Signs, Symptoms, and Types of a Miscarriage


Our mothers and grandmothers didn’t discuss it, but losing a pregnancy within the first 20 weeks is incredibly common, with most losses occurring before the 13th week.  As many as 10-25% of all recognized pregnancies will end in miscarriage. Of these, nearly 50-75% will be chemical pregnancies or a pregnancy that ends just after implantation so that any bleeding coincides with an expected period and often goes unrecognized as a miscarriage.



Symptoms of miscarriage can vary, be vague, or be completely absent. Some of the signs that could indicate that there is a miscarriage are decreased pregnancy symptoms, spotting or bleeding, and unusual persistent cramping. 



If you’re pregnant and experiencing any of the above symptoms, please contact your doctor or medical provider immediately. He or she can advise you as to the next steps.  But keep in mind that many women experience some vaginal spotting in the first trimester of pregnancy that does not result in a miscarriage.




A doctor can diagnose a miscarriage in several ways:

Bloodwork:  Your doctor can check to see if your levels of hCG (human chorionic gonadotropin) and progesterone are normal. Levels of both rise quickly in early pregnancy. Depending on how far along you are, your doctor may order several sets of blood tests several days apart to compare results.

Ultrasound:  To check for a fetal sac and heartbeat, your doctor can use a transvaginal or abdominal ultrasound.

Pelvic Exam:  By conducting a pelvic exam, your provider can determine whether your cervix has thinned or opened.



Most first trimester miscarriages are the result of chromosomal abnormalities; there is very little a mom can do to prevent one from happening outside of IVF with Genetic Testing. Having chromosomal abnormalities means something was wrong with the baby’s genetic structure—likely an extra chromosome or missing chromosome—the result of damaged egg or sperm or a problem during cell division.  Other causes can include:

  •   Womb structure abnormality the restricts development of the fetus
  •   Placental problem that interrupts blood supply
  •   Polycystic Ovary Syndrome (PCOS) which causes a hormonal imbalance
  •   Weakened cervix
  •   Infection
  •   Rubella
  •   Improper implantation
  •   Lifestyle factors:  malnutrition, exposure to toxic substances, smoking, drinking alcohol, and use of drugs can increase the risk of miscarriage
  •   Maternal age
  •   Underlying health problems: certain pre-existing health conditions have been known to contribute to miscarriage—high blood pressure, diabetes, lupus, thyroid problems, HIV, and other sexually transmitted diseases
  •       Being at an unhealthy weight – either over or underweight
  • immune disorders
  • clotting disorders



Depending on where you are in the process, you may hear your doctor use a variety of different medical terms to describe what you’re experiencing.

Threatened Miscarriage: Some degree of bleeding in early pregnancy with backache and cramping. Often a result of implantation and the cervix remains closed. In this case, pregnancy continues.

Inevitable or Incomplete Miscarriage:  Abdominal or back pain, bleeding, with dilation or effacement of the cervix or rupture of the membranes. If the cervix is open, the miscarriage is considered inevitable. Bleeding and cramps may continue If the miscarriage isn’t complete.

Complete Miscarriage:  When the embryo and all products of conception have emptied from the uterus, a miscarriage is termed complete. With this, bleeding and cramping usually subside quickly. An ultrasound can confirm that all tissue has been expelled. If some remains, your doctor may recommend you have a dilation and curettage (D&C) performed.

Missed Miscarriage:  There are no other symptoms, such as bleeding or pain. In this, the fetus didn’t form or has died but is not expelled.  We don’t know why this occurs, but a mother typically experiences a loss of pregnancy symptoms with no fetal heartbeat detected on ultrasound. 

Blighted Ovum:  When a fertilized egg implants into the uterine wall but fetal development never begins. A gestational sac is seen on ultrasound, but no fetal growth occurs.

Recurrent Miscarriage:  Defined as three or more consecutive first trimester miscarriages of clinical pregnancies.  Recurrent Pregnancy loss affects about 1% of couples trying to conceive. The good news is that nearly two-thirds of women who have recurrent miscarriages will eventually carry a healthy pregnancy to full-term often without any treatment.  Pregnant women older than 35 have a higher risk of recurrent miscarriage.



Once a miscarriage starts to take place, there is nothing that can be done to prevent that miscarriage.

There are however many dietary, lifestyle, and pharmacological approaches that may help reduce the odds of having a miscarriage in the future.

Diet: It is recommended that those in pregnancy eat a high fat low carbohydrate diet, which helps reduce inflammation and quiet the immune system, which is thought to play a role in recurrent pregnancy loss. It is also important to take prenatal vitamins.

Lifestyle: Mild exercise like yoga, tai chi, walking are recommended, while high-intensity exercise should be avoided. Similarly, acupuncture can help manage stress and improve pregnancy outcomes. It is also imperative one stays away from tobacco, alcohol, and other drugs.

Medications: Numerous pharmacological drugs can help maintain a healthy pregnancy like low dose aspirin, Lovenox, Intralipids, LDN, and more.



