Infertility

Infertility and women in the military

Fertility issues may be common in women in the US military

A recent survey suggests that infertility may be a common problem among American servicewomen

How common are fertility issues among women in the US military?

According the Service Women’s Action Network, 37% of women from the various branches of the military (army, navy, air force, marines) surveyed experience difficulty in conceiving.

Is it easy to get infertility treatment in the military?

While treatment is available, respondents reported that treatment services were limited and difficult to access. Many basic fertility procedures such as IUI and access to a fertility specialist were unavailable on base, and for those who require advances treatments such as IVF, there are only a few military medical facilities which offer it. Frequently, those centers have long waiting lists, and require significant travel.

What about off base fertility treatment for service women?

Like other practices in different parts of the country, we are close to an active military base. Joint Base McGuire-Dix-Lakehurst is not far and we do participate with Tricare, so we do get to help many couples from the base seeking fertility treatment. The obstetricians and midwives in our practice also see many of the service women and family members for pregnancy care and gynecologic issues.

Losing weight before conception

Weight loss before baby: Princeton IVF blog
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This time of year is a time when many couples who are having trouble conceiving decide it’s time to start seeking help. That help could come from the OBGYN, a midwife or a fertility specialist. It’s also a time in the year, after indulging during the holidays, when many of us have a few extra pounds to shed.

For those who are overweight, part of that advice will be to lose weight before conception.

While this may not be easy, there are multiple reasons why weight loss before pregnancy is good advice.

  • Being overweight will reduce the chances of you getting pregnant on your own

  • Being overweight will increase the chances that if you do get pregnant, you will miscarry

  • Being overweight will increase the chances of medical complications during pregnancy such as diabetes and high blood pressure.

  • While diet and exercise during pregnancy can help limit weight gain during pregnancy, it is not likely to reduce the likelihood of pregnancy-related complications such as diabetes and hypertension.

Delaying pregnancy and excess weight are both bad for fertility, so delaying pregnancy for weight loss is balancing two risks.

At what point do the risks of delaying pregnancy offset the benefits of weight loss?

  • According to a recent study presented at the American Society for Reproductive Medicine, women in their late 30’s or those have poor ovarian reserve may be best off not delaying childbearing despite the obvious benefits.

Adenomyosis and your fertility

Adenomyosis and fertility: Princeton IVF blog

Adeno what?

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Most women have never heard of adenomyosis, but most gynecologists have, and it is a condition that may affect your chances of having a baby.


What is adenomyosis?

Adenomyosis is a disease where the glands that line the uterine cavity (the endometrium) are growing into the muscle of the uterus (the myometrium). In the past adenomyosis was considered a form of endometriosis, a disease in which the glands that normal grow in the endometrium grow outside of the uterus.

What are the symptoms of adenomyosis?

The symptoms of adenomyosis are similar to those of fibroids, painful and heavy periods. Not everyone with adenomyosis had symptoms though.

How is adenomyosis diagnosed?

In the past and sometimes still, adenomyosis was diagnosed when the tissue from a hysterectomy (removal of the uterus), usually done on someone who is thought to have fibroids, is examined in the laboratory. Sometimes, adenomyosis can be seen on ultrasound and can be seen even better on MRI.

Does adenomyosis affect fertility?

In the past, the answer was unclear. Recent research suggests that it may harmful to your fertility. Women undergoing with adenomyosis undergoing IVF had lower implantation rates, lower pregnancy rates, lower live birth rates and higher miscarriage rates.

How is adenomyosis treated?

Most adenomyosis is treated by hysterectomy, but this is not an option for fertility patients. There are newer experimental procedures such as ultrasound ablation, but it is not clear how safe and effective they are.

Eight million IVF babies

World welcomes the 8 millionth IVF baby: Princeton IVF blog

2018 sees the number of IVF babies top 8 million

IVF is a now a common treatment for infertility

It’s been 40 years since Louise Brown, the first IVF baby, was born in the United Kingdom. At the time, it was both a miracle and controversial. Now in 2018, it has become a common medical procedure, not just in Britain and the US, but around the world. Now we have reached a new milestone.

2018 marks the birth of the 8 millionth IVF baby

So what is IVF all about?

IVF means in vitro fertilization. In vitro literally means in glass. The eggs and sperm are removed from the body, fertilized in a dish (it’s plastic, not glass though) and returned to the womb.

Why has IVF become so common?

Because it works. While IVF is not always successful, it is the only fertility treatment that has higher pregnancy rates than those of normal fertile couples. The technology has improved, and as the developing world has become more prosperous, these technologies have spread outside the US and Western Europe. IVF is now largely accessible to infertile couples worldwide.

