InVia Fertility Specialists Blog

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:

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.

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.

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:

“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.

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.

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.

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.  

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.

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.

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.

Embryo fragmentation is a fairly common occurance. It happens when there is an uneven division of the cells of the embryo.

It's as if you were breaking apart a piece of crusty bread. When you try to break the bread apart, crumbs or fragments are formed. These fragments are of no use to the embryo and are considered “junk” pieces of cytoplasm. The higher the degree of fragmentation, the lower the likelihood of pregnancy.

AMH or anti mullerian hormone level testing and ovarian reserve testing are frequent topics of questions from people who are having trouble getting pregnant. Since my last blog on this subject, a lot of new information has been released. Below are are five additional facts about anti mullerian hormone level (AMH) and ovarian reserve testing.

The male partner can sometimes be overlooked when couples try to conceive. Approximately 15% of couples pursuing a pregnancy experience infertility. Within these couples, a “male factor” is the sole cause in 30%, and both male and female factor issues are present in another 20% of couples. Collectively, 50% of couples have a male factor involved as a cause of their infertility.

Examining and evaluating the man is often invaluable in helping to optimize not only his reproductive potential, but also the reproductive potential of the couple. Here's what we look for when evaluating a man in a fertility clinic. 

At InVia Fertility Specialists (InVia) we have been providing fertility services to our patients for the past 16 years. Our in vitro fertilization (IVF) program has been very successful and has been consistently reporting excellent success rates.

One of our goals has been to maintain high pregnancy rates and at the same time minimize the incidence of twin pregnancy. This is because of the increased risk of complications with twins. According to the Society for Assisted Reproductive Technologies (SART); compared to singletons, the risk of infant death is more than 4-fold higher with twins and 13-fold higher with triplets.

Anti-mullerian hormone (AMH) is now a well-established marker of ovarian reserve. AMH is released by the (granulosa) cells surrounding small (antral and pre-antral) follicles in the ovary. It prevents these follicles from becoming responsive to follicle stimulating hormone (FSH) and thus prevent them from growing into dominant follicles.

The highest values of AMH in women are attained after puberty and subsequently decrease with age, likely reflecting the age-related decline in ovarian reserve.

Vitamin D (25OH-D), is a regulator of calcium and phosphate metabolism, and also plays a crucial role in reproductive physiology. Vitamin D has been shown to interact with the AMH gene and increase its functionality (up-regulation).

So, the question is, does Vitamin D influence AMH levels?

1) It is generally accepted that as a woman ages, her ability to reproduce will diminish and she will begin having trouble getting pregnant. There, however, is a wide range as to the age at which a woman’s ovarian reserve (reproductive potential) will diminish. Some women progress through menopause in their early thirties, while others conceive readily at age 45. A basal (cycle day 2 – 4) follicle stimulating hormone (FSH) level is a useful screening test of ovarian reserve.

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:

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. 

Fertility treatment can be stressful on your emotions, your schedule and your finances. Fortunately, you have someone in your corner the entire way: your fertility nurse!

Your fertility nurse is here to help guide you through the process and make your journey a little bit easier. Here are the ten most common questions patients tend to ask their fertility nurse.

One of the most difficult things IVF patients have to deal with is the fact that there are no external symptoms or signs of what's happening inside their bodies.

Are the follicles growing well? Is the uterine lining maturing properly? Are you responding well to the medications? Are the eggs of good quality? Are the embryos implanting?

An important marker of the reproductive cycle is bleeding - and this can become a major source of stress during IVF treatment. This post explains what kinds of bleeding can happen during IVF, and what (if anything) you should do about them.

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?

Egg donation is generally very safe with no long-term risks. Society would not permit a young, healthy woman to donate her eggs if the procedure was always dangerous.

However, there are some short-term risks associated with egg donation, and some egg donors will experience complications. Knowing the warning signs and being educated about these complications will help reduce their impact drastically.

Here are some of the most common complications you should be aware of when making the decision to donate your eggs.

Takeaway: If you’re having trouble getting pregnant, don’t wait. See a Reproductive Endocrinology and Infertility Specialist!