There’s a lot of misinformation about miscarriages, but thankfully also a large body of research to separate fact from fiction. Here is a list of things that are NOT known to cause a miscarriage:

  •   Working outside the home (unless in a harmful environment)
  •   Sex
  •   Moderate exercise


Even though your chances of miscarrying during your reproductive years are quite high, that doesn’t make the loss any easier to bear.  Suffering a miscarriage at any stage can be quite traumatic. A sense of guilt often follows it: was there anything I could have done to prevent it?  Was it the glass of wine I had before I knew I was pregnant? In most cases, there was nothing a mother could have or should have done differently to prevent the loss.

Miscarriage takes both a physical and emotional toll, and it affects both parents. You go from the high of rejoicing your awaited baby to the low of mourning the loss of a child and all the hopes you had for them. A full range of emotions can be expected:  sadness, anger, guilt, anxiety, resentment, despair, withdrawal, and acceptance. In many ways, it can feel like things are simply beyond your control. There’s no right or wrong reaction.

The grief you feel is real, and it’s important to reach out to your partner, friends, support group, clergy, or mental health counselor to find the support you need for as long as you need it. Many women find that once they work up the courage to discuss the topic of miscarriage with friends, they are surprised by the number of women close to them who have shared the same heart-breaking experience.

As time passes, you should begin to feel better. If you don’t, seek professional counseling so you can start to heal.

Similarly, it can be a good idea to reach out to a fertility specialist, particularly if you have experienced two, three, or more miscarriages to reduce the risk and discover the cause of your recurrent pregnancy loss.

If you’re ready to build your family, CNY Fertility is prepared to help no matter where you are in your journey.  Schedule your consultation today, or give us a call 1-844-315-BABY. We’re here for you every step of the way!


What is a Reproductive Endocrinologist?


If you’re trying to get pregnant or have suffered from recurrent pregnancy loss or miscarriage, you may be wondering what type of doctor to see.  

 Cue the Reproductive Endocrinologist (Re-pro-duc-tive En-docri-nol-o-gist). It’s a bit of a tongue twister, but fortunately, most people simply call them REs or REIs (as in Board Certified in Reproductive Endocrinology and Infertility).  

A reproductive endocrinologist is the only type of medical doctor with specialized training focused solely on helping people become and stay pregnant. 

Reproductive Endocrinologists diagnose causes of infertility such as PCOS, endometriosis, anovulation, and male factor infertility along with many other issues. An RE also uses assisted reproductive technologies (ART) like IUI, IVF, Donor Egg IVF, Egg Freezing and more to help those with these diagnoses, those in the LGBTQ community, and those with genetic disorders (or even elective reasons) to start or expand their families.

Many REs also receive special training in surgical procedures to correct physical deficits preventing conception or causing pregnancy loss. This can include surgeries like a myomectomy or tubal ligation reversal.


The answer may seem obvious by now, but when most people think about trying to conceive, they typically think about OBGYNs first. 

While some OBGYNs help with fertility in basic ways like prescribing Clomid, the majority of OBGYN work is focused on general women’s issues like breast and pelvic exams along with routine pregnancy check-ups and assisting in childbirth.  

 Meanwhile REs receive specialized training and have extensive professional experience focused exclusively on helping those suffering from infertility. To become a reproductive endocrinologist, one must first complete training to become an OBGYN (4 years of medical school + 4 years of OBGYN residency), and also complete an additional three years of training called a fellowship in reproductive endocrinology and infertility. This fellowship includes intensive training in both the male and female reproductive anatomy, the endocrine systems, and all the medications and procedures to treat infertility.  

In addition to this training, REs typically hand off the care of patients to OB/GYNs after the first few months of early prenatal care when the pregnancy has been confidently established. That means that in addition to those three extra years of specialized training, they focus their entire career on this brief 3-4 month period of conception and the critical early months of pregnancy. 

You may also be wondering about the endocrinology side of reproductive endocrinology and how it’s different from the medical specialization of general endocrinology. The primary difference is in the area of focus. An endocrinologist covers a broad range of endocrine disorders like  diabetes and bone disease. An RE focuses exclusively on those affecting the reproductive system. Because of this, REs are more highly suited to treat the nuances of hormonal imbalances impacting fertility. 


Obtaining a medical license to practice medicine and being board certified are two very different things. Board certification is a voluntary process that demonstrates a physician’s exceptional expertise in a particular specialty or subspecialty, whereas a medical license is simply the bare minimum required by law to practice medicine. Board certification ensures that a physician is up to date on the latest medical practices in their specialty. 

Because of the rapid advancement of fertility science, it’s important to find a fertility specialist who is indeed Board Certified in Reproductive Endocrinology and Infertility to ensure they are knowledgeable and trained in the latest advances.


Reproductive immunology is a further subspecialty of reproductive medicine (requiring no formal training like a fellowship) that studies the way the reproductive system interacts or fails to interact with the body’s immune system.  

The immune system is believed to interact with the reproductive system through two main avenues: 

  1. The immune system correctly/incorrectly identifies the embryo as an “invader” and attempts to stop the growth of these cells. While an embryo is indeed a “foreign” organism made up of completely different cells, the goal of reproduction requires that a mother’s immune system does not act upon this distinction. 
  2. The immune system is overactive creating a chronically inflamed environment resulting in the body’s inability to heal, deliver nutrients, and maintain adequate blood flow required to sustain a developing embryo/fetus.

