Fertility Cares

A blog with advice, guidance and updates on fertility care

03.08.2012
Advocating for Family Building in New Hampshire: Your Voice Matters!

Brian E. Miller, Ph.D.

Brian E. Miller, Ph.D.

In 1987, the Commonwealth of Massachusetts was the first state to mandate that certain infertility benefits be provided by insurance companies.  Since then, fourteen additional States have passed legislation to offer or cover infertility treatment.  However, the last State to mandate coverage for infertility services was CT in 2005 and there is currently no Federal mandate to offer infertility coverage through insurers.

New Hampshire is one of the 35 States without infertility coverage legislation.   For those without insurance coverage, the prices charged for IVF services vary between regions of the country, individual states and even within the same city. According to the American Society for Reproductive Medicine, the average cost of IVF in the United States is $12,400 for a single IVF cycle (The Fertility Centers of New England charges $6,800 per cycle, excluding fertility medications).  Importantly, the average number of IVF cycles needed to achieve a successful pregnancy is approximately 1.5 depending on a woman’s age and other medical variables. In women over 38 years of age, more than two IVF cycles may be needed to achieve a successful pregnancy.

While there is no current fertility legislation proposed in the State of New Hampshire , residents can support a new Federal Bill called the Family Act.  Recently, Dr. Joseph Hill met in Portsmouth with staff from the office of U.S. Senator Jeanne Shaheen (D-NH) to discuss S. 965 The Family Act.  This bill would provide a tax credit for patients seeking IVF treatment and give couples who otherwise could not afford the treatment an opportunity to have a family.  It is important that Senator Shaheen’s office hears from residents in NH about how important her support for this legislation is.  Please call (202) 224-2841and let the person who answers the phone in Senator Shaheen’s office know 1) who you are, 2) where you are calling from, and that 3) you would like Senator Shaheen to co-sponsor S. 965.  You can also send her a quick letter to reinforce your request by clicking here.  With your help, we can ensure that patients with infertility have improved access to care by easing the cost burden for treatment.

Call Now!!!

 

Tags: , , , , , , , , ,
Posted in Fertility

03.01.2012
Thyroid Hormone: Optimizing the Engine for Pregnancy and Beyond

Danielle Vitiello, Ph.D., M.D. Board-Eligible Reproductive Endocrinologist

Danielle Vitiello, Ph.D., M.D. Board-Eligible Reproductive Endocrinologist

Previous blogs have detailed mechanisms of thyroid hormone, the thyroid gland and its essential function in allowing us to function both in pregnancy and beyond.  The American Thyroid Association (ATA) task force has outlined recommendations for assessing and monitoring levels.  Salient recommendations are listed below:

  • Oral thyroid hormone is indicated for women who demonstrate overt hypothyroidism.
  • Hypothyroidism is associated with an increased risk of miscarriage and preterm birth.
  • Women with subclinical hypothyroidism and thyroid antibodies should be treated as well.
  • Women receiving thyroid replacement should increase their dose by  at least 25% when they become pregnant
  • Two pills on the weekends should meet the needs for pregnancy.
  • (TSH) Serum hormone levels should be monitored every month through 20 weeks then at least once between 26-32 weeks gestation.
  • TSH range should be 0.1-2.5 mIU/L for the first trimester increasing to 0.2-3.0mIU/L for the second trimester and 0.3-3.0mIU/L for the last trimester.
  • The RDA of Iodine is 250ug daily not to exceed 500ug daily from diet and/or supplements.

Remember, healthy mothers make healthy babies.  Optimizing your chances and affording you the healthiest pregnancy possible favors great outcomes!


Tags: , , , , , , , , , , , , , , ,
Posted in Fertility

02.23.2012
Growing Sperm from Germ Cells

R. Ian Hardy, M.D., Ph.D. Board-Certified Reproductive Endocrinologist, Medical Director

R. Ian Hardy, M.D., Ph.D. Board-Certified Reproductive Endocrinologist, Medical Director

Scientists at the Institute of Reproductive Medicine in Munster, Germany recently reported on their ability to grow mouse sperm from germ cells.  For men with azoospermia (zero sperm), this technology may, in the future, permit germ cells from a man’s testicle to produce sperm for fertilization.  Currently men with no sperm in either the ejaculate or in a testicular biopsy proceed with use of donor sperm.

