InVia Fertility Specialists Blog

    Why Does a Thin Endometrium Lower Embryo Implantation?

    Posted by Dr. Vishvanath Karande on Jun 6, 2019 10:05:00 AM

    For successful implantation to occur, an embryo needs a “receptive” uterine lining (endometrium). A thin endometrium can result in lower implantation of the embryo. In previous blogs, Katie Koss and Janet Chiarmonte have discussed the various pathologies that can prevent implantation and the three common techniques used to evaluate the uterine cavity. In this blog, the thickness of the endometrial lining and measurement of the lining during cycle monitoring will be discussed.

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    Topics: Infertility, Infertility treatment, IVF, InVia Fertility Specialists

    FAQ for Gay Men: Sperm Provider Selection, PGS

    Posted by Vicki Meagher on Jun 5, 2019 5:00:00 AM

    There are many choices to make in starting a family as a gay male couple. Let's say you've chosen a fertility clinic that has a track record of success serving same-sex couples, and you've secured an egg donor and surrogate. What’s next?

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    Topics: Egg donation

    Do I Need an Egg Donor?

    Posted by Dr. Sigal Klipstein on Jun 2, 2019 3:00:00 AM

    Women are born with all the eggs that they will ever have. In fact, when a female fetus is only 5 months along, she has approximately seven million eggs in her ovaries. By the time that baby girl is born, only 2 million eggs remain.

    At the time of her first period, this number is further decreased to 300,000 eggs. Every month, a woman loses eggs. This process occurs even if she is on birth control pills or has irregular menstrual cycles.

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    Topics: Egg donation, Infertility

    Antioxidants and male fertility

    Posted by Dr. Vishvanath Karande on May 31, 2019 3:38:00 AM

    I have previously written a blog on how to improve your chances of success with fertility treatment.

    Improving your lifestyle is a big step in the right direction. Weight loss, regular exercise, quitting smoking tobacco and marijuana, drinking alcohol only in moderation are absolutely necessary to maximize chances of success.

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    Topics: Infertility, Infertility treatment, IVF, Male factor

    Timeline with images of embryo development in IVF

    Posted by Liza Roscetti Meyer on May 30, 2019 7:00:00 AM


    Many fertility patients are curious about what exactly happens in the embryology lab, from the time their eggs are retrieved to the time they are transferred. When people have answers to their questions about the details of embryo development, IVF can become a less mysterious process for them.
    With that in mind, here is a day-by-day timeline of what happens in the embryology lab in IVF.
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    Topics: Infertility, Embryology

    Why Do We Freeze Slow-Developing Embryos?

    Posted by Liza Roscetti Meyer on May 30, 2019 6:00:00 AM

    You have had your egg retrieval and are now waiting for your embryo transfer. Instead of having your transfer 5 days later, you are told that the embryos are “dividing slowly” and the transfer is postponed or cancelled. On day 6 finally, blastocysts are formed and you are recommended to freeze the embryos instead of having a transfer.

    It is natural to feel disappointed, and we do know how anxious you are to get pregnant. However, there is a very good reason why freezing slow developing embryos and transferring them in a subsequent programmed cycle makes sense.

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    Topics: Infertility treatment, IVF, InVia Fertility Specialists, Embryology

    Understanding the Blastocyst Grading Scale

    Posted by Kelly Schorsch on May 21, 2019 9:00:00 AM

    If you're undergoing or researching IVF, you may have learned that not all embryos are able to implant, and therefore sometimes the decision is made not to transfer an embryo to the patient after an analysis is performed. The analysis used to make that determination is called blastocyst grading. What exactly is the embryology lab looking for when they perform blastocyst grading?

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    Topics: IVF, InVia Fertility Specialists, Embryology

    How To Increase AMH Levels On Your Own

    Posted by InViaAdmin on May 17, 2019 8:00:00 AM

    If you're having trouble getting pregnant, you've probably heard of anti-mullerian hormone or AMH. The level of the hormone's presence in the body is directly linked to the number of growing follicles able to produce eggs. Having a low AMH level is a hurdle many women face on the road to motherhood.

