Selected Podcast
Fertility: That was Then, This is Now
As RSC celebrates our 40 Anniversary, we will be taking a look back at where we were and all the many changes and advancements that have propelled us to where we are today.
Featuring:
Dr. Weckstein has served on the board of directors of the Pacific Coast Reproductive Society and was a past California representative to the National Advisory Council of the American Society of Reproductive Medicine. Dr. Weckstein has authored more than 50 publications and abstracts with a focus on IVF and Egg Donation. He serves as a special reviewer for the infertility journal “Fertility and Sterility.” He is medical and IVF director at RSC. Dr. Weckstein also serves on Progyny’s Medical Advisory Board.
•Reproductive Science Center of the San Francisco Bay Area
•Undergraduate degree: University of Michigan
•Medical training: University of Michigan
•OB/GYN residency: University of California, Irvine
•Postgraduate training in IVF and infertility: University of California, Irvine
•Joined RSC Bay Area: 1990
•RSC location: San Ramon facility
Louis Weckstein, MD
Dr. Louis Weckstein received his training in infertility at University of California-Irvine in 1988 with one of the most successful IVF teams in the country at that time. After establishing a successful OB/GYN private practice in Southern California, he returned to training that included special emphasis on assisted reproductive technologies. He is certified by the American Board of Obstetrics and Gynecology and is a member of the Society for Assisted Reproductive Technology and the Society for Reproductive Surgeons.Dr. Weckstein has served on the board of directors of the Pacific Coast Reproductive Society and was a past California representative to the National Advisory Council of the American Society of Reproductive Medicine. Dr. Weckstein has authored more than 50 publications and abstracts with a focus on IVF and Egg Donation. He serves as a special reviewer for the infertility journal “Fertility and Sterility.” He is medical and IVF director at RSC. Dr. Weckstein also serves on Progyny’s Medical Advisory Board.
•Reproductive Science Center of the San Francisco Bay Area
•Undergraduate degree: University of Michigan
•Medical training: University of Michigan
•OB/GYN residency: University of California, Irvine
•Postgraduate training in IVF and infertility: University of California, Irvine
•Joined RSC Bay Area: 1990
•RSC location: San Ramon facility
Transcription:
Maggie McKay: Finding out your infertile as a woman can be crushing news, but it's more common than you may think. It accounts for 37% of infertile couples according to the latest study from the World Health Organization. But it's not always a heartbreaking journey for many women that it once was.
To talk with us about fertility, That was Then, This is Now, is Dr. Louis Weckstein, founder and senior partner of the Reproductive Science Center of the San Francisco Bay Area.
This is Fertile Edge, a podcast from the Reproductive Science Center of the San Francisco Bay Area. I'm your host, Maggie McKay. Dr. Weckstein, what an honor to have you here today. Thank you for making the time.
Dr. Louis Weckstein: Happy to be here with you.
Maggie McKay: Doctor, you've been working in the fertility field for more than 30 years. I bet you've seen some huge changes over those years.
Dr. Louis Weckstein: Big changes. The first IVF baby born in the world was in 1978 and in the United States, 1981. I joined RSC in 1990 and IVF success rates in the world were quite low. Thirty percent live birth rate per IVF transfer was considered good at that time. But today, in successful IVF centers, live birth rates twice that number are being achieved.
Maggie McKay: That's amazing. What are some of the biggest areas of change you've seen over these years?
Dr. Louis Weckstein: Yes. Some of the biggest areas of change have been in the IVF laboratory, the secret door behind which all the magic happens, embryo blastocyst culture, pre-implantation genetic testing of embryos, egg freezing for fertility preservation, being able to work with very low sperm counts by using ICSI or intracytoplasmic sperm injection to fertilize eggs. These have had a huge impact on our success with IVF. And Dr. Kristen Ivani, our first IVF laboratory director at RSC, will tell you a little more about what happens in the IVF lab and those changes in a future podcast.
Maggie McKay: Dr. Weckstein, what about the criticism of IVF resulting in too many multiple pregnancies over the years?
