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

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10/03

2017

Infertility: The Waiting Game

Tick-tock. Waiting may be the most nerve-wracking part of the infertility journey.

Whether you are undergoing intrauterine insemination (IUI) or in vitro fertilization (IVF), an infertility treatment cycle consists of many steps. Everyone involved in the process–doctors, nurses, embryologists and patients–does their part to ensure the cycle will be as successful as possible. Then the waiting begins, euphemistically known in the “trying to conceive” world as the tortuous two-week wait.

At HRC Fertility we try to support our patients and their partners as much as possible during this emotionally turbulent time. The emotional roller coaster does not necessarily end with the announcement of the first test results, and, in fact, often continues throughout the several months before we discharge patients to their obstetricians.

For most infertility patients, a pregnancy test is not as simple as seeing two lines on a home pregnancy test (HPT). They will undergo several blood hormone tests as well as ultrasounds to confirm the health of their pregnancy.

Initial beta hCG blood test
We will administer the initial blood test, known as a beta hCG, 12-14 days after an IUI or embryo transfer. It will assess the presence of human chorionic gonadotropin (hCG), which is produced by placental cells that nourish the fertilized egg after it becomes attached to the uterine wall.

It takes about two weeks for the test to determine if the embryo is creating a sufficient amount of new hCG versus the hCG that can linger in your body after it was administered as the ovulation trigger shot. Because of this, we need to wait an adequate amount of time to ensure patients do not get a false positive.

Even though those weeks may seem like an eternity, blood tests can detect the presence of hCG earlier than commercially sold urine tests, which require you to wait until you’ve missed a period in order to obtain an accurate outcome. We advise patients to be patient and avoid taking a home pregnancy test.

Congratulations, you’re pregnant!
When the day finally arrives to learn your test results, you probably will be on pins and needles. A positive result is considered above 25mlIU/ml.

As your pregnancy progresses, hCG levels typically double every 72 hours, confirmed by blood tests over the next several days. Your hCG levels will reach their peak in the first eight to 11 weeks of pregnancy. Repeat blood tests should be performed by the same laboratory so results are consistent. After several positive hCG beta blood tests with increasing levels of between 1000-2000 mIU/ml, we will order one or two ultrasounds to look for the presence of an amniotic sac and a heartbeat. After eight to 10 weeks, we will feel confident to discharge you to the care of your obstetrician for further prenatal care.

This transition period can be equally stressful as the two-week wait, especially for those who have experienced previous IVF failures or miscarriages.

If your results are negative
Though we were hoping to tell you good news, this, unfortunately, is not always the case. Before you start a cycle or at the the embryo transfer, we try to be candid about your prognosis. If we find that you’re not pregnant, we’ll do our best to communicate this news to you in the most sensitive way possible, as well as be available to answer your questions. We will schedule you for a follow up appointment where we can discuss what we learned from this cycle and how we suggest you move forward. Though delivering bad news is never easy, we are committed to supporting you every step of the way.

Additionally, you could experience a chemical pregnancy, where beta hCG levels at first rise appropriately, but we cannot confirm the pregnancy at the ultrasound. This is devastating news, though hopefully we can glean some information about what caused the implantation failure, whether it’s a chromosomal abnormality or issues with the uterine lining, which can be used to fine-tune your next cycle.

We will also observe your results for indications of an ectopic or molar pregnancy.

Knowing what to expect in the testing process can be very empowering Though we cannot guarantee a positive outcome for every treatment cycle, we can assure you that we will provide all the information and support you need to survive the two-week wait, the results of your pregnancy tests and your transition to an OBGYN.

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09/26

2017

A Couple’s Journey to the HRC Fertility Baby Reunion

It took four years and multiple treatment cycles, but this November Yuli Reisner and her husband Derek will finally get their chance to attend HRC Fertility’s Baby Reunion picnic.

Like many patients, their road to parenthood was longer than they had anticipated, as well as very emotionally challenging. On her last IVF attempt, Yuli and her husband achieved their miracle: a successful pregnancy and birth of their precious son Sasha. They will proudly bring Sasha to the reunion, a fun event and rite of passage for many HRC patients, who long to show their bundle of joy to the doctors and staff who made their dreams possible.

