modifiable factors that appear to have such a big impact on sperm counts is truly exciting,” said lead author Audrey Gaskins, a doctoral student at HSPH.

The study was based on 189 men in Rochester, NY. Study subjects, who had an average age of 19, were surveyed on their television viewing habits, exercise regimen, tobacco use and diet. Samples of their semen were then analyzed for sperm concentration; sperm motility; sperm morphology, or shape; and total sperm count.

While more exercise and less TV were closely associated with higher total sperm count and concentration, they appeared unrelated to sperm motility or morphology, according to the report.

Reduced sperm count has been linked to lower fertility. However, it does not absolutely prevent men from fathering a child, authors said.

“The majority of the previous studies on physical activity and semen quality had focused on professional marathon runners and cyclists, who reach physical activity levels that most people in the world cannot match,” said senior author Jorge Chavarro, an assistant professor of nutrition and epidemiology at HSPH.

“We were able to examine a range of physical activity that is more relevant to men in the general population,” he said.

Copyright © 2013, Los Angeles Times

Sandy’s Most Delicate Rescue Was Fertility Clinic’s Embryos

View Story On ABC News Website
Nov. 1, 2012

[image_frame style=”framed” align=”right” height=”96″ width=”91″]”[/image_frame]Among all the rescues carried out during the chaos caused by Sandy, the most delicate was the mission to save embryos in rows of incubators that were in jeopardy when the NYU Fertility Center lost its power.

The Manhattan clinic lost power shortly after Sandy struck Monday night. A generator perched atop the 8-story building kept incubators running through the night, but flooding in the basement cut off its fuel supply.

“The generator ran out of gas around 8:15 Tuesday morning,” said Dr. James Grifo, the clinic’s director.

Without power, the incubators housing delicate embryos at womb-temperature for in vitro fertilization began to cool. But Grifo and his team took action, hoisting five-gallon cans of diesel fuel up darkened stairwells to feed the failing generator.

“It was really a privilege to be part of that,” Grifo said of his staff’s “heroic” efforts.

The fuel bought the team enough time to transfer the embryos into liquid nitrogen, where they can be stored indefinitely. The embryos were secured as another urgent issue arose.

At 10 a.m., a patient arrived for an egg retrieval — a surgical procedure timed down to the hour after a two-week run of expensive fertility drugs.

Grifo loaded the woman into his car, along with her husband and their baby, and rushed them to a colleague’s clinic uptown.
“It’s amazing what people can do when everyone’s on the same page,” Grifo said, adding that the rest of the clinic’s patients were booked into clinics throughout the city to “salvage” their cycles.

“It’s a testament to the people in New York who work in medicine,” he added. “Some of our most vicious competitors offered assistance.”

Sandy spawned record-breaking tides around lower Manhattan, prompting power outages from East 39th Street to Battery Park at the southern tip of the island. The NYU Fertility Center is on First Avenue and 38th street, just a block from the overflowing East River.

The storm forced the nearby NYU Langone Medical Center to evacuate 300 patients in gusts of wind topping 70 miles per hour. Cells, tissues and animals used for medical research were left to die in failing refrigerators, freezers and incubators.

But thanks to Grifo and his team, eggs and embryos at the fertility clinic were spared.

“Hopefully we’ll get some babies out of it, and that’ll be a nice story as well,” he said.

Sandy was an example of what some fertility clinics call an “act of God,” an unfathomable tragedy that patients are warned about before starting the IVF process.

“There’s so much riding on this,” said Dr. James Goldfarb, director of the University Hospitals Fertility Center in Cleveland. “Even when everything’s going smoothly, it’s stressful for women. But add the stress of having to start all over again, that’s extremely stressful.”