Dr. Louis Weckstein: Yes. This has been an area that we've also made great strides by working together on the clinical and laboratory side. Multiple pregnancy, meaning twins and higher order multiple pregnancy rate s like triplets and quadruplets, are at great risk for having premature delivery and many problems. So, we've tried very hard over the years to reduce those rates of multiple pregnancies by growing embryos more days in the laboratory before transfer, selectively using PGT genetic testing to transfer embryos that are more likely to be genetically normal, and doctors not transferring more than one embryo in most situations. Our multiple pregnancy rate with IVF in many centers is now less than 5% with a less than 1% chance of triplets or more.
Maggie McKay: Speaking of triplets, I just have to add this and let you know, my mom had triplets, her first baby, had no idea. They're 70 now, but it was before all this stuff. She just by chance had them. And then, her brother's wife, her sister-in-law, had twins as well. So, anyway...
Dr. Louis Weckstein: Wow. Yeah. And, you know, very often those multiple pregnancies do really well, but they also are at much higher risk, particularly when their triplets or more, for being born so early, that they have a lot of problems.
Maggie McKay: Right. Yeah, they got lucky. Doctor, what changes have you seen on the clinical side?
Dr. Louis Weckstein: Yeah. So as I mentioned, doctors have been a critical part in the movement to reduce these multiple pregnancies by believing in the success of their center and only transferring one embryo and working with the IVF lab to help select the best embryo for transfer. It's important for us to be continually reevaluating the way we stimulate women's ovaries with medication to mature eggs by searching for new combinations and medications to accomplish this while reducing the risks. The use of the medication leuprolide or Lupron as a trigger shot to mature eggs has almost eliminated the risk of ovarian hyperstimulation. Many years ago, 5% of our patients would have fairly severe hyperstimulation side effects from IVF, and that is now very rare.
Maggie McKay: What about the uterus? Have there been changes that can help it be more receptive to an embryo implanting?
Dr. Louis Weckstein: The uterus and implantation is an area that we're trying to impact with some new ideas In recent years. Different combinations and timing of medication and hormonal support may be helpful in some situations, though there are mixed reviews on uterine lining biopsy testing to improve so-called uterine receptivity.
Maggie McKay: And what about infections in the uterus? Does this play a role when helping to create a successful pregnancy?
Dr. Louis Weckstein: Yes, the microbiologic environment in the uterus is a relatively new area that is being explored to see how important it is for the uterus' influence on implantation. Some studies are suggesting that there are good microbiologic organisms. These can be helpful for an embryo to stick. But if these are lacking, implantation and maintenance of an early pregnancy is not as good. We may be able to improve this with probiotics to replenish the healthy uterine microbiology environment. And there are also bad microorganisms that can cause infection or inflammation in the uterus. And if they are treated, successful implantation and pregnancy may be more likely.
Maggie McKay: Dr. Weckstein, is IVF being used to prevent diseases?
Dr. Louis Weckstein: Yes. Disease prevention is now a huge area in the fertility field. If we can identify a life-impacting disease with genetic testing to see if a person carries that disease and is likely to pass it on to their child, we're now able to test embryos for some severe diseases and preferentially transfer the healthy embryos.
I see two to three patients each month who have no infertility problem, but had a child with a severe genetic disease and they only found out that they were both carriers of this disease once they had a child with a disease. And they are now coming to us, even though they have no fertility problem, to do IVF with pre-implantation genetic testing of the embryos to greatly reduce their chance of having a child with a severe disease.
Maggie McKay: When you started out in medicine, did you ever think you'd see the day where this kind of thing was possible?
Dr. Louis Weckstein: It definitely boggles our minds these days. Being in this field for so long and seeing all the changes and the increase in success, it really was unimaginable when I started my career.
Maggie McKay: That's amazing. I hear about machine learning and AI learning. Is that happening in the fertility field?
Dr. Louis Weckstein: Yes. At RSC, we are actively engaged in research using machine learning, AI technology to both select the embryos for transfer that have the highest likelihood of resulting in a successful pregnancy, as well as helping us to choose the best combination, dosage and timing of IVF medication to get the healthy eggs and embryos for success. Our IVF laboratory director, Dr. Barash, has been very engaged in this research for a few years now.
Maggie McKay: Wow. You have seen so many changes and improvements in the IVF field over time. Any parting words as to what the future may bring?
