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  • Explaining Unexplained Infertility

    I was asked by a patient this week why I felt she had unexplained infertility when she had been told by her gynecologist that several issues had arisen during their infertility evaluation.  Her previous physician had told her that she did not ovulate very well and that, at laparoscopy, he found endometriosis.  She had been treated with clomiphene citrate (Clomid, Serophene) and experienced at least 8 ovulatory cycles with the medication.  Also, endometriosis had been seen at her diagnostic laparoscopy and treated with a laser. Despite having been treated for both of these problems, she had not conceived.

    A couple is considered to have a fertility problem if they have not conceived after 6-12 months of unprotected (not using contraception) sexual intercourse.  The diagnostic evaluation for these couples include a semen analysis, hormonal studies to evaluate ovulation, a hysterosalpingogram to evaluate the uterus and fallopian tubes, a pelvic sonogram, and a diagnostic laparoscopy. If all for these tests are normal, the couple is considered to have unexplained infertility. In addition, if something is found to be abnormal, is corrected and the couple still has not become pregnant, then they are considered to have unexplained infertility, as well. 

    The woman whom I saw in the office felt that the cause of their fertility problem was her ovulation dysfunction and the endometriosis. However, one could argue that if these two problems were the cause, why didn’t she conceive once the problem had been corrected? This is a good argument and, thus, it is best to consider that, in her situation, there must be something else that is responsible for her infertility. Just because the reason for the infertility has not been discovered does not mean that there is not a reason, but rather that the cause has not be determined by the tests that are currently available.

    Despite the fact that couples are really frustrated to hear that they have unexplained infertility, it is important for them to understand that there are procedures available to increase their chances of conceiving. The recommendation for treatment for couples who have had a problem and had it corrected but have not conceived is the same as patients with completely normal tests. These couples have an excellent chance of conceiving with clomiphene/ IUI, Gonadotropin/ IUI, or in vitro fertilization.

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    Thomas Vaughn, M.D.

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  • What Does His Age Have To Do With Things?

     It is well known that a woman’s age has a large impact on her fertility.  However, what impact does a man’s age have on his partner’s fertility and pregnancy?  Recent research tells us that the father’s age impacts these issues, though the overall effect is quite modest compared to the effect to that of the mother.  

    In contrast to women (who are born with all the eggs they will ever have), men continue to make sperm throughout their life.  As men age, the volume of their ejaculate goes down, as does the percentage of normal-appearing sperm in their ejaculate.  However, this does not necessarily correlate with a decrease in ability to father a child. 

    Interestingly enough, advanced paternal age (> 40 years) may be linked to a slightly increased risk of miscarriage.  Also, there appears to be a slightly higher birth defect rate in couples with older fathers.  In addition, there may be slight increases in the risk of schizophrenia and autism in offspring of older fathers. 

    To avoid even slight risks, it would reasonable for men to consider the completion of childbearing with their partner by the age of 40.  However, keep in mind that the risks associated with fathering a child at a later age indeed appear to be minimal

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    Natalie Burger, M.D.

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  • Fertility Facts and Statistics

    Infertility is a very common condition estimated to affect approximately 1 in 8 couples. This may even be an underestimate since many couples never end up seeking care. As patient awareness and education increases, the number of couples seeking care and achieving their goal of family building will increase. Presently the CDC estimates that ART (Assisted Reproductive Technologies) accounts for slightly more than 1% of total U.S. births.  There were 142,435 ART cycles reported in 2007 and 57,569 infants born as a result of ART cycles in 2007. These numbers only reflect those births where the babies were conceived via in-vitro fertilization procedures. There are many couples who can conceive with simpler and less expensive treatment than in-vitro fertilization. They key is to seek care early so that appropriate interventions and treatment can be done in a timely fashion.

    Generally, it is recommended that if the female partner is under age 35 and the couple has been trying at least for a year without success then they should consider undergoing an evaluation to identify any factors that can contribute to infertility. If the female partner is over age 35, then it is best to seek an evaluation after 6 months of trying without success. This is of course true assuming that there are no known causes of infertility present such as blocked tubes or lack of ovulation or poor sperm etc. If there is a known cause then evaluation should be sought ASAP.

