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  • Austin IVF and LabCorp

    Austin IVF (AIVF) and LabCorp are pleased to announce that, effective April 1, 2011, AIVF will be performing andrology testing for LabCorp Austin.   This partnership allows Austin IVF’s experienced lab personnel to provide high quality accurate results and makes insurance claims submission a breeze. Labcorp is contracted with most major insurance plans, and they will submit a claim on your behalf to your insurance provider.

    Austin IVF is the only full service embryology/andrology laboratory in Austin and the surrounding areas and will provide andrology tests including: Complete semen analysis,Simple and complex intrauterine (IUI) preparation, Anti-sperm antibody testing, Retrograde ejaculation sperm evaluation

    In order for Austin IVF to perform any testing, a lab order is required by your physician. Please make sure to bring this laboratory order to your scheduled appointment. Tests are performed Monday thru Friday by appointment only by calling (512) 610-7474.   For your convenience, specimen collection instructions can be downloaded from our website, www.austinivf.com. Following your appointment, your test results will be sent directly to your ordering physician within 2 business days.

    Please visit www.austinivf.com for more information or contact Austin IVF directly at
    (512)-610-7474.

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  • 25th Annual IVF Baby Reunion

    Strollers, Babies, and Toddlers….Oh My!

    There were strollers everywhere as the staff at Texas Fertility Center and Austin IVF celebrated our 25th annual Baby Reunion. The event was held April 17th at the Dell Jewish Community Center. It was a fun-filled celebration that included bounce houses, face painting, balloon animals, and pictures. The event provided an amazing opportunity for us all to see how many families have succeeded in overcoming the challenges of infertility.

    This year, there were 431 guests in attendance; the youngest was 2 weeks old, and the oldest was 24 years old. We were excited to reconnect with families that we have helped build and to meet the little miracles we’ve helped to create. The Baby Reunion is also a time for us all to reflect and celebrate the advancements in reproductive medicine over the years. Texas Fertility Center, which was started in Austin in 1980, has seen the birth of more than 10,000 babies as a result of these advancements. With each passing year, we continue to add to our ever-expanding circle of family and friends. We look forward to continuing our success and helping new families achieve their family dreams.

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  • Does Every Woman Undergoing an Infertility Evaluation Need a Laparoscopy?

    In general, couples who have had trouble conceiving for 6-12 months should undergo a basic infertility evaluation. The tests include obtaining a semen analysis from the woman’s partner, undergoing an evaluation for ovarian function, having a pelvic sonogram, and undergoing a hysterosalpingogram (HSG). The final diagnostic test is a laparoscopy. However, this procedure is not always necessary. On the other hand, if an abnormality is found with the other diagnostic tests, such as an ovarian cyst suggestive of an endometrioma, fibroids that should be removed, and/or evidence of fallopian tube blockage, it seems clear that laparoscopy will be very beneficial. When all of the basic tests are normal, it is not so obvious if it is worthwhile for a woman to undergo a laparoscopy.

    Several studies in the past have looked at the likelihood of finding pelvic abnormalities at laparoscopy in patients considered to be “unexplained”. Patients were considered to have “unexplained infertility” if they had a normal basic fertility evaluation. Years ago, several investigators offered those patients with unexplained infertility a diagnostic laparoscopy to determine if a cause for the infertility could be discovered that was not evident from any of the basic infertility tests. In these studies, abnormities were found in 40% of couples. In the group where something was found, approximately 65% of the couples had endometriosis and the 35% of the couples had pelvic adhesions. With the results of studies like this, laparoscopy became a standard diagnostic procedure for couples trying to discover why they were not becoming pregnant.

    However, if during the investigation a semen analysis reveals the man has a very low sperm count and the woman has no other symptoms to suggest the presence of endometriosis and/or pelvic adhesions, then it is unlikely that a laparoscopy will be helpful. It this situation, the man should be evaluated by a urologist to determine if a treatment is available that might increase sperm production in the male. If not, then the couple should proceed with in vitro fertilization (IVF), unless the couple decides to undergo artificial insemination with donor sperm or proceed with adoption. Women with fallopian tube obstruction may chose to proceed directly to IVF, rather than undergo a laparoscopy in hopes of opening her fallopian tubes. Also, some couples who were found to have normal finding on the basic fertility tests may choose to try one of the treatments known to increase the chance of conceiving even when the cause of infertility has not been discovered and forego a laparoscopy. They may choose to try clomiphene (or letrozole) with intrauterine insemination (IUI), superovulation with gonadotropins combined with IUI, or IVF. In this situation the couple is gambling that laparoscopy would not reveal any abnormalities and want to move directly to these treatments.