The couple had been trying to create their family for four years, starting when they were in their mid 30s. Yuli’s OBGYN, a former patient of Dr. Robert Boostanfar, referred her to him. Yuli already had experienced an ectopic pregnancy after one of two unsuccessful intrauterine inseminations at another clinic.

After Dr. Boostanfar ran diagnostic tests, he discovered Yuli had immunologic issues and started her on a blood thinning medication and prednisone. The couple underwent several IVF cycles, one of which resulted in a miscarriage of a twin pregnancy.

Those were trying times for the couple. However, on their final try, Yuli became pregnant with Sasha. Dr. Boostanfar prescribed progesterone injections to ensure her pregnancy would work. For the first time, Yuli was able to carry a pregnancy to full-term.

Yuli admitted how hard the experience was to endure emotionally: “I was ready to give up several times. However, my mother-in-law and husband encouraged me to try again. Those pep talks motivated me to persevere and become my own best advocate.”

The new mom was also very impressed by the responsiveness of the nurses and other staff members. She felt they were always available to answer her questions. Recalled Yuli: “I felt very cared for both medically and emotionally. HRC Fertility’s state-of-the-art lab is extremely impressive and Dr. Boostanfar is the master of the embryo transfer. Emotionally, they always supported us through our trials and tribulations.”

Yuli continued: “We are so grateful to our HRC Fertility family and are looking forward to seeing the entire team at the picnic. They are a group of compassionate people who understand and truly care about what you’re experiencing. I highly recommend Dr. Boostanfar and HRC to any couple having trouble conceiving.”

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09/21

2017

Dr. Mickey Coffler and the Importance of PCOS Advocacy

September is PCOS Awareness Month, a wonderful opportunity to educate the public about polycystic ovary syndrome (PCOS), the most common hormonal disorder impacting women.

According to the PCOS Awareness Association, PCOS affects seven million women in the U.S., more than the number of people diagnosed with breast cancer, rheumatoid arthritis, multiple sclerosis and lupis combined. Though millions of women have this syndrome, public awareness about it is not high and support organizations receive very little funding. As a result, close to 50 percent of women are not diagnosed properly or may not learn they have PCOS until they try to get get pregnant.

This year, one of the leading PCOS advocacy organizations, PCOS Challenge, is taking awareness a step further. PCOS Challenge wants Congress to pass legislation (H. Res. 495) to officially designate September as PCOS Awareness Month. This law recognizes the seriousness of PCOS and the need for further research and treatment options and, potentially, a cure. This is a historic, bipartisan effort.

Contact your Member of Congress
PCOS Challenge is encouraging PCOS patients and medical professionals to contact their Congressional representatives to let them know the importance of the bill’s passage. If your Congressional representative is not already a sponsor, you can identify him or her at this link: http://bit.ly/2ePFWy0. Sponsors are listed here: http://www.pcoschallenge.org/prioritize-pcos.

PCOS advocacy organizations
In addition to advocating for positive legislation, PCOS organizations play important roles in moving the conversation forward about how to help women with PCOS control their symptoms, prevent future disease complications like heart disease and diabetes, and combat fertility if pregnancy is their goal. Two of the leading ones are PCOS Challenge and the PCOS Awareness Association.

PCOS Challenge (http://www.pcoschallenge.org), the group behind the passage of H. Res. 495, is one of the leading nonprofit support organizations advancing PCOS awareness and serves nearly 45,000 members. Its focus is education and raising public consciousness; it also provides “confidence” grants to women for laser hair removal and other treatments to deal with body hair growth.

The PCOS Awareness Association (http://www.pcosaa.org) is another not-for-profit providing resources and information to women with PCOS.

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09/05

2017

Finding the Right Answers with Dr. Michael Feinman

Today Amanda is enjoying her life as a busy mother of newborn twin boys. But for more than four years she was frustrated both by her inability to get pregnant as well as by not being able to find a doctor who could provide her with a diagnosis.

Amanda recalled, “I Just wanted to know why I wasn’t conceiving. I’m the type of person who needs to have answers about my problems, but no one could tell me why I couldn’t get pregnant. It was frustrating.”