    When a couple decides they want to start the process of getting evaluated for infertility they could either go to their Ob Gyn, PCP or come directly to a reproductive endocrinology and infertility specialist. Simple treatment and be initiated with the Obgyn however studies have shown that time to pregnancy is the shortest with a specialist. Typically once pregnant, the patient is followed by the reproductive endocrinologist until about 8-10 weeks gestation and then referred back to their obgyn for continued obstetric care.

    Seeking care in a timely fashion is very important. There are many causes of infertility that are amenable to simple treatment options and chances of successful conception are high for many couples.

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    Kathy Reynolds, RN

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  • Day 3 vs. Day 5 embryo transfers

    We often get asked about the differences between doing an embryo transfer on Day 3 or Day 5.  Many of our patients are Internet savvy, and they seem to all want Day 5 transfers, as they believe that the “literature” says that this will give them a better chance of having a baby.  In fact, if you look at basic statistics that compare pregnancy rates between Day 3 and Day 5 transfers, it does look at first blush like Day 5 results are better. 

    There are several possible explanations for this.  First of all, it could be that longer incubation of embryos in the laboratory allow the better embryos to grow, while those that are not healthy stop growing.  This would increase the likelihood that the better quality embryos would be transferred into the patient’s uterus.  Second, some people have suggested (without significant data to support their belief), that longer incubation in the laboratory can actually “rejuvenate” poor quality embryos.  Delaying the transfer could, therefore, allow embryo quality to improve and perhaps result in a better chance for pregnancy.  Third, it is possible that delaying the embryo transfer to Day 5 allows for better synchrony between the Day 5 embryo, or “blastocyst”, and the uterine lining, which could theoretically result in an improvement in pregnancy rates.   Finally, it is possible that physicians advise patients with many good quality embryos on Day 3 to delay their transfer to Day 5.  By doing this, patients with the best prognosis for pregnancy are placed in the Day 5 group, artificially raising the pregnancy results in this group.

    In science, and in clinical medical research, the best way to answer questions like these is to perform a prospective, randomized trial.  In other words, an investigator takes, for example, 100 patients and prospectively divides them at random into two treatment groups.  In this example, 50 would have an embryo transfer on Day 3 and 50 would have a transfer on Day 5.  Pregnancy and delivery rates would then be compared to see if there is a statistical difference in outcome between the two treatments.  In fact, this research has been done, and several prospective, randomized studies have been published in both the American and European literature.  The overwhelming majority of these studies show that there is no difference in either pregnancy or delivery rates between Day 3 and Day 5 transfers.  In addition to well designed clinical trials, there is also a compilation of the literature – published by the Cochrane Collaboration – that shows no difference between these two treatments.  

    In summary, it appears from the medical literature that delaying embryo transfer to Day 5 offers no advantage to the typical patient undergoing IVF.  The numerically higher pregnancy rates observed in most programs with Day 5 transfers can most likely be explained by the fact that physicians advise patients with many high quality Day 3 embryos to delay their transfer.

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    Kaylen Silverberg, M.D.

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  • Meet Robin Collet

    Robin Collett is our New Patient Coordinator who will call you, after you have scheduled your appointment with a nurse, to make sure that you are fully prepared for your first appointment at Texas Fertility Center. She takes the time to review your benefits with you as well as make sure that you have all the necessary paperwork ready when you arrive at the office. This way your appointment is not rushed and allows quality time to be spent with the physician rather than in the waiting room.

    Robin graduated in2008 and is a proud member of the Fighting Texas Aggies, “Whoop!” She spent four years in the Improvisation Troupe “Freudian Slip” while in college “attempting” to spread contagious laughter across the Bryan/College Station area. She is originally from Conroe TX, but since graduating from Texas A&M she has called Austin her home. She loves living in Austin and all the variety of things the city has to offer with the exception of the Texas Longhorns. She is the proud mother of her of her four year old Black Mini-Schnauzer, Miss Catalina Collett.

    Robin is excited that she will be ending the streak of “always a bridesmaid, never a bride” in the spring of 2012. Robin is very excited for what the future holds for her.

    Robin is an amazing person whose personality will light up a room. She has a knack for making every person feel special and important when she speaks to them. Robin will help answer any questions you may have about your initial appointment at our office. Stay tuned as we continue to feature different staff members to help you learn fun facts about us. We want you to know more than just our names. At Texas Fertility Center, you are part of our family.