 A Reproductive Immunologist studies these interactions carefully and prescribes medications often not seen in standard fertility clinics, medications like prograf, which was originally developed as an anti-rejection medication for organ donor recipients.  

Truly, reproductive immunology is the latest advancement in reproductive endocrinology and and fertility medicine. New treatments are frequently being developed to reduce inflammation throughout the body and suppress the immune system to support successful pregnancy outcomes. Treatments include a low carb/high-fat diet, a host of pharmacological medications like low-dose steroids (Prednisone and Humira), intravenous immunoglobulins and intralipids which are made up of egg protein and soy fat, CBD oil, and Platelet-Rich Plasma (PRP) and much more.  

While growing in number, REs experienced in reproductive immunology are not that common. Most fertility clinics do not sub-specialize this far into reproductive medicine, but there are a handful that do. They are worth seeking out if your medical history includes repeated miscarriages or several unsuccessful IVF attempts.   


There are three major instances when you should consider scheduling a consult with an RE. 

First, if you’ve had difficulty getting pregnant and have been trying for over a year (for those age 35 and younger) or just 6 months if you’re older than 35, make an appointment. 

Also, if you’ve been able to get pregnant, but not stay pregnant and carry a baby to full-term, you should probably sit down with an RE. Infertility by definition is an inability to become or stay pregnant. Some couples get pregnant easily but suffer miscarriage after miscarriage. Other couples never experience the joy of a positive pregnancy test despite months and even years of trying and doing everything right. In either instance, an RE is the best place to start.

Second, if you are interested in or have a medical need to preserve eggs, sperm, or embryos, a consult is a good idea. Men or women about to begin chemo, radiation or other cancer treatment who haven’t started a family or are interested in having more children should discuss their fertility preservation options before beginning treatment. Those in the military or people pursuing other goals during their most fertile years also might want to consider fertility preservation as a way of protecting their future family building options. Reproductive endocrinologists are the only doctors qualified to perform egg retrievals and offer egg and embryo freezing.

Third, if you are a member of the LGBTQ+ community or a single man or woman and interested in starting a family with or without a partner, an RE can help you understand all of your options, which include IUI, IVF, Reciprocal IVF, using a Gestational Carrier or Surrogate, and using donor sperm, donor eggs, or donor embryos. For those transitioning from male to female or female to male, preserving eggs or sperm before hormone therapy offers the best chances for a biological connection to a future child.


If you’re asking yourself the question, “Should I/We make an appointment?”, chances are you should! Unfortunately, our ability to conceive declines with age, starting as early as age 30 for women. Many couples let month after month slip by convincing themselves that next month will be their lucky month. With fertility, time is of the essence. Consulting with a fertility doctor can provide clarity and much-needed answers. An RE will evaluate both partners and develop a game plan that works for everyone.


If you’re ready to build your family, CNY Fertility is ready to help no matter where you are in your journey.  Schedule your consultation today or give us a call 1-844-315-BABY. We’re here for you during every step of the way!


Why Fertile Hope Yoga is Your Secret Weapon Against Infertility


It’s no secret that many different organ systems in our bodies work in conjunction to support reproduction. We’ve got hormones (endocrine system), reproductive organs, immune or lymphatic system, circulatory, muscular, respiratory, and so on.  Even seemingly unrelated body systems are connected, with all ten body systems playing their role. Our bodies are a finely tuned machine, and when all systems are working correctly, that’s the sweet spot. We feel good (mentally and physically), look good and feel stable and balanced, the calling cards of homeostasis. But when they’re not, that’s when there’s room for trouble.

Infertility is a good example of a kink in the system. A lot of times, we don’t understand where or what the problem is. Is it a confused immune system attacking the fetus? Misfiring hormones? An inhospitable uterus? Then there’s the mind-body connection. Western trained physicians have been a little slower to focus on it, but it is a critical (and ancient) component of eastern medicine. Fertile Hope Yoga founder Erin McCollough has found that leveraging the mind-body connection for clients struggling to get pregnant can be a game-changer.

Statistics from a Harvard research study show patients who participated in a mind-body program for a 10-week period (which included yoga and meditation) conceived 3 times more often.

Fertile Hope Yoga is Erin’s brainchild.  After twenty years of training in therapeutic yoga and the healing arts (she’s also a licensed massage therapist, certified in Reiki, myofascial release, and Arvigo Therapy), ten years working for Dr. Robert Kiltz at the highly successful CNY Fertility (she’s also a Doula), and more than a decade of teaching yoga specifically for fertility in the Rochester, New York area, Erin discovered her one-of-a-kind program was achieving incredible results.

90% of Erin’s yoga for fertility students have achieved pregnancy over the last 10 years.

Was there a way she could help struggling women who live more than a quick car ride away? Yes, she thought, there was, and thus, Fertile Hope Yoga was born.

Fertile Hope Yoga is a comprehensive yoga fertility program for women going through IUI, IVF, ICSI, egg donor cycles, ovulation induction, frozen embryo transfer (FET), or any reproductive assistance or procedure as part of their fertility journey.  

But it’s more than just yoga . . .

What if releasing your emotions and sharing your fertility story meant you could go from 1 in 5 women to 1 in 2 women who become pregnant?

Erin found that many clients were keeping their fertility journeys private and holding in their emotions while trying to avoid pain by not being too optimistic. In truth, releasing the emotions and opening up and sharing your story and experiences is one of the best things you can do for your health.

