InVia Fertility Specialists Blog

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.

It is not uncommon for women with PCOS to have a problem with ovulation.  Typically, the over-the-counter ovulation predictor kits do not work for PCOS patients because many PCOS patients will get false positive tests and it may appear that you are ovulating all the time. So how do you know if you have a problem with ovulation?

One easy way to determine if you are probably not ovulating is the frequency of your periods.  If the beginning of your period (day 1) to the beginning of the next period (day 1) is either less than 21 days or more than 35 days, there is a good chance that you are not ovulating. Another way to determine if you are not ovulating is a medical approach: by testing a progesterone level.

You will only produce a significant amount of progesterone if you are ovulating.  If you are not ovulating regularly you should see an infertility specialist sooner than is usually recommended. There is no point in trying to conceive for a whole year if you are not ovulating because you can’t get pregnant if you are not releasing an egg from the ovary regularly.

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?

It is now more than 30 years since the first live birth after transfer of a frozen (cryopreserved) embryo (Zeilmaker et al., 1984).  The ability to successfully freeze embryos had a profound impact on assisted reproductive technologies. 

It improved efficacy, encouraged the transfer of fewer embryos into the uterus and hence reduced complications arising from prematurity. Recent research indicated frozen embryo transfer babies do better than babies from fresh embryos.

After egg retrieval, many IVF patients are anxious to know how their embryos are developing in the embryology lab. It's an exciting but difficult part of the IVF process for patients, because they want the best outcome and want to make sure everything is going well in the lab.

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.

Intrauterine insemination (IUI) is a reasonable first step in patients with unexplained infertility, minimal or mild endometriosis and mild male factor.

The pregnancy rate with IUI vs. intercourse in natural cycles is similar. Therefore, we will generally perform IUI along with fertility drugs (clomiphene citrate, letrozole or gonadotropins).

During intrauterine insemination, the semen sample is “washed” in a centrifuge so as to separate the sperm from the seminal plasma (which contains prostaglandins that can cause severe cramping). The motile sperm are then loaded in a tube (catheter) and deposited in the uterine cavity when the woman is ovulating.

Prior to IUI the total motile sperm count (TMSC) in the sample is usually estimated. Generally speaking, a post-wash TMSC greater than 10 million is considered optimal. The pregnancy rates with a TMSC are very low and these patients are generally considered unsuitable for IUI. But, is this really true?

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.

Progesterone is a steroid hormone involved in the female menstrual cycle and is essential for pregnancy. Progesterone also has many roles relating to the development of the fetus.

Anti-mullerian hormone (AMH) level is now routinely used to evaluate ovarian reserve. AMH levels decrease with age and are a more consistent predictor of “ovarian age” than antral follicle count on ultrasound, inhibin b, or FSH levels. The ovary produces AMH and this is confirmed by the fact that AMH levels are undetectable after surgical removal of ovaries as well as menopause. It is therefore reasonable to ask, “Does AMH level predict age at menopause?”

Many patients who have been through an in vitro fertilization (IVF) cycle have blastocysts that have been frozen. These blastocysts are cryopreserved by a process known as vitrification, which is a highly successful method of cryopreservation, with survival rates of about 98%.

Once the embryos have been vitrified, they can stay in that state indefinitely until a patient is ready to try to achieve a pregnancy.

In many cases, patients with cryopreserved blastocysts have had a successful outcome with the fresh cycle. There are also instances where a pregnancy was achieved, however, the pregnancy resulted in a miscarriage. And unfortunately some patients, despite having embryos with a good morphological grade, do not achieve a pregnancy with the fresh cycle.

We use several blood tests to assess a woman's potential to respond to fertility treatment. Initial research on measuring anti-Mullerian hormone (AMH) levels, used for gauging assessing ovarian reserve, showed that they do not vary during and between menstrual cycles. A single blood test done at any time during the cycle was supposed to be diagnostic.

This was a huge improvement over FSH levels, which must be measured on cycle days 2, 3 or 4 and are known to vary widely from cycle to cycle.

At InVia, we have been measuring AMH levels for many years now. Our clinical experience was that repeat AMH levels did seem to vary in the same patient. We have therefore been careful not to base treatment protocols based on AMH alone. We do keep other relevant factors (age, day-3 FSH, AFC, previous ovarian response, BMI) in mind when planning an IVF treatment protocol. The basic question, however, remains “Do AMH levels vary”?

