InVia Fertility Specialists Blog

Sperm morphology and IUI pregnancy rates

Posted by Dr. Vishvanath Karande on Apr 21, 2017 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

National Infertility Awareness Week: April 23-29, 2017

Posted by Dr. Vishvanath Karande on Apr 19, 2017 9:15:00 AM

National Infertility Awareness Week (NIAW) is April 23 – 29, 2017.  NIAW is sponsored by RESOLVE: The National Infertility Association.  This year, RESOLVE wants you to “Listen Up!” when it comes to issues around infertility and family building. This public awareness campaign is created so anyone who cares about the infertility community can feel empowered to do something that makes a difference, either in your own family building journey or to help someone else.

Infertility impacts millions of Americans and does not discriminate based on race, religion, socioeconomic status or sexuality. “Listen Up!” and become part of the movement.

We are posting the following information from RESOLVE’s website to help spread this message.

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Topics: Infertility, Infertility treatment

Miscarriage after IVF treatment

Posted by Dr. Aniruddha Malpani on Apr 17, 2017 8:00:00 AM

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Topics: Infertility, Infertility treatment, IVF

How accurate is a home pregnancy test with IVF?

Posted by Katie Koss on Apr 12, 2017 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

Anti-mullerian hormone (AMH) and age

Posted by Dr. Vishvanath Karande on Apr 10, 2017 10:30:00 AM

Anti-mullerian hormone (AMH) is a useful measure of the follicular supply in a woman. It is generally accepted that as a woman ages, the follicular supply decreases and AMH levels decrease. Blood (serum) AMH levels correlate to antral follicle count (AFC) and are more accurate than age and other routinely used blood tests (FSH, Estradiol, inhibin B) in predicting the ovarian response to fertility drugs.

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Topics: Infertility, Infertility treatment, Diminished ovarian reserve, Ovulation Induction

Embryo Transfer: A Critical Step in the IVF Process

Posted by Dr. Vishvanath Karande on Apr 7, 2017 9:00:00 AM


Embryo transfer is arguably the most critical step in the IVF process. On the surface, it seems like a relatively simple procedure. The embryos are loaded in a catheter and the physician deposits them through the cervical canal into the uterine cavity. It takes only a few minutes and is usually done with the patient wide awake, often with the partner right next to her.

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Topics: IVF, InVia Fertility Specialists

Same Sex and Single Parent Fertility Treatment Options

Posted by Vicki Meagher on Apr 5, 2017 10:00:00 AM

Nothing should stop any individual or couple who wants a family from achieving that dream. There are several fertility treatment options for same-sex couples and potential single parents to grow their families.

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Topics: Egg donation, Infertility treatment, InVia Fertility Specialists

Symptoms after IVF Embryo Transfer - The Two-Week Wait

Posted by Dr. Aniruddha Malpani on Apr 3, 2017 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

Can Endometriosis Cause Cancer?

Posted by Dr. Vishvanath Karande on Mar 31, 2017 9:00:00 AM

While many people understand why and how endometriosis causes infertility, fewer know whether endometriosis can cause cancer. This is one of the key questions addressed by a group of experts from The European Society of Human Reproduction and Embryology (ESHRE). The ESHRE Guideline Development Group recently published guidelines for management of endometriosis in patients, and this is what they conclude:  

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Topics: Endometriosis

Impact of stress reduction on IVF outcome

Posted by Dr. Vishvanath Karande on Mar 29, 2017 10:00:00 AM

Infertility is a profoundly stressful experience, physically and psychologically, write Dr Alice Domar and Lauren Prince in their recent study in Sexuality, Reproduction and Menopause. The study sheds light on the impact of stress reduction on IVF outcomes for women who are having trouble getting pregnant.

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Topics: Infertility, Infertility treatment, InVia Fertility Specialists, Handling stress

Does the IVF Process Hurt?

Posted by Katie Koss on Mar 27, 2017 10:00:00 AM

As a nurse doing consultations before IVF treatment, I'm often asked, "Does it hurt?"

The IVF process can be intimidating, and many patients naturally have a fear of the unknown. To help ease this anxiety, in this blog I'll review key parts of the IVF cycle and discuss how patients typically experience them in terms of physical sensation.

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Topics: Infertility, Infertility treatment, IVF

Getting Pregnant at 44: What are the Chances and Options?

Posted by Dr. Vishvanath Karande on Mar 24, 2017 9:00:00 AM

A reader recently posted this question on a previous blog:

I am 44 years old healthy non-smoker yoga practitioner, AMH 1.45 and FSH 9, high prolactin (25) but all else normal/good. Cycle regular with variation b/t 28-31 days ... married recently and trying for 6 months. My husband’s sperm is very good, he is 45. What are our chances for conceiving naturally? About to see rep. endocrinologist and view options, of which I think Clomid is one.

