InVia Fertility Specialists Blog

A cycle day-3 follicle stimulating hormone (FSH) level and anti-mullerian hormone (AMH) level are commonly used to evaluate ovarian reserve. FSH level generally predicts pregnancy rates with in vitro fertilization (IVF) and a level < 10 mIU/mL is considered “reassuring”.

On the other hand, AMH levels predict the number of follicles (eggs) that the patient will produce during IVF and a level > 0.8 ng/mL is considered “reassuring”. (It is important to note that these cut-off levels can vary based on the assay used and can vary from lab to lab.) 

A combination of reassuring FSH and AMH levels is generally considered “good” and a combination of concerning FSH (> 10 mIU/mL) and concerning AMH level (< 0.8 ng/mL) is generally considered “bad”.

But, what if there is discordance between FSH and AMH levels?

The first live birth after an IVF frozen embryo transfer was in 1983. Since then, there have been hundreds and thousands of babies born the world over with frozen embryos. A third of the babies born today with IVF are with frozen embryos. At InVia Fertility Specialists, currently, in about 40% of IVF cycles the embryos are frozen and transferred in a subsequent cycle.

Patients with polycystic ovary syndrome (PCOS) often do not ovulate, and thus getting pregnant with PCOS can be a challenge. The first line of treatment usually is the fertility drug clomiphene citrate (CC).

The starting dose of CC is usually 50 mg orally daily for 5 days. If ovulation does not begin, the dose is increased to 100 mg and then finally to 150 mg.

To detect ovulation, one can do serial blood tests and ultrasounds or measure an appropriately timed progesterone level. What are the treatment options for patients that do not respond to the highest dose of CC?

A failed IVF cycle causes a lot of heartache – for both patients and doctors. Aside from pain and grief, many of people start playing the blame game. Was the doctor negligent or incompetent? Did the patient fail to follow medical advice?

The truth is that we can learn much from a failed cycle, and this is why it's important to create a framework, so that we can analyze the failed cycle and increase the chances of success for the next attempt.

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.

1) What is adenomyosis?

White blood cells in semen, detected in semen analysis, often causeconcern to infertile couples, those who are having trouble getting pregnant, and even their doctors. On the one hand, this makes sense, because pus cells or white blood cells in semen are commonly thought of in association with infectious diseases. However, the mere presence of white blood cells in the semen is not sufficient to make a diagnosis of a genital tract infection.

A hysterosalpingogram (hystero = uterus; salpingo = fallopian tubes; gram = X-ray) or HSG is a simple procedure where X-rays are used to evaluate the uterus and the fallopian tubes.

A HSG is a routine test done as part of an infertility work-up. It is to be done in the first half of the cycle so that we can be sure that the patient is not pregnant. In experienced hands, a HSG is quick, efficient and can be painless.

In this post, I explain why we might use HSG, how we administer it, what we can learn from it, and what its limitations are when it comes to helping us find out why you're having trouble getting pregnant..

A low sperm count is a common cause of male infertility. If a man ejaculates even the tiniest number of sperm, we can help the couple achieve pregnancy with in vitro fertilization and intracytoplasmic sperm injection (ICSI). But, what if there is no sperm in the ejaculate (azoospermia)?

There are two types of azoospermia . The first is obstructive azoospermia; where there is an obstruction in the reproductive tract. Obstructive azoopermia can be due to a vasectomy or a condition where the tube from the testes to the urethra (vas deferens) is absent (congenital absence of vas deferens). Congenital absence of vas deferens can be associated with cystic fibrosis.

The second type is non-obstructive azoospermia. This is a condition where sperm is produced in the testis but is not released into the ejaculate. In both these conditions, sperm can still be obtained surgically from the testes. The sperm obtained is usually immature and will fertilize an egg only with ICSI.

In many cases couples decide to cryopreserve their remaining embryos after an in vitro fertilization (IVF) treatment. They could freeze the embryos right after treatment before proceeding to a transfer due to concern of ovarian hyperstimulation syndrome or high progesterone. Others cryopreserve their embryos in case their first cycle is unsuccessful or for future use. Either way all the frozen embryos will have to be thawed in the same fashion for an FET cycle. With all the nerves and excitement come lots of questions about the thawing process.