Erin offers the NURTURE Yoga for Fertility Course for women who believe in a holistic approach to fertility wellness. It is a sacred space to share stories, focus on the power of positive thoughts, and expect miracles. It is a wonderful gift and resource for women no matter how you’re trying to conceive (natural cycle or receiving IUI/IVF or FET treatments with the help of a doctor), and an opportunity to build an unshakable foundation while supporting your unique fertility journey.   You’ll hear from women who have been in your shoes and see how other women’s Fertile Hope stories have transformed their lives. Fertile Hope Yoga supports women in all types of partnerships: single moms by choice, mom and mom couples, mom and dad couples, and couples experiencing secondary infertility.

The support you’ll experience will set you up for lifelong success as a mother, partner and woman. You’ll become so much bigger than your fertility story.  

Fertile Hope Yoga will help you learn about getting pregnant, how to reignite your hope, and everything else your doctor doesn’t discuss with you. Western medicine might be one part of your equation, but just as important is –

  • Addressing and rewiring your underlying beliefs
  • Embracing who you are, where you are right now
  • Shoring up support, love, and a network of people to catch you

That’s how you overcome any obstacle, persist, and succeed in your fertility journey.

Working hand in hand with a reproductive endocrinologist and fertility clinic, Erin is the only yoga teacher to develop a program that addresses all of this. Her methods are proven and safe.

Go from hopeless to hopeful while boosting your fertility

The NURTURE Yoga for Fertility online program offers a deliberate way of practicing yoga that honors exactly where you are in your cycle no matter how you are trying to conceive.

The cycle-specific yoga sequences meet your needs physically, mentally and emotionally – exactly where you’re at – maximizing benefits for what is needed to increase pregnancy rates in that part of your cycle. Your reproductive organs and body will experience an energy boost and blood flow creating a positive physical environment for your miracle baby.

What is included in NURTURE?

  • Access to 10 pre-recorded Fertile Hope Yoga Videos designed to increase pregnancy rates. You can stream anytime, anywhere, and on any device (videos range in length from 15 to 75 minutes).
  • Videos are cycle specific, safe & great for beginners.  Each video was designed to meet your needs emotionally, mentally, physically and your energy level depending on where you are in your cycle.
  • 4 Paths within the program (Yoga for Natural Fertility, Yoga for IUI/IVF, Yoga for Frozen Embryo Transfer, and Yoga for when you are “on a break”).
  • Powerful Getting Centered Meditation that you can use as an SOS whenever you need it.
  • 15 Minute Yoga for Fertility video that can be practiced anytime you need a quick yoga fix.
  • Easy start guide and getting started checklist
  • Downloads – Gratitude Journal, Fertility Affirmation Deck, Fertility Yoga 101 Guide

If your family building plans aren’t progressing as you had hoped, this is where your new fertility story begins.  Let Erin and Fertile Hope Yoga show you the way.

Right now, Erin is offering a FREE yoga for fertility program.  You’ll receive immediate access to the tools that will help you get off the emotional roller coaster, reclaim a sense of control, and actually increase your chances of pregnancy by 175%.

To get started, click here.


Back to Basics: Fertility and the Menstrual Cycle


At CNY Fertility Center, founded by Dr. Robert Kiltz, with offices in Latham, Syracuse and Rochester, you will be asked a common question at your consultation. How are your menstrual cycles? Have you ever wondered why this is so significant?
Many women do not give to much attention to their menstrual cycle. Typically only concerning themselves with knowing that their period comes every month and when the best time to conceive a pregnancy is. For the many women that are having trouble conceiving, having some knowledge of what happens during this 28 day menstrual cycle may actually shed some light on your fertility treatment.
The menstrual cycle begins on the first day of blood flow; this is counted as day 1.On average the menstrual cycle can range from 24-35 days. The menstrual phase may last 4-8 days. On day 1 the hypothalamus is telling the pituitary gland to produce FSH, follicle stimulating hormone, and LH, luteinizing hormone. The pituitary is also telling the ovaries to produce estrogen. The production of FSH tells the follicles (tiny cysts which house the egg) to grow. This is the follicular phase. Typically one follicle will become dominant and many others will degenerate. During fertility treatments FSH and LH are added through daily injections resulting in more follicles. The dominant follicle(s) is producing estrogen and a small amount of progesterone. The estrogen is causing the uterine lining to thicken in preparation for an embryo to implant. Once the follicle(s) reach about 20mm in size, on average around day 14 if the cycle is 28 days, the pituitary secretes a large amount of LH, the LH surge. There will also be a surge in FSH, these two combined signal the ovary to rupture the follicle(s), and this is ovulation. It is at this time fertilization can occur. Preparation of the uterus continues for fertilization. This is now considered the luteal phase of the cycle.  The ONLY true test that ovulation has occurred is when a pregnancy is established.
The pituitary continues to produce LH and the hypothalamus will produce gonadatrophin releasing hormone (GnRH). The follicle from which the egg was releasing now becomes a corpus luteum cyst. The higher levels of LH signal the corpus luteum to produce progesterone. This progesterone is necessary in sustaining early pregnancy. There continues to be estrogen produced also. If pregnancy does not occur the LH and the FSH stop. The progesterone and the estrogen drop and the uterine lining sheds. The cycle begins again.
There are many factors which can affect this cycle, causing a hormonal imbalance, such as stress, diet and exercise. Also conditions such as polycystic ovaries and ovarian cysts can affect normal menses due to elevated levels of estrogen.
At CNY Fertility Center we want you to understand your treatment. We are here to help you achieve your goal of conceiving a baby. We will ask you about your menstrual cycle in order to gain valuable information which will help plan your treatment. If you do not fully understand any aspect of your treatment, please do not hesitate to ask one of our providers.
Sheila Miller, RT RDMS
Ultrasonographer and Radiology Technician
CNY Fertility Center, Latham, NY