    Laparoscopy is one of the great tools that is available for treating many gynecological problems, including infertility. However, it is not always necessary for it to be a part of the evaluation of infertility. If you have any questions as to whether a laparoscopy will be helpful for your infertility evaluation, do not hesitate to ask your physician.

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  • Donor Oocytes vs. Adoption: Is There Really a Difference?

    One of the most difficult discussions that we have with patients concerns what they should do when conventional fertility treatments have failed or are not a good option. While some patients find themselves in this situation after trying to conceive unsuccessfully with ovulation induction or even in vitro fertilization, many more patients are actually presenting to our office at their first visit with a very poor prognosis for success before they even attempt fertility treatment.

    Some of these couples have chosen to delay childbearing until the woman is in her late 30s or even early to mid-40s, while others come to see us after undergoing treatment with therapies that have left them with a markedly diminished number of eggs. Due to tremendous advances in cancer treatment, many women are now surviving their disease – and they rightfully desire fertility after winning their battle. Unfortunately, surgical procedures for endometriosis or other ovarian pathology that result in removal of one or both ovaries, or chemotherapy that destroys eggs, make the goal of having a child much more challenging.

    When we see these patients, we rapidly assess their ovarian reserve in order to determine how many eggs we have left to work with. This is accomplished through a combination of hormone testing (such as Day 3 FSH and estradiol and/or anti-mullerian hormone levels) and ultrasound measurement of ovarian size. Women with diminished reserve who desire children have a very difficult dilemma in front of them; continue to try conventional therapies – recognizing that they have a very low chance for pregnancy, move on to donor oocytes, or consider adoption.

    Many couples initially see little difference between donor oocytes and adoption. Adoption may actually seem “more fair”, as the child has no genetic attachment to either member of the couple. In fact, there are profound differences between the two alternatives which may or may not be important to the couple. Adoption offers a higher chance for success (90+% vs. 60-70% for donor oocytes), and it also offers many options, including the opportunities for international adoption, adopting a child who is racially or ethnically different from the parents or adopting a child who is economically disadvantaged, or even physically or emotionally disabled. On the other hand, adoption is typically more expensive than donor oocytes, and can also involve extensive legal proceedings.

    Oocyte donation also offers many advantages. Unlike women who make the difficult choice to place their babies for adoption, all oocyte donors are screened extensively for infectious, genetic, and psychological conditions, according to FDA guidelines. Donors are chosen by the recipient couple, after extensively reviewing their medical history, pictures, and biography. In addition, donor oocytes in Texas are governed by state property statutes. Therefore, once eggs are retrieved from the donor, they belong to the recipient couple – the donor irrevocably relinquishes all legal rights and cannot change her mind at a later date. The recipient woman then carries the baby, and accepts responsibility for obtaining good prenatal care and avoiding behaviors such as alcohol or drug abuse, that could adversely affect her baby’s health. In addition, the recipient couples’ names are on the birth certificate; no additional legal procedure is required to make them the legal parents of the child.

    Both adoption and donor oocytes represent excellent options for couples seeking parenthood. There are, however, significant differences between them. Our job, at Texas Fertility Center, is to provide patients with the information that they need to make the decision that is right for them and their family in a caring, non-judgmental manner.

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  • Dr. Kaylen Silverberg presents at the Pacific Coast Reproductive Society Meeting

    Dr. Kaylen Silverberg was a guest speaker at the Pacific Coast Reproductive Society Meeting in Palm Springs last week. His talk was entitled Optimizing Endometrial Receptivity and he shared his experience and expertise on the evaluation of the uterine cavity prior to treatment to increase pregnancy rates with IVF. Dr. Rinku Mehta was able to attend as well.