Amanda and her husband underwent one unsuccessful cycle of IUI with their OBGYN in Florida. After the couple moved to California, they decided to take a short break from fertility treatment. But Amanda was in her mid 30s and soon realized it was “do or die” time for her fertility. After researching clinics, she met with a few doctors and quickly learned how important it is to be compatible with the physician who treats you.

Amanda found her perfect match with Dr. Michael Feinman. “More than with other doctors I met, Dr. Feinman seems to push the envelope of fertility treatment and thinks out of the box,” she said. “Dr. Feinman suggested we have an Endometrial Receptivity Analysis (ERA) before the egg retrieval for our first IVF. This was a game-changer. He wanted to know why I couldn’t get pregnant almost as much as I did. Plus, I liked his dry sense of humor and how he didn’t sugarcoat my situation.”

The ERA assesses the optimal time when the endometrium will be ready for the embryo transfer. Based on the ERA results, Dr. Feinman froze Amanda’s eggs and prescribed progesterone and Estrace for a month. The two embryos Dr. Feinman transferred a month later became Amanda’s twins, Hunter and Cooper.

Amanda advises other couples to be realistic, but hopeful: “With fertility treatment, you may not always get the answers you want. But with a doctor like Dr. Feinman, you can be assured he will go the extra mile to get you answers so you can make the final decision about what is best for you.”

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08/30

2017

Dr. Diana Chavkin Explains Primary Ovarian Insufficiency

A woman in her early 20s or 30s who may have trouble getting pregnant, or a woman who is concerned about irregular periods, hot flashes, night sweats and vaginal dryness may find that she has primary ovarian insufficiency.

This can be one of the hardest diagnoses for a woman to face.

What is Primary Ovarian Insufficiency?
Primary Ovarian Insufficiency (POI), previously called “premature ovarian failure (POF) is when menopause occurs before the age of 40. POI occurs in 1 in 1,000 women between the ages of 15-29 and 1 in 100 women between the ages of 30-39. Twenty seven is the average age of onset.

Women with POI have complete or near complete ovarian follicular depletion with resulting low estrogen and high Follicle Stimulating Hormone (FSH) levels. They often will experience menopausal symptoms such as hot flashes, night sweats and vaginal dryness and will rarely ovulate.

Some women with POI can still ovulate and menstruate and may be able to conceive. However, the odds are low. According to the National Institute of Health, between five to ten percent of woman with POI have conceived and have carried normal pregnancies without medical assistance.

Who is at risk?
In about half the cases, a reason for POI is not found. However, we know that women with a family history of POI are at greater risk. The condition is also associated with autoimmune disorders affecting the thyroid and adrenal glands. And it is also linked to genetic causes such as Turner and Fragile X syndrome. Additionally, women exposed to chemotherapy and radiation are at greater risk for POI.

Long-term effects
The low estrogen levels associated with POI may make women particularly prone to develop osteoporosis and early heart disease. Women may also be at a greater risk for depression. If POI in a particular case is linked to a genetic condition, then there might be a risk to future children.

Emotional impact
This can be an emotionally devastating diagnosis for many young women. Dreams of motherhood and ideas about self worth may be challenged. At the same time, they may have to deal with the physical symptoms of menopause years before their peers. This can take an emotional toll on one’s psyche and relationships. Counseling and support are available.

Treatments
There is no cure for POI, just as there is no cure for aging eggs. Many women don’t find out about this condition until their FSH level is measured when they see a doctor because their periods are irregular or nonexistent.

To achieve pregnancy, a woman with POI may opt to undergo IVF with her own or with a donor’s eggs. Additionally, a woman with POI will likely be advised to take supplemental estrogen in order to avoid some of the detrimental effects that low estrogen can have on her bones and heart.

References
http://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/fact-sheets and-info-booklets/what-is-premature-ovarian-insufficiency-also-called-premature-ovarian-failure/

http://www.mayoclinic.org/diseases-conditions/premature-ovarian-failure/symptoms-causes/dxc-20255567

http://medlineplus.gov/prematureovarianfailure.html

http://www.hormone.org/diseases-and-conditions/womens-health/primary-ovarian-insufficiency

https://www.nichd.nih.gov/health/topics/poi/conditioninfo/Pages/treatments.aspx

http://www.resolve.org/about-infertility/medical-conditions/premature-ovarian-failure-1.html?referer=https://www.google.com/

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