Reference: http.www.medhelp.org


Are you thinking of doing a Mini-IVF?


Hi this is Dr. Rob Kiltz, founder and director of CNY Fertility Center with locations in Syracuse, Rochester and Albany, NY.  We recently had a client ask us about whether or not we do “mini-IVF”.  The question was about the protocols and whether we use  Clomid, Letrozole, injectables, or do we use just FSH, or both FSH and LH. Many people may be interested in this type of IVF cycle so we wanted to share the information to all, on our website. If you have questions about your journey to fertility please don’t hesitate to call us toll free at 800.539.9870, request a phone or in-office consultation or send us your questions here.

Mini-IVF is a term of minimal stimulation.  Invitro Fertilization (IVF) was 1st started with no stimulation (natural cycle, 1 egg) and the pregnancy rates were much lower per cycle.  Over time, protocols were developed using gonadotropins,  FSH (follicle stimulating hormone), LH and medications like Pergonal, Repronex, Gonal-F,  Follistim, Bravelle & Menopur .  These are injectable medications that stimulate the ovary to mature multiple eggs.   On average we are getting 6-10 eggs which means more embryos.  This means a higher chance of pregnancy but at the same time a higher chance of multiples.

By using minimal stimulation, so either Clomid (a pill) which stimulates 1 or 2 eggs at a time, or Letrozole which is similar to Clomid but does not have the same anti-estrogenic effects (it is also not authorized by the manufacturer to be used this way, but many Reproductive Endocrinologists are using Letrozole), there is some success to be obtained by the 1 or 2 or 3 eggs that are retrieved.  In a similar fashion, Clomid or Letrozole would be used day 3-7 of the cycle and then monitoring would happen between day 8 and day 10 of the cycle with ultrasound and blood testing.  When the lead follicle is 18-22 mm in size and an endometrial lining of about 7mm or greater, HCG 10000 units or Ovidrel 250 units is used to stimulate the release of the egg, then 36 hours later egg retrieval is performed in the office.

Now gonadotropins can also be added to that, along with Cetrotide or Ganirelix, to prevent premature release of the eggs.  And this may have a slightly improved number of eggs without the same high-cost because the biggest issue is the expense of the gonadotropins and using mini-IVF (that’s low- dose gonadotropins, or Clomid/ Letrazole)  you can reduce the cost significantly.
The protocol is basically either low-dose gonadotropins with a natural cycle, and beginning on day 2 or 3 of the cycle with 37 to 75 units of gonadotropins with Cetrotide or Ganirelix beginning about day 5 to 7 of the cycle when the lead follicles are about 12 mm and ultrasound monitoring and blood testing so that when the eggs are 16 – 18 mm, HCG or Ovidrel is used to stimulate release and the egg retrieval is performed similar to the standard IVF.

These are all performed at CNY Fertility Centers, yet they are not our predominant protocols, but all are possible and based on your individual needs and can be utilized in the process.
Dr. Rob Kiltz


When should I change my fertility treatment approach?


