InVia Fertility Specialists Blog

    High dose stimulation for the poor ovarian responder: is more better?

    Posted by Dr. Vishvanath Karande on Sep 5, 2019 7:00:00 AM

    The patient in the in vitro fertilization / IVF process who is a “poor ovarian responder” remains a challenge in clinical practice. The European Society for Human Reproduction and Embryology (ESHRE) working group on Poor Ovarian Response published a consensus definition of “poor ovarian response” after a meeting in Bologna, Italy around 2011. 9 – 24% of patients undergoing the IVF process are poor ovarian responders.

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    Topics: IVF, InVia Fertility Specialists

    Progesterone: IVF Requires Injections, and Here's Why

    Posted by Dr. Vishvanath Karande on Sep 3, 2019 5:45:00 AM

    Given a choice, a majority of patients would prefer to take medications orally. So when it comes to progesterone, why do we prefer the intramuscular or the vaginal route? It's simple: the oral route doesn't work as well. Here’s why:

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

    Do I Have PCOS?

    Posted by Janet Chiaramonte on Aug 29, 2019 9:00:00 AM

    do-i-have-pcos.jpgPCOS stands for polycystic ovary syndrome. It is a common condition related to an imbalance of hormones. It affects as many as 1 out of 15 women, and is a leading cause of infertility as well as other health problems. Getting pregnant with PCOS can be possible with the right diagnosis and treatment.

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    Topics: Infertility, Infertility treatment

    All About Thawing Frozen Embryos

    Posted by Kelly Schorsch on Aug 29, 2019 3:55:00 AM

    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.

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    Topics: IVF, InVia Fertility Specialists, Embryology

    Fifth vs Sixth Day Blastocyst Grading

    Posted by Liza Roscetti Meyer on Aug 26, 2019 8:00:00 AM

    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.

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    Topics: IVF, InVia Fertility Specialists

    Understanding the Causes of Failed IVF

    Posted by Dr. Aniruddha Malpani on Aug 21, 2019 7:02:00 AM

    A failed IVF cycle is heart-wrenching.Your dreams of a pregnancy are shattered, your hard-earned money has gone down the tube, and you do not know what to do next! As humans we all need explanations for the failures we encounter.

    If we get an answer, then we tend to have peace of mind, because we believe that we can achieve success the next time around if we can avoid past mistakes. But when an IVF cycle fails, unfortunately, often there's no good answer as to why. So much about human reproduction is still yet to be discovered, that often even the most experienced doctor may not understand what happened.

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    Topics: Infertility, Infertility treatment, IVF

    Abnormal Ultrasound in Early Pregnancy

    Posted by Dr. Vishvanath Karande on Aug 20, 2019 7:00:00 AM

    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:

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    Topics: Conception, Early pregnancy

    Does Letrozole Increase the Risk of Birth Defects?

    Posted by Dr. Vishvanath Karande on Aug 15, 2019 9:35:00 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

    Actually, Oral Contraceptives DO Lower Women's AMH Levels

    Posted by Dr. Vishvanath Karande on Aug 13, 2019 9:00:00 AM

    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.

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

    What Do Pus Cells in the Semen Mean?

    Posted by Dr. Aniruddha Malpani on Aug 7, 2019 8:02:00 AM

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    Topics: Infertility, Infertility treatment, Male factor, Understanding Test Results

    hCG measurements in pregnancies following in vitro fertilization (IVF)

    Posted by Dr. Vishvanath Karande on Aug 4, 2019 8:00:00 AM

    A pregnancy test, in an IVF cycle, is generally scheduled approximately two weeks after an embryo transfer. This involves a blood test to measure the hormone of pregnancy - hCG (human chorionic gonadotropin). If positive (greater then 5 mIU/ml) the test is repeated two days later and it should rise appropriately. Initial studies had suggested that in naturally conceived pregnancies, the 2-day rise should be at least 66%. A slow rise was believed to be associated with an abnormal intrauterine pregnancy or a tubal pregnancy. More recent studies have shown that the rise could be as slow as 53% in 2 days and the pregnancy could still turn out to be normal.

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    Topics: Infertility treatment, IVF, Conception, Early pregnancy

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

    Posted by Dr. Vishvanath Karande on Jul 29, 2019 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

    hCG levels in pregnancies from day 5 vs. day 3 embryo transfers

    Posted by Dr. Vishvanath Karande on Jul 17, 2019 7:24:00 AM

    Human chorionic gonadotropin (hCG) is a hormone produced by the embryo after conception. Human embryos can produce hCG as early as 8 days after fertilization. During IVF, however, final egg maturation is triggered by an hCG injection (generally 10,000 units) given approximately 36 hours prior to egg retrieval, increasing hCG levels in the patient's body. It takes approximately 14 days for the hCG from the trigger shot to be cleared (metabolized).

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    Topics: IVF, Early pregnancy, Multiple pregnancy

    3 key steps for handling the stress of infertility

    Posted by Dr. Mary Speno on Jul 8, 2019 6:46:00 AM

    The experience of feeling stress is part of our biological survival mechanism as human beings. It is a signal that danger is impending and action must be taken to seek safety. While it is a simple matter to obey traffic signals in order to cross a busy street safely, it is a much more complex matter to manage the chronic stress experienced in a situation where there is no simple solution. Infertility is just such a complex problem and requires effective stress management skills.

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

    Letrozole or Clomid - Which Drug is Best for PCOS Patients?

    Posted by Janet Chiaramonte on Jul 2, 2019 8:00:00 AM

    Polycystic ovary syndrome (PCOS) affects 6 – 8% of women and is a common cause of infertility. Women with PCOS often have absent or irregular menses. They therefore either do not ovulate or ovulate infrequently.

    Getting pregnant with PCOS can be possible with the right diagnosis and treatment. For the past many decades, clomiphene citrate (Clomid, Serophene) has been the drug of choice for making PCOS patients ovulate. The ovulation rates with clomiphene citrate are good, however, the pregnancy rates are quite low.

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    Topics: Infertility treatment, IVF, Ovulation Induction, PCOS

    Top 10 facts about anti-mullerian hormone levels and ovarian reserve testing

    Posted by Dr. Vishvanath Karande on Jun 24, 2019 4:35:00 AM

    1) Anti-mullerian hormone (AMH) is the substance that is responsible for destroying the mullerian ducts (female reproductive organs) in developing male embryos. An important discovery was the synthesis of AMH by granulosa cells (the cells surrounding a mature egg) and this was followed by the development of accurate blood tests to measure AMH. For the past 20 years the importance of AMH with regard to ovarian function has been extensively studied.

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    Topics: Infertility, Infertility treatment, InVia Fertility Specialists, Diminished ovarian reserve, Top 10

    I’m Pregnant and I’m Bleeding. What’s Happening to Me?

    Posted by Dr. Elizabeth Puscheck on Jun 13, 2019 10:00:00 AM

    Bleeding during pregnancy is scary, particularly when you have been trying to get pregnant for a long time with the help of a fertility specialist. In this post, I’m going to look at different reasons why bleeding happens during early pregnancy—including reasons that DON’T involve miscarriage.

    Please note that if you’re very worried about bleeding, especially heavy bleeding accompanied by pain, cramps, or clots, you should call your physician first and follow his or her advice.

     

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    Topics: Early pregnancy

    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, www.sart.org) 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 www.sart.org). 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?”

    fertility-diet-happy-family-300x214.jpg

     

    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

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