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  • Lifestyle Factors and Fertility

    Many of us don’t always think about how the things that we consume can affect our bodies. This is especially so when it comes to fertility. Certain lifestyle factors such as smoking cigarettes can have a profound negative impact, not only on egg quantity and quality, but also increase the risk of miscarriage and ectopic pregnancies. Studies have shown that women who smoke have a lower chance of conception with IVF than women who don’t. Same goes for the men, heavy smokers can have increased DNA fragmentation in sperm and this can have a negative impact on the vitality of the sperm. Marijuana use also has a negative impact on reproductive health. With respect to alcohol consumption we usually recommend limiting to less than 5 drinks a week, especially for the female partner. A recent study in Fertility and Sterility showed a negative impact of consuming over 4 alcoholic drinks per week on IVF success rates.

    Unfortunately, many other things can affect fertility such as high transfat consumption as is present in fast food and excessively high carb consumption in certain groups of women can be harmful. For people having issues with fertility, it would be advisable to keep your diet as healthy and natural as possible and avoid completely things like cigarettes and alcohol. In Austin we are lucky to that there are so many great places to get farm fresh produce and restaurants using natural ingredients, that at least it can be easier to avoid the bad for you processed stuff and fast food. Be good to your body!

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  • Lowering the Risk of Multiple Pregnancies

    It is not unusual for a couple struggling to become pregnant to hope for twins as they proceed through fertility treatments. This is especially true if the couple has not had children. Sometimes they feel that they can have two babies at one time and not need to worry about trying to become pregnant again. However, those couples who have had children in the past usually are more interested in having one baby at a time since they have experienced how much is involved in raising a child. Despite what a couple may think, it is important to realize that it is safer for the mother and her baby to have a singleton pregnancy.

    Most patients appreciate that pregnancies are more complicated when a woman is carrying triplets, quadruplets or even more, but they commonly do not appreciate that a twin pregnancy can be significantly more risky than a singleton pregnancy. Risks to the mothers include an increase in miscarriage (2X), hyperemesis (morning sickness), pregnancy-induced hypertension (3X), preeclampsia, gestational diabetes, acute polyhydramnios (excessive amount of amniotic fluid), vaginal and/or uterine bleeding and hemorrhage (uncontrolled bleeding), preterm labor and delivery, prolonged hospitalization and surgical delivery (Cesarean section).

    Also, a twin pregnancy is more risky for babies. The complications of the mother from carrying multiples can create complications for the babies. The maternal problems commonly result in babies being delivered prematurely. On average, the more babies that the woman is trying to carry, the earlier she will probably go into labor. Pregnant women with one baby tend to carry the pregnancy to 40 weeks, while pregnant women two babies rarely go beyond 38 weeks and tend to deliver 4-5 weeks early. Consequently, infants born from a multiple pregnancy have a greater risk of infant mortality (4-5 times higher for twins than for a singleton pregnancy) and a greater risk of mental and physical problems that can result from a premature delivery. The chance of a premature baby having cerebral palsy and other types of permanent neurological damage is significantly higher.

    Also, there is a significant health care cost for premature infants. Some babies average $500,000 for their hospitalization in the neonatal intensive care unit. Traveling back and forth to the hospital during the time the baby is hospitalized creates its own challenges for the couple. All of these issues create additional stress for the new parents.

    Unfortunately, to increase the chance of becoming pregnant with a fertility treatment, there is a risk of a multiple pregnancy. When utilizing in vitro fertilization, there is an opportunity to minimize this risk by limiting the number of embryos being transferred back to the woman. Our national organization, American Society of Reproductive Medicine, (ASRM) has published guidelines for the number of embryos to transfer according to the age of the woman to minimize triplets and to lower the number of twins. Not too many years ago, IVF programs averaged a triplet rate of 4-8%. The goal is to have a triplet rate of <2%.

    In a spirit of trying of eliminating triplets and significantly reduce the rate of twins, our group developed criteria to help guide couples in deciding to transfer only one embryo. As laboratory procedures become more refined, many more patients can benefit by transferring only one embryo without compromising their chance of becoming pregnant.

    We noted that in a select group of women that their chance of becoming pregnant was not lower by transferring one embryo instead of transferring two embryos. Couples were given the opportunity to transfer one embryo if they met the following criteria: the age of the egg <35 years, no previous unsuccessful IVF cycles, a day 5 transfer, and having at least one other embryo that met criteria for cryopreservation on the day of embryo transfer. Patients who did not choose to transfer one embryo underwent transfer of two embryos. The pregnancy rates were 68% for the single embryo group and 76% for the group transferring two embryos. These pregnancy rates were not statistically different. Therefore, young women undergoing IVF with embryo development sufficient to have at least one other embryo available for cryopreservation on the day of the embryo transfer had an excellent chance for pregnancy when they chose to transfer only one embryo.

