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My husband and I have been trying for 4 months. I'm 32, he's 38. How long do you keep trying to conceive before seeing a fertility specialist?

Alison Zimon, MD: In general, if a couple does not conceive after six months to a year of trying, we recommend referral to a fertility specialist.

This is in part based on the chance of natural conception which remains reasonable through the first year of attempting to conceive for younger couples, particularly when the female partner is less than 35 years of age, as you are.

However, in some instances, couples will be seen sooner to address specific concerns or medical problems that may affect fertility. Your physician or gynecologist may be able to help you determine whether referral is appropriate at this time.

Of course, you may also call our Patient Liason, Rhonda Gannon who can help you with as many questions as you have! She's amazing at giving advice! Best of luck!

My first IVF cycle was unfortunately not successful. What steps do you recommend taking to investigate why it did not work? Or is it just like flipping the coin? What questions should I ask my doctor? I am scared since an IVF cycle did not work for me?

Brian Berger, MD: It is quite difficult to assess reasons for why IVF didn't work without having all of the pertinent clinical information.

That being said, they are certainly broad categories that should be checked prior to initiating IVF.

These include ovarian function testing, testing of uterine/tubal anatomy, and testing for male factor infertility. Assuming that these were all checked and the appropriate diagnosis was made, a follow-up assessment of the IVF treatment cycle is necessary including an evaluation of the treatment protocol and an assessment of the laboratory/embryo information.

I'm 38 and single. A friend said to check my ovarian reserve. What does that exactly do? Is it accurate? Will it tell me that my prospects are low, even right now?

Alison Zimon, MD: Ovarian reserve testing may be a very good idea for you, particularly if you hope to conceive at some point, soon or in the future. All women slowly lose eggs during their reproductive lifespan and ovarian reserve tests are screening tests that help us predict whether you are likely to have an age-appropriate supply of eggs or a reduced supply. Ovarian reserve testing may help your egg quantity, but not the egg quality, which will be affected by age, and unfortunately in a negative way.

Typical ovarian reserve tests are serum follicle stimulating hormone, estradiol, and anti-mullerian hormone as well as an ultrasound that measures small follicles in the ovary to report an “antral follicle count.”

All these tests are informative, but as any screening test in medicine, they are never 100% accurate. I would recommend you consider such testing as it may be helpful for you to make some decisions about your reproductive plans. If you are not yet ready to become pregnant, you may even wish to consider fertility preservation through egg freezing and this testing would be helpful here as well.

I tested my ovarian reserve. One time the number was 7 (on day 3), but the next time it was 13. How do you determine what it really is if it so changeable? (I am 40 years old.)

Alison Zimon, MD: My guess it that the numbers to which your refer are your day three FSH (follicle stimulating hormone) levels. FSH levels can fluctuate quite a bit and so it is not surprising that the level may be 7 on day3 in one cycle and 13 on the next. Other data, such as your day-three estradiol (estrogen) level helps interpret the FSH level and better predict how the FSH reflects your ovarian reserve.

Additional testing is helpful as well, such as the AMH (anti-mullerian hormone level) and the AFC (ultrasound antral follicle count).

I suggest you review your test results with one of our doctors who can help you make sense of the variation in results and also help you predict your egg reserve.

I am a carrier of a rare genetic disease and am considering pursuing IVF to help increase the chance of carrying a healthy baby. Does Boston IVF have a genetic counselor that works there and do all of the doctors work with PGD testing?

Brian Berger, MD: I am sorry to hear about this genetic disorder that you carry.

Yes – we do a large number of cycles involving genetic testing and we do have a genetic counselor with whom we work in close collaboration. As long as the specific genetic disorder has been identified and we can develop a genetic probe for the abnormal gene, then treatment with IVF along with preimplantation genetic diagnosis (PGD) should be an excellent option for you.

You also may be able to obtain insurance coverage for the entire treatment cycle depending on your insurance coverage and location.

Overall, feel confident that this can be overcome. Science has evolved and here at Boston IVF, we're using a new and exciting genetic technology (PGD and PGS) that tests all 23 chromosomes, improves implantation rates and lowers miscarriage rates. A lot to process, I know, but do check it out on our website when you have a chance! Wishing you the best of luck and let me know if you need anything.