Why do IVF instead of other medical procedures?

IVF is not necessarily the first treatment we try. Many patients will conceive with other lower tech ways such as intrauterine insemination or fertility pills and don’t need IVF. Some couples, such as those with damaged fallopian tubes or with very poor quality sperm, cannot conceive without IVF.

Celebrities having babies over 40

Pregnancy in your 40s- how realistic is it?: Princeton IVF blog
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The media shows plenty of Hollywood stars having babies in their 40s, but are they telling the whole story?

For many it is exciting to hear about the celebrities they adore having babies. Like many women in the society at large, many celebrities have chosen to delay having children for a variety of reasons. It should come at surprise, then, that many of the celebrity moms depicted in the magazines are in their 40s.

Knowing how women trying to start a family (or growing her current family) as they get older face an uphill battle,  are the media who cover these stories doing a disservice to women's reproductive health?

To answer this question, researchers at New York University looked at all the issues of 3 popular magazines widely read by women of reproductive age over a 4 year period.

This is what they found:

  • There were 1,894 references to pregnancy or fertility
  • 1/3 of the issues had cover stories related to fertility
  • There 240 celebrities, who averaged age 35
  • Only 2 articles on 40+ year olds using donor eggs
  • There were 10 stories about adoption and 5 about using a gestational carrier. Not one of these mentioned that they had previously suffered from infertility

It is understandable that a celebrity (or anyone else for that matter) would not want to share the very personal details of what it is like to go through fertility testing and treatment.  Still, the stories presented to the public are far from complete. While there is nothing that appears to be inaccurate in the articles, they present an unrealistic view of normal fertility after 35.

Modern fertility treatments have revolutionized the ability of couples suffering from infertility to get pregnant, but it has not been able to eliminate reproductive aging. Implying that waiting to have children is not harmful to your fertility through human interest stories is doing a disservice to women. 

Is treating infertility a crime?

Is treating infertility a crime?: Princeton IVF blog

Irish government proposes draconian new regulations of IVF treatments

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Fertility treatments, particularly IVF have been subject to strict government regulations around the world, but has the Irish government's proposals gone too far this time?

Recently, the Irish government Department of Health has decided to develop a plan to provide IVF treatment for its citizens who suffer from infertility. While this is excellent news, they are also proposing some regulations, that are a bit over the top including...

One can understand their desire to refuse to cover treatments that would be less likely to result in a healthy live birth, but to threaten jail time for doctors and staff for performing IVF. That makes no sense. Hopefully, these absurd regulations are never enacted.

 

A spoonful of sugar may may the medicine go down, but will it harm your chances for pregnancy?

Sugary drinks, articifical sweeteners and fertility: Princeton IVF blog
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Recent studies suggests that sugary drinks, even those with artificial sweeteners may harm the chances for pregnancy.

Although it is far from conclusive, several recent studies suggest that sweet drinks may have an adverse effect of a woman's chance for pregnancy, including...

  • Harvard doctors found that drinking one sugary drink a day can lower the success rate of IVF by 12% and more than one sweet drink a day by 16%

  • Brazilian researchers found that consuming sugary or artificially sweetened drinks reduced embryo quality and the chances for an embryo to implant. interestingly

Interestingly this effect did not occur with unsweetened coffee.

The reason for this is not totally clear, though we know both obesity and polycystic ovarian syndrome (PCOS), which are both associated with infertility and miscarriage, and associated with changes in how the body handles sugar, can lower the chances for pregnancy.

So, what should I do?

It is a good idea to keep sugary products to a minimum when you are trying to get pregnant, and to minimize artificial sweeteners such as Splenda, Equal or Sweet-and-Low. These sugar substitutes may be just as harmful as sugar itself.

Don't panic. Women who use artificial sweeteners and drink sweet drinks still get pregnant all the time, even if the chances are a little lower. There are many factors that go into your fertility, so it is far from clear that consuming these drinks is actually harms your chances for pregnancy.

Trying IUI before IVF

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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.

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.

Delaying the diagnosis of PCOS

PCOS may take years to diagnose: Princeton IVF blog
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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. 

 

 

Dr Derman discusses IVF and Assisted Reproduction with the Princeton Packet

HEALTH MATTERS: Assisted reproductive technologies available

By Seth G. Derman

What is in vitro fertilization with Dr. Seth Derman

 

This article previously appeared in the Princeton Packet  

Infertility – the inability to get pregnant or stay pregnant – is a common problem in the United States, affecting about 10 percent of women of childbearing age, according to the Centers for Disease Control and Prevention.

Fortunately, many couples can still realize their dream of having a child with the help of assisted reproductive technologies (ART), most commonly in vitro fertilization.