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    Topics: Infertility, Infertility treatment, Diminished ovarian reserve

    PCOS and IVF Success Rates

    Posted by Dr. Vishvanath Karande on May 16, 2019 5:55:00 AM

    Anti-mullerian hormone (AMH) is a highly sensitive marker of ovarian reserve. It is released by the cells surrounding follicles in the ovary. AMH levels decrease with age and may be the most sensitive marker of ovarian aging. In fact, AMH levels have been shown to decrease earlier in life before other traditional markers, such as cycle day-3 follicle stimulating hormone (FSH).

    Other advantages of measuring AMH levels include the fact they are not influenced by menstrual cycle timing or pregnancy. AMH levels are correlated with the number of antral follicles on ultrasound (small dark circles seen in the ovary which are usually 2 - 8 mm in diameter). AMH levels have been shown to predict the number of eggs retrieved during in vitro fertilization (IVF). AMH levels can also be predictive of pregnancy rates with IVF.

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    Topics: Infertility, Infertility treatment, InVia Fertility Specialists, PCOS

    Treatment of Uterine Septum

    Posted by Dr. Vishvanath Karande on May 14, 2019 9:00:00 AM

    A uterine septum is a common anomoly of the uterus that is seen in 1 – 15 per 1,000 women (shown in the picture at right).  In this condition, the cavity of the uterus is separated by a long piece of tissue, while the outside of the uterus has a normal shape.

    According to several studies, treating a uterine septum is associated with an improvement in live-birth rates for women with prior pregnancy loss, recurrent pregnancy lossmultiple miscarriages, or infertility.

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    Topics: Infertility, Infertility treatment, Recurrent pregnancy loss

    How Many Times Can You Donate Eggs?

    Posted by Vicki Meagher on May 10, 2019 10:35:00 AM

    how-many-times-can-you-donate-eggs.jpgI’m often asked by donors how many cycles they are allowed to do and the answer is always six. But where did that number come from? Did we make it up? Can they go somewhere else and do more?

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    Topics: Egg donation, Infertility, Infertility treatment, IVF, InVia Fertility Specialists

    Newer Indications for In Vitro Fertilization (IVF)

    Posted by Dr. Vishvanath Karande on May 9, 2019 9:00:00 AM

    In vitro fertilization (IVF) is now a fairly commonly used procedure and has resulted in the birth of tens of thousands of babies every year. According to the latest statistics available (2015, there were 209,336 IVF cycles performed in the U.S. alone. This is an increase from 154,412 IVF cycles being performed in 2011.

    In addition, the success rates with IVF have been steadily increasing with fewer embryos being transferred (details once again at Initially, IVF was devised as a treatment for patients with diseased fallopian tubes (tubal factor). There have since been several other indications for IVF and a couple of brand new ones, which will be discussed in this blog.

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    Topics: Egg donation, Infertility, Infertility treatment, IVF, Male factor, Embryo donation, Egg freezing, fertility preservation

    Why Fertility Doctors Shouldn't Give hCG Booster Injections

    Posted by Dr. Vishvanath Karande on May 8, 2019 7:43:00 AM

    I have by now answered several questions from readers who tell me they have a positive pregnancy test. They will often give me their pregnancy test result and ask me if the level is okay. On further enquiry, I often find out (and am furious) that these patients have been taking booster human chorionic gonadotropin (hCG) injections after the egg retrieval (luteal phase)! These injections result in a false positive pregnancy test since the patients are taking the same hormone (hCG) that the pregnancy test detects. This fools patients into thinking that they were pregnant when they really are not.

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    Topics: IVF, InVia Fertility Specialists, Risks

    Testing for Pregnancy After IVF Embryo Transfer

    Posted by Dr. Aniruddha Malpani on May 3, 2019 10:36:00 AM

    While all IVF patients understand that not every IVF cycle results in success, in their heart of hearts, every patient wants to get pregnant every cycle. After months or years of having trouble getting pregnant, the two weeks after the embryo transfer can seem like an eternity and can be very nerve-wracking.


    Am I pregnant or not? Have the embryos implanted or not?

    The suspense can be even worse than the pain of the IVF injections!

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    Topics: Infertility, Infertility treatment, IVF, Conception

    What is a Good First hCG Level after Embryo Transfer?