It is important to point out that the technology is not being used in humans today and will likely be several years before its routine clinical use in humans and IVF centers.  As evidence of time required furthering these techniques, the initial publication on germ cell transplantation occurred in 1997.  The recent publication describes placement of male germ cells in a soft agar and methylcellulose matrix.  After several weeks in culture and with addition of gonadotropin hormonal support, morphologically normal spermatozoa were embedded in the matrix substance.  It is important to point out that ability or functionality of these mice spermatozoa to produce offspring has not been confirmed, again requiring further time and research.

For further information, the recent publication can be found in the Asian Journal of Andrology advance online publication. Click here for more info.

 

Tags: , , , , , , , ,
Posted in Fertility

02.16.2012
Natural and Minimal IVF: Caveat Emptor

Joseph A. Hill, III, M.D. Board-Certified in Reproductive Endocrinology and Infertility

Joseph A. Hill, III, M.D. Board-Certified in Reproductive Endocrinology and Infertility

Environment friendly business promotions have a receptive audience. Cost consciousness together with ‘green’ polices embracing such terms as ‘small is beautiful’ and ‘less is better’ can be a good thing. However, when these neologisms are applied to In Vitro Fertilization (IVF) using terms like, “Natural Cycle IVF” or “Minimal Stimulation IVF” under the guise of being “Patient Friendly” are no doubt emotionally appealing, never the less they have a very low likelihood of achieving a healthy baby. These therapies are thus better termed, ‘Minimally Effective IVF.”

‘Natural Cycle IVF’ and ‘Minimal Stimulation IVF’ are not new techniques as they were tried decades ago and abandoned due to the very poor success rates, minimal change in the surgical risks compared to conventional IVF, and the costs involved to achieve a successful pregnancy.  For example, in approximately 20% of “Natural Cycle IVF” cases, no egg is obtained at the time of surgery for egg retrieval and of those that are retrieved, an additional 20% fail to fertilize resulting in no embryo. In cases where fertilization does occur, almost 50% fail to cleave into an embryo suitable for transfer. Even when embryo transfer occurs, the chance of a pregnancy is less than 10%.

Finally, in those rare cases in which a pregnancy does occur, the subsequent miscarriage rate is over 25% leaving the chance of a baby resulting form “Natural Cycle IVF” no higher than that achieved using non-IVF therapy. Sadly, the chance of a baby using “Natural IVF” is even lower in women who have been advised to have donor eggs due to poor oocyte stimulation in conventional IVF.

The emotional appeal to “Natural” and “Minimal IVF” is compelling especially to those in need of donor eggs due to diminished ovarian reserve.  However, these techniques will never be the standard of care, but will remain on the fringe. So for those who are contemplating such enticements, please be reminded of the ancient Latin adage, ‘Caveat Emptor,’ which is ‘Buyer Beware.’

 

Tags: , , , , , , , , , , , , , ,
Posted in Fertility

02.09.2012
Spitting: A Bad Habit. The Role of Saliva vs. Serum (Blood) Test for Hormone Evaluation

Brian E. Miller, Ph.D.

Brian E. Miller, Ph.D.

Patients undergoing infertility treatment are faced with numerous appointments, various testing, “needle-pricks” by phlebotomists, and injections of fertility medications.  Quality centers search for ways to minimize the stress and inconvenience that infertility treatment can impose on patients and search for ways to make treatment more “patient-friendly“ without compromising  pregnancy success rates.  We believe that making infertility treatment convenient and stress free are important considerations and that is why our team focuses on care and convenience everyday.

One possible way to reduce the inconvenience of treatment is to minimize daily blood sampling to monitor hormone levels.  There are many ways to evaluate hormone levels including measuring in saliva, serum (blood), and even urine.  The gold standard for testing hormones is by obtaining a serum sample via blood draws.   Although testing for hormone levels in both urine and saliva is possible, they are certainly not new technologies.  In fact, the first study evaluating the use of saliva to monitor hormone levels in an IVF cycle was published in 1985.  Even though this study was published over 25 years ago, using saliva to monitor hormone levels during infertility treatment never became “standard” because serum (blood) testing is the most accurate and reliable method for assessing hormones.   In fact, the accuracy and validity of saliva hormone testing has even been questioned by health insurance plans. (Click here for detailed information.)

