Lacey Berning dreamed of having a little girl. What she never imagined, however, was that the journey to that child would be wrought with delays and heartache. But Lacey never gave up hope, and with support from a team of Mayo Clinic infertility specialists, she and her husband finally realized their dream of becoming parents.

Like most mothers, Lacey Berning has a pregnancy story filled with happiness, transformation and new life. But Lacey's journey to having her baby also involved loss, sickness and lots of needles.

For Lacey and her husband, Seth, however, the waiting, worry and needlesticks — a necessary component of the in vitro fertilization (IVF) process they went through to become pregnant — along with the extreme nausea and vomiting Lacey experienced while pregnant, fade away when they look at their daughter, Brielle.

"My pregnancy was awful. I was really sick," Lacey says. "I was going in for fluids every three days at the hospital, and I lost 15 pounds before the third trimester. But it's one of those things where I just kept thinking how lucky I was and just couldn't complain about being sick because it was a miracle I was pregnant."

The odds of Lacey and Seth conceiving naturally were minute because both of them had fertility issues. Even using IVF, the couple had less than a 50-50 chance of achieving a live birth. But Lacey, who always dreamed of having a daughter, had to give it a shot. "I knew I could never live with myself if we didn't try," she says.

She and Seth are forever glad that they did. With the support of a Mayo Clinic team from the Division of Reproductive Endocrinology and Infertility that included Zaraq Khan, M.B.B.S, and Elizabeth Stewart, M.D., the couple achieved pregnancy following one cycle of egg stimulation, retrieval and embryo transfer. On July 5, 2018, Brielle was born.

Now Lacey is happy to share her family's story with others. "You always hear about the bad stories where patients leave unsatisfied," she says. "I thought if I could give some positivity, even if I change one person's mind, and they get the miracle of having kids, then it's totally worth it."

Frustration, elation and anguish

When they decided they wanted to have a baby, Lacey and Seth, who live in Eyota, Minnesota, had no idea that they might face infertility. But after a year of trying to conceive, Lacey, who was 28 at the time, grew concerned that something was wrong. She took those concerns to her Mayo Clinic primary care physician.

Lacey's doctor ordered a hormone test to measure her ovarian reserve. That test came back below normal. Lacey was directed to track her menstrual cycle to hone in on her most fertile time. For about a year, Lacey recorded her cycles while she and Seth kept trying. When that didn't work, Lacey made an appointment in Mayo Clinic's Division of Reproductive Endocrinology and Infertility. At the visit, Lacey was prescribed clomiphene — a medication that causes ovulation.

"The first month, nothing happened. The second month is when we got pregnant for the first time," Lacey says. "We did an ultrasound early, and at six weeks, everything was good. We had another ultrasound at eight weeks, and they told us that once there is a heartbeat, the odds of losing a baby are a lot less, so we told our parents."

An ultrasound at 10 weeks came back normal, as did one a week later. However, a day after that appointment, Lacey had a miscarriage at home. When they went to the hospital, Lacey and Seth were met by Cassandra Liss, a certified nurse-midwife in Mayo Clinic's Department of Obstetrics and Gynecology.

"When Cassie came in into the room, she looked at me," Lacey says. "I will never forget seeing her. With tears in her eyes, she said: 'I know we will see you again, and I know you will have a positive outcome. You just have to hang in there.' Those words are burned into my mind."

Genetic testing revealed the fetus carried a chromosomal defect that would have resulted in an abbreviated life expectancy had the child survived pregnancy. In addition, test results showed it had been a partial molar pregnancy. That meant that Lacey's placental tissue formed abnormally and couldn't support the developing fetus.

"For young patients like Lacey, molar pregnancy is a difficult diagnosis because it jeopardizes a lot of timelines for getting pregnant."

Zaraq Khan, M.B.B.S.

Women who have molar or partial molar pregnancies require extremely close monitoring and follow-up care because the condition can lead to a serious disorder known as gestational trophoblastic disease in which abnormal placental cells in the uterus develop into fast-growing tumors akin to cancer.

"For young patients like Lacey, molar pregnancy is a difficult diagnosis because it jeopardizes a lot of timelines for getting pregnant," Dr. Khan says. "We have to be more hands-on with monitoring to make sure their pregnancy hormone levels come back to normal for a certain time period before we can start talking about them trying again. For fertility patients, time is of the essence. Telling them they have to wait for six months to a year can be devastating."

Waiting, testing and success

Following the miscarriage, Lacey went on birth control to prevent another pregnancy because becoming pregnant at that point would cause abnormal placental tissue to quickly multiply. Her pregnancy hormone levels initially were checked every two weeks and then every month to monitor her levels.