    Posted by Dr. Vishvanath Karande on May 1, 2019 9:00:00 AM

    You've seen a fertility specialist, started IVF, and gotten through the first embryo transfer. You've spent a long time waiting for good news.

    And finally you get it! The results of your pregnancy test, which measures hCG level, are positive. Congratulations!

    Almost before you can celebrate, however, you start wondering, “Is my hCG level good?” Is the pregnancy going to progress normally? Here's what we can tell you about how hCG levels relate to a successful pregnancy.

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    Topics: IVF, Early pregnancy, Understanding Test Results

    Bed rest after embryo transfer could negatively affect IVF outcome

    Posted by Liza Roscetti Meyer on Apr 25, 2019 6:35:00 AM

    “Should I lie down for a while after my embryo transfer to optimize our chances of success?”



    That is a question we are asked on a daily basis. We've always advised our patients that bed rest after transfer was not going to increase the likelihood of success, but a new study has actually shown that bed rest following transfer might, in fact, actually DECREASE the likelihood of success. 

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    Topics: IVF, Embryology

    What Are Follicles? Not Eggs!

    Posted by Dr. Aniruddha Malpani on Apr 22, 2019 9:00:00 AM

    We often talk about follicles (affectionately called "follies") during the IVF process. But IVF patients often don’t understand the difference between follicles and eggs. If eggs aren't follicles, what are follicles, anyway?

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    Topics: Infertility treatment, IVF, Embryology, Understanding Test Results

    Symptoms after IVF Embryo Transfer - The Two-Week Wait

    Posted by Dr. Aniruddha Malpani on Apr 17, 2019 9:00:00 AM

    After months or years of having trouble getting pregnant, all the action and the excitement of taking injections, going for scans, monitoring your blood test results and admiring your embryos is now over.

    Your doctor has put your embryos back into your uterus, and now all you can do is wait for the final outcome, in order to find out whether the embryos have implanted or not. This wait is extremely frustrating: the outcome of the treatment is completely out of your hands, and there is no way of finding out what is happening to your precious embryos inside your body.

    As any IVF patient will attest, the two-week wait after the embryo transfer is the longest fourteen days of your life. The symptoms after IVF embryo transfer-- physical and emotional-- can be hard to deal with.  Do any of these sound familiar?

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    Topics: IVF, Handling stress, Understanding Test Results

    10 Facts About Metformin and PCOS

    Posted by Janet Chiaramonte on Apr 16, 2019 8:06:00 AM

    Polycystic ovary syndrome (PCOS) is a relatively common hormonal disorder that is one of the leading causes of infertility. Some women who have PCOS develop insulin resistance. This occurs when the cells of the body don’t respond well to a hormone known as insulin. Insulin allows the cells to take sugar (glucose) from the blood. If the cells don’t take in this sugar it leads to higher levels of glucose and insulin circulating through the body in the bloodstream. This, in turn, leads to increased levels of androgens (male hormones) which cause the classic symptoms of PCOS such as excess hair growth and more importantly in terms of fertility – lack of ovulation. Getting pregnant with PCOS can be possible with the right diagnosis and treatment plan.

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    Topics: Infertility, Infertility treatment, Top 10, PCOS

    Don't Delay Frozen Embryo Transfer After Failed IVF

    Posted by Kelly Schorsch on Apr 12, 2019 8:00:00 AM

    Many times women are concerned after experiencing failed IVF with a fresh embryo transfer if it is best to move right along into another cycle for a frozen embryo transfer. They wonder if there are any carryover effects from the ovarian stimulation and if they should wait to cycle to minimize any residual effects that could potentially impact endometrial receptivity. So, the question is, “Will waiting before performing my frozen embryo transfer cycle increase my chances to become pregnant?

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    Topics: IVF, InVia Fertility Specialists, SMART IVF, Embryology

    Top 10 Facts About Vaginal Progesterone and Assisted Reproductive Technologies

    Posted by Dr. Vishvanath Karande on Apr 10, 2019 8:00:00 AM

    I have written previously on the role of progesterone (P) and the various methods of administering P. Historically, during the early days of IVF, P was administered exclusively via intramuscular (IM) injections. These involved a long needle that was used to deliver the medication in the buttocks.

