Egg freezing involves a series of medications that are self administered over a period of two to three weeks. Egg retrieval is performed under light anesthesia and then they are quickly frozen in a process known as vitrification. Vitrified eggs can be kept indefinitely or until you are ready to try and have a baby. Egg freezing has the potential to free women from the constraints of their biologic clock giving them the potential to control when is the best time for them to try and have a baby.

Cost is a major barrier for many young women wanting egg freezing. The American Society for Reproductive Medicine has said that the price for egg freezing is as high as $18,000. At the Fertility Centers of New England, we understand the financial burdens imposed by these advanced technologies. That is why we offer egg freezing for $5,000 to enable young women the reproductive freedom to choose when they are ready to become mothers.

Historically, obstetricians have been hesitant to advise non-exercisers to become active and many have recommended that women tame the vigor of their exercise regimens with pregnancy. It is assumed that these cautions are attributed to the lack of evidence regarding safety of exercise in pregnancy.

Recently a study was undertaken to evaluate fetal well-being in women with otherwise healthy pregnancies (low-risk). Women studied included those who exercised < 60 minutes weekly, > 60 minutes weekly and those who described themselves as “highly active” exercising > 4 days weekly.  These three categories of women were then subjected to aerobic exercise and their aerobic capacity was monitored as well as was the fetal response in utero. Although there was transient increase in fetal heart rates mirroring the increases in the maternal heart rate with exercise; no immediate or long term adverse effects were noted.

Healthy mothers make healthy children. The benefits of exercise extend to the mother and fetus alike. Women, in conjunction with approval from their obstetricians, should be comfortable following established guidelines.

Many hypotheses have been proposed for acupuncture’s mechanism and nearly all of these have been prefaced with the word “may”.  Acupuncture may modulate ovarian blood flow, may increase uterine blood flow, may inhibit uterine irritability, may reduce anxiety and may modulate immune function.  A study of 34 IVF patients receiving multiple acupuncture treatments showed higher levels of cortisol and prolactin in intermittent cycle days as compared to non-acupuncture patients.  Acupuncture patients in this small study also had a higher clinical pregnancy rate (51% vs 37%) but no definitive association with increased cortisol and pregnancy could be made.  More recent evaluations pooled results of multiple acupuncture studies in a “meta-analysis”.  A Chinese study of over 5000 pooled patients (Fertil Steril March 2012 97(3):599-611) concluded that acupuncture improves live birth rate in IVF patients.  A similar meta-analysis in London of 2500 women ( BJOG 115(10):1203-13) showed no difference in pregnancy rates when using acupuncture.  A Chicago study of 168 patients randomized to acupuncture (Fertil Steril 95(2):583-7) also showed no statistically significant difference in pregnancy rates.

So, 10 years after the initial acupuncture study, where do we stand?  The general consensus is that it may help and it does not seem to hurt.  No large study showed detrimental effects of acupuncture.  There is a patient consensus that acupuncture reduced their anxiety associated with the IVF process and that alone may be cause to pursue its use.

There are a finite number of protocols for doing IVF. Some include pretreatment with birth control pills and many forms of medications requiring injections. One protocol does not fit all and your doctor will select the one thought to be the best for your particular situation based on your age, weight, previous cycle experience, and the results of your screening tests. If you are under age 35 and your baseline hormone levels are normal, you may be started on one of two basic protocols each requiring sub-cutaneous (under the skin) injections. The first is a down regulating cycle using a GnRH Agonist called Lupron and is referred to as either a Long Cycle Lupron or Luteal Lupron protocol because it starts in the luteal phase of the cycle before the ovaries are stimulated to make eggs.  The second most common protocol uses a GnRH Antagonist called Ganorelix or Cetrotide. This is given after the ovaries have begun to be stimulated.  Both of these protocols are designed to suppress your own LH surge so you will not ovulate before your eggs are retrieved.

In addition to being given one of the above medications to prevent egg release, your protocol will also include gonadotropins in the form of follicle stimulating hormone (FSH). These medications require sub-cutaneous infections either once or twice a day to stimulate your ovaries to make eggs.  These medications come in several varieties under the brand names Gonal F, Follistim, and Bravelle. In addition, many physicians add additional gonadotropins to their protocols that have the hormone LH as well as FSH in them. The most common of these medications is called Menopur and contains equivalent amounts of both FSH and LH. This medication is also a sub-cutaneous injection.   Medications to stimulate the ovaries to make eggs are usually begun on Day 2 after your period starts while medications containing LH are generally but not always begun on the fourth day after starting FSH.  Many physicians call when LH is added to FSH, a “sweetened protocol.”