Princeton IVF in Lawrenceville, provides care for couples struggling with infertility and enables many women to deliver happy and healthy babies.

How does IVF work?

When most people talk about ART, they are referring to in vitro fertilization or IVF. IVF has been used for decades to help women get pregnant. In fact, the first IVF baby is now over 30 years old and has a child of her own.

With IVF, eggs are surgically removed from the body, fertilized with sperm and allowed to grow in the laboratory. In vitro literally means “in glass,” as the fertilization and early development happens in a laboratory dish.

Fertilization can occur naturally with the sperm selecting the egg or in cases where there are problems with the sperm, can be assisted with doctors inserting the sperm directly into the egg. After 3-6 days the embryos are inserted directly into the uterus.

While IVF was first developed to help women with missing or damaged fallopian tubes, it is now routinely used to treat infertility caused by many different problems such as sperm problems, endometriosis, unexplained infertility and any other type of infertility that does not respond to more conventional treatments.

Other methods of ART include gamete intra-fallopian tube transfer (GIFT), zygote intra-fallopian tube transfer (ZIFT) and tubal embryo transfer (TET). With these, the embryo is transferred to the fallopian tube through laparoscopic surgery instead of into the uterus, except with GIFT in which the eggs and sperm are inserted into the tube and fertilization occurs inside the body. With ZIFT and TET, fertilization occurs outside the body. These procedures are rarely performed today as their advantages in terms of pregnancy rates have been overcome by modern laboratory technology and improved methods of embryo transfer.

ART also refers to use of donor eggs and gestational carriers, which are variations of IVF.

Who is a candidate for IVF?

The majority of patients who are candidates for ART suffer from tubal problems, sperm problems, unexplained infertility or certain inherited genetic diseases, according to the Society for Assisted Reproductive Technology (SART). Candidates for ART generally have:

  • No evidence of premature menopause
  • At least one accessible ovary, and
  • A normal uterus

Menopause and ovarian function are irrelevant for candidates using donor eggs. SART recommends that all ART candidates should be in good health and have no medical conditions that would pose a serious health risk to themselves or the children they would carry.

How successful is IVF?

Success rates vary and depend on many factors. Some factors that can affect the success rate of ART include the following:

  • Age of the partners
  • Reason for infertility
  • Type of ART
  • If the egg is fresh or frozen
  • If the embryo is fresh or frozen

In addition, the clinic itself can have an impact on success rates, according to the CDC. Princeton IVF's affiliated Laboratory takes advantage of the latest in “clean room technology,” to help improve pregnancy rates.

A specialized ventilation and HVAC system allows for improved air quality, flow and temperature control. Air quality is further enhanced by the use of eco-friendly, low VOC (volatile organic compounds) paints and building materials. This type of technology can have an enormous impact on embryo quality, survival and clinical outcomes of IVF treatment, research has shown.

What are risks of IVF?

The biggest risk factor associated with ART is multiple fetuses, but that can typically be prevented or minimized in many different ways. Other risk factors include surgical risks from the egg retrieval, side effects of the fertility drugs for mom and risks associated with pregnancy.

And while ART can be expensive and time-consuming, it has enabled many couples to have children that would have otherwise not been conceived.

What is pre-implantation genetic testing?

Pre-implantation genetic testing (PGD) and pre-implantation genetic screening (PGS) can be used following IVF to diagnose genetic diseases prior to implanting the embryo in the uterus. Doctors can test a single cell from the embryo to determine chromosomal abnormalities that, among other things, can lead to miscarriage and birth defects.

Talk with your doctor

If you are one of the millions of couples struggling with infertility, talk with your doctor about ART. For many, it is a promising option that can help couples realize the joy of parenthood.

To learn more about Princeton IVF or to our physician from Princeton HealthCare System, call 609-896-4984 or visit www.princetonivf.com.

   Seth G. Derman, MD, FACOG, is board certified in gynecology and reproductive endocrinology. He is a fellow of the American College of Obstetricians and Gynecologists and a member of the medical staff at University Medical Center of Princeton at Plainsboro.

Pioneer of IVF in America Remembered

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The father of IVF in the US and his legacy

This past month the Reproductive Medicine community lost one of the giants in our field, Dr. Howard Jones. Although I never had the opportunity to work under Dr. Jones, my own mentors did train under him in Norfolk and Johns Hopkins. Like all reproductive medicine specialists in the country, not just those who trained under him, we owe a special debt to him for enabling us to do what we do.

In the early days of our specialty, fertility doctors could do little to help our patients. There were medications to help women with irregular cycles ovulate and fertility surgeries that had limited success. Still, many causes of infertility remained remained very difficult to treat. After leaving Johns Hopkins for Norfolk, Dr. Jones' team was the first in the US to perform successful IVF on an infertile couple, and his team's numerous contributions to the advancement of IVF continued for years to come.