"All fertility care is very high-anxiety provoking," Dr. Khan says. "But for her, it was even more because she was just waiting out a condition where we wanted to make sure she was healthy first before we could start talking about pregnancy planning."

In November 2017, after eight months of monitoring, Lacey's pregnancy hormone levels were normal, and she was cleared to begin fertility treatment again. For the couple, resuming their efforts to conceive meant a new round of testing — this time for Seth. His tests reveal a below-normal sperm count. That result coupled with Lacey's low ovarian reserve led the couple's medical team to suggest IVF.

"They were in a unique situation where there was room for improvement on both sides," Dr. Khan says. "I talked to them about the best way of approaching this appropriately and aggressively with IVF."

The couple waited to begin the process until the following September. On their wedding anniversary, Lacey gave herself the first injection to begin stimulating her ovaries. The daily injections continued for 10 days. Then the day before her egg retrieval, Seth gave Lacey an intramuscular shot that prompted her ovaries to release the mature eggs.

Lacey's care team retrieved 13 eggs. Four of them survived fertilization and grew into embryos. Her team monitored the embryos' growth, and five days after retrieval, one embryo was transferred into Lacey. "I remember Zaraq saying, 'This is the one that is going to be your baby," Lacey says. "He was always super optimistic. Both he and Dr. Stewart were really good to work with. "

Fourteen days after the embryo transfer, Lacey took a home pregnancy test. "My husband and I couldn't decide who got to look at the pregnancy test first, so I peed on two sticks and gave him one to look at. We counted down and looked at the same time. They both said pregnant."

Illness, infusions and wonder

At Lacey's first ultrasound a month later, the baby's heartbeat was strong and easy to find. "They told us we were due on the Fourth of July," she says. "Obviously, we were just stoked."

Lacey held on tight to that emotion through her pregnancy, the first two-thirds of which required IV infusion therapy to manage relentless nausea, daily vomiting and extreme dehydration. "Christmas morning, I was in getting fluids. New Year's morning, I was in getting fluids. It was rough, but (the infusions) were a game-changer," Lacey says.

"People tell you what a miracle having a kid is, and it's just amazing how your heart triples in size the day they're born."

Lacey Berning

Lacey's extreme nausea subsided in her third trimester, and she gained back seven pounds. In the days leading up to July 4, Lacey felt great. "The third of July, I felt so good. I was like, 'There is no way this baby is coming tomorrow."

At 5 a.m. the next day, Lacey woke up having contractions. Throughout the day, she kept herself busy while the contractions went from seven minutes apart to two, which is the point at which she was directed to go Mayo Clinic Hospital — Rochester, Methodist Campus. Lacey's labor slowly progressed until early the morning of July 5, when she was finally ready to begin pushing. After just 15 minutes of hard labor, Brielle entered the world.

"People tell you what a miracle having a kid is, and it's just amazing how your heart triples in size the day they're born," Lacey says. "I knew I would love my kid, but you don't realize how much."

Their child, Lacey says, is the light of her family's life. "She is this little girl who is so spoiled and loved. There's just something special about having a little girl. All her little boy cousins think she's just the bees' knees."

Although the couple has two more embryos frozen and will consider trying for a second child in the future, simply having their daughter is a gift. "In a perfect world, we would love to have one more," Lacey says. "But I know that if it doesn't work out, I'm totally satisfied with our little miracle. I feel lucky to have Brielle."

HELPFUL LINKS

• Learn more about in vitro fertilization.
• Check out the Division of Reproductive Endocrinology and Infertility.
• Explore Mayo Clinic.
• Request an appointment.

The post Sharing Mayo Clinic: A long road through infertility to parenthood appeared first on Mayo Clinic News Network.

Ovarian hyperstimulation syndrome (OHSS) is an exaggerated response to excess hormones. It usually occurs in women taking injectable hormone medications to stimulate the development of eggs in the ovaries. OHSS causes the ovaries to swell and become painful. It may occur in women undergoing in vitro fertilization (IVF) or ovulation induction with injectable medications. Less often, OHSS happens during fertility treatments using medications you take by mouth, such as clomiphene.

Treatment depends on the severity of the condition. OHSS may improve on its own in mild cases, while severe cases may require hospitalization and additional treatment.

Symptoms

Symptoms of ovarian hyperstimulation syndrome often begin within a week after using injectable medications to stimulate ovulation, though sometimes it can take two weeks or longer for symptoms to appear. Symptoms can range from mild to severe and may worsen or improve over time.