When a diagnosis of recurrent pregnancy loss (RPL) is reached after multiple miscarriages, there are many things to consider, including the causes, tests, and common treatments of RPL.

One of the single most important things to look for in a fertility clinic is the presence of a Board-Certified staff. Much like you would in other medical fields or a variety of life situations (buying a new home, boarding a plane, or even hiring a fitness instructor) you want to put your trust in someone who has the proper credentials and qualifications.

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.

You've been waiting for this for so long and at last your pregnancy test after IVF is positive. Now what happens? Well, in spite of the fact that you might want to shout the good news from a rooftop, it is probably best to be cautiously optimistic for now. A positive pregnancy test is just one step in the IVF process. You've cleared another hurdle, but there are still a few more to go.

One of the most important things to consider when looking into infertility treatments is that no two patients are identical. In fact, every patient is unique and each should receive a treatment plan tailored to their specific needs. Going to a fertility clinic that offers a standard, "cookie-cutter" treatment plan could result in misdiagnosis and could lengthen the time you wait to have a child. The right fertility clinic for you will be sure to take several factors under consideration and treat you with a tailored approach.

We have now posted several blogs discussing the impact of anti-mullerian hormone (AMH) and fertility. AMH levels predict number of eggs that will be retrieved during in vitro fertilization (IVF) and pregnancy rates. AMH levels vary based on age and we have previously discussed what constitutes a “normal” AMH level. Young patients with low AMH levels will do better than their older counterparts. IVF success rates in patients with low AMH levels have also been discussed previously.

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.

Intrauterine insemination (IUI) is a simple in-office procedure, which involves placing “washed” sperm inside the uterus to facilitate fertilization. With IUI, we bypass the vagina (which is acidic and where most sperm are destroyed) and the cervical mucus (which can impede sperm progression).

By depositing the sperm directly in the uterus, we increase the likelihood that a maximum number of healthy sperm will swim into the fallopian tubes and fertilize a waiting egg, resulting in a normal pregnancy.

A common misconception is that fertility preservation is just for cancer patients. Fertility preservation is exactly what it sounds like; preserving your fertility. For women, it involves stimulating your ovaries to release many mature follicles to then be retrieved and cryopreserved for your own use later in life.

You've had an embryo transfer, and now it's time for a pregnancy blood test. You may be wondering whether the hCG level in your blood predict how healthy your very new pregnancy is.

The short answer is yes - but only to a certain extent. For a more complete answer, read on!

Now it is fairly common for women to achieve their educational goals and establish a career path before they consider having children. It often takes years to obtain these goals and this occurs during the most fertile period: ages 15 - 30. Often women will consider having a child between the ages of 35 – 45 and by then, her fertility has already starting to decline. In previous blogs, I have discussed the fact that after age 40, fertility declines precipitously, and have described treatment options for this age group. But what about women seeking pregnancy after 45? What are the treatment options available? How risky are these pregnancies?

On Monday, August 27, 2018, Illinois enacted a new law requiring health insurance companies to pay for freezing eggs, sperm and embryos for cancer patients!

Thanks to Governor Bruce Rauner, State Representative Robyn Gabel, the bill's initial sponsor, and all those activists, researchers, and supporters who made this possible!

Great news! InVia Fertility Specialists (InVia) has been selected as a study site for several IVF clinical trials! If you qualify, you could get an IVF cycle at minimal or no cost. 

InVia has a well-established and very successful in vitro fertilization (IVF) program. We use state-of-the art technology and offer individualized care to our patients. Part of what makes us a “Center of Excellence” is continued interest in clinical research that evaluates new medications and technologies.

Before a new drug or device is approved by the FDA, it has to be evaluated in a clinical trial using real patients. Over the years, we have participated in several clinical trials which evaluated medications that are now used routinely in clinical practice e.g. Follistim, Gonal-F.

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). 

An anti-mullerian hormone (AMH) level is a test now routinely used to evaluate ovarian reserve. AMH levels were believed to NOT vary during the menstrual cycle and can be drawn any time.

In a recent blog I had presented data which suggest that AMH levels in fact DO vary! AMH levels are also not supposed to be influenced by the use of birth control pills. A recent study from Finland suggests that this may not be true either.