Fertility specialist

Dr Derman featured in Princeton Packet

Infertility causes and solutions in the Princeton Packet: Princeton IVF blog

YOUR HEALTH: Infertility: causes and solutions

By Stephanie Vaccaro

Dr. Derman talks about the causes and treatments for infertility

This article recently appeared in the Health Matters Column of the Princeton Packet...

   So You Want to Have a Baby?

   Infertility is defined as the inability to conceive after engaging in unprotected sex for one year, according to the Centers for Disease Control and Prevention.

   What causes fertility problems?

It can be a number of factors. Dr. Seth Derman of Princeton IVF and Delaware Valley OBGYN, said that approximately 40 percent of the fertility issues he sees are due to male problems, 40 percent are due to female problems, and 20 percent a combination of both partners.

   ”The exact cause of male infertility is a little harder to diagnose because it’s not well understood,” Dr. Derman said. “With female infertility, the most common cause is ovulation problems, which usually show up as irregular cycles. Polycystic ovarian syndrome is the most common of these.”

   Fertility problems can be caused by endometriosis. They also can be linked to damage to the fallopian tubes, which can be caused by previous sexually transmitted diseases. This is particularly a problem in women who have had prior Chlamydia infections.

   And sometimes infertility has no identifiable cause.

   What options exist for treatment?

   ”Well, it depends what’s wrong,” Dr. Derman said. “If there’s an ovulation problem, usually the treatment is fairly simple with fertility drugs. These are medications that induce ovulation, such as clomid or letrozole.”

   ”For tubal problems — the treatment is usually surgery or IVF (in vitro fertilization),” Dr. Derman said. “IVF is clearly the most effective treatment for these problems.”

   Oftentimes the most effective option involves treating the female partner. IVF allows for the sperm to be injected directly into the egg, and is the most effective treatment for male infertility. “The poorer the husband’s sperm the more likely the couple will need more invasive treatment such as IVF,” Dr. Derman said.

   A less invasive alternative to IVF is insemination, in which sperm is injected up into the uterus. In contrast, IVF involves fertilization of the egg outside of the body, and the transfer of that embryo into the woman’s womb. It is also much more effective than insemination. When patients have unexplained infertility, insemination is oftentimes done first, and if that doesn’t work then they may try IVF, Dr. Derman said.

   What are the odds of success?

Typical fertile couples have a 20 to 25 percent chance of getting pregnant each month. Infertile couples have a 3 percent chance when trying on their own. IVF increases the odds of having a child to twice what it would be in a fertile couple. Those numbers can vary based on age.

   IVF is very often successful in the first or second cycle, particularly in young women. If it isn’t successful, it’s not unusual for a couple to try three or four times, according to Dr. Derman.

   Who pays for IVF?

In New Jersey, the Family Building Act (August 2001) requires companies with more than 50 employees to cover fertility testing and treatment, including IVF. There are exceptions in the law, and since the passage of healthcare reform, those exceptions have gotten even larger.

   Some of the other treatments can be relatively inexpensive. “For instance, treatment using fertility pills and some monitoring is not terribly expensive,” Dr. Derman said.

   When should you go see a fertility doctor?

   ”Generally, over 35, we recommend coming after six months,” Dr. Derman said. “If they are under 35, one year is the right time.”

   What should you expect when you go see a fertility doctor? When patients go to see Dr. Derman for the first time, the first stage in the process is to try to understand why they are unable to conceive. After getting a detailed history, tests will be ordered, which include testing to make sure their eggs are not running out, to make sure their tubes are open, to make sure the ovulation process is going well and that the sperm is normal. After getting a clearer picture of what is going on, they can better determine the next steps.

   ”Not everybody with infertility needs IVF, even though it is the most effective treatment out there,” Dr. Derman said. “IVF is the last thing that we do, not the first thing.”

 

Celiac disease, fertility and pregnancy

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Is there a link between celiac disease, infertility and pregnancy complications?

Celiac disease is a relative common disorder of the gastrointestinal tract caused by an allergy to gluten, a protein commonly found in wheat and other grain products. Like many other diseases, it what we call an autoimmune disorder, a disease in which the body's immune system attacks the person's own normal cells. Treatment of this disease rarely requires any drugs and almost always is helped by changing one's diet to a gluten-free one. The disease is also known as celiac or nontropical sprue, or gluten-sensitive enteropathy. Women (and men) who suffer from celiac disease may have symptoms such as:

  • abdominal bloating and pain
  • diarrhea or constipation
  • weight loss
  • fatigue

Studies on Celiac disease have also reported higher rates of infertility, miscarriages and menstrual problems among women with the disease, and then once pregnant, higher rates of a number of pregnancy complications such as low birth weight babies. It has even been reported to affects male fertility.

So, does this mean the Celiac disease causes fertility and pregnancy problems? Not so fast. Many of these studies are really too weak and small to draw any real conclusions. Still other studies fail to show that Celiac disease causes any reproductive issues. At this time, issue is far from settled.

For those looking to find a reason for their otherwise unexplained infertility, this may not be for the answer. However, for those who are having trouble getting pregnant and have lots of gastrointestinal symptoms, it may not be a bad idea to ask your doctor about getting tested for Celiac disease.

 

Dr. Derman named top doc

Seth G Derman, MD selected as a top doctor by Castle Connolly

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Princeton IVF and Delaware Valley OBGYN are pleased to congratulate Dr. Seth Derman for his selection as a regional Top Doctor in Reproductive Endocrinology by Castle Connolly.  The organization is a leader in helping patients find the best doctors in various medical specialties. They assist magazines such as Inside Jersey, New York Magazine and Philadelphia Magazine in compiling their top doctor lists.

Reproductive Endocrinology (also referred to as Reproductive Medicine) is the subspecialty of Obstetrics and Gynecology that deals mainly with infertility and recurrent miscarriages, but also other reproductive hormonal disorders such as polycystic ovarian syndrome (PCOS), endometriosis and developmental disorders of reproductive system.

According to  Castle Connolly's website:

These Top Doctors' medical educations, training, hospital appointments, disciplinary histories - and much more - are screened by the Castle Connolly physician-led research team. Those doctors who are among the very best in their specialties and in their communities are selected for inclusion. Doctors do not and cannot pay to be included in any Castle Connolly Guide or online directory.