Mild to moderate OHSS

With mild to moderate ovarian hyperstimulation syndrome, symptoms can include:

• Mild to moderate abdominal pain
• Abdominal bloating or increased waist size
• Nausea
• Vomiting
• Diarrhea
• Tenderness in the area of your ovaries

Some women who use injectable fertility drugs get a mild form of OHSS. This usually goes away after about a week. But, if pregnancy occurs, symptoms of OHSS may worsen and last several days to weeks.

Severe OHSS

With severe ovarian hyperstimulation syndrome, you might have:

• Rapid weight gain — more than 2.2 pounds (1 kilogram) in 24 hours
• Severe abdominal pain
• Severe, persistent nausea and vomiting
• Blood clots
• Decreased urination
• Shortness of breath
• Tight or enlarged abdomen

When to see a health care provider

If you're having fertility treatments and you experience symptoms of ovarian hyperstimulation syndrome, tell your doctor. Even if you have a mild case of OHSS, your doctor will want to observe you for sudden weight gain or worsening symptoms.

Contact your doctor right away if you develop breathing problems or pain in your legs during your fertility treatment. This may indicate an urgent situation that needs prompt medical attention.Request an Appointment at Mayo Clinic

Causes

The cause of ovarian hyperstimulation syndrome isn't fully understood. Having a high level of human chorionic gonadotropin (HCG) — a hormone usually produced during pregnancy — introduced into your system plays a role. Ovarian blood vessels react abnormally to HCG and begin to leak fluid. This fluid swells the ovaries, and sometimes large amounts move into the abdomen.

During fertility treatments, HCG may be given as a "trigger" so that a mature follicle will release its egg. OHSS usually happens within a week after you receive an HCG injection. If you become pregnant during a treatment cycle, OHSS may worsen as your body begins producing its own HCG in response to the pregnancy.

Injectable fertility medications are more likely to cause OHSS than is treatment with clomiphene, a medication given as a pill you take by mouth. Occasionally OHSS occurs spontaneously, not related to fertility treatments.

Risk factors

Sometimes, OHSS happens in women with no risk factors at all. But factors that are known to increase your risk of OHSS include:

• Polycystic ovary syndrome — a common reproductive disorder that causes irregular menstrual periods, excess hair growth and unusual appearance of the ovaries on ultrasound examination
• Large number of follicles
• Age under 35
• Low body weight
• High or steeply increasing level of estradiol (estrogen) before an HCG trigger shot
• Previous episodes of OHSS

Complications

Severe ovarian hyperstimulation syndrome is uncommon, but can be life-threatening. Complications may include:

• Fluid collection in the abdomen and sometimes the chest
• Electrolyte disturbances (sodium, potassium, others)
• Blood clots in large vessels, usually in the legs
• Kidney failure
• Twisting of an ovary (ovarian torsion)
• Rupture of a cyst in an ovary, which can lead to serious bleeding
• Breathing problems
• Pregnancy loss from miscarriage or termination because of complications
• Rarely, death

Prevention

To decrease your chances of developing ovarian hyperstimulation syndrome, you'll need an individualized plan for your fertility medications. Expect your doctor to carefully monitor each treatment cycle, including frequent ultrasounds to check the development of follicles and blood tests to check your hormone levels.

Strategies to help prevent OHSS include:

• Adjusting medication. Your doctor uses the lowest possible dose of gonadotropins to stimulate your ovaries and trigger ovulation.
• Adding medication. Some medications seem to reduce the risk of OHSS without affecting the odds of pregnancy. These include low-dose aspirin; dopamine agonists such as carbergoline or quinogloide; and calcium infusions. Giving women who have polycystic ovary syndrome the drug metformin (Glumetza) during ovarian stimulation may help prevent hyperstimulation.
• Coasting. If your estrogen level is high or you have a large number of developed follicles, your doctor may have you stop injectable medications and wait a few days before giving HCG, which triggers ovulation. This is known as coasting.
• Avoiding use of an HCG trigger shot. Because OHSS often develops after an HCG trigger shot is given, alternatives to HCG for triggering have been developed using Gn-RH agonists, such as leuprolide (Lupron), as a way to prevent or limit OHSS.
• Freezing embryos. If you're undergoing IVF, all the follicles (mature and immature) may be removed from your ovaries to reduce the chance of OHSS. Mature follicles are fertilized and frozen, and your ovaries are allowed to rest. You can resume the IVF process at a later date, when your body is ready.

This article is written by Mayo Clinic staff. Find more health and medical information on mayoclinic.org.