You may be doing IUIs, or you have done a number of IUIs, or tried intercourse with Clomid or whatever cycle it may be, and now you’ve reached a point where after doing a few of the cycles, one of the practitioners has suggested that you move onto IVF or an IUI injectable cycle, or something a little more invasive than you are used to.  While that decision can be a little challenging and kind of scary, there are good benefits to it as well.  The challenge comes when you are trying to discern whether it’s time to switch, a lot of emotions can arise.
A lot of our patients say that they feel anxiety, grief; a lot of those same original emotions that come from the diagnosis of infertility come up again.  What you’re doing is you’re delving a little further into the topic; you’re further acknowledging that you need some help to conceive.  You’re also further acknowledging that what you’re doing hasn’t necessarily been enough or been right in those cycles.  It’s OK to revisit those feelings of grief and those very basic emotions of anxiety, depression, and stress, just lack of confidence and unknowing, is very common to revisit those.
What you can do is when you’re approached with the idea or when you’re coming to the idea yourself of going onto the next step and you’re feeling those concerns and you’re wondering, “Maybe I should do another couple cycles of IUI, what I have been doing, to start to feel more confident, more ready to switch?”; you can place yourself in that situation.  If you’re discerning between IUI and IVF, place yourself in the situation of doing an IVF cycle.  How would you feel?  Would you be anxious?  Would you be excited?  Would you feel hope?  Would you feel like you didn’t do enough IUIs… maybe there’s still some opportunity there?  Try to really meditate on that for a few moments.  Write down your emotions, maybe see what your partner is feeling, if you’re in a relationship with a partner that’s going through this with you.   Just really try to place yourself in that position.  Try to recreate what that would be like.  Really just get in touch with those emotions.  Also, do the same thing with the IUIs.  If you were to continue doing another IUI cycle or two or three or however many, reassess those emotions as well.  Do you feel like you’re stuck in the same kind of cycle, repeating it over and over again?  Do you feel comfortable that you’re working towards a positive goal and that you’re confident that the treatment is right for you?
Assess your emotions in both areas and really look at them and see which one makes me feel most comfortable?  Which one makes me feel less anxious and less stressed?  Which one makes me feel like I’m moving most towards my goal?  That can be a good gauge for you to decide which way to go, and while this method isn’t foolproof, it isn’t 100 percent; it can give you a little bit of an idea as to when you’re going to make that decision or as you move towards it.  Also, know that you don’t have to make the decision immediately.  It’s always OK to take a break as long as you check with the physicians.  You don’t ever have to feel bad about that or that you’re missing time because it can help.  It can be beneficial sometimes the body, the mind, and the spirit need take a break.  Just take your time discerning what the next step is.
If you ever want to talk to us, you can.  You can always make a follow-up appointment if you want to just get into the office, have a practitioner open your chart up and reassess where you are, take a look at your previous cycles, and where you are physically and mentally right now, maybe come up with a new plan.  You could always call or e-mail me, I’m always able and willing to go through your options with you on more of an emotional level and just kind of help you talk through it and relay back what you’re saying.  It always helps to have a third person just to give you their perspective and just to hear what you’re saying and listen to you and give you some good advice.  So, please, feel free to contact us.  If you are feeling those emotions that you’re stuck between two decisions or protocols; don’t worry, you’re not alone.  There’s always someone here to give you support.


CNY Fertility Center Video About Embryo Testing, PGD and PGS


Dr. Rob: Hi this is Dr. Rob Kiltz sitting here with Kelly Ketterson from..
Kelly: Reprogenetics..
Dr. Rob: She’s here to help share and help us learn and increase our knowledge about PGD.  What is PGD?
Kelly: Pre-implantation Genetic Screening or Diagnosis, depending on what type of testing you’re doing.
Dr. Rob: It’s all words and it’s important though to understand it and we’re learning and moving to new technology where we typically would do something called “FISH” although it’s still available, you guys offer that also.
Kelly: Right.
Dr. Rob: We’re looking to be able to take a cell from an embryo and…
Kelly: Well, we can either fix it on a slide or put it in a tube and basically we’re looking to analyze the chromosomes in that cell to make sure that the embryo that corresponds to that cell has the right number of chromosomes.
Dr. Rob: So, it allows us to better select embryos that are more likely to create a live-born baby, it can also help identify reasons why someone is not conceiving or maybe miscarrying.
Kelly: Correct.  Often one of the things that patients are worried about is not having an embryo to transfer.  What happens if I don’t have an embryo to transfer?  What I tell patients is that just because you have no normal embryos in a cycle doesn’t always mean that you will never have a normal embryo.  It just means that you’re getting to the point that you’re at where your eggs are less and less likely to produce a normal embryo.  I think it does help patients make some family building options where they can decide if they want to do another cycle and then do the selection process again or think about using a donor egg or moving on to adoption.
Dr. Rob: So this is a good point, because often we do not know when you see beautiful embryos whether it’s an embryo issue or a uterine factor, environment is very critical.  If you had the information that there was a chromosomal abnormality which was more likely the cause of you not conceiving or miscarrying, that would help you to either just continue to be persistent or move onto donor eggs.  If you had normal embryos and they were not implanting, this may lead you to other methods which would improve uterine implantation and/or use a gestational carrier.
Kelly: Correct.  You bring up an important point because FISH limited us; we could only look at so many chromosomes.  We were looking at twelve chromosomes on a routine basis.  New technologies to screen embryos, it’s called Erase CGH and this is a way we can look at all the chromosomes.  There are chromosomes that when there are the wrong number each cell should have two of the chromosomes that we test for, but if there’s one or three, that’s incorrect for the number of chromosomes, but those chromosomes don’t necessarily implant.  Previously, with FISH testing, we were only looking at the chromosomes that would cause a baby to be born with some abnormality, we weren’t’ necessarily looking at chromosomes that would not implant.  Now, we can tell when the embryo is abnormal and will not implant.
Dr. Rob: So this technology has been around for a while and you guys have been providing this technique?
Kelly: We’ve been providing it for about two years now.  Initially, there are many steps in the technique.  You have to take the cell out and instead of fixing it on the slide; you put it into a tube.  When you put it in the tube, there’s not enough DNA in that cell to make a diagnosis, so you have to amplify the DNA, so you have to make many copies of the same cell and that was sort of the initial trick to getting the technique to be consistent on the amplification process.  The first couple of amplification processes that we tried, we didn’t feel like we’re producing consistent results, so we had to optimize that.  So now we feel like for the past year, we’ve really optimized and we look at our diagnosis and we check it again and feel that we are very consistent.
Dr. Rob: Is it to a point where we should be doing this routinely, do you think?
Kelly: We feel that for Day #3 embryos it’s now time to switch from FISH to these methods that will allow us to look at all the chromosomes.
Dr. Rob: I imagine there may be a time where we analyze all embryos for couples to identify these abnormalities and/or looking for the best embryos for implantation.  What’s your thoughts on that?
Kelly: We may get there.  Right now, I think that I would still stay focused on patients with recurrent Miscarriage, repeated IVF failure, patients who have had a previous anueploid conception or conceived a baby with a known abnormality until we can feel that we can show a benefit to the patients that don’t have one of those diagnosis.
Dr. Rob: You’ve had some experience talking to clients because you’ve acted as a coach for many clients going through fertility treatments.  What’s your experience in some of their biggest fears?  You mentioned not getting an embryo to transfer, anything else that comes up?
Kelly: I think that not getting an embryo to transfer is the biggest fear.  There’s no other side effect to the procedure.  The patient doesn’t have to do anything additional to have PGD or there are no additional procedures for them, there are no additional risks to them personally.  The biggest risk is that if a patient has few embryos, you do have to take a cell out and there’s a risk to the embryo when you do that.  You could potentially have an embryo that is diagnosed as normal but then you can’t transfer it because it doesn’t advance.  I think that would be the only other thing that I can think of that would be a concern to the patient.
Dr. Rob: Well, I really appreciate you taking the time to come and visit us and see my fertility center and we talked about doing some monthly seminars, having clients come to our centers and also doing some webinars but you’re also available by telephone for consulting because it really is about connecting and sharing thoughts and ideas and helping people to go through the process and down the journey.  It’s all a journey and thank you, Kelly.
Kelly: Thank you.
Dr. Rob: Reprogenetics…we’ll throw some connections and some numbers that we can also connect.  What’s your website?
Kelly: It’s www.reprogenetics.com.
Dr. Rob: Don’t forget CNY Fertility www.cnyfertility.com, www.cnyhealingarts.com, and www.mindbodysmile.com.  Blessings and enjoy the day, Dr. Rob Kiltz and Kelly.
Kelly: Bye.
Dr. Rob: Have a great day.


