Our high pregnancy rates result from applying advanced fertility treatments in a caring and empathetic environment.

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The Quest for Eggs and the Risk of OHSS

During IVF, infertility doctors prescribe injectable medications called gonadotropins to help women produce as many robust looking eggs as possible for their upcoming IVF cycle. This is called controlled ovulation induction.

We are on a quest for the optimal number of eggs to combine with sperm to create as many viable embryos as possible. All of these efforts increase our patients’ chances to have a successful IVF cycle now and in the future with frozen cycles.

But there can be side effects from taking these medications. One of the most serious is ovarian hyperstimulation syndrome (OHSS). At HRC Fertility, we are committed to educating our patients to recognize the symptoms of OHSS as well as knowing what to do if they start experiencing any of them. Our first duty to you is to “do no harm.”

Who is most at risk?
Women with polycystic ovary syndrome (PCOS) and those who are underweight are more prone to OHSS. Other indicators are being under 30, having a large number of follicles, an increasing level of estrdiol before an HCG shot and a history of OHSS episodes. Some research has indicated anti-mullerian hormone and antral follicle count levels may be predictive of OHSS, but more studies are needed.

When does OHSS start?
OHSS starts approximately seven to 10 days after your egg retrieval. So be on the alert because it can start with mild symptoms that progress to more serious, and even life-threatening ones.

What is OHSS?
Fertility drugs used for stimulation cause the ovaries to enlarge. In some cases, the ovaries are so sensitive to these medications that they enlarge four to five times their normal size, producing very high levels of estradiol, a form of estrogen.

Having hCG (human chorionic gonadotropin) in your system, which is given in a “trigger” shot to release eggs from mature follicles, also plays a role in OHSS. OHSS may worsen if you become pregnant and create your own hCG.

Occasionally, additional substances may be produced in excess and fluid can collect in the abdomen, which causes swelling and discomfort.

What are the symptoms of OHSS?
It is important to recognize when your symptoms are not normal. Many women will experience a mild amount of bloating or abdominal pain, but when combined with other symptoms or a rapid worsening, it is best to err on the site of caution and let your health care provider know you are feeling discomfort.

Mild to moderate symptoms
Mild to moderate abdominal pain, bloating, nausea, vomiting, diarrhea, ovarian tenderness and a sudden weight increase of two more pounds on any two consecutive days

Severe symptoms
Symptoms can quickly escalate into the severe form and can include excessive bloating; unusual abdominal tenderness or pain; sudden, rapid weight gain as high as 40 to 40 pounds in five to 10 days; noticeable increase in urination; nausea and the inability to eat routine meals or to take fluids; and shortness of breath.

What should you do if you suspect OHSS?
Immediately call your doctor or nurse coordinator. We would rather you be safe than sorry.

Can we prevent OHSS?
Researchers are looking for ways to better predict which patients may be most at risk as well as fine tune medication protocols.

Our physicians closely monitor patients with serial ultrasounds, laboratory testing and by educating you about signs and symptoms of OHSS. Severe OHSS is rare, with one to two percent of women experiencing it, but our goal is to prevent any of our patients from experiencing it. Education, monitoring and communication are key to prevention.




A Fertility Doctor’s Struggle With (Her Own) Infertility

I am a 41-year-old woman with a one-year-old child. She is my first child. Her birth was not my first time in a delivery room, though. I’m an Ob-Gyn who had been in hundreds of delivery rooms before I was checked in under my own name. I’m also a fertility specialist who helped hundreds of other women get pregnant before I admitted that I was a specialist who needed a specialist.

Even fertility doctors can have a hard time conceiving. No matter how much help we give other people, like all human beings, sometimes we have to ask for help too.

Consider also that I was doing everything “right.” Sure I was in my late thirties when my partner and I started trying to have a baby. But I also felt young, and I am a healthy woman who exercises, eats well and takes care of myself. It should have been easy, right? Not so much. After many months of trying, we realized that it wasn’t happening.

It became harder to be around happy moms with their beautiful kids. That was something my clients often expressed when they first visited me, and here I was, having similar thoughts.

If they could do it, why not me? So I gave myself the advice I’ve given countless friends in similar situations: go see a specialist.
My doctor told me what I had told so many women: getting pregnant at age 39 can be tricky. And even though I already knew that as a fact, coming from my doctor, it still made me feel better.

Sometimes women who come to see me are shocked to learn how difficult it can sometimes be to get pregnant in their late and sometimes mid-thirties. This is in part because the media too often highlights celebrities who get pregnant in their 40’s and50’s which lets us draw the incorrect conclusion that this is the norm. What is not advertised though is that women conceiving in their late 40’s and 50’s usually conceive with the eggs of younger women rather than their own.

There are many reasons to see a fertility specialist.