The post Women’s Wellness: What is ovarian hyperstimulation syndrome? appeared first on Mayo Clinic News Network.

ANSWER: In vitro fertilization (IVF) is a procedure that can be used to help couples who are dealing with infertility issues conceive a child. It is the most commonly used and most effective form of assisted reproductive technology available today.  

About 10 to 15 percent of couples in the United States have trouble getting pregnant. In general, a couple is defined as having fertility problems when they have been trying to get pregnant without success for six months or more and the woman is older than 35. For women younger than 35, doctors typically recommend couples try to get pregnant for 12 months before going through a fertility evaluation.  

In vitro fertilization involves taking eggs from a woman’s ovaries and fertilizing them with sperm in a laboratory. The resulting embryos are cultured in the lab for several days. During that time, they are monitored closely to gauge how well they are developing. The embryos that grow best are placed into the woman’s uterus. About a week and a half after embryos are placed in the uterus, a pregnancy test is performed.  

Traditionally, multiple embryos were implanted during an IVF treatment to raise the chances for a successful pregnancy with at least one of them. In the last 10 to 15 years, however, IVF success rates have increased enough that it’s now possible to implant just a single embryo, decreasing the risk of a multiple pregnancy.  

The success rate of IVF depends on many factors. Age is one of the most important. The younger a woman is, the more likely she is to get pregnant and give birth to a healthy baby using her own eggs with IVF. For women age 34 and younger, the chance of pregnancy with one round of IVF is about 60 percent. For women who are 40, the success rate is about 25 percent. At age 45, the success rate for IVF is around just 1 percent. IVF can be performed with eggs donated from another woman, and that can increase the chance for success.  

Other factors that make a difference include whether the embryos are fresh or frozen. The birth rate with frozen embryos is slightly lower than with fresh embryos. Women who have given birth before are more likely to get pregnant using IVF than those who have never given birth.  

The cause of infertility also can have an effect on IVF success. For example, having a normal supply of eggs increases a woman’s chances of being able to get pregnant with IVF. Women who have endometriosis — a condition in which tissue that normally lines the inside of the uterus grows outside of the uterus — are less likely to get pregnant using IVF than are women who have blocked or damaged fallopian tubes.  

Lifestyle can make a difference, too. Women who smoke typically have fewer eggs retrieved during IVF. Smoking can lower a woman’s chance of success using IVF by about 50 percent. Using alcohol, recreational drugs, lots of caffeine — more than 200 milligrams a day — and certain medications also can hurt a woman’s chances of getting pregnant with IVF.  

As you consider IVF, it’s important to keep in mind that this procedure should not be used as the first step in dealing with infertility. A variety of less aggressive, less expensive treatment options are available that should be tried before turning to IVF. These alternatives may include medications to stimulate ovulation, as well as minimally invasive procedures to correct problems that can lead to infertility, such as blocked fallopian tubes.  

Before you make up your mind about IVF, talk to your doctor or visit with a reproductive endocrinologist to discuss which infertility treatments are right for your situation. — Jani Jensen, M.D., Reproductive Endocrinology & Infertility, Mayo Clinic, Rochester, Minn.

The post TUESDAY Q & A: IVF the most effective form of reproductive technology available appeared first on Mayo Clinic News Network.

Click here for Full Medical edge Radio show - 11/3/12 44min - mp3

We also spoke with Co-Director of the Mayo Nicotine Dependence Center, Dr. Richard Hurt about second hand smoke.  Since 2007 when "The Freedom to Breathe Act" was passed in Minnesota, there has been a 33% decrease in heart attacks in Olmsted County!  If you would like help to quit smoking, call 800-Quit-Now or 507-266-1930.

You can listen to our show on I Heart Radio on our flagship station KROC AM.

The post In Vitro Fertilization appeared first on Mayo Clinic News Network.

Mayo Clinic has announced its first births resulting from in vitro fertilization (IVF) using a new time-lapse incubator. It minimizes disturbances from human handling and helps fertility specialists identify the healthiest embryos.

Dean Morbeck, Ph.D., embryologist and director of Mayo Clinic’s In Vitro Fertilization Laboratory, says, “With current technology, IVF is successful for many patients; however, we believe it can be improved even further." Mayo experts say it may improve pregnancy outcomes for all patients receiving IVF.

Sound bites with Dr. Morbeck and b-roll are available in the downloads above.

Expert title for broadcast cg: Dr. Dean Morbeck, Mayo Clinic Embryologist

For entire news release.

The post Time-Lapse Incubator for In Vitro Fertilization appeared first on Mayo Clinic News Network.