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.

Intrauterine adhesions (scar tissue), also called Asherman syndrome, can cause infertility, menstrual irregularities (light or absent menses) and recurrent pregnancy losses. In a previous blog, I have discussed the causes of Intrauterine adhesions. In this blog, we will discuss the treatment of intrauterine adhesions.

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.

Endometriosis happens when the lining of the uterus (womb) grows outside of the uterus. It affects about 5 million American women. Endometriosis is especially common among women in their 30s and 40s; it can create difficulty getting pregnant and can cause infertility.

Pain is one of the most common symptoms of endometriosis. Endometriosis pain happens most often during your period, but it can also happen at other times.

Embryos have been successfully frozen (cryopreserved) since the early 1980’s. Worldwide literature has confirmed that there is no increase in birth defects in children born from frozen embryos. The pregnancy rates with frozen embryos have been increasing steadily. For the past few years, we have been freezing embryos at the blastocyst stage (5 or 6 days after egg retrieval) using a technique called vitrification.

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:

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. 

One of the important criteria that are assessed during a semen analysis is sperm morphology (the others are count, motility and volume). Sperm morphology is the term used to describe the appearance (size and shape) of sperm. We will often have patients worried because the sperm morphology is “low” (teratospermia). While there are some things that can be done to improve sperm morphology, whether or not they will work depends on the cause of the abnormality and whether it is genetic or environmental.

The American Society for Reproductive Medicine has as part of its practice guidelines that a couple wishing to engage in an egg donor recipient cycle must visit with a mental health professional. Given the road you have already travelled with all the hurdles you have jumped to get this far, why would you be required to see a mental health professional?

While the idea of going to a counselor’s office may be foreign and perhaps concerning to you, the entire experience is constructed to be informative, educational, and emotionally supportive. There is no “pass/fail” pronouncement made and the sole intent is to partner with you to do everything possible to achieve your goal of having a baby.

Studies have shown that approximately 40% of patients will abandon the IVF process after a single cycle. The most common cause of dropout is the physical and psychological burden of the treatment, which accounts for 35% of dropout.

But another common cause is an inadequate response to ovarian stimulation, which is unexpected in most cases, with 10% of couples quitting the IVF process simply because of an inadequate response in the first cycle.

Traditional Chinese Medicine (TCM) can be used to assist couples going through Assisted Reproductive Technology (ART) such as IUI and IVF.

The primary modality used in TCM to treat infertility and/or to enhance fertility is acupuncture. Chinese diet therapy and massage are also integrated into the treatment plan to ensure greater success. 

A widely published German study found that using acupuncture with IVF achieved a 42% clinical pregnancy rate compared to only 26% in the control group that did not receive acupuncture.

Maintenance of early pregnancy requires progesterone. Progesterone is a hormone produced by the ovary (corpus luteum) in the second half of the menstrual cycle (after ovulation, also called luteal phase) and for the first few weeks of pregnancy. At around seven weeks of pregnancy, the placenta starts producing progesterone.

There are many issues to think about when you're pregnant or considering becoming pregnant using an egg from an egg donor. Among the health issues to consider is the research associating donor egg pregnancy with an increased risk for preeclampsia or hypertension.

 is a test commonly used for testing ovarian reserve. AMH levels reflect the number of eggs (oocyte pool) that remain in the ovary(ies). AMH levels will decline as a woman ages. AMH levels also indicate the number of eggs that will be retrieved and IVF pregnancy rates – a high number is associated with a better outcome. In many IVF clinics, an AMH level > 1.0 ng/mL is considered normal. At InVia we like our anonymous egg donors to have an AMH level > 1.5 ng/mL. Low AMH levels, on the other are associated with a low number of eggs retrieved and a lower pregnancy rate. There are several physicians who will recommend using an egg donor to patients based on low AMH levels alone. If this is a correct policy, it will save a lot of money for the health system. If it is incorrect, then these patients are being treated unfairly. So, it is logical to ask, “What are the pregnancy rates in women with low AMH levels?”