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    Jamie Leonard, RN

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  • Miscarriage

    Last week on our radio talk show (Talk Radio 1370 AM at noon each Saturday), we discussed a very frustrating problem of miscarriage. Losing a pregnancy in the first trimester is so common that health professionals may not realize how devastating the event can be to a couple. Approximately 15% of all pregnancies end in a miscarriage. In younger women, the incidence may be slightly lower; however, in older women it can exceed 50% of all pregnancies! The most common cause of a miscarriage at any age is a genetic abnormality of the embryo. Most physicians view this as “bad luck”. A genetic abnormality usually leads to poor development of the conceptus and eventually lack of support from the hormonal environment for the uterus to hold the pregnancy. Consequently, the pregnancy tissue is usually passed from the uterus. Other causes of pregnancy losses include structural problems with the uterus, hormonal insufficiency, and immunological problems.

    Whatever the cause of a miscarriage may be, it is a true loss to the couple and not just a medical event. Even when the loss is very early, not requiring medical intervention, the couple still suffers the emotional toll of the miscarriage. Health professionals need to be aware of the significance of the impact of a miscarriage on a couple’s emotions. The emotional effects of this sad event not only vary from couple to couple, but also, may be different for the woman and the man. Although the man may be sad, the pregnancy is more nebulous to him and he may not have felt as connected to the pregnancy as the woman. He may not have noticed any changes in his partner because the woman usually does not show any dramatic physical changes in her body in the first trimester of pregnancy to remind him that she is pregnant, in contrast to the second and third trimesters of pregnancy. However, because the woman experienced the pregnancy, she commonly feels more stress from the loss and will probably need longer to grieve. Although a woman may be told by her gynecologist that she is ready to attempt pregnancy after one normal menstrual period, emotionally, she may not be ready that quickly and she may need more time. The couple will be better prepared to proceed with becoming pregnant again once they are able to complete their grieving.

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    Thomas Vaughn, M.D.

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  • To Vaccinate or Not to Vaccinate

    Now that flu season is upon us, the question continually arises, “Should I get the flu shot if I am pregnant or planning on becoming pregnant?”  The answer is “YES!” with very few exceptions.  According to the CDC,

    “…No evidence exists of risk from vaccinating pregnant women with inactivated virus or bacterial vaccines or toxoids. Live vaccines pose a theoretical risk to the fetus. Benefits of vaccinating pregnant women usually outweigh potential risks when the likelihood of disease exposure is high, when infection would pose a risk to the mother or fetus, and when the vaccine is unlikely to cause harm.” 

    Therefore, women who are planning to become pregnant or are all ready pregnant should receive the influenza vaccine attained from inactivated virus, but not the live attenuated virus which is generally delivered via an inhaled aerosol.  The most common vaccine which should NOT be administered during pregnancy or in the 4 weeks preceding pregnancy is the MMR (mumps, measles, and rubella) because it is derived from live virus.

    The next question, especially in Austin, is what medicines are safe to take for allergies since now is the time for ragweed, pigweed, milkweed, and soon cedar.  Medications which relieve symptoms such as antihistamines (Benadryl, Claritin), decongestants (Sudafed), and fever reducers and analgesics (Tylenol) are all generally considered to be safe.  If you take any other prescription medicines for allergies, please be sure to ask your physician if they are safe during pregnancy.  Otherwise, grab the Kleenex and eye drops, head outside, and enjoy the fabulous October weather!

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    Lisa Hansard, M.D.

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  • Not all fertility centers are created equal

    I think it is important for patients to understand that you do have a choice regarding where you decide to seek your fertility treatments. I received a phone call from a patient, just recently, that really stood out in my mind and really inspired me to convey the message of why it is important to do your “homework” when selecting your fertility center.

    One important question to be sure to ask yourself is whether the doctors are board certified Reproductive Endocrinologists (RE) at the center you are considering. RE’s are specialists in the both infertility and endocrinology and have had much more extensive training than OB/GYN’s. Many places advertise that they provide services for fertility, but they do not have board certified Reproductive Endocrinologists on their staffs. All Texas Fertility Center physicians are Reproductive Endocrinologists, having completed 2-3 years of fellowship (specialized training) in Reproductive Endocrinology following their 4 year OB/GYN residencies.

