Posts

17
Jan

Intra-uterine hCG at Embryo Transfer: “Jump-Starting” the Implantation Process

by

Dr Robert Greene - CNY Fertility CenterDuring the IVF process, the emphasis has traditionally been on creating the best possible embryos for transfer. Although this embryo based approach has lead to a steady improvement in pregnancy rates for IVF patients; success rates have reached a plateau during the last decade. It seems appropriate therefore that we now step back and devote similar efforts to bolster implantation by improving the receptivity of a woman’s uterus. Such was the recommendation of a 2006 review article [r1] that suggested in its title that the “…endometrium is a fertility determining factor.” Yet only recently have practical ideas verified how we can optimize the chance for a healthy embryo to implant and grow.
Although most clinics monitor the ultrasound appearance of the endometrium (the lining of a woman’s uterus) this does not always reflect the hormonal, immunologic and nutritional environment where the embryo is expected to implant and grow. In 1998 a study [r2] demonstrated that a small amount of the hormone called “human chorionic gonadotropin (hCG) can be placed into the uterus and trigger a cascade of events that improve implantation. In fact, we now understand that process of “implantation” involves the embryo being “engulfed” as the tissue grows up and around the embryo. hCG promotes that process to take place. This same critical hormone promotes beneficial changes in the uterine muscle and the immune cells in the uterus necessary to enhance pregnancy.
A recent study [r3] measured the effect of putting a small drop containing 500 IU of hCG in the uterus immediately before an embryo transfer. They demonstrated about a 30% improvement in implantation and on-going pregnancy in women that received this treatment. They also tested smaller doses and found no improvement—further supporting that a crucial level of hCG is necessary to induce this measured benefit. As a result of this information, we are encouraging the use of 500 IU of Intra-uterine hCG as part of our embryo transfer routine.
Robert Greene, MD, FACOG
CNY Fertility Center
e-mail me at rgreene@cnyfertility.com
Call our toll-free number at 800.539.9870 or request a consult here.

17
Nov

Fertility Preservation: Some Women Choose to Delay Pregnancy and Sometimes Life Chooses for Them

by

Our society puts a priority on reproduction. That makes sense since it is hardwired into our brain. Unfortunately, that value often results in the assumption that women that choose to wait and begin their family later in life are somehow selfish or narcissistic for “wanting to have it all.” I am pleased to share that a recent report made great strides in dispelling this myth.
A British psychologist recently performed a thorough review [r1] of women’s motivations and situations resulting in “delayed motherhood.” In fact, she even took exception with the term “delayed” because it so strongly suggests that it is a choice that women are consciously making to wait until their late thirties or early forties to become pregnant. Instead, she found that it more often women are responding to their situation. Her research revealed that many women today are having babies later as a result of strategic decision making, extensive negotiations or response to their life’s circumstances. Better still women today have more options to preserve their fertility.
Techniques [r2] are available today to more efficiently freeze and store unfertilized eggs or viable embryos. Embryo freezing has been available for several decades but the efficiency of the process is much greater today. Egg freezing now makes it possible for women to preserve their unfertilized eggs when they are more plentiful and at their healthiest but actually delay fertilization and pregnancy until the time is right. Recently, the technique for freezing unfertilized eggs has been refined so much and the availability of the procedure [r3] has become so readily available that it is no longer considered experimental. So as more women speak out [r4] about their own choices and empower others to do so, it is rewarding to be able to meet their needs with more treatment options.
[r1]Link to http://www.sciencedaily.com/releases/2012/09/120903143056.htm#.UEdNOMzjAq4.email
[r2]Link to http://thegreeneguide.wordpress.com/2011/12/26/to-freeze-or-not-to-freeze-that-is-question-faced-by-many-couples-going-through-fertility-treatment
[r3]Link to http://www.asrm.org/Fertility_Experts_Issue_New_Report_on_Egg_Freezing_ASRM_Lifts_Experimental_Label_from_Technique
[r4]Link to http://www.nytimes.com/2012/10/23/opinion/we-need-to-talk-about-our-eggs.html?_r=1

Robert Greene, MD, FACOG
CNY Fertility Center
e-mail me at rgreene@cnyfertility.com
Call our toll-free number at 800.539.9870 or request a consult here.