ICSI is an acronym for intra-cytoplasmic sperm injection. In basic terms it means we are injecting a sperm into an egg. ICSI IVF differs from the conventional IVF process in that a single sperm is injected into an egg, instead of fertilization taking place in a dish where millions of sperm are placed near an egg.

People often assume a woman is infertile if she and her partner cannot conceive; however, this is not always the case. Males play a big role in fertility, accounting for at least 35% of infertility cases. Therefore, in order to test a male's fertility, a semen analysis is performed. A semen analysis provides both qualitative and quantitative information.

It is an established fact that risks associated with giving birth to babies conceived through IVF, are increased for both mothers and infants.  Most of that increase in risk is related to the higher occurrence of multiple births. Currently, more than 30% of IVF pregnancies are twin or higher-order multiple gestations.

In a previous blog we discussed the expected ultrasound findings in a normal intrauterine pregnancy. Variations from the expected pattern of development are worrisome or, if major, definitive for early pregnancy failure or miscarriage. These were discussed in a recent review article by Doubilet et al. (N Engl J Med 2013;369:1443-51). Here is a summary:

Early miscarriage (early pregnancy loss or spontaneous miscarriage) is defined as a the loss of an intrauterine pregnancy within the first 12 6/7 weeks of pregnancy. It is usually diagnosed with ultrasound (either an empty gestational sac or a gestational sac containing an embryo or fetus without fetal heart activity).

Preimplantation Genetic Diagnosis (PGD) is a procedure used to screen embryos or eggs for genetic or chromosomal abnormalities during a cycle of in vitro fertilization (IVF). There have been several advances with the technique used to biopsy the embryos (e.g. testing embryos at the blastocyst stage 5 or 6 days after egg retrieval) and the technology used. However, what are the success rates for IVF with PGD?

In order to maximize pregnancy rates in an egg donor program, it is very important that a good egg donor is selected. You may already know that it's important that the egg donor be in good health, including being a non-smoker, drug-free, and of a healthy weight. All of these things should be on the list of requirements that your fertility clinic has for being an egg donor.

Polycystic ovary syndrome (PCOS) has become more widely known in recent years as a fairly common hormonal disorder and as a leading cause of infertility. Many doctors prescribe metformin – a drug primarily used to treat type 2 diabetes – to balance the hormones in patients with PCOS. In medical terms, metformin reduces hyperinsulinemia and suppresses the excessive ovarian production of androgens (male hormones) in women with PCOS.

For many decades, we focused mainly on sperm count and motility when doing a semen analysis. For the past 25 years or so, especially with the advent of in-vitro fertilization (IVF), fertility treatment providers have realized the importance of sperm morphology (shape). Sperm morphology reflects the quality of sperm production (spermatogenesis). Abnormal morphology (teratospermia) is associated with male factor infertility with reduced fertilization and pregnancy rates.

For years, we used to use the World Health Organization (WHO) criteria for assessing morphology. These criteria were fairly liberal and a value > 70% oval forms was considered to be normal. However, we at InVia have changed our assessment standards, because we've found that the old WHO criteria have very little value in predicting fertilization in IVF cycles.

Many couples who are trying to get pregnant think that the more sex they have, the better.The truth is that there is only a small window each month during which a woman can become pregnant.

This time is called the "fertile window," and it corresponds to the three days leading up to ovulation. Once an egg is released, it only lives for 12 to 24 hours. But not to worry, as sperm can live for several days. The trick is to have sperm “waiting” for the egg to drop.

A vaginal egg collection is a very routine part of the IVF process. The procedure is over in about 20 minutes, and experienced doctors will usually get one egg from each mature follicle.

During in vitro fertilization (IVF) in order for implantation and pregnancy to occur, the embryos must reach a stage of development known as ‘blastocyst’. Reaching the blastocyst stage is an integral part of the development of an embryo.

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.