    Also, there were no multiple pregnancies in the group that chose to transfer only one embryo compared to 55% for the group transferring two embryos. And, there were three sets of triplets for the group transferring two embryos. Therefore, transferring two embryos in that group increased the risk of multiples without increasing the chance for pregnancy. This data provides the needed information for a couple to help them decide whether to transfer one or two embryos. Consequently, we recommend to the couples who meet those criteria that they transfer only one embryo. This data was so significant that this study was presented by our group last October at our annual national meeting (ASRM) in Colorado.

    It is incumbent on physicians to minimize multiples when assisting couples with conceiving. Although each couple may have different fertility problems, different expectations, and different chances for success with the fertility treatments, the ultimate goal is have a safe pregnancy. Don’t hesitate to discuss ways to minimize your risk of having a multiple pregnancy with your physician.

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  • A survival guide for surviving the two week wait

    The “two week wait” can often be a very stressful time for women who are trying to conceive. The two week wait is the time between ovulation and when the next period should occur.  This is the time when women are waiting to find out if they are pregnant.

    For many women the two week wait can be stressful and worrisome. Throughout the treatment cycle you are kept busy with appointments, blood draws, sonograms, and other distractions that that help to keep your mind busy. During the two week wait, many women have more time to think about what the cycle outcome may be.  Many women’s minds are circling with the questions, “What if I am not pregnant?”  “What will my doctor recommend next?”, “Can I afford it – emotionally and financially?”…

    There are many strategies that can help you to make the two week wait a little less stressful and easier to get through.

    Keeping busy is an important way to help lower your anxiety during the two week wait.  Time always seems to go by a little bit slower when we are anxious or excited about something.  Keeping busy will help pass the time because it keeps your mind focused on something else.  Some ideas to help pass the time would be to:  plan a fun date or outing with your spouse or partner, plan a trip to the movie theater or rent movies, read a book, take a day trip, go for a leisurely walk, or plan a night out with your girlfriends

    Another important thing to help make the two week wait less stressful is to try not to consume your day with thoughts about which pregnancy symptoms you are or are not having.  It is important to know that you are very early in pregnancy when you draw your pregnancy test and it is not uncommon to not have any pregnancy symptoms at all.  Many of the symptoms that you may feel such as tender breasts, tiredness, etc. may be caused by the hormones that you are taking or hormones that are naturally found around the time that you would start a menstrual cycle.  It is well known that the graphs of hormone levels found near the end of a menstrual cycle in women who are pregnant and those who are not are virtually identical.

    It is important to find support during the two week wait from others who understand what you are going through.  Infertility is a stressful and emotional process and it is important to find someone who can relate to your feelings.  You can find support through local support groups or online support groups, and you can also talk to a counselor who specializes in infertility. These entities can all help you develop ways to cope with the emotions and stress of the infertility process as a whole.

    Finally, it is important to do things that help you relax during a period of time where you may have a lot of nervous energy and worry. Going for light walks is an excellent way to reduce stress and also get a little bit of exercise too.  You can do acupuncture and many women do deep breathing techniques and meditation to help during this time and any other stressful time in their lives. Reading a book can also help you to relax and take you mind off of things.

    The two week wait can be a time that can be worrisome and stressful for many women attempting pregnancy.  The stress is increased for many when infertility is involved.  There are many things that you can do to help survive the two week wait and make this time period more productive and less stressful.

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  • Diagnosing Endometriosis, or “Finding a New Use for Your Belly Button”

    As I have been discussing for the past several weeks, endometriosis is a very common condition – affecting anywhere from 25-45% of all women of reproductive age and up to 65% of infertile women. It is well known that endometriosis can cause infertility, as well as many other symptoms, such as chronic pelvic pain, pain with intercourse, and pain with periods.

    In last week’s blog, I wrote about the tests that are available to diagnosis endometriosis. Although there is no accurate blood test to use when making the diagnosis, many radiologic studies, especially ultrasound, can be useful. This week I want to write about the only reliable way to definitively diagnose endometriosis, which is for the physician to actually see it, and preferably to biopsy it.