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:

One of the first steps in fertility testing for any male infertility issues is a semen analysis. A semen analysis gives a good representation of the male’s quantity and quality of sperm, as shown in this sample semen analysis. Sometimes even debris and cells can be found in the sample. Debris, such as epithelial cells, is commonly found in small quantities, as well as, white blood cells. White blood cells in semen is not an issue, unless there is the presence of more than 1 million white blood cells per milliliter of semen.

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?

Once a healthy, developing embryo is successfully transferred into your uterus, it has to attach itself to the uterine lining and then grow there, a process known as implantation.

For successful implantation, your uterine cavity must be "receptive". That means not compromised by inflammation, growths, or other problems, so that the embryo can "stick" and begin to grow.

In the fertility community, when we say "think sticky thoughts" after an IVF embryo transfer, this is what we're talking about. Lack of implantation or compromised implantation can lead to early miscarriage.

So, what kinds of issues can impact implantation, and how can your fertility team spot them?

Ovarian reserve is a term that is used to determine the capacity of the ovary to provide egg cells that are capable of fertilization resulting in a healthy and successful pregnancy. Cycle day-3 follicle stimulating hormone (FSH) and anti-mullerian hormone (AMH) levels are routinely used to evaluate ovarian reserve in infertile women.

FSH levels predict egg “quality” and increase (> 10 mIU/mL) in women with diminished ovarian reserve (DOR). AMH levels, on the other hand, predict the ”number” of eggs that a woman will produce during ovarian stimulation for in-vitro fertilization (IVF). An AMH level < 0.7 ng/mL is consistent with a diagnosis of DOR. A combination of FSH and AMH levels is an excellent measure of ovarian reserve in infertile patients.

Of late, women who are not planning to get pregnant have obtained tests to use these levels as a “fertility test”. For example, Mrs. Smith is a 32-year-old with a two-year-old son who is using barrier contraception. She is not quite ready to have another child, but requests ovarian reserve testing from her Ob-Gyn doctor based on something she has read on the internet.

The question is: Are ovarian reserve tests useful as a “fertility test” in women who are not planning to get pregnant? What should be done if Mrs. Smith has a low AMH level? Should she try to get pregnant immediately? Should she freeze her eggs?

Single people and same sex couples that would like to have children that are theirs, biologically, can use this blog as a guide to starting the single and same sex parenting process.

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.  

There are often social challenges endured by LGBT families and parents. There is a lot of confusion and information to be sorted through, from friends, family members, Internet searches, and even from medical professionals. When choosing a fertility clinic, it's important to find a specialist that can guide you while providing a judgment free zone for you to feel safe and comfortable as you go through this very important step toward building your family.

For same-sex male couples, planning a family starts with a lot of questions—about getting an egg donor, surrogacy, and other fertility treatment options. Some of these questions can be answered by you, while others require input from professionals. 

Here are a few of the commonly seen abnormalities when we do a hysterosalpingogram (HSG).

Most of us remember very little from our Biology 101 class we had to pass in order to finish high school or college. The terms were technical and the processes complex. However, now that reproduction has taken center stage in your life, you keep hearing some of these terms long since forgotten.

In this post, I'll clarify some of the mystery around one part of IVF, pre-implantation genetic screening (PGS). This testing looks at genes and chromosomes to determine an embryo's risk of miscarriage.

 One of our routine tests is to evaluate egg quality is a day-3 follicle stimulating hormone (FSH) level. A high FSH level indicates diminished quality of a woman's eggs (ovarian reserve).

Patients with high FSH often ask us if we can lower their FSH levels. Before answering this important question, let's start with a primer on the basics of FSH testing.

One of the most frustrating group of patients for IVF specialists are those with recurrent implantation failure. These are patients for whom we've done multiple IVF cycles but who still do not get pregnant.

These patients as labeled as having "repeated IVF failure" or "recurrent implantation failure". In reality, these are just  bucket diagnoses which means we really do not know why the embryos we transfer do not implant for these women.

On an intellectual level, we understand that there are broadly only two groups of reasons for failure of implantation. One could be that the embryos are not of good quality. The other is that there is a problem with endometrial receptivity. Unfortunately, because it is still very difficult for us to pinpoint what the problem is in an individual patient, there is a lot of hocus-pocus and mystery surrounding the treatment options for these patients.