At the Fertility Centers of New England, we understand that the elimination of blood draws is attractive for patients.  However, there is no evidence to support the use of saliva hormone testing as a reliable method for monitoring response to infertility treatment.  Importantly, there are no data to support improved pregnancy rates when substituting serum testing with saliva testing for hormone levels.  The team at the Fertility Centers of New England is focused on minimizing the number of blood draws required during infertility treatment, which also minimizes the number of days a patient needs to visit our center during treatment. Typically, patients are required to have their blood drawn 3-4 times during an actual IVF treatment cycle.  While we continually look for ways to minimize stress and improve the patient experience during infertility treatment, our number one priority is to maximize your chances to achieve  a successful pregnancy.

Tags: , , , , , , , , ,
Posted in Fertility

02.03.2012
Should You Get the Influenza Vaccine During Infertility Treatment?

Joseph A. Hill, III, M.D. Board-Certified in Reproductive Endocrinology and Infertility

Joseph A. Hill, III, M.D. Board-Certified in Reproductive Endocrinology and Infertility

Many people being treated for infertility are unsure whether to get the “Flu Shot.”  During the 2012 influenza season both the Centers for Disease Control (CDC) and the National Health Department of Health and Human Services (NH DHHS), Division of Public Health Services continue to have a universal recommendation for influenza vaccination to anyone over six months of age in the absence of medical contraindications. Medical contraindications include: history of severe allergic reaction to a prior influenza vaccination; persons who developed Guillain Barre Syndrome (a rare disorder that causes your immune system to attack your peripheral nervous system) within 6 weeks of receiving a prior influenza vaccine; and people with a severe egg allergy.

The above agencies and the American College of Obstetrics and Gynecology and the American Society for Reproductive Medicine endorse that all pregnant women and those contemplating pregnancy be vaccinated against influenza. However, you should not take the version of the vaccine given in a nasal spray as it contains a live albeit attenuated form of the virus. You should only take the vaccine made from ‘killed’ virus because of the chance of catching the flu from an attenuated vaccine and the side effects and danger of a pregnant woman with the flu are more of a health risk than getting vaccinated.

So, no matter how you get pregnant, the consensus from all governmental agencies and medical societies is that vaccination with ‘killed’ virus against influenza offers you and your baby the best chance of staying healthy during flu season.

Tags: , , , , , , , , , , , , , , , ,
Posted in Fertility

01.26.2012
Pregnant or Not Pregnant? That is the Question

Danielle Vitiello, Ph.D., M.D. Board-Eligible Reproductive Endocrinologist

Danielle Vitiello, Ph.D., M.D. Board-Eligible Reproductive Endocrinologist

Fertility treatments allow patients to be empowered and to regain hope.  Once the patient has engaged in treatment, the two-week wait prior to pregnancy confirmation can be unbearable.

Not surprisingly, patients search for both emotional and physical signs to affirm or deny the potential of pregnancy; all while watching the calendar turn at a turtle’s pace.  One becomes hyperaware of weight, the body’s reaction to elevating progesterone and the psychologic stress involved.  The amount of rent-free brain space afforded to becoming pregnancy often is greater than prior to presenting to the fertility center to initiate treatment.

This two-week time between anticipated fertilization and pregnancy test is related to biology.  Once the embryo is created from fertilization of the egg by the sperm, the embryo must develop.  As it develops, the implanting blastocyst (stage of embryo development) becomes more specialized forming both the fetus and the placenta.  This placental tissue much reach a critical mass as it is releasing pregnancy hormone into the maternal circulation.  Pregnancy hormone is hCG (human chorionic gonadotropin).  Patients return to the center on one of the first days that this level can be detected accurately.

We recommend that patients refrain from performing home pregnancy tests as they are not as sensitive as blood levels and can render both false-positive as well as false-negative results; thus, they can provide more angst than affirmation.

Pregnancy hormone, along with progesterone (natural and supplemented) causes very rapid transitions in the women’s body in preparation for providing the most accommodating environment for the pregnancy.   Some women perceive these changes and some do not.