Donor Egg vs. Donor Embryo: What’s the difference?


At CNY Fertility Center we are proud to offer both Donor Egg and Donor Embryo cycles through our Donor Program.  While these programs sound similar, they are actually quite different.  Keeping in mind that each cycle is unique, let’s explore the philosophy behind Donor Egg and Donor Embryo cycles:
Donor Egg
Donor Egg cycles, the heart of our Donor Program, have been consistently creating families at CNY Fertility for years.  The many compassionate women who come forward and donate their eggs, are the driving force behind this program.  Many women will come forward to donate, expressing their desire to give the gift of motherhood to another woman.  This typically comes from their personal, positive experiences in motherhood
After an extensive medical and social history review, our donors are placed on the Active Donor List.  Once placed on the list, potential recipients may review the donor profiles.  It is important to note that the donors do not actually donate their eggs until they are matched with a recipient.  Once matched, we then begin the process of coordinating the donation.
Unlike Embryo Donation, Egg Donation allows for the selection of sperm.  Whether it is from a partner or chosen donor, it is the recipient’s choice.  It is also important to note that any remaining embryos from the Egg Donation cycle may be frozen, and belong to the recipient.
Donor Embryo

Our Donor Embryo program has been recently established, with very positive outcomes.  This unique program differs greatly from our Donor Egg cycles, but offers just as much hope and opportunity for the creation of family.  The embryos available are those remaining from other patients’ IVF cycles.  These patients have decided that they do not wish to transfer these embryos, and would like to give that opportunity to someone else.
Similar to the nature of the Donor Egg cycles, the donor profiles (of both egg and sperm) are available online, and they have completed a similar medical and social history.  While the recipient does not have the ability to choose the sperm used, there are many benefits to this program.  These embryos are readily available, and all of the testing has been completed, so cost and time are both greatly decreased.
This considerably simplified description of each program is intended to give you a general knowledge of the similarities and differences.  It is important to remember that regardless of whatever path you follow to achieve your goal of motherhood, the end result the same: love.  In those first few moments with your child, all thoughts of discernment between donors, cycles, and protocols will vanish.  All that will matter is the little one who looks at you with all the love in the world.
For more information regarding Donor Egg or Donor Embryo cycles, please contact our Donor Coordinators:
You may contact the Syracuse team by calling 800.539.9870 (toll free)
Or via email:
Pati Breh: Pbreh@cnyfertility.com
Stephanie Rogers: Srogers@cnyfertility.com
Kari Gardner: Kgardner@cnyferility.com
You may also contact Chris Gray, our Donor Coordinator located at the Albany office:  866.375.4589 (toll free) or via email: cgray@cnyfertility.com

We look forward to hearing from you, and creating the family you have always wanted.
Our donation team would be happy to further explain the cycles available to you.  Please visit our website for more information: http://cnyfertility.com/donor-gametes/


Why So Many Ultrasounds and Blood Draws?


