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Will I still be fertile when I am ready to have kids?

Blood test may not predict future fertility: Princeton IVF blog
AMH-to-predict-future-fertility.jpg

Fertility specialists (and obgyns) get this question all the time.

How can I know when my fertility will run out?

Many fertility doctors have recommended checking a test called AMH to see whether a women is approaching the end of her fertility. This is a blood test that we commonly use to determine ovarian reserve, which is a measure of how many eggs are left and how many eggs a woman might expect to be able to make when on fertility drugs, like those drugs taken for an IVF cycle. We know that AMH is fairly good predictor of how a woman will respond to drugs, and to a lesser extent how likely she is to conceive on treatments. This test is now easy to obtain, helpful for counseling and it use has become fairly routine among fertility specialists.

So, if it is good to determine the chances for success in women seeking fertility treatment, shouldn't it be useful in determining which women might have trouble getting pregnant down the line?

It certainly makes sense. Use the AMH to determine which women are starting to run out of eggs, and encourage them to start trying to get pregnant sooner, not delay seeking help with a specialist or even freeze her eggs for the future.

To test this idea, researchers in North Carolina looked at AMH as well as several other markers of aging ovaries to see if they might predict whether a women would have trouble getting pregnant going forward.

It turned out that AMH and the other tests could not predict infertility in the near future, and that the only thing that could predict the chances for pregnancy was age.

The take home message: there is no magic test at this time that can predict your future fertility. The best recommendation is the old recommendation. Don't wait.

Ready to give up after IVF? It's not time to give up.

Many couples with unsuccessful IVFs get pregnant on their own
Upto a third of couples who failed to get pregnant with IVF may get pregnant on their own.

IVF treatment can be incredibly stressful, even when it is successful. Imagine how difficult IVF can be when it is not? That is likely why so many couples give up after an unsuccessful IVF cycle.

According to reasearchers in the UK, almost a third of couples who are not successful at IVF and stop treatment will conceive on their own, although that might take up to 2 years.

Surprisingly, many of the couples who did conceive this way were not as thrilled as one might expect. Some couples have moved on in their life situations, and others were felt that maybe they never needed IVF in the first place.

Dr. Seth Derman, Inside Jersey Top Doctor

Dr. Seth Derman- a top fertility doctor in NJ
Seth G Derman, MD, Reproductive Medicine Specialist and Inside Jersey top doctor

Dr Derman named to the top doctor list once again for 2017

The medical director at Princeton IVF and a Reproductive Endocrinologist at Delaware Valley OBGYN and Infertility, Dr. Seth Derman has been named one of Inside Jersey Magazine's Top 2128 Doctors for 2017.

Candidates for the top doctor list are vetted  by Castle Connolly, and nominated and selected by their peers for inclusion in this list.

Can having a miscarriage increase your chances of having a baby?

Miscarriage after IVF may mean a better chance for future baby

An unsuccessful IVF cycle can be downright devastating to couples going through fertility treatments, particularly when the cycle results in a miscarriage. Between the guilt, the disappointment and the "if I only had's," many couples leave the experience totally devastated.  But are those concerns really warranted?

Probably not.

Fertility specialists have known for years that women who miscarry, are actually more likely to have a baby, even though most patients are a understandably somewhat skeptical about this.

To look further into this fertility specialists at the University of Aberdeen in Scotland looked at well over 100,000 IVF treatment cycles performed between 1999 and 2008. They were particularly interested in women who had a first cycle at that was unsuccessful, whether that was there was a miscarriage or no pregnancy at all. What they found was not surprising considering what we already know.

Women who had miscarried had a higher 49% chance of livebirth in the subsequent IVF cycle as compared to only a 30.1% chance had the first cycle not resulted in a pregnancy.

So, what does this all mean? 

  • Don't be in a rush to give up. Lots of women conceive on subsequent cycles.
  • Having a miscarriage from IVF, and likely from other treatments, means you are more likely to have a baby, not less likely.