1
Nov

Seafood Allergy and HSG Contrast: A Myth Dispelled

by

In medicine, well intended advice often proves wrong. Sometimes, such recommendations are repeated for years until we lose sight of the where/how the ideas originated. It then takes well documented research to retract the outdated ideas—even then correction is often resisted. An example is the frequently repeated advice that women allergic to seafood should not undergo a hysterosalpingogram (HSG). This rationalization is due to the fear that the iodine-containing contrast that is used to perform the test may provoke a reaction in sensitized patients[r1] .
Food allergies occur in about 4% of the population[r2] . Seafood is among the most common of the foods that people are allergic to. Shellfish and seaweed are the most common foods that contain high levels of iodine. That fact aside, it is difficult to establish how the concern between seafood allergy and iodine first originated. True allergies result when your immune cells react to a protein—not a mineral like iodine—by producing antibodies. These antibodies can then create a reaction upon repeat exposures to the allergen (protein that the person is allergic to). A true seafood allergy is typically a response to a protein called tropomyosin. There is no tropomyosin in the HSG contrast. Therefore, a classical allergic effect isn’t possible.
A recent review [r3] of the medical literature confirmed that the actual risk of a reaction to the contrast is rare. In fact, the odds of a severe reaction were far less than 1% (0.02-0.5%). So given the importance of the information obtained by performing an HSG, most patients benefit from this part of the infertility evaluation.
[r1]Link to http://www.asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/hsg.pdf
[r2]Link to http://www.ncbi.nlm.nih.gov/pubmed/18291306
[r3]Link to http://www.ncbi.nlm.nih.gov/pubmed/20045605

Robert Greene, MD, FACOG
CNY Fertility Center
e-mail me at rgreene@cnyfertility.com
Call our toll-free number at 800.539.9870 or request a consult here.

27
Aug

Fatty Acids can Improve Male Fertility

by

When couples are having difficulty conceiving, studies show that at least 1/3 of the time, there is a contributing male factor. Yet today the bulk of our tests and treatments are directed toward women. For couples that already know that they are dealing with a sperm problem, there are very few good recommendations on what they can do at home to improve their outcome; until now.
Many studies have found that dietary fats can impact pregnancy outcome [r1] in women. More recent data has even helped differentiate that some fats can improve fertility[r2] . But very little of the nutritional intervention has been directed toward men.
Polyunsaturated fatty acids (PUFA) are critical for sperm function and production. These fats are necessary to make healthy sperm as well to optimize their ability to swim. They are called essential fatty acids because you need to consume them in the foods that you eat so that your body can use them to manufacture hormones and other substances. Unfortunately, the typical foods that most of us consume don’t contain them. Instead, many of us eat foods that contain unhealthy fats; a situation that worsens the imbalance between good fats and bad fats.
Now that we know male fertility is improved with PUFA’s, the challenge is getting men to change their diet or take a supplement. Nutritionists have been encouraging men to increase their consumption of fish, flax seed and other foods with healthy oils but only with limited success. Now a group of researchers has found a practical solution[r3] . They had a group of men begin eating 75 grams of walnuts per day. After only 12 weeks they demonstrated an improvement in sperm count, better sperm motility and increased sperm vitality. Better still, they did not experience any increase in body weight or body mass index proving that this recommendation is practical with no identifiable drawbacks. In fact, eating walnuts has also been shown to be heart healthy [r4] and may reduce the risk of prostate problems [r5] as well. So, it’s time for men to “go (Wal)nuts!”
Robert Greene, MD, FACOG
CNY Fertility Center
e-mail me at rgreene@cnyfertility.com
Call our toll-free number at 800.539.9870 or request a consult here.

[r1]Link to http://thegreeneguide.wordpress.com/2012/02/01/high-fat-diet-before-pregnancy-increases-risk-of-gestational-diabetes/
[r2]Link to http://thegreeneguide.wordpress.com/2009/12/15/neither-%e2%80%9clow-fat%e2%80%9d-nor-%e2%80%9chigh-fat%e2%80%9d-but-the-%e2%80%9cright-fat%e2%80%9d-for-better-implantation-and-pregnancy-omega-3
[r3]Link to http://www.sciencedaily.com/releases/2012/08/120815151610.htm#.UC0Xy4S7zMg.email
[r4]Link to http://www.sciencedaily.com/releases/2011/03/110327191040.htm
[r5]Link to http://www.sciencedaily.com/releases/2010/03/100322153953.htm