Some women want to conceive faster than they are able to do so on their own. Some women have their potential pregnancies can be tested before conception in order to increase the chance that they will give birth to a healthy baby.

Some women want to use donor sperm to conceive either because they are in a same-sex relationship, because their husbands are unable to donate, or because they want to be single moms.

A young and healthy woman who wants kids “one day” may consider visiting a fertility specialist to check on the status of her eggs now. If you have a good and healthy egg supply then you may feel comfortable waiting and seeing.

On the other hand, if you are running out of eggs faster than would be predicted based on your age, you may want to make a decision earlier. A fertility specialist can help figure this out using blood tests and ultrasound.

Technology today also gives you choices your mother and grandmother never had. For instance, you may want to freeze your eggs. This would allow you to use those eggs one day in the future if you happened to have trouble conceiving down the road.

For me, deciding after a very emotionally difficult period of time to take some of my own medicine was the best thing I ever did. I saw a specialist and was treated for infertility. After a few bumps in the road, I gave birth a year ago to a little baby girl who has brought more joy to my life than I could have ever imagined was possible. I often thank her for coming into this world and making me a mommy.

So, should women eat healthily and stay fit and decrease their stress?? Absolutely! That will only increase the chance that a woman’s body will be able to house a happy, healthy and growing baby one day. But sometimes we just need some expert, outside help.




Medical Evaluation of the Surrogate Mother

Surrogacy is a unique and wonderful family-building option that is often described as third party reproduction. Individuals turn to surrogacy for a variety of medical and social reasons–including infertility, multiple pregnancy losses, being part of a same sex couple or being a single male. They all need the generosity of a third party — a surrogate mother — who will help them build their family.

Surrogate mothers, also known as gestational carriers, are caring, compassionate women who love being pregnant and want to give the gift of family to those who yearn to become parents.

One of the major concerns intended parents might have as they embark on surrogacy is whether the woman they’re matched with is a good candidate from health, obstetrical and mental health perspectives. They want to be reassured she will be able to get pregnant, have a successful pregnancy, deliver a healthy baby to term and not harm herself in the process.

HRC Fertility works with many surrogacy agencies that recruit and select surrogate mothers. Together we have developed guidelines for medically clearing potential surrogate mothers. It’s our job as fertility specialists to ensure that your surrogate mother can help you fulfill your dream of having a baby as well as have a healthy outcome for herself.

Typically, potential surrogates will undergo the following evaluations:

Social disease and drug screening
Surrogate mothers and their partners will be screened for a variety of sexually transmitted and infectious diseases, including but not limited to HIV, syphilis, herpes, hepatitis, cytomegalovirus (CMV), gonorrhea, and chlamydia. If unknown, they will be tested for RH factor and to ascertain their blood group. In addition, they will undergo urine testing for any prescription or illegal drug usage that could harm the surrogate mother and the baby.

Medical assessment
The focus of the medical evaluation is the health of the surrogate mother’s uterus and her ability to have a healthy pregnancy. Gestational carriers are not providing the egg for the pregnancy; either the intended mother or an egg donor is.

Surrogate mothers generally are between the ages of 21-45, have had at least one successful pregnancy, and have raised that child/children. They should not have had more than five vaginal or two cesarean deliveries (exceptions can be made with clearance from the surrogate’s OB). The agency and/or fertility specialist will want copies of all their obstetrical medical records to review them for other medical conditions or concerns.

Evaluation of the uterus
A key component of the evaluation is making sure the surrogate mothers has a healthy, receptive uterus and will have a successful embryo transfer. There are several procedures doctors can use to determine this including:

1) Vaginal ultrasound: examination of the uterus and surrounding organs
2) Hysteroscopy or sono-hysterogram (HSG): options offered at the discretion of the doctor. Sono-HSG is less invasive.
3) Mock cycle/trial transfer (optional): similar to a “test run” of an embryo transfer where the doctor can take measurements from the cervix to the transfer spot in the uterus, determine the best transfer location and verify there will be no unexpected issues or “bumps” in the road. Also the doctor can determine the best type of catheter to use for the transfer.
4) Pap smear

Psychological testing
A licensed psychologist will talk to the surrogate mother to get a sense of her motivation and psychological readiness to assist another family-to-be.

Our goal at HRC Fertility is to make sure everyone involved in the surrogacy process knows the health of the surrogate mother is optimal to start the baby making journey. Once that hurdle is passed, the surrogate mother and intended parents can focus on creating a strong and life changing relationship with each other.




Everything You Were Afraid to Ask About Sperm

June is Men’s Health Month–and a great opportunity to learn some interesting and unusual facts about sperm, a man’s small but mighty reproductive material.

Sperm and semen are not the same
Sperm are too tiny to see with the naked eye, while semen is the white fluid that is ejaculated after a man achieves orgasm. Even though sperm are microscopically small, they show up in abundant numbers. The 10 to 500 million sperm found in a single semen contribution would stretch for six miles if they were lined up end to end.