    The most commonly employed technique used to find endometriosis is laparoscopy. This outpatient surgical procedure involves the passage of a small surgical telescope through the patient’s belly button and into her abdomen. The procedure is performed in an operating room under general anesthesia, and it generally takes anywhere from 30 minutes to 2 hours to perform. Once the patient is asleep, a 10 mm (less than ½ inch) incision is made in the belly button itself. Although you may be a little squeamish about anything touching your belly button, there are actually several good reasons for the incision to be made here. First of all, this is the easiest place on your abdomen to hide a scar. Most importantly, however, it is one of the safest sites on your abdominal wall through which we can insert the telescope. The likelihood of injuring any of the abdominal or pelvic organs is far lower when the belly button is used for access.

    After making this small incision, a needle is passed into the abdomen. Carbon dioxide gas is then gently passed through the needle in order to inflate the abdominal wall away from the organs underneath and create a gas-filled space in which the scope can be safely placed. The telescope is then introduced into the abdomen with a camera attached to the lens. This camera is hooked up to a large TV monitor so that everyone in the operating room can see exactly what the surgeon is seeing. The surgeon then carefully examines all visible abdominal organs, including the liver, the gallbladder, the appendix, the diaphragm, and the intestine for any signs of abnormality. Once this examination has been completed, the operating table is tilted so that the patient’s head is lower than her feet. By doing this, gravity pulls the intestine out of the pelvis, making it easier for the surgeon to see and evaluate all of the pelvic organs.

    One or two 5mm incisions are then made just below the top of the pubic hair line (again to eventually hide the scars). These incisions are for the insertion of additional instruments that the surgeon needs to move the pelvic organs around, find, and eventually treat endometriosis, scar tissue, or other abnormalities. Endometriosis has a variety of different appearances and the actual implants can be many different colors – from clear to red, white, blue, or black. There is a lot of controversy as to what the different colors mean. Some studies suggest that red lesions are the most aggressive, while blue or black lesions are older. Other studies suggest that it may not be quite this simple. Regardless, once the surgeon confirms the presence of endometriosis, the next step is to treat it.

    There are two basic techniques used to surgically treat endometriosis: destruction or removal. Most surgeons choose to destroy the lesions, using a variety of different types of energy – such as light (laser), electricity (cautery), or sound (harmonic scalpel). Regardless of the method chosen, the basic purpose of the energy is to super-heat the endometriosis cells to the point that the material inside the cell is destroyed, killing the lesion. The same types of energy can be used to actually cut the lesions out. While it may make more sense to actually remove the lesions, the concern is that this removal may create more scar tissue (adhesions) than actually destroying the lesions. There are many scientific studies that have looked at this issue, but there is not yet any definitive conclusion as to which method is best.

    The two main purposes of endometriosis surgery are to make a definitive diagnosis and, most importantly, to get rid of all of the lesions. This is often not the end of the story, however. Next week we will discuss what to do after surgery.

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  • Metformin and PCOS

    Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disorder that affects approximately 10% of reproductive age women. It causes menstrual irregularity due to disruption of normal ovulatory mechanisms. PCOS is also associated with increased male hormones in the circulation which cause increased coarse facial/body hair and acne. Many women with PCOS are obese, however lean women can also have PCOS. One of the fundamental metabolic abnormalities in PCOS is insulin resistance. This is especially more common and profound in women who are obese. Resistance to insulin and glucose intolerance can eventually develop into Type 2 diabetes. A few years ago, it was common practice to start women on a medication called Metformin (glucophage) as soon as they are diagnosed with PCOS. Metformin is a medication which improves the sensitivity to insulin. Through subsequent studies we now know that Metformin therapy is only indicated if a woman actually has glucose intolerance, otherwise it is not of any significant benefit. In order to diagnose glucose intolerance it is important to perform a 2 hour glucose tolerance test, a simple fasting glucose is not sufficient. If the diagnosis is made, then the therapeutic dose of Metformin is 1500 mg, if glucose intolerance is not present then it is not to the patient’s benefit to subject them to the side effects of Metformin without any clear benefit. For those patients with PCOS who are reading this, it may be of benefit to discuss with your doctor, whether or not you have been tested for glucose intolerance and if Metformin is of benefit to you.

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