9
Aug

Potential Benefits of IVF Cycle with FET (Frozen Embryo Transfer) vs Fresh Embryo Transfer

by

One of the most common questions infertility patients going through Advanced Reproductive Treatments (ART) ask is: “will freezing embryos reduce my chance at a pregnancy?” During the first decade and a half of IVF treatment, there was a much lower success rate through Frozen Embryo Transfer (FET). In a recent post, I summarized how the newer technique of “vitrification[r1] ” helped overcome the potential impact of cryotherapy upon embryo quality. And in a separate post[r2] , I described the importance of properly preparing a woman’s uterus prior to placing an embryo. Newer data is showing that due to these combined factors some patients can actually see an improvement in their pregnancy rate by deferring transfer of their embryos from a “fresh cycle” to an FET.
It has long been noted that the highest pregnancy rates are achieved when using an egg donor. Although it has often been assumed that this is due to improved embryo quality, newer data is showing that endometrial receptivity may also be a factor. The largest review to date [r3] recently combined the results of 64 clinical research studies—including 3 randomized trials. They found that freezing embryos and transferring them in a later cycle was associated with about a 30% increase in pregnancy rate. There was no difference in the rate of miscarriage; further reassuring that the process of freezing/thawing embryos maintained their health and viability.
Another important benefit of a freeze-all (or “staggered”) cycle is that it substantially reduces a woman’s risk of ovarian hyperstimulation syndrome (OHSS). So when considering your treatment options with your provider it might be worth considering the potential benefit of creating embryos now that you plan to actually transfer later.
 
Robert Greene, MD, FACOG
CNY Fertility Center
e-mail me at rgreene@cnyfertility.com
Call our toll-free number at 800.539.9870 or request a consult here.
———
[r1]Link to http://thegreeneguide.wordpress.com/2011/12/26/to-freeze-or-not-to-freeze-that-is-question-faced-by-many-couples-going-through-fertility-treatment
[r2]Link to http://thegreeneguide.wordpress.com/2010/10/13/is-your-uterus-ready-and-able-to-support-a-pregnancy
[r3]Link to http://www.sciencedaily.com/releases/2012/07/120704124319.htm

18
Jul

Do You Really Need Bed Rest After an Embryo Transfer?

by

Traditionally, bed rest has been recommended for women after any medical procedure. For instance, after delivery of a baby, women were prescribed 6 weeks of bed rest until it was ultimately proven that that inactivity increased their risk of DVT (blood clots in the deep veins). Even though bed rest had been encouraged with good intentions; it did not result in the best outcome. Nonetheless, it is challenging to reverse widely accepted but unhelpful advice. Now that IVF has been around for over 3 decades, it is time to review how we advise patients going through treatment and reconsider whether bed rest is still advisable.
In the early days of IVF, women were restricted to bed rest for 2 weeks after an embryo transfer. In fact, patients were not even allowed to stand up for quite some time after the procedure. Instead they were transported to a hospital gurney and relocated to a hospital bed—even using a bedpan when required instead of going to the toilet. It gradually became apparent that such severe limitation wasn’t needed. Back in 1997, the first study [r1] appeared suggesting that even a 24 hour period of bed rest was unnecessary. Specifically they demonstrated that even when patients were only limited to 20 minutes of activity restriction; pregnancy rates were comparable.
Subsequently, in 2005 a much larger [r2] and well designed study found that when patients were allowed to get up immediately after their embryos were placed; their pregnancy rates were as good as patients that were asked to lie flat for an hour. Finally, a 2011 review [r3] of all of the published research on this subject confirmed that there is no advantage to bed rest and instead that there may be a disadvantage to being totally sedentary. This isn’t surprising since inactivity combined with high levels of estrogen can promote blood clot formation as well as a rise in insulin resistance. By contrast, exercise reduces inflammation, lowers stress hormone levels and promotes healthy blood flow.
During pregnancy there has also been a reversal of the popular myth that exercise should be limited. In 2008, the US Department of Health and Human Services issued comprehensive guidelines that healthy women should begin or continue aerobic exercise of moderate intensity during pregnancy. In fact, it was confirmed in a well designed study [r4] that both mother and baby benefit from aerobic work outs. Despite the research, it is difficult to dispel advice from popular culture. It was even found in one study [r5] that when IVF patients were advised by their doctors to remain active; most still restricted their daily activity. So as we look for ways to further boost our pregnancy rates and improve the health of the pregnancies that result it is important that we constantly re-evaluate how we guide women following IVF.
Robert Greene, MD, FACOG
CNY Fertility Center
e-mail me at rgreene@cnyfertility.com
Call our toll-free number at 800.539.9870 or request a consult here.
———————————
[r1]Link to http://humrep.oxfordjournals.org/content/12/11/2489.abstract
[r2]Link to http://www.ncbi.nlm.nih.gov/pubmed/15749486
[r3]Link to http://www.ncbi.nlm.nih.gov/pubmed/21300426
[r4]Link to http://journals.lww.com/greenjournal/Fulltext/2012/03000/Exercise_During_Pregnancy__Fetal_Responses_to.17.aspx
[r5]Link to http://www.ncbi.nlm.nih.gov/pubmed/11393126