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

Top 10 Facts about Clomiphene Citrate (Clomid, or Serophene)

Posted by Dr. Vishvanath Karande on Mar 22, 2017 10:00:00 AM

Clomiphene citrate (CC), marketed, as Clomid or Serophene, is the most commonly used drug for ovulation induction. It was first synthesized in 1956 and was approved for clinical use in the United States by the Food and Drug Administration in 1967. Here are the Top 10 facts about CC. 

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Topics: Infertility, Infertility treatment, Ovulation Induction, Top 10

Using Androgel or DHEA for infertility

Posted by Dr. Vishvanath Karande on Mar 20, 2017 9:00:00 AM

If you are having trouble getting pregnant and are a poor ovarian responder, you may have heard that ovarian response can be increased with testosterone during IVF.

The possibility of using testosterone supplements such as Androgel or DHEA for infertility raises many questions, including:

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

Endometriosis and IVF or Laparoscopy? 4 Steps for Choosing

Posted by Dr. Aniruddha Malpani on Mar 16, 2017 9:00:00 AM

Patients with endometriosis who are infertile are often very confused. They don't know which doctor they should go to? Gynecologist? Infertility specialist? What treatment they should take?

The first point of consultation is usually their gynecologist - and most gynecologists usually advise doing a laparoscopy. This is usually a knee-jerk reflex - for many reasons. The importance of making the right diagnosis has been drilled into doctors right since Day 1 of medical school - and the only way of making a definitive diagnosis of endometriosis is a laparoscopy.

They also sell the patient on this procedure, by telling them that will also allow them to "treat" the endometriosis in the same operation!

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Topics: Infertility, Infertility treatment, IVF, Endometriosis

What is a Good First hCG Level after Embryo Transfer?

Posted by Dr. Vishvanath Karande on Mar 14, 2017 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

What Are Follicles? Not Eggs!

Posted by Dr. Aniruddha Malpani on Mar 8, 2017 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

Does Endometriosis Cause Infertility?

Posted by Dr. Vishvanath Karande on Mar 6, 2017 9:00:00 AM

Endometriosis is a condition where the uterine lining (endometrium) is found outside the uterus. It is a common, chronic disease that typically presents with pelvic pain, infertility or an ovarian cyst.

Classical studies suggested that 25% to 50% of infertile women have endometriosis and that 30% to 50% of women with endometriosis are infertile. Infertile women are 6 to 8 times more likely to have endometriosis than fertile women. Among women with pelvic pain, 30 to 80% will have endometriosis.

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Topics: Infertility, Endometriosis

Top 10 Questions About Endometriosis

Posted by Dr. Vishvanath Karande on Mar 2, 2017 10:00:00 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

Why Does a Thin Endometrium Lower Embryo Implantation?

Posted by Dr. Vishvanath Karande on Mar 1, 2017 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

Use of Birth Control Pills In the IVF Process

Posted by Janet Chiaramonte on Feb 27, 2017 11:05:00 AM

You may be surprised to find out that in many cases, the first step in the IVF process is to take birth control pills. Though this seems to be counter-productive to your goal of getting pregnant, there are several reasons why they are used.

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Topics: Infertility, Infertility treatment, IVF

No Fertilization? Why Eggs Don’t Fertilize, and What We Can Do

Posted by Liza Roscetti Meyer on Feb 22, 2017 11:17:00 AM

One of the hardest parts of being an embryologist is having to tell a patient that, after all their hard work getting their eggs ready for retrieval, there is nothing good to report the next morning when we check the eggs for fertilization. Hopefully this never happens to you. 

But  there are times when we have to make that unfortunate call to patients waiting to hear about fertilization. While we expect, statistically speaking, about 75% of mature eggs to fertilize, sometimes it happens where none fertilize, despite all of our best efforts in the lab. Why does this happen? And more importantly, is there anything that can be done after the fact?

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

Ten quick tips about endometrial thickness

Posted by Dr. Vishvanath Karande on Feb 20, 2017 9:05:00 AM

Good eggs and a healthy embryo aren't enough to assure pregnancy during IVF. A receptive uterine lining (endometrium) is also critical for successful implantation after embryo transfer. A commonly used parameter for assessing the endometrium is to measure its thickness (endometrial thickness, EMT).

During the stimulation phase of IVF, EMT usually increases in response to estrogen released by the ovaries. EMT is now routinely measured using transvaginal ultrasound during in vitro fertilization (IVF). 

