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.

• 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!

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.

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.

SMA is an autosomal recessive genetic disease.  One in 35 Caucasians carries the SMA gene; one in 53 Asians and one in 66 African Americans carry the SMA gene.  The disease can only be acquired if both parents carry the gene and then the risk of having a child with SMA is 1 in 4.  The 1 in 35 simply carrying the recessive gene alone will not have the disease or any associated symptoms.  The statistical odds that both parents carry SMA = 35 x 35 = 1 in 1225 couples.

Although the odds that both parents carry the gene is low at 1 in 1225, the Fertility Centers of New England strives to reduce this risk to zero.  The Centers’ goal is not just to achieve pregnancy but to achieve a healthy pregnancy and child.  To undergo the rigors of fertility treatment without awareness of the genetic risk can be stressful and does not take advantage of the current screening technologies.  From a simple saliva sample, patients can be pre-screened and be fully aware of their genetic risks.  Those couples shown to both be carriers of an autosomal recessive trait, including SMA and others, may proceed with preimplantation genetic diagnosis (PGD) of their embryos.  Healthy embryos diagnosed not to carry the gene are then transferred for pregnancy.

Physicians at the Fertility Centers of New England are available to further discuss pre-conception genetic screening.  Further information on SMA can also be found here.

Endometrial biopsies where a random representation of tissue is taken, has been one of the mainstays of assessment.  Biopsy results were aimed at looking for pathology (such as inflammation and infection) as well as dating of the tissue to correlate it to what is happening at the level of the ovary.

The advent and use of transvaginal ultrasound has replaced much of what is assayed with biopsy regarding endometrial dating.    Such ultrasound is used for monitoring ovarian stimulation during an ART cycle (IUI or IVF).  As a part of these ultrasounds, basic elements of endometrial growth and development are followed.

This modicum plays a key role in timing for frozen embryo transfer cycles and donor egg programs, in particular.  From the body of evidence accrued, we know estrogen and progesterone are the only two hormones necessary to provide for an adequate endometrium.  The length  of time of estrogen exposure does not seem to be as important (5-30days) as is the development and resultant thickness of the endometrium prior to progesterone exposure.

The consensus seems to be that an endometrial thickness of > 7mm seems to be adequate.  Thinner endometrial linings (<6mm) are associated with earlier delivery rates.

There are many speculations regarding what makes an ideal thickness for the endometrial lining.  It does not appear to be just a matter of thickness or cushioning. (As an example, a plush mattress is always preferred to a sleeping bag.)   There are probably many factors contributing to increased chances of successful embryo implantation.

Lynette Scott, PhD, HCLD, Fertility Center of New England’s ART Lab Director, will be presenting a seminar entitled “Journey through the IVF Lab”.  Those attending will have an opportunity to conceptually look through the lab’s microscopes and learn about the embryo culture process from retrieval to transfer.  I will be presenting a lecture entitled “Why Infertility Shouldn’t Be Unexplained” highlighting the importance of a thorough evaluation to guide appropriate fertility treatments.  We will also review how to avoid initiating treatments which could be predicted to fail based on prior evaluation results.

The conference is designed to educate and support infertility patients at all levels of treatment, whether you are just beginning your journey or have experienced many treatment options.  The conference is a full day event from 8:30 am to 5:00 pm with lunch provided.  There will also be peer-led support groups for both educational and emotional support.

The full conference schedule and on-line registration for this event can be found at Resolve of New England’s website: http://www.resolveofthebaystate.org/conferencesession.html

Hope to see you there!

Nearly 50% of  women show some degree of thyroid dysfunction by the age of 60. In many women in their 30s and 40s, the  thyroid gland begins to under function. The human bodies first response to an under functioning thyroid gland is to increase the TSH to try to get the throid to work harder; hence, an elevated TSH level is an accurate marker for an under functioning thyroid. Most women with TSH levels>5.0 will be hypothyroid.

Although normal levels of TSH have been considered to be 0.5-5.0, most endocrinologists feel the level should be below 3.0 in early pregnancy. Women with levels above 3.0 may be at increased risk of miscarriage and preterm labor. Recent studies suggest that a level>2.5 in early pregnancy may increase the risk of miscarriage and preterm labor.

At FCNE, we screen all women with TSH levels. Although levels between 2.5-5.5 might be considered normal levels, we treat all women with thyroid replacement if there TSH level is>3.0. Remember an elevated TSH level points to low levels of thyroid functioning, and the need to supplement the thyroid’s own production of thyroid hormones with synthroid or levoxyl.

If you have further questions please feel free to post them here!