Each ejaculate of semen is about a half teaspoon of fluid. In addition to sperm, semen contains proteins, fructose and other organic fluids that allow sperm to survive and fertilize the egg. With the help of clear secretions produced by the bulbourethral glands, sperm move into the vagina and cervix with the goal of meeting and penetrating an egg.

Men are sperm-production machines
In contrast to women and their eggs, men are constantly producing sperm. In fact, in less than the time it takes to read this sentence, a man will produce more than 1500 sperm in a second. Because sperm live fast but die young, they must be constantly replenished.

It takes approximately two to three months for sperm germ cells to fully mature into healthy sperm ready to fertilize an egg. This regeneration process is good news for men trying to give up bad lifestyle habits that are affecting their sperm count and quality.

There are male and female sperm
It’s the father who is responsible for determining the gender of his child. Sperm that carry the X chromosome typically live longer than sperm with a Y chromosome. Sperm with an X chromosome give rise to a female and Y-bearing sperm will result in a male, which may account for the slightly higher percentage of females in the population.

If only King Henry VIII had known he was determining the gender of his children, a few more of his wives might have survived when they did not give birth to sons!

Lots of sperm are abnormally shaped
A significant percentage – 50 percent or more – of sperm have really strange shapes, such as two heads, two tails, deformed tails or other oddities. These deformities may have an impact on the ability of the sperm to penetrate an egg.

A man only needs one testicle to become a parent
If a man loses one testicle to cancer, for example, his other testicle will make up for this loss by producing additional sperm. This is a handy way for nature to adapt to challenging circumstances.

Male infertility
Male infertility has been shown, by well-controlled scientific studies, to be present in up to 47 percent of infertile couples. Sperm abnormalities are one of the major causes of this problem.

At HRC Fertility, we consider the semen analysis as the first step in evaluating the male factor for couples undergoing an infertility evaluation. Most men with an abnormal semen analysis can father children with appropriate treatment. This can include intrauterine insemination, in vitro fertilization and intracytoplasmic sperm injection (ICSI). In addition, we might refer a man to a urologist for further specialized evaluation and treatment.

Though only one sperm is needed to make a baby, Mother Nature has created a fascinating production and transport process for male genetic material. Scientists are always learning new facts about sperm that hopefully will contribute to the resolution of man forms of male infertility.




HRC Wants You to Declare Fertility Independence

Instead of fireworks and parties, let’s this year think of July 4 as a way for reproductive age men and women to declare their “independence” from future fertility worries.

Though there are no assurances with baby making, some current planning could pay off in the log term.

Know your risk factors
Are you predisposed to infertility? For example, do fibroids, endometriosis or polycystic ovary syndrome (PCOS) run in your family? If your sister or mother has had one of these conditions, you might, too. It’s also helpful to know the age when your mother started menopause because it can be an indicator of when you will. Your mother may have given birth to all of her children in her early 20s, but if you want to start in your late 30s, her early menopause could foreshadow trouble for you.

Take a fertility assessment
Many fertility clinics offer fertility assessment tests to give you a snapshot of your fertility potential. For men, it’s relatively simple. They need to provide a sample of their ejaculate (semen) so it can be evaluated for count, shape (morphology) and movement. A female evaluation includes blood tests and an ultrasound that measure ovarian or egg reserve.

Resolve to change some of your unhealthy lifestyle habits
Incorporating healthier habits into your lifestyle can enhance your fertility. However, the time to start making those changes is long before you want to get pregnant. For women, maintaining a healthy weight and normal Body Mass Index (BMI) is especially important. In one study, researchers evaluated the BMI of more than 2000 pregnant women. It took those who had a pre-pregnancy BMI considered overweight twice as long to get pregnant; conversely, it took underweight women four times as long to conceive.

Smoking is another bad habit that takes a while to break. Cigarette smoking can reduce sperm production and damage DNA. Numerous studies of more than 5000 European men concluded that smoking was associated with decreased sperm count and motility as well as poor sperm morphology.

Freeze your eggs or sperm
Increasing numbers of reproductive age women are opting to freeze their eggs as they become more mindful about their fertility longevity while balancing career and education demands. Freezing oocytes (eggs) is an insurance policy for women who aren’t sure when they might have a partner to start a family but want to have a back up plan. Many employers, including the military, are offering fertility preservation benefits.

Enroll in Fertility Basics 101
It’s never too late to learn some of the basics about your fertility. Since sex education in middle and high school tends to focus heavily on how to prevent pregnancy, many men and women are woefully undereducated about reproduction and the problems they can encounter.

There are many excellent resources, including at RESOLVE: The National Infertility Association (http://wwww.resolve.org) and http://www.reproductivefactors.org, a website developed by the American Society for Reproductive Medicine.