15
Jul

IVF Success Rates Reach All Time High: Repetition Can Be the Key

by


The latest review of the pregnancy rate achieved through advanced reproductive techniques (ART) like in vitro fertilization (IVF) is the most encouraging ever. One press release read “Success of Fertility Treatment May Approach Natural Birth Rate.” Considering that many couples that need IVF have no other treatment options; this is an extremely encouraging revelation. Since the first successful IVF pregnancy was achieved in 1977 (resulting in the birth of Louise Brown in July 1978); it is estimated that 5 million babies have been born through this technology[r1] ! With the success rate and the need for treatment increasing, it is important that we consider what else we can do meet the needs of even more couples.
Here is what we now know. Even the most fertile couples have a natural fertility rate of about 20% for any given month. Their ultimate success is achieved through repetition; if not successful one month they can try next month, and the month after that until they are successful. Observation shows that they typically achieve a pregnancy rate of 65% within 6 months and 80% within a year. By contrast, couples that need fertility treatment have to pay for each cycle that they are attempting to conceive which often limits their effort to one or two attempts. New data shows that with persistence, infertile couples can achieve success rates that are as good or better than people that are considered fertile.
Specifically, the New England Journal of Medicine published data summarizing the results of nearly a quarter of a million women[r2] treated at centers throughout the USA. This is the best estimate of the average success since it does not reflect a specific group of women or the experience of one specific IVF center. What they found was very hopeful. Nearly 60% of the women that were undergoing treatment had a baby (live birth). In fact, 30% of the women that underwent ART had a baby following their first IVF attempt! The majority of those not successful on their first attempt; did achieve a success rate as high as or higher than those of fertile patients the same age. In other words, IVF is able to overcome most obstacles to achieving a successful pregnancy except those related to age and its impact upon egg quality. Even though live birth rates were lower when older women used their own eggs; the same study found a cumulative live birth rate of 60-80% when women used an egg donor—regardless of the age of the woman carrying the pregnancy and delivering the baby.
Other studies released the same week [r3] demonstrated that women that were experiencing anxiety or depression before IVF did not have a lower chance for achieving a pregnancy. However, they did find that a failed IVF cycle can exacerbate these problems. This further emphasizes the need to focus on the success rates achieved with repeat IVF cycles. Currently there are about 1.5 million ART cycles being performed globally each year resulting in the birth of about 350,000 new babies. The key to focus on is that success rates are very high but it can take up to 6 IVF attempts for couples with more complicated problems to actually have a baby. Clearly the path to parenthood for couples that need ART is repetition. That is why it is so important to make treatment accessible. Personally, I am proud to work at a center that offers treatment at the most competitive prices [r4] in order to make IVF treatment accessible to all of those that need/want it.
Robert Greene, MD, FACOG
CNY Fertility Center
e-mail me at rgreene@cnyfertility.com
Call our toll-free number at 800.539.9870 or request a consult here.
———————————
Link to http://www.sciencedaily.com/releases/2012/07/120702134746.htm#.T_ME1uhqlZY.email
Link to http://www.nejm.org/doi/full/10.1056/NEJMoa1110238?query=TOC?query=NC
Link to http://www.reuters.com/article/2012/06/27/us-ivf-depression-idUSBRE85Q19120120627
Link to https://www.cnyfertility.com
 