Dr. Louis Weckstein: We've come a long way over the past 40 years. When doctors and IVF lab embryologists work together, I believe we can continue to refine fertility treatment to make it even more successful. I've been so fortunate to work in this field for many years and had the privilege to work with so many wonderful patients and medical providers to help patients have families.
Maggie McKay: Dr. Weckstein, thank you so much for sharing your expertise and offering some encouraging information for couples on this difficult journey. I'm sure you've given people a lot of hope knowing about the latest treatment options for infertility, and I'm sure you know how important the work you do is and your center to all those couples who do have success.
You know what? We still go and visit and thank our doctor who helped us 19 years ago and consider him kind of part of our family, even though we only see him once a year. But because without his help, we may not have had our son. So, thank you for what you do.
Dr. Louis Weckstein: Thank you very much. It's my pleasure and my honor to be doing this for so many years.
Maggie McKay: Again, that's Dr. Louis Weckstein, founder and senior partner of the Reproductive Science Center of the San Francisco Bay Area. If you'd like to find out more, please visit rscbayarea.com. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you.
This is Fertile Edge, a podcast from Reproductive Science Center of the San Francisco Bay Area. I'm Maggie McKay. Thanks for listening.
Maggie McKay: Finding out your infertile as a woman can be crushing news, but it's more common than you may think. It accounts for 37% of infertile couples according to the latest study from the World Health Organization. But it's not always a heartbreaking journey for many women that it once was.
To talk with us about fertility, That was Then, This is Now, is Dr. Louis Weckstein, founder and senior partner of the Reproductive Science Center of the San Francisco Bay Area.
This is Fertile Edge, a podcast from the Reproductive Science Center of the San Francisco Bay Area. I'm your host, Maggie McKay. Dr. Weckstein, what an honor to have you here today. Thank you for making the time.
Dr. Louis Weckstein: Happy to be here with you.
Maggie McKay: Doctor, you've been working in the fertility field for more than 30 years. I bet you've seen some huge changes over those years.
Dr. Louis Weckstein: Big changes. The first IVF baby born in the world was in 1978 and in the United States, 1981. I joined RSC in 1990 and IVF success rates in the world were quite low. Thirty percent live birth rate per IVF transfer was considered good at that time. But today, in successful IVF centers, live birth rates twice that number are being achieved.
Maggie McKay: That's amazing. What are some of the biggest areas of change you've seen over these years?
Dr. Louis Weckstein: Yes. Some of the biggest areas of change have been in the IVF laboratory, the secret door behind which all the magic happens, embryo blastocyst culture, pre-implantation genetic testing of embryos, egg freezing for fertility preservation, being able to work with very low sperm counts by using ICSI or intracytoplasmic sperm injection to fertilize eggs. These have had a huge impact on our success with IVF. And Dr. Kristen Ivani, our first IVF laboratory director at RSC, will tell you a little more about what happens in the IVF lab and those changes in a future podcast.
Maggie McKay: Dr. Weckstein, what about the criticism of IVF resulting in too many multiple pregnancies over the years?
Dr. Louis Weckstein: Yes. This has been an area that we've also made great strides by working together on the clinical and laboratory side. Multiple pregnancy, meaning twins and higher order multiple pregnancy rate s like triplets and quadruplets, are at great risk for having premature delivery and many problems. So, we've tried very hard over the years to reduce those rates of multiple pregnancies by growing embryos more days in the laboratory before transfer, selectively using PGT genetic testing to transfer embryos that are more likely to be genetically normal, and doctors not transferring more than one embryo in most situations. Our multiple pregnancy rate with IVF in many centers is now less than 5% with a less than 1% chance of triplets or more.
Maggie McKay: Speaking of triplets, I just have to add this and let you know, my mom had triplets, her first baby, had no idea. They're 70 now, but it was before all this stuff. She just by chance had them. And then, her brother's wife, her sister-in-law, had twins as well. So, anyway...
Dr. Louis Weckstein: Wow. Yeah. And, you know, very often those multiple pregnancies do really well, but they also are at much higher risk, particularly when their triplets or more, for being born so early, that they have a lot of problems.
Maggie McKay: Right. Yeah, they got lucky. Doctor, what changes have you seen on the clinical side?