They symptoms can include a perception in ability in changes in respiratory rate – pregnant women tend to breathe more rapidly with more shallow breathes; Bloating and constipation can be an issue – intestinal motility slows so maximal nutrition can be pulled from the gut.   Breast soreness and tenderness is a direct effect from progesterone exposure and it is exceedingly difficult to make it not noticeable.  Having more symptoms does not mean that pregnancy did not occur.  Ironically, many women are more hopeful the more uncomfortable they become.

One of the best ways to get through this time is to keep one occupied.  A calendar with daily projects and activities will help to pass the time.  Women should continue their healthful diets and ways as well continue to take their prenatal vitamins as discussed previously with their health care teams.  Remember, healthy mothers make healthy babies.

Tags: , , , , , , , , , , , , , , , , , , ,
Posted in Fertility

01.19.2012
Male Fertility: The Other Half

Joseph A. Hill, III, M.D. Board-Certified in Reproductive Endocrinology and Infertility

Joseph A. Hill, III, M.D. Board-Certified in Reproductive Endocrinology and Infertility

Approximately 40% of infertility is related to the male.  Key to understanding male fertility is analysis of the semen.  Semen samples can vary from month to month, or even day to day because it takes about 72 days for sperm to develop within the testicles. Unlike eggs, which are present since you were born, sperm are made all the time following puberty.  Since men are producing sperm all of the time and  since illnesses, injuries, medications, or illicit drug use a few months before could make one sample abnormal, a repeat semen analysis three weeks later should be done.

Sometimes a semen analysis shows a low number of sperm which is less than 20 million and is called oligospermia. If no sperm are found , it’s called azoospermia. When sperm do not swim very well, this condition is called asthenospermia. Sometimes there are a lot of moving sperm, but the sperm themselves look abnormal.  Abnormal sperm morphology (what the sperm look like) is the most sensitive indicator of whether a man will get their partner pregnant the old fashion way.  In spite of their small size, sperm have three distinct regions: the head, neck or mid-piece, and tail.  An abnormality in any of these sections can cause infertility. The head of the sperm contains the genetic material (DNA) needed to make a baby. If the head is abnormally  shaped, fertilization may be impaired and if fertilization is able to occur, an abnormal embryo may result not capable of implantation or making a baby.  The mid-piece of the sperm contains the energy producing organelles enabling the sperm to get to an egg and the tail of the sperm makes the sperm move rapidly through the maze of the female reproductive tract.

There are two ways of determining sperm morphology: an out-dated method using criteria established by the World Health Organization (WHO) in the 1970’s and is still used in most hospitals and path-labs; and Kruger morphology using ‘strict criteria’ which is used by the best fertility centers.  Studies using ‘strict criteria’ morphology assessment have been correlated with fertilization in IVF. Men with greater than 14% normal appearing sperm had normal fertilization rates, while men with intermediate morphology (between 4-14%) had intermediate fertilization.  Men with less than 4% normal looking sperm had only an 8% chance of achieving fertilization using standard insemination techniques (one egg per 10,000 sperm). Less than 4% normal morphology is called teratospermia. Successful pregnancies can  be achieved especially when using IVF together with Intracytoplasmic Sperm Injection or ICSI. This is when one sperm is injected per egg using a microscopic techniques.

The identification of sperm morphology using Kruger’s ‘strict criteria’ is an integral part of the semen analysis and hence the most important part of the evaluation of male fertility. So make sure that your physician uses this test when doing a semen analysis. In this way the most likely treatment to help you have a baby can be done.

 

Tags: , , , , , , , , , , , , , , , , , , , , , ,
Posted in Fertility

01.12.2012
Diet and Lifestyle Issues While Attempting to Conceive

Robert M. Weiss, M.D. Board-Certified Reproductive Endocrinologist

Robert M. Weiss, M.D. Board-Certified Reproductive Endocrinologist

Although a healthy lifestyle, including exercise and proper diet, is important for general health, it is not necessary to abstain completely from caffeine and alcohol while trying to conceive. On the other hand, extremes of weight and cigarette smoking have been shown to be detrimental to people trying to conceive.