You will be asked to have blood tests and ultrasounds performed at various times during your ovulation induction cycle to monitor the progress of egg development. Just before the most advanced follicles are thought to be mature according to the estrogen levels and ultrasound appearance of your ovarian follicles, the final steps of egg maturation are set in motion with an injection of human chorionic gonadotropin (hCG).  You will then be scheduled for your egg retrieval.  Being anxious about how to mix and administer the medications required in an IVF cycle is normal. One way to manage such stress is to take the time before you start to learn how to do it. Many centers offer IVF classes either in person, online, or both. You medications will arrive before your cycle is to begin. When they do open the package and make sure you have all that your protocol requires. If in doubt call for an appointment with your team nurse and go over again and again your protocol until you are comfortable in doing what you will need to do.  At the Fertility Centers of New England, we understand the fear and anxiousness going through IVF can cause. That is why we will be by your side every step of the way before, during and even after treatment.

Don’t worry. Your body is not trying to reject the pregnancy that you have worked so hard to have. Nausea and vomiting is extremely common in pregnancy (70-80%) and women with a history of infertility are as likely to experience this as any other pregnant woman.  A continuous spectrum of the severity of nausea and vomiting ranges from the nausea and vomiting that occurs in most pregnancies to the severe disorder called Hyperemesis Gravidarum which occurs in 2% of all pregnancies (about 5 per 1000 pregnancies).  It is thought that nausea is caused by a rise in hormone levels just as it sometimes occurs during ovulation induction; however, the absolute cause remains unknown.

Hyperemesis Gravidarum is characterized by severe nausea, vomiting, weight loss, and electrolyte disturbance.  Women with this condition have increased risk for delivering babies of low birth weight, who are small for gestational age, preterm delivery, and who have low Apgar scores.  Hyperemesis Gravidarum is not preventable, but there are ways of managing it. Severe cases may require hospitalization so that intravenous fluids can be administered and electrolyte balance restored.  Rarely tube feeding and intravenous medications are required.  Milder cases may be treated with:

• Bed rest, but not too much
• Dietary changes and antacids
• Acupressure: The pressure point to reduce nausea is located at the middle of the inner wrist, three fingerbreadths away from the crease between the two tendons. Locate and press firmly, one wrist at a time for three minutes. Seabands also may help with acupressure and can be found at your local drug store
• Herbs-Ginger or Peppermint
• Hypnosis
• Antiemetic Medications: It is important that the risks and benefits be weighed as some drugs may have adverse effects on you or the development of your baby and should only be take under physician supervision

Evidence has accumulated for the role of Vitamin D in maintaining glucose homeostatsis –effectively, reducing the tendencies toward diabetes.  In a relatively recent study of women both deficient and repleted in Vitamin D, those women with lower circulating blood levels were 2-fold more likely to be diagnosed with Gestational Diabetes Mellitus (diabetes in pregnancy).

It also has been proposed that adequate Vitamin D levels during pregnancy may afford protection against the risk of Type I Diabetes in early childhood.  In a large population study performed in Norway representing over 29,000 women, it was reported that women deficient in Vitamin D in pregnancy had a higher tendency toward diabetes in their offspring.  Women with adequate Vitamin D were 2-fold less likely to have a child with diabetes then their Vitamin D-deficient counterparts. (Sorensen et. Al.  Diabetes 2012. Jan; 61(1):175-8.)

Maintaining adequate Vitamin D levels will not abolish childhood diabetes, but it may lower its frequency.

• “Is the cost of anesthesia included?”
• “Are procedures such as intra-cytoplasmic sperm injection (ICSI) included in the price?”
• “Does the price include all hormone testing and monitoring, including pregnancy testing after embryo transfer?”

If the answer to these questions is “no”, then chances are the total cost of treatment will exceed the advertised price.

At the Fertility Centers of New England, we make the process of comparing cost of treatment patient friendly.  Our IVF Assist program is $6,800 per cycle and includes cycle monitoring, egg retrieval and anesthesia, insemination with ICSI, embryo culture and transfer, and finally pregnancy testing after embryo transfer.  To make it even easier and completely transparent, we list our price for IVF on our website.  Moreover, we realize that some patients require more than one or two cycles to achieve a successful pregnancy.  In order to help more patients afford treatment, we cover the cost of treatment for the 3^rd cycle (for those patients not pregnant after two cycles).  Although medications are always an additional cost, our physicians provide realistic estimates on what your out of pocket expense will be for fertility medications.  Our team is always available to discuss your fertility treatment options and if you don’t have insurance coverage, your initial consult is free of charge.  The Fertility Centers of New England is where care centers on you. Contact us today!