    Also, P only dissolves in oil (peanut, olive, ethyl-oleate etc) and repeated injections were painful and sometimes resulted in sterile abscesses. Patients also had allergic reactions to the oil. This was a nightmare for patients as these daily injections were sometimes continued for 8 – 10 weeks!

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    Topics: Infertility, Infertility treatment, IVF, InVia Fertility Specialists, Early pregnancy, Top 10

    What Can Be Done When Sperm Motility is Zero?

    Posted by Dr. Vishvanath Karande on Apr 4, 2019 7:56:00 AM

    The treatment of male factor infertility was revolutionized in 1992 when Palermo and co-workers introduced intracytoplasmic sperm injection (ICSI). With ICSI, embryologists use a micromanipulator to inject sperm directly into the egg (that has been retrieved as part of an IVF cycle). It was now possible for men with severe male factor infertility to father a child. ICSI can be used even in cases where the wife produces more eggs than the husband produces sperm!

    Using high magnification, an oval-appearing motile sperm is selected for ICSI. When a sperm is motile-- moving and swimming-- it indicates that it is viable and therefore is capable of fertilizing the egg.

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    Topics: Infertility, Infertility treatment, IVF, Male factor

    Top 10 Facts about Adenomyosis

    Posted by Dr. Vishvanath Karande on Apr 1, 2019 5:00:00 AM

    1) What is adenomyosis?

    Adenomyosis is defined as the presence of endometrial tissue, which normally lines the uterus, which has grown into the muscular wall of the uterus. It can be diffuse or localized (focal) and the lesions can be solid or cystic.

    2) Is it the same as endometriosis? 

    Adenomyosis differs from endometriosis — a condition in which the uterine lining becomes implanted outside the uterus — although women with adenomyosis often also have endometriosis.

    In endometriosis, the “functional” part of the uterine lining is implanted – these implants respond to the (monthly) cyclical changes in your hormone levels. In adenomyosis the “basal” layer of the uterine lining grows within the uterine musculature. The basal lining is NOT responsive to cyclical changes in your hormone levels. The cause of adenomyosis remains unknown, but the disease typically disappears after menopause.

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    Topics: Infertility, IVF, Endometriosis, Top 10

    Do AMH levels predict IVF pregnancy rates?

    Posted by Dr. Vishvanath Karande on Mar 27, 2019 8:00:00 AM

    Anti-mullerian hormone (AMH) levels are now routinely used clinically to assess ovarian reserve. AMH levels are believed to reflect the pool of oocytes (eggs) that remain in the ovary (ies). Low AMH level are associated with a reduced number of eggs that are available and will often predict low ovarian response during IVF. AMH levels are therefore believed to reflect the quantity of eggs that remain. The question is, do AMH levels also reflect egg quality and therefore pregnancy rates with IVF?

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    Topics: Infertility, Infertility treatment, IVF, Diminished ovarian reserve

    InVia Fertility Specialists Named a First Blue Cross Blue Shield Blue Distinction® Center+ for Fertility Care

    Posted by Dr. Sigal Klipstein on Mar 22, 2019 10:00:00 AM

    We have always done everything we can to ensure you receive the best possible fertility care when you trust InVia Fertility Specialists to help you on your pathway to pregnancy. Now, we’re proud to announce that our high standard of care has received national recognition: Blue Cross Blue Shield Illinois has named us one of Illinois’ first Blue Distinction® Centers+ for Fertility Care.

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    Topics: InVia Fertility Specialists, IVF Success

    Megan and Phil’s InVia Fertility Journey

    Posted by InViaAdmin on Mar 15, 2019 9:30:00 AM

    My husband and I met at the young age of 19. We met one night in Philadelphia through a mutual friend and essentially fell in love. I know it’s extremely cheesy, but it’s the truth. We were both in college—I attended the University of Iowa while he was at Rowan University in southern New Jersey. Our relationship was long distance, established over the phone—you’d be amazed how much you can learn about someone after six months of talking on the phone.

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    Topics: fertility preservation, InVia Fertility Journeys, IVF Success

    Sperm morphology and IUI pregnancy rates

    Posted by Dr. Vishvanath Karande on Mar 13, 2019 10:00:00 AM

    I often get questions from patients with low sperm morphology (shape) during semen analysis. A typical question is “My sperm morphology is only 3% normal forms; what can I do?” or “What is the best treatment in this situation?” "Do I need in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI)?"