The infertility journey has been described as an emotional roller-coaster filled with ups and downs. A description of the positive hope and the sometimes negative outcomes of treatments. As part of your treatment you will experience many ups and downs and pokes and jabs. Ultrasound and blood work are key tools in monitoring your cycle during fertility treatments.
At CNY Fertility Center, founded and directed by Dr. Robert Kiltz, with offices in Latham/Albany, Syracuse and Rochester, we want you to understand every step of your treatment. Many clients wonder why we need to perform so many ultrasounds and blood draws. Monitoring a woman through the many different stages of her menstrual cycle is necessary to find a potential missing piece. So many events need to occur in order to provide the best chance of conception. Reviewing the hormone levels in the blood and monitoring changes in the uterus and the ovaries are key components to evaluate these events, thus requiring frequent blood draws and ultrasounds.
It all starts with the first day of a woman’s menstrual cycle. We will bring you into the office for what is called baseline blood work and a vaginal ultrasound, usually on the second or third day of menses. This is the time when things are mainly quiet, as the ovaries are getting ready to stimulate and produce follicles. Follicles are the fluid filled sac within the ovary which houses the egg. At this time a woman may feel uncomfortable about having the vaginal ultrasound, this is normal apprehension. This is a routine ultrasound and is done with the utmost respect for your feelings. We are looking at the uterus for any abnormalities and at the ovaries for any signs of a cyst.
The blood work will evaluate the hormone levels. With a normal baseline exam you may begin stimulation through various treatments as determined by one of our physicians at consultation. We will continue to monitor your progress with blood work and ultrasound throughout the cycle, as often as every other day and occasionally, everyday. While this may seem like an inconvenience, it allows us to optimize the cycle and increase the chance of conception. The ultrasound will give us information about the follicles that are being produced, the quantity and the size. The follicle(s) have to reach a certain size before they are considered mature. When the follicles are mature, ovulation should occur and hormone levels may indicate pending ovulation.
During treatment ovulation may be triggered with a hormone injection. The blood work is done with every ultrasound. We monitor certain hormone levels which fluctuate during the cycle and we correlate these labs with the ultrasound. The goal in frequent monitoring is to enhance our ability to pinpoint when ovulation will be likely to occur, thus, increasing the odds for you to achieve pregnancy.
Although the only true test of ovulation is pregnancy, the ability to gain valuable information from frequent blood draws and ultrasounds will assist in that goal. We want you to have a successful journey and we appreciate just how valuable your time is. We will make every attempt to accommodate your scheduling needs. We too want to minimize the stress associated with frequent office visits.
Please do not hesitate to ask us how we can make your schedule easier for you. Please contact us at 800.539.9870 (toll free) if you would like more information or have any questions regarding your care.
Sheila Miller, RT RDMS
Ultrasonographer and Radiology Technician
CNY Fertility Center, Latham, NY


Relevance of Inositol and Choline Supplementation for Women with PCOS


Inositol is a biological compound related to the vitamin B complex group.  Its actions in the body include: the formation of cell membrane integrity, the transportation of fats from the liver, and the activation of serotonin receptors.  In short, inositol’s physiological roles are especially important for those with diabetes, high or imbalanced cholesterol, PCOS, and mood disorders such as anxiety, panic attacks or depression.

Phytic acid from fiber ingested through fruits, nuts, whole grains and vegetables is converted into bio-available inositol in the intestines.  In women with PCOS the mechanism of this conversion is obscured causing a decrease in available inositol (as myo-inositol or D-chiro-inositol) necessary for the above mentioned physiological processes.  Glucose can inhibit the absorption of inositol through the intestines and into the body’s tissues.  It is notable to observe that insulin resistance (and higher glucose levels) is one of the symptoms of most women with PCOS.
One of the roles of inositol in th

e body is the development of follicles.  Studies have shown that myo-inositol supplementation, where there is depletion, can promote the healthy maturation of follicles.  This is of interest to women with PCOS because of evidence showing decreased levels of circulating myo-inositol and increased levels of myo-inositol excreted in the urine, lending an overall deficiency of inositol available for use by the body.

Because inositol is widely available in the foods eaten through a balanced diet-the issue of an inositol deficiency lies in the individual’s inability to absorb the nutrient or perhaps convert it from foods.  Aside from this, coffee appears to have the ability to wipe out inositol from the body.

Choline is similar to inositol in its functions in the body. It is an intermediary in the production of an important neurotransmitter, acetylcholine.  It aids in the regulation of homocysteine- a compound whose elevated levels are associated with a greater risk of cardiovascular disease.  Choline is also important in the metabolism and transport of fats from the liver.
Foods that are adequate sources of choline are peanuts, eggs, milk, wheat germ, lecithin and liver.  Inositol and choline are essential nutrients.  They both have functions in the body that are relevant to human reproduction and may be considered for supplementation especially by women with PCOS.  These two supplements are available in the Essentials Supplement on Dr. Rob’s USANA website here.

Rebecca Rice M.S., L.Ac.
CNY Healing Arts Center, Latham, NY

1.    Papaleo E., Unfer V., Baillargeon J.P., Chiu T.T.  Contribution of myo-inositol to reproduction.  Eur J Obstet Gynecol Reprod Biol. 2009 Dec;147(2):120-3
2.    Chan J, Deng L, Mikael LG, Yan J, Pickell L, Wu Q, Caudill MA, Rozen R.  Low dietary choline and low dietary riboflavin during pregnancy influence reproductive outcomes and heart development in mice.  Am J Clin Nutr. 2010 Apr;91(4):1035-43.