Male mitochondria derived from sperm do not survive after fertilization.  Therefore we know the entire mitochondrial content of the developing embryo is maternal.  It is estimated that mature oocytes contain between 20,000 and 800,000 mitochondria.  Oocytes deficient in mitochondria may account for the variable quality seen in IVF embryos.  The mitochondrial activity may also influence oocyte quality.  Oxygen consumption has been one way to measure mitochondrial metabolism and we know that the rate of oxygen consumption increases in the peri-ovulatory period.  One of Dr. Hardy’s patents used NADH fluorescence to measure embryo metabolism.

So why the current interest in mitochondria?  OvaScience, a Boston-based life science company, will soon begin a clinical trial to determine if oocytes may be improved by adding mitochondria to the retrieved oocyte.  The mitochondria will be obtained from the female patient through a laparoscopic biopsy of the ovarian tissue.  Mitochondria will be extracted from the patient’s oocyte stem cells and then injected into the oocyte at time of fertilization.  This will be the first use of autologous (from the same patient) mitochondrial transfer; prior use of mitochondrial transfer from non-autologous (from one woman to another) was banned by the FDA in 2001 after concern with the early data.  The medical community will be looking with interest at the outcomes of this initial small trial to determine if further studies are warranted.  Eventually this may provide a tool for optimizing oocyte quality in IVF patients.

There are 3 fundamental components to a successful IVF cycle. The first is how well were you prepared?  Was the choice of medications to stimulate your eggs right for you?  Did you respond as expected? Was the quality of the eggs and embryos sufficient? Was your uterine lining prepared appropriately?  The second component of a successful lVF cycle is the embryo transfer. Was it easy or difficult? Was it associated with discomfort (other than having a full bladder), pain, or bleeding?  The third component is the embryo chosen for transfer. Was the embryo of sufficient quality to achieve a successful pregnancy?  Following transfer where there any remaining embryos of sufficient quality for freezing?  Recommendations to go forward with another cycle should be made if something of value was learned from the unsuccessful cycle.

Sometimes it is not possible to know precisely why pregnancy does not occur following IVF. More times than not, however, a good deal of information can be obtained about your body and your particular preparation from your unsuccessful IVF cycle attempt. This information can be used to suggest a different course of action that may increase your chances for subsequent success. Remember, your chances of success do not drop until after your first two IVF cycle attempts. Also remember that statistics, although important, are just averages. At the Fertility Centers of New England approximately 1.3 IVF cycles are required to have a baby.

Simplistically, to maintain your weight, approximately 15 calories per pound are required if you lead a very active life style. In older women who are active, 13 calories per pound is all that is needed, and for those who are relatively inactive, only 10 calories per pound are necessary to maintain current weight.

To lose weight, you should subtract 500 calories from your maintenance caloric level, while to gain weight, you would need to add 500 calories.  Therefore, if your maintenance caloric needs are 2,000 calories per day, you should consume no more than 1500 calories each day to lose approximately one pound per week.  If you are very inactive, have a difficult time losing weight, or are obese (Obese=BMI > 30,  which for a 5 foot 5 inch tall women would be a weight over 180 pounds), then you should consume no more than 9 calories per pound which would be no more than 1680 calories for a 5 foot 5 inch tall woman who was 180 pounds.

No diet works for everyone. Each plan must be tailored to suit the individual. A diet should not be thought as short term but rather as a healthy lifestyle choice.  Select lower glycemic index carbohydrates like whole grains, fruits, vegetables and legumes instead of rice, potatoes, white bread, and sweets.

Prepare balanced meals.  Select healthy unsaturated fats and eliminate saturated and trans fats. Include omega 3 fats found in fatty fish like salmon, canola oil, leafy green vegetables, and walnuts.  Beware, however, of very low fat diets, as these may lead to food cravings. Don’t  go overboard on fats as one tablespoon of olive oil contains 120 calories.

Aerobic exercise is an important  component of maintaining a healthy life style. Three to four 20-30 minute brisk walks every week is sufficient especially if combined with resistance training using light weights and more repetition.

Make small changes one at a time. Get adequate sleep and practice stress management. Vitamin and mineral supplements are also worthwhile and should include a standard multivitamin with at least 400 mcg of Folic Acid. Additional daily supplements of Vitamin D, 2000 IU together with 1500 mg of Calcium (equivalent to 2 Extra Strength Tums tablets) has been shown to enhance egg and embryo quality especially in women with ovulation dysfunction and endometriosis. B complex should be taken if you have PCOS and are taking Metformin.  Approximately 1-2 grams of mega 3 fatty acids should be taken if you are not eating fatty fish at least 3 times per week.

Weight management can be frustrating.  However, you can empower yourself to be healthier and thereby improve your chances for a successful pregnancy. This can be done using common sense by making a few healthy lifestyle choices.