Now, built on the foundation by Drs. Howard and Georgeanna (his late wife and partner) Jones, today we can actually help most of our patients have a baby to take home, and that is a truly a life to celebrate.

Endometriosis and pregnancy complications

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It is well known that women who suffer from infertility and become pregnant are more like to have a difficult pregnancy. The rates of a number of pregnancy complications are increased in these women even if the pregnancy was not the result of treatment such as fertility drugs, IVF or IUI.  It is also widely known that endometriosis may cause infertility.  What is less clear is whether is there is a relationship between endometriosis and pregnancy complications.

Now a group from the UK has studied the link  between the two and found that women with endometriosis in fact do have higher rates of pregnancy complications than other women. Their findings were presented at  The European Society of Human Reproduction and Embryology . They found that that pregnant Endometriosis patients were more likely to experience:

  • Ectopic pregnancy 
  • Miscarriage 
  • Placenta previa 
  • Preterm birth  
  • Heavy bleeding before or after birth  

While the study may be small and limited, it does suggest that like infertility, endometriosis in itself may be a risk factor for a complicated pregnancy.

Basic facts about fertility and infertility for NIAW

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This week April 19-April 25, is National Infertility Awareness Week (NIAW).  In recognition of NIAW, we would like to share some of the basic facts about fertility and infertility

Tuberculosis and infertility

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Tuberculosis (TB) and Infertility

Just recently, we passed World Tuberculosis Day. If you are like most folks, you probably never even knew that such a day even existed. In fact, most doctors here in the US, including fertility doctors, don't pay much attention to tuberculosis anyhow and think of it as a disease of the past, not really much of an issue here at home. Certainly, tuberculosis is a disease that is uncommon here in 21st century America. But that is not necessarily true around the world.

Practicing here in New Jersey, we see patients who have moved here from all over the world, and particularly quite a few from India. TB is endemic in India where it has been estimated that 40 % or more of the population is affected. Many who have been infected with tuberculosis are not even aware of it. 

While we generally think of TB as respiratory disease, it can also affect the reproductive system. While here in the United States, it is very uncommon to see genital tuberculosis, that is not necessarily true in other countries. TB can infect and damage the fallopian tubes and the lining of the uterus resulting in infertility. While this is relatively uncommon, it seen by New Jersey fertility doctors and obgyns from time to time, though most are unaware that it is even a possibility. Many can be helped by modern technologies such as IVF.

It turns out after all there is a connection between World TB Day and the world of Reproductive Medicine. Its a reminder that not all of the diseases we though we have conquered have completely been defeated.

Common preception is often incorrect: Infertility rates are not rising.

A recent report from the Centers for Disease Control suggests that infertility is actually becoming less common despite the popular wisdom that it more common than ever. The why is unknown. It could be due to couples seeking treatment sooner, economic concerns in this uncertain age or reductions in sexually transmitted diseases.  For more on this story, click here.

Plastic bottles, BPA and infertility

nalgene-bpa free bottle

Bisphenol-A (BPA), a chemical found in some plastic bottles has been shown to affect egg development. Researchers at Brigham and Womens Hospital/Harvard Medical School showed that the left over eggs from IVF were less likely to develop properly if there were exposed to high levels of BPA. Click here from the story from the Boston Globe. Click here for the original article from the journal Human Reproduction. It is not clear whether the low levels seen in most plastic bottles is enough to cause any problems though.

Happy 35th Birthday Louise Brown !

Today Louise Brown the first child born from In Vitro Fertilization(IVF) turned 35 years old. The pioneering work of Drs. Steptoe and Edwards has led to a revolution in infertility care that has led to over 5.5 million births.

Weight does impact the chances for IVF success

We have know for years that being overweight can affect fertility and lower success rates for infertility treatments such as IVF. Some centers have even set weight limits on IVF treatment for this reason. However, it wasn't clear if being overweight was harming the eggs or making the uterus less receptive to pregnancy. A recent study from Spain found that overweight patients had lower pregnancy rates even when they got eggs from a normal weight woman, meaning that this effect is due at least in part to a problem with the uterus. The take home lesson: weight loss may improve your chances of having a baby even with donor eggs. For more information from Dr. Sanjay Gupta's Guide, click here

Do human embryos like music? Maybe

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For many years, people would talk to their plants to try to make them to grow better. In a new twist on this same idea, IVF researchers in Spain fertilized eggs (using ICSI) and cultured half of the eggs with music and half without.  It turns out that the eggs exposed to music were more likely to fertilize.  Click here for more.