I am 27 and my husband is 37. We are considering IUI...and was wondering how many times you allow/advise them before moving on to IVF? Thanks!

Dr. Steven Bayer: Most pregnancies with any treatment generally occur within the first 3-4 cycles.

There are different approaches to IUI treatment—natural and medicated. The natural approach is associated with a low success rate. Using clomid in combination with the IUI will increase the chance of success. The average success rate with this approach is 10-12% per cycle such that after 3 cycles there is approximately a 25% chance of success. There is a 10% chance of a multiple pregnancy with clomid. Since you are young I would give CC IUI a try for 3 cycles.

Thanks for having this chat! We are working with BIVF and a donor and are hoping to start the donor screening process with you very soon. Tell me the latest trends of whether couples are keeping in touch with donors after birth of a child and how they do?

Brian Berger, MD: You are very welcome! In answer to your question, very few couples are interested in identifying their donors and my impression is that very few keep in touch with identified donors beyond the pregnancy.

That being said, for recipients who wish to identify their donors (assuming that the donor is willing to be identified), there are strategies which are usually arranged by the agency in order to allow them to maintain communication. This can be in the form of letters, emails, or even phone conversations.

Ultimately it all depends on the match, but is certainly possible to do!

Where does the RE role end and the embryologist start? How does one ensure that they are obtaining the best embryologist, the way the most credible RE was selected to work with?

Brian Berger, MD: Hi there ˜ in more established IVF centers such as Boston IVF, there are a number of embryologists in the lab that share different duties and responsibilities. In other words, each of our patients eggs/embryos are managed by a world class team of embryologists, each specializing on a specific area within the lab on any given day.

Our lab is overseen by two head PhD's in addition to three additional PhD's, each with specific expertise and oversight responsibilities. There are hundreds of quality control criteria, each of which are also checked daily to ensure that each of the patients gets care that they expect and deserve.

In a nutshell, every embryologist is trained the exact same way, according to the standards of our scientific team.

I am 39 going 40 years old, and am considering egg freezing. Is this still a viable option? What are the chances of success? Do I have the option of choosing which doctor to work with at Boston IVF for egg freezing?

Brian Berger, MD: Egg freezing is certainly an option at age 39/40, although I would preface that by saying that it is critical to undergo complete ovarian function testing before making the final decision. You can choose from a number of physicians at Boston IVF and I would be happy to consult with you if you wish to speak with me about possible egg freezing.

Having assisted with the first birth from a frozen egg in MA, we've (Boston IVF) been on top of this technology and would be happy to answer any questions you have.

Hello, how long does the whole donor egg and gestational process take?

Brian Berger, MD: On average, the process takes 3 to 4 months to complete.

This duration can be lowered or increased depending on how long one takes to identify the donor and carrier, and how much testing is required for each, respectively.

Another factor affecting the timeline can be whether or not one is using a fresh donor versus frozen eggs from the egg bank. It can also be affected by a non-medical issues such as donor/carrier availability.

Hi - I am wondering about soy products such as tofu etc. when TTC. I am going through my first IVF cycle and had always heard that soy was not a good thing to consume. Should I avoid tofu and similar products all together, or just not eat a lot of it?

Hillary Wright, MEd, RD: I get this question a lot both here and at my other job at Dana Farber Cancer Institute from women with breast cancer.

Soy contains phytoestrogens or plant estrogens that are about 1000 times weaker than estradiol, which is what women make. My recommendation that it’s fine to include whole soy foods, like tofu, tempeh, miso, soy milk, in reasonable quantities (maybe a serving or so per day), but avoid processed soy foods, like pills, powders, bars and soy burgers, fake chicken nugget things, etc. That way you can benefit from all the positive health effects without worrying about going overboard.

I was diagnosed with PCOS recently and a friend said to eat organic foods only and it will help. True?

Hillary Wright, MEd, RD: There’s isn’t science that tells us that people who eat organic are healthier, whether this is applied to PCOS or any other condition.

Having said that, we don’t have legions of people who have been doing nothing but eat organic for a few decades to study. For this reason, organic is a personal choice.