Trying IUI before IVF

IUI-vs-IVF-treatment.jpg

A new study suggests a few months of IUI might work just as well.

No surprises here. We have been advising our patients to consider intrauterine insemination (IUI) as an alternative to IVF for years.

A recent study again confirms the that IUI is a reasonable approach to treating infertility. Researchers in New Zealand found that women who did IUI along with oral medications (clomiphene was used in this study) for 3 months has similar pregnancy rates to those who went straight to IVF on their first treatment cycle.

So, why would one to go straight to IVF? IVF offers several advantages over inseminations:

  • higher pregnancy rates
  • shorter time to conception
  • ability to genetically test the embryos before putting them back
  • elimination of most multiple births when only one embryo transferred
  • the ability to freeze left over embryos for future use 

IUI also has some significant  advantages:

  • much less expensive (about 1/5 of the cost)
  • much less invasive
  • fewer drugs, fewer injections
  • no need for anesthesia
  • less stressful
  • lower multiple birth rates when oral fertility drugs are used and multiple embryos are transferred with IVF

All couples have a different comfort level when it comes to fertility treatment. Like most medical treatments, fertility treatments involve balancing the effectiveness and risks of the various options. This is an important discussion to have with your doctor.

Noise and fertility

Traffic noise may increase time to conceive: Princeton IVF blog

Could a noisy neighborhood be making it harder to get pregnant?

Danish study suggests couple who live in neighborhoods with lots of traffic noise may take longer to get pregnant.

A study from Denmark suggests that it may have some impact.

The researcher looked at 65,000 Danish women who delivered between 1996 and 2002, and interviewed them to determine, among other things, how long it took them to conceive. They also looked at the traffic volumes for their neighborhood to see if they could compare the two.

They found that for every 10 decibels of additional traffic noise, there was a 5-8% increase in the chance it would take more than six months to conceive. 

Fortunately, increased traffic noise did not affect a couples chances to take longer than a year to get pregnant. Infertility is defined as a disease in which a couple is unable to conceive after one year's time, so the traffic noise itself did not cause infertility.

They could not determine whether the delayed time-to-conception (TTC) was due to the male or female partner, and the this delayed TTC was not affected by other factors such as poverty or levels air pollution that could delay conception.

Editing embryos- fiction, science fiction or both?

Designer babies and gene editing: fiction, science fiction or both: Princeton IVF blog
Researchers in Oregon 

A recent report from Oregon describes how researchers edited the genes in a human embryo.

To many of us, myself included, it sounds a bit scary.

An article in the NY times argues that it is huge leap from gene editing to designer babies, since most human traits require the interaction between a number of genes and the environment

There are thousands of what are called single gene mutation disorders that this gene editing technology may be able fix. Examples of this include Cystic Fibrosis, Tay Sachs disease and Sickle Cell Anemia. These types of diseases are due to a single gene mutation which could potentially be repaired using this technology. Many of these disorders can currently be screened for and diagnosed (if anticipated) during the IVF process using Preimplantion Genetic  Diagnosis (PGD)

Picking out your child's height, or athletic or intellectual abilities are another story. Height alone is likely to controlled by tens of thousands of genes, of which less than a thousand have been identified. Even if all of the genetics could be worked out, the task of editing those genes would be enormous.

So, for now at least, designer babies are the stuff of science fiction.

Rhode Island mandates fertility preservation

First state mandates egg freezing insurance coverage: Princeton IVF blog

First state requires fertility preservation coverage from insurers

Egg freezing insurance coverage

What is fertility preservation?

It refers to obtaining, freezing and storing eggs, sperm or embryos for future use. 

Why would one want to preserve fertility?

There are several reasons:

  • If you are undergoing treatment for cancer or other diseases that require treatments such as chemotherapy, radiation or surgery which are likely to cause infertility.
  • If you need to defer having a baby but are concerned you may be too old when you are ready
  • If you do not have a partner, are concerned about waiting but not ready to use a sperm donor.