    It seems intuitive that if 97% of the sperm have abnormal shape, then the chances are the couple does need IVF + ICSI. But, is that really true? What, if any, is the relationship between low sperm morphology and IUI pregnancy rates?

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    Topics: Infertility treatment, IVF, InVia Fertility Specialists, Ovulation Induction

    Should Endometriosis Treatment Come Before IVF?

    Posted by Dr. Aniruddha Malpani on Mar 8, 2019 4:00:00 AM

    Since many patients who have endometriosis are also infertile, they are not too sure about what they should do. Should the endometriosis be treated first or should the infertility be attended to first? In most instances, this advice can be very conflicting.

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    Topics: Infertility treatment, IVF, Endometriosis

    Top 10 Questions About Endometriosis

    Posted by Dr. Vishvanath Karande on Mar 4, 2019 7:25:00 AM

    Endometriosis affects one in ten women in the United States, and can cause fertility problems.

    At InVia Fertility, we have treated many women who have this condition over the years. Here are the top ten most common questions we've received about it:

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    Topics: Infertility, Infertility treatment, Endometriosis, Top 10

    InVia Fertility Journeys: Mehgan and Kevin K.

    Posted by InViaAdmin on Feb 26, 2019 6:17:00 AM

    My husband Kevin and I met in 2000 and got married in 2008. We knew we always wanted children but were in no rush. When the time came to start trying, our mentality was “whatever happens, happens”. After almost a year of trying, at my annual OB-GYN appointment, the discussion came up about starting a family. How long had we been trying, my OB-GYN wanted to know?

    After answering a bunch of questions and based on my answers, I was asked to give blood for a few tests. At that appointment, I remember being so carefree and felt that the doctors were more concerned about me not getting pregnant than we were - we honestly never gave it much thought.

    After waiting a few days, my results came back. Tears flooded my eyes when I heard the nurse tell me that my levels were so low, we’d go straight to IVF. So many emotions came to mind, but what upset me most was that my body wasn’t capable of having children the “natural” way. Plus, Kevin and I did not know one thing about infertility.

    I went onto so many websites to try to educate myself. I talked to a couple of friends who have gone through the infertility treatment process. No matter what journey was ahead of us, Kevin and I knew we were ready.

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    Topics: IVF, InVia Fertility Journeys, IVF Success

    How accurate is a home pregnancy test with IVF?

    Posted by Katie Koss on Feb 22, 2019 9:00:00 AM

    10 days!? 12 days!? I have to wait how long to find out if I’m pregnant or not!? While patients engaged in IVF are scheduled as early as possible for their serum (blood) hCG level (pregnancy test), many women cannot resist the urge to "cheat" and take a home pregnancy test with IVF.

    Although in most cases this can be an accurate measurement of whether you are pregnant or not, it is not always a true reading.

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    Topics: Infertility, Infertility treatment, IVF, Early pregnancy

    When and Why We Use Metformin to Help Manage Polycystic Ovary Syndrome (PCOS)

    Posted by Dr. Vishvanath Karande on Feb 18, 2019 6:22:57 AM

    What is polycystic ovary syndrome?

    Polycystic ovary syndrome (PCOS) is a common cause of infertility. Briefly, its diagnosis is based on presence of two of the following three criteria:

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    Topics: PCOS

    Implantation Failure in IVF - Why Does It Happen?

    Posted by Dr. Aniruddha Malpani on Feb 14, 2019 10:05:00 AM

    My doctor said that my embryos looked picture-perfect, yet they failed to implant – why did this happen?” 

    This is the question in the minds of women who undergo IVF failure, and this becomes a particularly nagging doubt when they face multiple IVF failures. Many women naturally think that their uterus is defective or their body is not good enough to accept the embryo-- that their uterus is rejecting the transferred embryo, or their own body is killing it. After all, fertilization happened in the lab, the embryo grew well in vitro, and they even saw their embryo (remember, you must always see your embryos and ask for photos before embryo transfer!).

    The embryologist assured them that they looked perfect, and they’ve read lots of IVF success stories of women who got pregnant with such good embryos. As a result, they naturally come to the conclusion that good embryos are meant to implant – and if they didn’t, this clearly means there’s a problem with their uterus or their body.