Many people feel like it helps maintain some control over at least this issue, which is fine as long as they don’t become over-concerned if they can’t eat organic at times.

Some research suggests that organic produce contains more phytonutrients. I tend to direct people to the Environmental Working Group’s “Dirty Dozen” 12 most pesticide contaminated fruits and vegetables. That way they can decide how to most wisely spend their organic dollars – maybe buy organic strawberries, which are on the dirty dozen, but save their money or bananas.

Having said all this, there are thousands of studies that tell us eating a lot of fruits and vegetables is healthy for you regardless of whether they’re organic or not. Just wash them well with running water and friction.

Definitely not soap!

We've gone through 4 IUI's and one IVF but all failed. My MD says nothing is wrong, but after these failures I am frustrated. I am 36, normal weight, healthy but wondering if I am one of the unlucky ones who am part of this unexplained infertility group.

Dr. Steven Bayer: We make the diagnosis of unexplained infertility in 30-40% of couples we see. It does not put you at a disadvantage as you move forward. The success rate with IUI treatment is around 10% and success with IVF is much higher.

At your age if 2 embryos of good quality are transferred the average success rate is around 40%. Don’t.

Are there tests that can figure out why i am having miscarriages?

Dr. Steven Bayer: The standard workup done for a woman who has had 2 or more miscarriages is as follows:

  • HSG—this is an xray of the uterine cavity to rule out a uterine septum or other abnormalities
  • Karyotypes – this should be done on both partners to rule out a rearrangement called a balanced translocation
  • Clotting studies—these tests are done if the miscarriages occur after 10 weeks

50-60% of couples with recurrent miscarriages all of these tests are normal.

Don’t get discouraged it can take time. Hang in there!

I was diagnosed with endometrial polyps shortly after having a miscarriage. Are polyps responsible for miscarriages...or do you think it was something else?

Dr. Steven Bayer: Hi and thanks for your question. Uterine polyps are common and vary in size. We don’t know what causes a polyp to form but it is an outgrowth from the lining of the cavity. Generally we recommend removing uterine polyps for our patients undergoing fertility treatment depending on their size.

The controversy is that we don’t know how many women in the general population have polyps and have no issue with their fertility or carrying a pregnancy.

Unless this polyp is large I don’t think it caused your miscarriage. I would suggest that you discuss this with your doctor who may recommend a hysteroscopy to remove the polyps before you move forward.

I was considering egg freezing and wondered where the eggs would be stored. Would it be with you or an outside location? Also — is there an age limit for using them? I'm 35.

After the eggs are frozen they would be stored here at our facility. It is best to freeze your eggs prior to the age of 40. I would recommend that you make appointment to see one of our physicians to learn more about this option.

What stats do you have to show that acupuncture helps fertility? Considering it before my transfer, because I'm so nervous and this is my 3rd cycle.

Alice Domar, Ph.D: There have been dozens of studies done on the impact of acupuncture on IVF outcome, including a few meta-analyses, which pool data from different studies.

Many show a positive impact on pregnancy rates, and some do not. One of the better researchers in the field, Eric Manheimer, estimates that acupuncture increases pregnancy rates by 65%.

Since the jury is still out on a definitive answer, my recommendation is to try it. At the least you will likely feel more relaxed and optimistic. Sometimes that's all it takes. And best of luck in your upcoming cycle!

How much does stress play a part in pregnancy? I am getting ready to start my second IVF with the first ending in a chemical pregnancy. I had 2 losses. I love my job and I don't want to change it, but I am concerned that stress may be part of my issue.

Alice Domar, Ph.D: Stress can play a role in fertility but most research shows that depression, more than anxiety, is a bigger contributor.

That said, there is some data which shows that women who have more work stress during an IVF cycle can have lower pregnancy rates.

Rather than quitting your job, maybe a better first line of attack would be to learn some stress-reduction strategies such a cognitive-behavior therapy and/or relaxation techniques.

ASK RHONDA
Have questions about your fertility? Need info on available treatments or just general advice on where to begin? Don't hesitate to call or email Rhonda! For 30 years, she has been a phone call (888-300-2483) or email away and the perfect resource if you need answers.

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