What is the signIficance of the Rhode Island law?

This is the first time in the US that fertility preservation insurance coverage has been mandated by law. A number of states do require treatment for infertility but not necessarily fertility preservation. That could change in the future.

Where can I learn more about the mandate?

Here is a link to the Rhode Island law.

What do I do if I am about to get chemotherapy and want to learn more?

This is a discussion you need to have ASAP with your oncologist and a reproductive medicine specialist. Ideally the process should happen before cancer treatment starts, and your oncologist will want to delay treatment as little as possible. If you are in our area and would like to see us at Princeton IVF, please call at 609-896-4984 or 609-896-0777 to set up an appointment.

 

Sperm selfies?

Testing for male fertility on your smartphone: Princeton IVF blog

Could your smartphone replace a semen analysis?

At home, iphone and android based sperm test kit

 

Can this device replace a semen analysis with your doctor? Maybe in the future.

Based on research from Harvard University, engineers have developed a new device for an at home "semen analysis." There are already at home sperm test kits available in stores, what is so unique about this one? Simply put, it is the smart phone. This device attaches to and taps the power of your iphone or android device through it's app, to analyze the data and give you a visual display of what the laboratory folks would see under the microscope.

The pros:

  • low cost
  • quick results
  • can be done at home without the awkwardness
  • you get to see what the actual sperm look like

The cons:

  • lacks the details your doctor may need (actual sperm concentration and motility)
  • unable to accurately determine morphology (another important part of the semen analysis)

The idea is a good one.

Reliable, inexpensive testing in a comfortable setting, and a way to determine when it's time to visit the fertility doctor or urologist. The reality is not quite there yet. The information is not quite enough to replace the formal semen analysis at a clinic, but with improvements in the software, it may well be in the future.

AMA calls Infertility a disease

AMA agrees Infertility is a diesase: Princeton IVF blog

It's official now. Infertility is now what we know it has been for years, a disease, not a problem or an inconvenience.

At the encouragement of the American Society for Reproductive Medicine, the American Medical Association has voted to call infertility a disease.

According to the ASRM, 

Infertility is NOT an inconvenience; it is a disease of the reproductive system that impairs the body's ability to perform the basic function of reproduction.

Now the AMA has accepted this fact.

Sperm counts are dropping

Sperm counts are declining across the west: Princeton IVF blog

A recent publication suggests that sperm counts may be declining all across the western world

Research suggest sperm quality is going down across the western world.

It is been all over the news lately.  Some in the media have even suggested this may bring our doom as a species. So, what's the real story behind this...


A recent paper published suggests that sperm counts may be declining in Western countries.  


While this is not entirely new, it is a continuation of a trend that has been noted for years.  This there has been a decline in sperm quality noted in the United States and other western nations. The authors compiled studies done over a number of years including:

  • 185 studies
  • over 42,000 men
  • between 1973 and 2011
  • from US, Europe, Australia and New Zealand

Over the 39 years, the sperm concentration dropped 52.4% and the total sperm count went down 59.3%, a hugh decline.

While this is concerning, it raises even more questions:

  • Have the counts really declined or is it just the techniques used to count the sperm?
  • If the counts are going down, is it actually affecting male fertility?
  • Is this a problem in the developing world or just in the west?
  • If this being caused by increasing obesity?
  • Is this being caused by something in the environment?

 

Only time and further research will answer these questions.

Your weight and your fertility

Your weight can affect your fertility: Princeton IVF blog
Being overweight can make it take longer to get pregnant in both men and women.

If either partner is overweight, it can harm your fertility

It has been know for for years that women who are overweight have a lower chance for success for IVF, and most fertility specialists encourage their patients who are overweight, to lose weight if possible, before treatment. So, the next logical questions is this: Does being overweight affect your chances of getting pregnant on your own even if you do not have infertility?

