Thursday, October 17, 2013

Baby Born From Single Frozen Sperm.



Everyone knows it takes just one sperm and one egg to make a baby, but nature usually provides extra, just to be sure.

In the case of 9-month-old Kenley Schiraldi of Campbell, Ohio, however, there was no back-up for the biology, requiring instead what scientists -- and her parents -- are calling a modern-day miracle.
Kenley was born last April, the result of a long-shot infertility treatment, a case Cleveland Clinic IVF experts say is the first time a single sperm has been frozen, injected into a single egg -- and resulted in a healthy pregnancy.

“It was better than hitting the lottery,” said Jennifer Schiraldi, 33, Kenley’s mom. “This never happens.”

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Indeed, even Nina Desai, director of the IVF laboratory at the Cleveland Clinic, hasn’t calculated the odds of Kenley’s conception, which occurred even though her father, Jason, produced no sperm in the regular way, and her mom had trouble producing eggs.

“It was like a shot in the dark,” said Desai, who has developed a ground-breaking technique that can find and store tiny amounts of sperm -- or even just one -- in a drop of fluid inside a straw as thin as a sewing needle. The sperm can then be frozen and later thawed for use in an in-vitro fertilization technique known as intracytoplasmic sperm injection, or ICSI.

The new method follows nearly two decades of efforts to save the smallest possible amounts of human sperm by storing the cells inside hamster eggs or on tiny nylon loops for easier retrieval later. It’s expected to be a boon for men with very low sperm counts, a severe form of the male factor infertility that can contribute to the 1 in 8 couples in the U.S. who struggle to conceive.

Jennifer Schiraldi, a hospital dietician, and her husband, Jason, 35, a cardiac catheterization nurse, came to the Cleveland Clinic in 2009, after trying for two years to get pregnant, with no success. High school sweethearts who’ve been married nine years, they were young and healthy with no warning that they’d have trouble having a baby.

“I’d never had any woman problems and you never think it’s the guy,” recalled Jennifer.
In fact, however, tests showed that the Schiraldis were among 30 percent to 40 percent of infertile couples with problems attributed to the man.

“They took a sample and we found out immediately: There’s no sperm,” Jennifer Schiraldi recalls.
The couple could have stopped there, but they decided to pursue aggressive infertility treatment, including a testicular biopsy, which involves surgery to remove tiny bits of tissue to test for evidence of sperm.

The procedure was difficult, admits Jason Schiraldi, but he said he was determined to try everything.
“We always wanted kids and I didn’t want to be the one who couldn’t do that for her,” he said.
But searching for Jason’s sperm proved even harder than imagined. As the surgeon sent down samples, Desai’s lab staffers, three in all, used microscopes to scan the tissue for any sign of viable cells.
A typical male produces 60 million to 100 million lively sperm in a single ejaculation.

After searching Jason’s tissue for a total of nine hours, the scientists found -- one.

“We froze that one sperm and we saved the rest of the specimens,” recalled Desai. “We really had no hope of it doing anything.”

Because any pregnancy with so few sperm would require in-vitro fertilization, Jennifer Schiraldi had to harvest her eggs. But when they went to retrieve them, doctors found she made far fewer eggs than normal.

“I got 12 but only eight were good,” she recalled.

IVF experts searched the rest of Jason’s samples, hoping to fertilize as many of Jennifer’s eggs as possible. When they found only a couple dead sperm, the one frozen viable sperm was the only option.
“They got the one sperm and implanted the one egg,” Jennifer Schiraldi said.

Desai admits she wasn’t optimistic.

“People don’t usually get pregnant when they have only one egg,” she explained, noting that it’s far more common to implant two or three embryos to make sure pregnancy occurs.

But then came the exciting part. With the help of a careful ICSI procedure, the egg was successfully fertilized. Three days later, it had divided into a viable embryo and was implanted in Jennifer’s womb.
Sixteen days after that, she was confirmed pregnant.

“It was very emotional,” said Jason Schiraldi.

Back at the clinic, the staff shared congratulations.

“I was really surprised when I saw she had a positive pregnancy,” said Desai. "This has been one of the real miracles in our IVF program."

The pregnancy was normal but taxing, with a fair amount of nausea and other ordinary complications, Jennifer Schiraldi said. And the baby was in the breech position, which required a C-section.

But when Kenley Karlin Schiraldi arrived on April 20, her parents said there was no doubt about what had occurred.

“Miracle is not a large enough word to describe it,” said Jason Schiraldi. “Of all the fascinating and amazing things we do in the health care field, it’s amazing that this happened to us.”

Jennifer Schiraldi says she looks at her daughter every day and marvels that she’s here.

“It’s crazy. Sometimes I’m, like, ‘Did we cheat?’” she said. “People ask if we’re going to have another child, but we made it this far to get her. I don’t know if I even want to press my luck.”

Desai and her colleagues plan to use the new sperm storage technique to help other patients with very low sperm counts. Next week, in fact, another man with the same problem is scheduled for the treatment.

Jason Schiraldi said other couples should be encouraged by their experience.

“People think once you’re stuck, you’re stuck,” he said. “But there are people who can make wonderful things happen.”

Monday, October 14, 2013

1 In 30 Babies Born In U.S. Is A Twin.



Women having children at older ages and the growing availability of fertility treatments has led to a marked increase in the birth of twins: In 2009, one in every 30 babies born in the United States was a twin compared with one in every 53 in 1980.
 The findings, presented by Michigan State University's Barbara Luke this week at the 14th Congress of the International Society of Twin Studies in Florence, Italy, have important health implications, including greater morbidity and mortality risks and higher health care costs.

 "Prior to 1980, the incidence of U.S. twin births was stable at about 2 percent of all births, but it has risen dramatically in the past three decades," said Luke, noting twin births increased for women of all ages, with the largest increases among women aged 30 and older. "Older maternal age accounts for about one-third of the rise, and two-thirds is due to the increased use of fertility treatments."
 Those fertility-enhancing therapies include both assisted reproductive technologies and ovulation stimulation medications. About 12 percent of U.S. women have had fertility therapies.

"With multiple births though there are greater health risks," said Luke a researcher in the College of Human Medicine's Department of Obstetrics, Gynecology and Reproductive Biology. "Continued research is necessary to improve outcomes."
 Luke, who first reported the numbers in a report with Joyce Martin of the Centers for Disease Control and Prevention, noted births for triplets and higher numbers also grew: one in every 651 babies in 2009 compared with one in 2,702 in 1980.
 In other research presented at the conference, Luke reported early embryo loss is associated with the significantly increased likelihood of lowered birth weight for the surviving fetuses.


Previous findings have shown mothers using fertility treatments experience more adverse health outcomes than spontaneous-conception pregnancies. Luke and her team hypothesized the residual effects of fetal loss may impact the subsequent growth and birth weight of the surviving fetuses.