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Topics: IVF, InVia Fertility Specialists, Top 10, Endometrial Thickness

Top 5 Things You Should Know about Egg Quality and IVF

Posted by Liza Roscetti Meyer on Feb 15, 2017 9:00:00 AM

When undergoing an IVF cycle you have a lot on your mind. If you are like most people, egg quality is typically not first on the list.

However, egg quality is one of the single most important aspects of a successful IVF cycle. With high egg quality, IVF is more likely to succeed. Good quality embryos come from good quality eggs.

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Topics: Infertility, Infertility treatment, IVF, Conception, InVia Fertility Specialists, Embryology, Top 5

What Can Be Done When Sperm Motility is Zero?

Posted by Dr. Vishvanath Karande on Feb 13, 2017 11:00:00 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

Implantation Failure in IVF - Why Does It Happen?

Posted by Dr. Aniruddha Malpani on Feb 10, 2017 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

Trouble getting pregnant with low AMH level?

Posted by Dr. Vishvanath Karande on Feb 9, 2017 3:00:00 PM

One of the commonest questions I get is from women with low AMH (anti mullerian hormone) levels who are having trouble getting pregnant. These women are often frantic and worried that they will never be able to get pregnant.

They often feel that having a low AMH level is the end of the world and it makes pregnancy impossible. Not necessarily true! Read on.

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Topics: IVF, InVia Fertility Specialists, Diminished ovarian reserve

Testing for Pregnancy After IVF Embryo Transfer

Posted by Dr. Aniruddha Malpani on Feb 9, 2017 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

Does Pre-Treatment Weight Loss Improve Fertility Outcomes for PCOS Patients?

Posted by Dr. Vishvanath Karande on Oct 4, 2016 10:04:00 AM

Polycystic ovary syndrome (PCOS)is the most common cause of infertility in women. PCOS is often associated with obesity. Obesity, however, is NOT a diagnostic criteria for PCOS, as it can also occur in normal weight women. 

At InVia Fertility Specialists, we often encourage our patients who are overweight for their height to lose weight prior to proceeding with fertility treatment. The resultant delay in treatment can be frustrating for patients. However, does pre-treatment weight loss improve outcomes?

This very question was addressed by researchers working with Penn State University's College of Medicine in a large, multi-center trial ("Benefit of Delayed Fertility Therapy With Preconception Weight Loss Over Immediate Therapy in Obese Women With PCOS." Legro, et al; J Clin Endocrinol Metab 2016 Jul;101(7):2658-66).

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Topics: Infertility, IVF, InVia Fertility Specialists, Weight loss, PCOS

Fertility Injections and IUI: RIP?

Posted by Dr. Vishvanath Karande on Sep 23, 2016 10:03:00 AM

 

Fertility drugs have been routinely used for ovulation induction for many years now.  Many women do not ovulate or ovulate infrequently.  In these women, fertility drugs are used to make them ovulate regularly.  Another group of patients from whom fertility drugs are used are those with unexplained infertility, mild male factor or endometriosis.  In these patients, fertility drugs are used to stimulate the ovaries to produce more than one egg, increasing the chance of conception. 

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Topics: Infertility, IVF, InVia Fertility Specialists, IUI

Seven Ways Obesity Affects IVF Success

Posted by Dr. Vishvanath Karande on Sep 21, 2016 9:21:00 AM

There is an obesity epidemic in America today. More than four in ten women of reproductive age are overweight or obese. Obesity increases the risk of a number of health conditions: high blood pressure, diabetes, cholesterol problems, heart disease, breathing problems, joint problems, and cancer, and of dying early.  (I have discussed the definition and grading of obesity in previous posts.)

The Practice Committee of the American Society for Reproductive Medicine (ASRM) recently published a report that included the effects of obesity on in vitro fertilization (IVF) success rates.  Here is a brief summary of seven key findings. 

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Topics: Obesity and reproduction, Infertility, IVF, InVia Fertility Specialists

Do Fertility Drugs Cause Cancer?

Posted by Dr. Vishvanath Karande on Sep 12, 2016 9:30:00 AM

 

Fertility drugs are used to stimulate the ovaries to produce multiple follicles.  Their use is associated with multiple ovulations and often with high estrogen levels.  It would therefore be reasonable to ask, “Do fertility drugs cause cancer?” 

This is an important issue as there are approximately one million IVF cycles reported per year worldwide. In addition, there are an unknown number of ovulation induction cycles.  

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Topics: Infertility treatment, IVF, Ovulation Induction

Should We Only Transfer Frozen Embryos?