Caffeine
Studies have shown that small amounts of caffeine are not necessarily detrimental to conceiving. Caffeine intake of up to one-to two cups of coffee per day has not been shown to decrease fertility. However, caffeine consumption greater than five cups of coffee per day has been associated with decreased fertility up to 50%. Also, consumption of 2-3 cups of coffee per day has been associated with an increased likelihood of miscarriage but does not affect risk of congenital anomalies. In summary, women who consume 1-1.5 cups of coffee per day, before and during pregnancy, should experience no adverse effects on fertility or pregnancy outcome.

Alcohol
Small amounts of alcohol prior to conception, up to 3-4 glasses per week, have also not been shown to decrease a woman’s fertility. Greater than two alcoholic drinks per day has been shown to decrease fertility in women. Certainly, once a woman believes she may be pregnant, she should, without question, abstain from all alcohol intake.

Patients who consume more than the above recommended amount of caffeine or alcohol should decrease their intake. However, it not necessary to bring intake of caffeine and alcohol down to zero.

Diet and Weight
Women who are significantly underweight (BMI<19) and women who are significantly overweight (BMI>35) will experience a 2-4 fold increase in time to conception. However, there is little evidence that specific dietary variations, such as low-fat diets, or vegetarianism, affect fertility. Women attempting to conceive should take 400 micrograms of folic acid. This is to reduce the risk of neural tube defects in the fetus. To calculate your own BMI, go to this link: http://www.nhlbisupport.com/bmi/.

Smoking
Smoking (even small amounts) has substantial negative effects on fertility. Women who smoke cigarettes have a 60% increased risk of infertility, as well as an increased risk of miscarriage. Additionally, women who smoke cigarettes go through menopause an average of 1-4 years earlier compared with women who do not smoke.  Smoking cigarettes appears to cause increased loss of healthy eggs. Smoking marijuana seems to have similar negative effects on fertility.

Men
When it comes to men attempting to conceive, small amounts of alcohol and caffeine use do not appear to adversely effect sperm parameters (density, motility, and abnormalities in morphology). However, cigarette smoking and marijuana use have been shown to decrease all sperm parameters. Severly overwight men also have decreased sperm parameters and decreased fertility.

In Sum
As Aristotle  wrote 2,500 years ago, “Everything in Moderation”: there is no need to be an ascetic while trying to conceive.

For more information, click here.

Tags: , , , , , , , , , , , , , , , , , , , , , , , , , ,
Posted in Fertility

01.05.2012
Cell Phones and Infertility: Is it Time to Hang Up the Phone?

Joseph A. Hill, III, M.D. Board-Certified in Reproductive Endocrinology and Infertility

Joseph A. Hill, III, M.D. Board-Certified in Reproductive Endocrinology and Infertility

Cell phones are an everyday part of life. The advances in technology enabling not only voice communication but most recently high resolution pictures and internet access have been accompanied by increased intensity and frequency of electromagnetic waves being emitted. Our bodies receive these waves and convert them into both electric and magnetic fields.  Adverse biological interactions attributable to cell phone-emitted radiation have been made. Reproductive cells, sperm and eggs, are electrically active cells and their exposure to cell phone electromagnetic waves and currents have been postulated to affect reproductive function.  Evidence for the adverse effects of cell phones on fertility comes from both animal and in vitro (laboratory) studies.  While these studies may be different from in vivo human exposure, clinical correlations, especially with abnormal sperm parameters and function, have been made. Until further studies and performed and reported in humans, warnings regarding further increase in the power density of emitted cell phone radiation should be heeded. Simple measures one may incorporate to minimize the impact of exposure include: use a land line whenever possible; use a speaker phone when possible; hold the phone well away from your body when sending a text or viewing images; avoid sleeping with the phone close to you; avoid wearing the phone on your body; and purchase a low radiation model and network.

Cell phone technology will undoubtedly continue to advance with more innovative and expansive services and newer and better products. Consumers need to be aware of the potential for adverse biological effects of this ever expanding technology so that proper precautions can be taken.

 

 

Tags: , , , , , , , , , , , ,
Posted in Fertility

Interested
in Learning More?

Patient Testimonials

“Thank you for all you do. Your offices have made a positive difference in my health and my sense of well being.”