A study by National Institutes of Health (NIH) addressed that particular issue. The study was called the Longitudinal Investigation of Fertility and the Environment (LIFE) Study and they looked at couples who were both normal and with various degrees of being overweight to see how long it took them to conceive, commonly referred to as TTC. They looked about 500 couples from Texas and Michigan  and broke them down into 4 groups, normal weight (BMI 18-25), overweight (BMI 25-25), class I (BMI 30-34.9) and class II (BMI 35 and higher).  

The researchers found that in couples with class II obesity ( BMI > 35), it took 55% more time to conceive, than in normal weight couples.

It means that being significantly overweight not only affects your chances for pregnancy with fertility treatments such as IVF, it also makes it more difficult to conceive on your own.

New Jersey updates Infertility Law

New Jersey fertility coverage mandate expanded: Princeton IVF

Governor Christie signs updated NJ fertility mandate

At least in the past, New Jersey has had among the most generous insurance coverage for infertility treatment in the US. The legal mandate for this, the New Jersey Family Building Act, passed over a decade and a half ago, required NJ employers with certain exemptions, to cover fertility treatment up to and including IUI and IVF.

Unfortunately, changes in the health care system, such the Affordable Care Act (Obamacare) have affected coverage. Fortunately, New Jersey state employees and most NJ teachers continue to be covered under the mandate. There are some gaps in this coverage, particularly for single women and those in single sex/lesbian relationships.

With an act of the NJ state legislature and the signature of Governor Christie, that has changed. The infertility mandate has been updated to reflect the new ASRM definition of infertility and includes the following:

  • A male is unable to impregnate a female;
  • A female with a male partner and under 35 years of age is unable to conceive after 12 months of unprotected sexual intercourse;
  • A female with a male partner and 35 years of age and over is unable to conceive after 6 months of unprotected sexual intercourse;
  • A female without a male partner and under 35 years of age who is unable to conceive after 12 failed attempts of IUI (intrauterine insemination) under medical supervision;
  • A female without a male partner and over 35 years of age who is unable to conceive after 6 failed attempts of IUI under medical supervision;
  • Partners are unable to conceive as a result of involuntary medical sterility;
  • A person is unable to carry a pregnancy to live birth; or
  • A previous determination of infertility pursuant to the law.

This update in coverage becomes effective in August 2017 and only applies to New Jersey state employee and teacher plans.

At Princeton IVF, we participate in the affected New Jersey State Health Benefits Program and School Employees Health Benefits Plan that are affected by these new rules, including NJ Direct  from Horizon Blue Cross Blue Shield and Aetna for NJ state employees.

One millionth IVF baby born in the US

One millionth IVF baby born in US: Princeton IVF blog

In Vitro Fertilization US reaches a new record.

The one millionth IVF baby was born in the United States in 2016

The one millionth IVF baby was born in the United States in 2016

This year, the Society for Assisted Reproductive Technology announced that the 1 million IVF baby was born in the United States.  IVF has been around for over 30 years, and performed successfully at multiple clinics in the United States and worldwide since then.  Worldwide, there have been millions of babies born from IVF, but limited coverage in the United States has delayed reaching this milestone.

Delaying the diagnosis of PCOS

PCOS may take years to diagnose: Princeton IVF blog
PCOS-delayed-diagnosis.jpg

How long to does it take to be diagnosed polycystic ovarian syndrome?

Apparently a lot longer than you might expect...

A recent study from University of Pennsylvania suggests that women with Polycystic Ovarian Syndrome may not receive the proper diagnosis for years.

Women across the US and Europe were surveyed and this is what the researchers found:

  • in 1/3 of women, it took at least 2 years to make the diagnosis
  • almost of half of women had visited at least 3 health care providers before the diagnosis was made
  • 84 % of women did not believe they received enough information about PCOS at the time of their diagnosis

As a Reproductive Endocrinologist, this is both surprising and not expected.