Posted by Dr. Vishvanath Karande on Aug 26, 2016 9:30:00 AM

The technologies for successfully freezing embryos have now been available for more than twenty-five years. 

With improved freezing techniques, the success rates with frozen embryo transfer (FET) are now equal to or even better than those achieved with the transfer of fresh embryos. The pregnancy outcomes with frozen embryos also seem to be better than their fresh counterparts. 

 

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Topics: Infertility treatment, IVF, Frozen embryo transfer

The Case for Elective Single Embryo Transfer (eSET)

Posted by Dr. Vishvanath Karande on Aug 10, 2016 11:30:00 AM

A common question I get asked is “How many embryos should I transfer?”  Most of my patients want to get pregnant as soon as possible, and a significant percentage actually want twins. 

The logical answer, therefore, would be to transfer more than one embryo to achieve this outcome.  However, this may not be the correct answer.  Read on!

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Topics: Infertility treatment, IVF, Embryology

Does Letrozole Increase the Risk of Birth Defects?

Posted by Dr. Vishvanath Karande on Jul 25, 2016 9:40:00 AM

letrozole-birth-defects-is-there-a-risk.jpgLetrozole (marketed as Femara in the U.S.) is a drug that is approved for the treatment of breast cancer after surgery. It is also used (“off label”) for ovulation induction. I have discussed its mechanism of action and success rates in a previous blog, as well as use of Letrozole versus Clomid for patients with PCOS. Despite its obvious advantages, Letrozole is used infrequently by fertility specialists in the U.S. A major reason for this is a controversy about the use of Letrozole and birth defects in the resultant children.

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Topics: Infertility, Infertility treatment, InVia Fertility Specialists, fertility preservation, Ovulation Induction, Risks

Do AMH levels vary across normal menstrual cycles?

Posted by Dr. Vishvanath Karande on Jul 20, 2016 9:00:00 AM

do-amh-levels-vary-across-normal-menstrual-cycles.jpgAnti-mullerian hormone (AMH) is a commonly used biomarker of ovarian reserve. AMH levels decrease with age and reach undetectable levels approximately 5 years before menopause. AMH levels are thought to have minimal within-menstrual cycle variation compared with inhibin-B or follicle stimulating hormone (FSH). Unlike FSH levels, which are drawn on cycle days 2, 3 or 4, AMH levels can be drawn on any day of the cycle. Is this really true?

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

How Many Times Can You Donate Eggs?

Posted by Vicki Meagher on Jul 18, 2016 9:00:00 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

Marijuana and Fertility: What Are the Effects?

Posted by Deanna Fedorenko on Jul 13, 2016 9:00:00 AM

As with smoking cigarettes, there's a connection between marijuana and fertility, and it's not a good one. Use of marijuana has a negative impact on trying to conceive, for both male and female users, for daily and occasional users alike.

While avoiding marijuana use is crucial if you're trying to get pregnant, you do not need to be using marijuana at the time you're trying to conceive in order for marijuana use to impact fertility. Using marijuana now can affect your ability to conceive in the future.

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Topics: Infertility, Infertility treatment, Conception

Early Pregnancy Bleeding: Why It Happens and What You Should Do

Posted by Dr. Vishvanath Karande on Jul 6, 2016 9:00:00 AM

early-pregnancy-bleeding-why-it-happens-and-what-to-do.jpgEarly pregnancy bleeding is fairly common and occurs in 20 – 30% of pregnancies. Vaginal bleeding in early pregnancy can be worrying, so it's only natural that if it happens to you, you're concerned about your baby, especially if you've had trouble getting pregnant and maintaining a pregnancy. It doesn't always mean that there's a problem, however, it can be a warning sign of a miscarriage or recurrent pregnancy loss. Here are the top five facts you should know about early pregnancy bleeding:

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Topics: Infertility, Infertility treatment, Early pregnancy, Top 5

Ten Facts About IVF and Tubal Pregnancy

Posted by Dr. Vishvanath Karande on Jul 5, 2016 9:00:00 AM

Tubal pregnancy is possible regardless of how you get pregnant. But there are some unique aspects to tubal pregnancy that pertain to cases in which IVF is used. Here are ten interesting facts about IVF and tubal pregnancy:

1) A tubal pregnancy (also called an ectopic pregnancy) is a pregnancy that is implanted outside the uterus. During in vitro fertilization (IVF) embryo(s) are transferred into the uterus. However, subsequent uterine contractions can squeeze the embryo(s) into the tube where they can implant and result in a tubal pregnancy.

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Topics: Infertility, IVF, Early pregnancy, Top 10