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



The Quest for Eggs and the Risk of OHSS

Posted by Dr Jane L Frederick | Filed under Uncategorized

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.




Everything You Were Afraid to Ask About Sperm

Posted by admin | Filed under IVF, Male Infertility, Uncategorized

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

Posted by admin | Filed under Uncategorized

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.








HRC Helps You Look into Your Fertility Crystal Ball

Posted by admin | Filed under Uncategorized

Want to look into the Fertility Crystal Ball?

Have you ever wanted to look into a crystal ball to get a sneak peek at your fertility future? Your local infertility doctor may not be clairvoyant, but he or she can assess your fertility potential, especially if having children is an important part of your future happiness and life goals.

The following are several tests that can help fertility providers determine the current status of your baby-making potential. They all are relatively inexpensive as well as easy to administer. The results can serve as a barometer of your ovarian reserve or egg supply.

Follicle Stimulating Hormone (FSH) Test
The follicle stimulating hormone (FSH) test measures the amount of FSH on day three of a woman’s menstrual cycle. FSH is produced by the pituitary gland in the brain. It stimulates the ovarian follicles, which is where eggs grow and are eventually released during ovulation. FSH also prompts the production of estrogen.

A normal FSH level is between 3-10 mIU/ml. As ovarian reserve decreases, the amount of FSH in the blood increases while estrogen (estradiol) levels decrease. This means the pituitary gland is working harder to produce more FSH in order to stimulate the ovaries.

Estradiol Level (E2)
By itself, a normal FSH level is not sufficient to describe your fertility health. We also want to measure estradiol (E2), a key form of estrogen produced by the ovaries, on day three of a cycle. Doctors evaluating your results will look for a high level of this hormone. It encourages the growth of the uterine lining and also stimulates the pituitary gland to release luteinizing hormone, which is essential for ovulation.

E2 and FSH have a complementary inverse relationship with each other. While the production of FSH causes the release of estrogen, estrogen inhibits the production of FSH.

Anti-Mullerian Hormone Test (AMH)
This test checks a woman’s ovarian reserve or egg supply by measuring the size of its pool of remaining microscopic or primordial follicles. Cells in the developing egg sacs or follicles secrete AMH. A low AMH level indicates a waning egg supply. It can be performed on any day of the menstrual cycle.

It is important to note that a high AMH value can be symptomatic of polycystic ovarian syndrome and is a measure of egg supply, but not necessarily egg quality.

Antral Follicle Count
Performed by vaginal ultrasound, this exam is used to count antral follicles, which are resting or primordial follicles that remain in the ovary waiting to be eventually released. It is also an indicator of how well a woman might respond to ovarian stimulation medications used during IVF.

Assessing Your Test Results
Many fertility physicians like to conduct all four tests to obtain the most likely scenario of fertility potential. No one test is sufficient.

Women are born with their lifetime supply of eggs. Though there is nothing they can do to increase or improve this supply, the can be proactive in becoming educated about their own reproductive health. Knowledge is power and these tests can provide you with a baseline of your ovarian reserve.

A fertility checkup may motivate you to either start trying to conceive earlier than you had originally planned or to freeze your eggs for use when the time is personally right for you, especially if your test results determine of a healthy reserve. Though they are not a guarantee of what the future holds, these assessment tests are a good start for taking charge of your fertility.





Every Day is Mother’s Day for this Dr. Boostanfar Patient

Posted by admin | Filed under Uncategorized

This month Allyson, mom to three-month-old Sean, celebrated her first Mother’s Day. At 51, she is savoring her new status and knows she is lucky to be cuddling her precious baby.

Allyson used the donor egg program at HRC Fertility after undergoing one cycle of IVF with her own eggs. When she married a few years ago, she and her husband understood she probably would have challenges because of her age, so she was not surprised this option would be necessary.

She found an anonymous donor and was referred to Dr. Boostanfar’s Encino office. After several diagnostic tests were completed, Allyson was able to start IVF treatment.

The rest of the process moved along very quickly. Said Allyson: “The communication was great, especially about all the medications and injections. With the frequent office visits, I got to know the staff. I felt it was important to have a close relationship with the providers since this was such an important process.”

Fortunately, Allyson received the happy news that she was pregnant after her second cycle.

Though the businesswoman isn’t getting her usual good night’s sleep, she is figuring out how to make motherhood work and relishing her new role. She advises other “older” moms to not let age limit their life.

“All the staff at HRC Fertility were judgment-free about my age, which I really appreciated, recalled Allyson. “They honored my wanting to fulfill my dreams. I felt I was in a safe place and would refer other women to seek treatment at Dr. Boostanfar’s office.”

Though the official Mother’s Day has passed, every day feels like Mother’s Day to Allyson, who is only feeling joy about a dream that finally has been realized.