In our practice, as in most fertility and gynecology practices, PCOS is one of the most common disorders that we see. It is the most common hormonal disorder in women of reproductive age and the ovulation problems associated with PCOS are the most common cause for infertility in women. So, as specialists, we are attuned to look for polycystic ovary, and are more likely to find it in its more subtle forms. We are also committed to educate our patients about their condition, what causes it, how it is treated and what other health implications it might have.

It is also very common for us to see women who were never told by their doctor that they might have PCOS, and only came to see us because they cannot conceive. Still others, looked up their symptoms online, realized they had PCOS and referred themselves.

Sometimes seeing a specialist can help.

Most of the time your OBGYN, midwife or even primary care physician can manage the symptoms of PCOS. If your symptoms are under control and have a good understanding of your condition, there is no reason to seek out help. If your symptoms not controlled, you are having trouble getting pregnant or you don't feel you have an adequate understanding of PCOS, seeing a sub specialist in Reproductive Medicine may be a good idea. 

 

 

New York: fertility treatment for all women?

NY Governor Cuomo expands fertility coverage: Princeton IVF blog

New York governor changes insurance rules

Governor Andrew Cuomo has instructed insurance companies in New York to cover infertility treatments on single women and women in same sex relationships.

New York is one of fifteen states, including our own, New Jersey, that requires insurance plans to include infertility treatment in their benefits. Typically, these mandates require a period of unprotected intercourse to kick in. In New York, the governor has eliminated that requirement for women in whom that is not an option.

It is unclear how impactful this change may be since New York's infertility mandate is rather limited. It has very limited coverage for IVF, and for insemination, the cost of donor sperm is high. Donor sperm is rarely if ever covered by insurance regardless on insurance mandates.

 

Here are 12 things to avoid telling your friend with infertility:

12 Things not to say to your friend with infertility: Princeton IVF blog
Dealing with friends who have infertility.

Infertility affects 1/8 couples, so chances are you either are having trouble getting pregnancy, had trouble in the past, or you know someone who currently is having difficulty. On this Infertility Awareness Week, here are some tips to be just a little more sensitive.

You should avoid saying these 12 things to your friend or colleague with infertility: 

1. Just relax.

Yes, stress does play a role infertility and stress reduction techniques can help couples conceive, but infertility is a medical diagnosis and seeing a fertility doctor can discover real problems that require treatment.

2. Minimize the problem.

Regardless of how you view it, research shows that the inability to get pregnant is one of the great stressors in life, up there with losing a job and being diagnosed with cancer. 

3. Worse things could happen.

Chances are your friend does not see it that way. 

4. Maybe you were not meant to be parents. 

Don't go there. Many couples with infertility see their condition as a divine punishment rather than what it is, a treatable medical disease. This will only reinforce their self doubt.

5. Why are you not doing IVF?  

IVF is the most effective treatment out there for infertility, but it is not for everyone. It can be expensive, invasive, stressful and conflict with some people's religious values. 

6. Just adopt. 

Adoption is always a reasonable option, but most couples take time to get there, and still others do not want children if they cannot have their own genetic children. 

7. You're young. There's still plenty of time.  

Younger women usually have an easier time getting pregnant, so if things aren't working, it's time to figure out why.  Yes, the chances for success are higher in younger women, but there are no guarantees.

8. Gossip.

Infertility is private. You wouldn't want someone talking about your medical problems to others.   

9. Crude remarks. 

Fertility problems deal with the most sensitive and personal parts of our lives. Don't assume your friend will find humor in it.

10. Complain about your own pregnancy. 

No matter miserable your pregnancy may be, your friend sees pregnancy as the greatest blessing she ever could hope for. Seeing other pregnant women is one of the most difficult challenges for women facing infertility.

11. Minimize their concerns because they already have a child. 

For many couples, a family is not complete with only one child, and it is just as common for couples to seek out help for child number two as for the first. Doctors refer to this as secondary infertility.