Dr. Louis Weckstein: Yeah. So as I mentioned, doctors have been a critical part in the movement to reduce these multiple pregnancies by believing in the success of their center and only transferring one embryo and working with the IVF lab to help select the best embryo for transfer. It's important for us to be continually reevaluating the way we stimulate women's ovaries with medication to mature eggs by searching for new combinations and medications to accomplish this while reducing the risks. The use of the medication leuprolide or Lupron as a trigger shot to mature eggs has almost eliminated the risk of ovarian hyperstimulation. Many years ago, 5% of our patients would have fairly severe hyperstimulation side effects from IVF, and that is now very rare.
Maggie McKay: What about the uterus? Have there been changes that can help it be more receptive to an embryo implanting?
Dr. Louis Weckstein: The uterus and implantation is an area that we're trying to impact with some new ideas In recent years. Different combinations and timing of medication and hormonal support may be helpful in some situations, though there are mixed reviews on uterine lining biopsy testing to improve so-called uterine receptivity.
Maggie McKay: And what about infections in the uterus? Does this play a role when helping to create a successful pregnancy?
Dr. Louis Weckstein: Yes, the microbiologic environment in the uterus is a relatively new area that is being explored to see how important it is for the uterus' influence on implantation. Some studies are suggesting that there are good microbiologic organisms. These can be helpful for an embryo to stick. But if these are lacking, implantation and maintenance of an early pregnancy is not as good. We may be able to improve this with probiotics to replenish the healthy uterine microbiology environment. And there are also bad microorganisms that can cause infection or inflammation in the uterus. And if they are treated, successful implantation and pregnancy may be more likely.
Maggie McKay: Dr. Weckstein, is IVF being used to prevent diseases?
Dr. Louis Weckstein: Yes. Disease prevention is now a huge area in the fertility field. If we can identify a life-impacting disease with genetic testing to see if a person carries that disease and is likely to pass it on to their child, we're now able to test embryos for some severe diseases and preferentially transfer the healthy embryos.
I see two to three patients each month who have no infertility problem, but had a child with a severe genetic disease and they only found out that they were both carriers of this disease once they had a child with a disease. And they are now coming to us, even though they have no fertility problem, to do IVF with pre-implantation genetic testing of the embryos to greatly reduce their chance of having a child with a severe disease.
Maggie McKay: When you started out in medicine, did you ever think you'd see the day where this kind of thing was possible?
Dr. Louis Weckstein: It definitely boggles our minds these days. Being in this field for so long and seeing all the changes and the increase in success, it really was unimaginable when I started my career.
Maggie McKay: That's amazing. I hear about machine learning and AI learning. Is that happening in the fertility field?
Dr. Louis Weckstein: Yes. At RSC, we are actively engaged in research using machine learning, AI technology to both select the embryos for transfer that have the highest likelihood of resulting in a successful pregnancy, as well as helping us to choose the best combination, dosage and timing of IVF medication to get the healthy eggs and embryos for success. Our IVF laboratory director, Dr. Barash, has been very engaged in this research for a few years now.
Maggie McKay: Wow. You have seen so many changes and improvements in the IVF field over time. Any parting words as to what the future may bring?
Dr. Louis Weckstein: We've come a long way over the past 40 years. When doctors and IVF lab embryologists work together, I believe we can continue to refine fertility treatment to make it even more successful. I've been so fortunate to work in this field for many years and had the privilege to work with so many wonderful patients and medical providers to help patients have families.
Maggie McKay: Dr. Weckstein, thank you so much for sharing your expertise and offering some encouraging information for couples on this difficult journey. I'm sure you've given people a lot of hope knowing about the latest treatment options for infertility, and I'm sure you know how important the work you do is and your center to all those couples who do have success.
You know what? We still go and visit and thank our doctor who helped us 19 years ago and consider him kind of part of our family, even though we only see him once a year. But because without his help, we may not have had our son. So, thank you for what you do.
Dr. Louis Weckstein: Thank you very much. It's my pleasure and my honor to be doing this for so many years.
Maggie McKay: Again, that's Dr. Louis Weckstein, founder and senior partner of the Reproductive Science Center of the San Francisco Bay Area. If you'd like to find out more, please visit rscbayarea.com. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you.
This is Fertile Edge, a podcast from Reproductive Science Center of the San Francisco Bay Area. I'm Maggie McKay. Thanks for listening.