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    Topics: Infertility treatment, IVF

    Letrozole for Ovulation Induction: How It Works, Why We Use It

    Posted by Dr. Vishvanath Karande on Feb 12, 2019 9:18:00 AM

    Letrozole is an oral non-steroidal aromatase inhibitor approved for the treatment of hormonally responsive breast cancer after surgery. It has been used (off-label) for ovulation induction as part of the IVF process since 2001.

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    Topics: Infertility, Infertility treatment, Ovulation Induction

    Miscarriage after IVF treatment

    Posted by Dr. Aniruddha Malpani on Feb 7, 2019 8:00:00 AM

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    Topics: Infertility, Infertility treatment, IVF

    What Does My hCG Level Mean?

    Posted by Katie Koss on Feb 4, 2019 9:00:00 AM

    So you're in the IVF process, and now you’ve waited the long 10-16 days for your first pregnancy test. Your hCG level comes back positive. Congratulations! 

    Then the panic sets in. Is my number too low? Is it too high? Does this mean I'm having twins? Triplets? At InVia Fertility, we often have patients ask us to interpret their hCG level from that first positive test—and the truth is, most of the time that's not possible.

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    Topics: Infertility treatment, IVF, Early pregnancy

    Does Endometrial Scratching Help with Implantation?

    Posted by Dr. Vishvanath Karande on Jan 28, 2019 3:24:28 PM

    Most IVF cycles fail after embryo transfer when the embryo fails to implant.  The three factors that can cause implantation failure are:

    • Problems with the embryo (e.g. embryo abnormalities, sub-optimal culture conditions in the embryology laboratory);
    • Embryo transfer technique issues; and
    • The lining of the uterus (endometrium) is not receptive.

    Several studies have looked at various medical approaches to improve implantation.  One such approach that has shown to improve implantation is a physical scratch on the endometrium in the cycle preceding IVF -- “endometrial scratch ”, or ES. We'll look at what ES is, how it's performed, and evidence about its effectiveness in this post.  

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    Topics: IVF, Endometrial Thickness, IVF Success Rates

    Ovarian reserve testing with Ovarian Assessment Report

    Posted by Dr. Vishvanath Karande on Jan 24, 2019 6:50:00 AM

    The Ovarian Assessment Report from ReproSource Fertility Diagnostics is used by some fertility clinics—including InVia Fertility Specialists—for ovarian reserve testing in patients. According to ReproSource, the Ovarian Assessment Report is the most advanced ovarian reserve testing system available using a single blood sample to assess ovarian egg supply in women considering egg retrieval.

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    Topics: Infertility treatment, IVF, InVia Fertility Specialists, Diminished ovarian reserve

    Ovarian Endometrioma: Surgery or IVF?

    Posted by Dr. Vishvanath Karande on Jan 21, 2019 9:56:53 AM

    Endometriosis is a common cause of infertility.  Findings associated with endometriosis include: painful periods that are getting progressively worse, pain with intercourse, infertility and ovarian cysts. Some patients may have bowel or bladder symptoms. A significant number will have no symptoms. 

    When endometriosis involves the ovary, it often manifests as cysts that are called endometrioma. These will have a typical “ground glass” appearance on ultrasound.  Endometrioma may reduce fertility by causing focal inflammation in the outer shell of the ovary (ovarian cortex), which manifests as massive fibrosis and loss in the part of the ovary that maintains the eggs (cortex-specific stroma).  This loss of eggs may may eventually result in loss of fertility.

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    Topics: Endometriosis, IVF Success Rates

    How to Get the Most from Your Initial Fertility Consultation

    Posted by Dr. Vishvanath Karande on Jan 14, 2019 11:11:00 AM

    Want to get pregnant in 2019? Maybe you have been trying on your own for a year (six months if you are more than 35 years old) and nothing has happened.  You may have been keeping track of ovulation with an ovulation predictor kit, or using an app to time intercourse.  You decide it is time for you seek help. 

    Here are some tips to help you choose a fertility doctor and suggestions to get the most from your initial consultation.

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    Topics: Infertility treatment, Understanding Test Results, Age and Fertility

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