    You will also want to get a good feel for how the office operates. Is the center open on weekends and on holidays? Can I be seen late in the evening or early in the morning? Fertility is not something that is always predictable and so you may need to be seen on a holiday or a weekend. Texas Fertility Center is open 365 days a year- except leap year! We understand that your fertility is important and we will be there for you every step of the way no matter what day your treatments need to fall on. Make sure you choose a center that you can trust and rely on. We offer appointments early in the morning, as early as 730 am , as well as late in the evenings to accommodate patients busy schedules. We understand that scheduling appointments can at times be challenging and we try our best to work with each patient’s schedule to make the fertility process as stress free as possible.

    I would also want to know if my physician will be the one performing the procedures (especially for IVF). Many centers batch their cycles, so that the procedures all fall during the week and avoid the weekend. While this may sound attractive, these centers typically rotate physicians so that whoever is on call will do your important procedures. At Texas Fertility Center, we custom tailor each patient’s schedule to ensure that your physician will be there for all of your important procedures.

    Another obvious, but often times overlooked, question to ask is if your procedures for IVF will be done in town or out of town. Many fertility centers have satellite offices in several locations but have their main offices (where the procedures are actually performed) may be located in another other city. At Texas Fertility Center, all IVF and IUI procedures are performed right here in Austin. Our laboratory and Fertility Surgery Center is in the same complex as our Mopac office.

    Ask as many questions as you can before scheduling your first appointment. At Texas Fertility Center, when you schedule your first appointment you will speak to a nurse who will answer all of the questions that you may have. Once you are an established patient, you will have an assigned nurse who is familiar with your case so you can have a direct point of contact at the office.

    Not all fertility centers are created equal. You have the ability to choose who you want to work with to have the family you always dreamed of. Texas Fertility Center works very closely with our patients to make sure that patient satisfaction continues to be our top priority.

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    Jamie Leonard, RN

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  • How old is too old?

    I have seen so many patients this week of age over 43 desiring fertility that I decided it would be useful to write a blog about it. Unfortunately many women as well as their primary care providers or even obgyns are unaware of the profound impact of a woman’s age on fertility. As a woman gets older, not only does the egg quantity decline but so does the egg quality. A woman is born with a finite number of eggs in the ovary which declines with increasing age. Studies have shown that the rate of decline is more rapid past age 37. Population statistics show that the chances of live birth after age 43 are <1%. Couple of the patients I saw this week had been trying to achieve pregnancy on their own for over 8 years. If only they would have sought care sooner, they would have been able to attempt conception with their own eggs as opposed to now needing to use an egg donor. Similarly I saw another patient who underwent fertility treatments for several years with her obgyn and now by the time she got to a specialist her only choice for achieving a successful pregnancy and live birth is via IVF with donor egg. So, long story short, I there is one message I could put out there it would be DON’T WAIT TOO LONG. Fertility is finite, the ovaries continue to age despite how healthy one is, how much organic food one eats or does yoga or how young one looks and feels. Women with no other known causes of infertility, if under age 35 should seek evaluation if not pregnant after one year of trying. For women over age 37 they should seek care if not pregnant after 6 months of trying. It is always okay to get tested, have all the information you need and then make an informed decision on whether or not proceeding with any treatment is right for you or you can choose to not do anything, but that would be a conscious, well informed choice.

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    Kathy Reynolds, RN

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  • Meet Anna Hernandez

    Anna Hernandez has been with Texas Fertility Center for one year.  Anna is our front office coordinator and she is responsible for greeting and checking in patients for appointments, making sure all forms are accurate, and making reminder calls to our patients regarding their appointments.  She usually is the first point of contact for patients who are being seen at our Mopac office.  Anna is an amazing asset to have and we are so glad she is a part of the TFC family.

    Now here are some fun facts about Anna to help you get to know our TFC family a little bit better.  Anna is a newlywed and actually got married shortly after she started working at TFC.  She will be married one year in November.   Anna loves to watch old and classic movies featuring stars such as Ingrid Bergman, Cary Grant, and Jimmy Stewart.  She enjoys dancing and is involved in a Dance Ministry, Signs of Promise.  She has been dancing with them for almost 2 ½ years.  Anna is currently enrolled in school, part time, and she is studying to become an Elementary school teacher. 

     Stay tuned as we continue to feature different staff members each week and help you learn fun facts about us.  We want you to know more than just our names. At Texas Fertility Center, you are part of our family.

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    Jamie Leonard, RN

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