12. Ask whose fault it is.

Infertility is a couples thing. While oftentimes, it is one of the partners who has the problem, it takes two to have a baby. Sometimes even when it is a male issue, the female partner must go through most of the treatment. Assigning blame, is counterproductive and can cause considerable strain i a relationship. Don't add to it.

adapted from Resolve.org.

Israeli couple has a live birth after 18 attempts

Couple has baby on 18th attempt at IVF: Princeton IVF blog

When is it time to give up on IVF?

Israeli couple has triplets on 18th attempt at IVF

Most couples give up on In Vitro Fertilization if it fails after a few attempts, but not this Israeli couple.  

While research does show that most couples who do not give up will eventually be successful with IVF, many give up due to some combinations of physical, mental or financial exhaustion. In a testament to determination, an Israeli couple tried a total of 18 IVF cycles. On that final cycle, the Hanans became pregnant delivered triplets at 32 weeks of pregnancy at a hospital near Tel Aviv, Israel.

The man who showed the secrets of human life to the world

Photographer who revealed the origins of life: Princeton IVF blog
Swedish photographer Lennart Nilsson pioneering embryo images

This year, someone who revealed the secrets of human reproduction quietly passed away, and you probably never heard of him... 

The Swedish photographer Lennart Nilsson is not exactly a household name, but his photographs adorn the offices of many fertility clinics across the world and his images of human reproduction and early human life are known throughout the world.

Those pictures, such as the one above, were first published in a Life Magazine article in 1965 called “The Drama of Life Before Birth.” and later on in a book entitled “A Child Is Born.” His photos were even shown in the PBS series NOVA, in an episode entitled, "The Odyssey of Life."

Nilsson developed techniques for microphotography that enabled him to produce stunning images of something was at one time invisible, the origins of human life. Today we live in a world where IVF is widely available, images of human embryos, eggs and sperm can downloaded to your phone in seconds and every OBGYN has an ultrasound in his or her office.  These are just things we take for granted.

In 1965, what Nilsson did was truly amazing. He revealed to us a hidden world, and what he shared with the world was even more amazing than fiction, a glimpse of the world that fertility specialists and embryologists see every day.

Red wine, Resveratrol and PCOS

Could a chemical in red wine help you if you have PCOS: Princeton IVF blog

Could one of the compounds found in red wine help women with PCOS?

red-wine-resveratrol-pcos.jpg

Yes, it actually might help women with polycystic ovarian syndrome.

What is resveratrol?

Reservatrol belongs to a group of chemicals call polyphenols which are commonly thought to act as antioxidants. It is found in the skin of grapes, as well is in peanuts and some berries. Most resveratrol supplements sold in the US, actually come from a plant grown in Asia, rather than from grapes. It has been used as a supplement to help inflammation and diabetes.

Why might resveratrol be helpful for with PCOS?

Polycystic ovarian syndrome is the most common hormone disorder in women of reproductive age, and a common cause for infertility. The symptoms of PCOS are largely related to irregular cycles and excess levels of male-like hormones, but the underlying cause is related to how the body handles sugars. Most women with PCOS have a condition called insulin resistance as the reason for their disorder, and diabetes drugs such as Metformin are commonly used as treatment.  Since resveratol can help women with diabetes, it is possible that it may help women with PCOS as well.

A new study suggests resveratrol may be helpful.

Researchers at University of California- San Diego took women with confirmed PCOS and gave them resveratol supplements to see what would happen. They found that these patient's levels of male hormone including testosterone dropped significantly, suggesting that resveratrol may be doing this by reducing insulin resistance. The researchers did not look at whether their cycles became more irregular or more fertility.

So, should I start drinking red wine if I have PCOS and want to get pregnant?

Not a great idea, at least when you are or might be pregnant. It is possible (but still unproven at this time) that resveratrol may help promote fertility in women with PCOS. On the other hand, it is well known that alcohol, including red wine, when consumed by pregnant women can increase the risk of serious birth defects. It may be reasonable to have red wine before conception, but no OBGYN or  Fertility Specialist would recommend you drink once you might be pregnant.