5
May

Women: Cancer Treatment and Fertility Preservation

by

The good news is that more women are surviving cancer; the bad news is few are counseled about future fertility.
Women are surviving cancer today in record numbers. Now that oncologists have made such great strides toward effective treatment, we need to focus more on helping women prepare for their life beyond cancer.  Unfortunately, many of the most effective cancer treatments can damage a woman’s ovaries leaving them infertile or even induce premature menopause.
In 2006[u1] , the American Society for Clinical Oncologists published guidelines on discussing “fertility preservation” with cancer patients. At that time they estimated that about 55,000 cancer patients per year were 35 or younger and should be offered options to prevent lifelong infertility. One of the concerns expressed by the panel at that time was that the cost of fertility preservation was prohibitive. Since that time, many organizations have taken steps to remove financial barriers by providing compassionate care options; making treatment widely accessible. I am pleased to work at such a center [u2] and have therefore had the good fortune to help many cancer patients in planning their future families.
Recently, a group of women that had survived cancer treatment agreed to participate in a study[u3]  investigating whether or not they had been counseled about fertility preservation prior to undergoing cancer treatment. Unfortunately, even though these women were between 18 and 40 years of age; only 61% had been counseled. They did find a more recent trend toward counseling then when the study began a decade ago. Most importantly, the women that had received counseling were far less likely to harbor regrets; even if they did not choose to freeze eggs or embryos prior to cancer therapy. In fact, women that discussed their options with a fertility specialist were most at peace with their decision and demonstrated the highest quality-of-life scores. So if you or someone you know has recently been diagnosed with cancer, consider scheduling a consultation with a reproductive endocrinologist. It’s a decision that will be appreciated over time.
Robert Greene, MD, FACOG
CNY Fertility Center
e-mail me at rgreene@cnyfertility.com
Call our toll-free number at 800.539.9870 or request a consult here.

9
Apr

Popcorn: Mindful Food Choices Can Boost Fertility

by

One of the best ways to boost fertility and have a healthy pregnancy is to make careful food choices. Nothing is more intimate than to swallow something and then digest it so that it becomes part of you. Yet most of us give little thought to what we eat. In today’s fast paced lifestyle it’s critical that we also find tips that are practical so that people can incorporate healthy changes with less effort. That’s why when a good study comes along, I feel compelled to share it.
Last week a study [u1] was presented at the American Chemical Society that revealed the potential health benefits of popcorn. Researchers found that popcorn contains more concentrated healthy antioxidants than fresh fruits and vegetables. Whole grains contain a group of chemicals called polyphenols [u2] which are able to capture free radicals and therefore protect your DNA and the proteins in your body from damage. More noteworthy, since these polyphenols are not soluble in water, they are more concentrated in dehydrated foods like uncooked popcorn so you get more of them with fewer calories. These are the same chemicals that make wine, tea and chocolate of interest to healthy conscious foodies.
What prompted researchers to investigate popcorn is that now that we know grains contain high concentrations of healthy chemicals and dietary fiber. In fact, popcorn is a completely unprocessed whole grain. As a result, one serving provides people with more than 70% of the minimal recommended daily intake. That’s more than most people in the US get on a daily basis! So that’s another health benefit of this easy to find snack.
It is important to pay attention to how popcorn is prepared since that can be its downfall from the wellness promotion aspects. Using too much oil or covering it with the unhealthy fake butter—a.k.a. “movie theatre style”—are the worst ways to prepare a serving of popcorn. Air popped popcorn is best since it is lowest in calories. Microwave popcorn often contains unhealthy trans fats as well as more calories. A healthy compromise is to cook popcorn on the stove in healthy canola/olive oil blend; about half the calories and the addition of some healthy omega-3. Enjoy!

Robert Greene, MD, FACOG
CNY Fertility Center
e-mail me at rgreene@cnyfertility.com
Call our toll-free number at 800.539.9870 or request a consult here.

20
Mar

Journaling & Fertility: A Powerful Step Toward Achieving Your Goal

by

A recently published study [r1] reminded me of the importance of taking time to think about goals and values. A group of women at college were given a writing assignment. Half were told to spend 15 minutes writing about a value or goal that was important to them while the others were told to write about a value that may be important to someone else. They were also weighed at the time of the class. Upon returning 4 months later, the women that had undergone self reflection by writing about themselves experienced an average of 3 ½ pound weight loss while the other students had a 2 ¾ pound weight gain—typical of new college students. This finding does not surprise me as I have long advocated that my patients begin journaling to help them in achieving their goal of becoming pregnant. Here is an excerpt from my book PERFECT HORMONE BALANCE FOR FERTILITY[r2] where I explain a bit further:
Journaling is one of the most effective tools for managing emotions and relieving stress. Writing is more powerful than talking because it calls for more introspection, and it helps you carefully identify your feelings and reactions. Many people have reported that journaling brings physical benefits along with emotional relief. Studies show that by journaling regularly, your words begin to reflect a greater sense of optimism, your memory improves, you become more effective in your daily activities, and you’re less bothered by intrusive thoughts. Try to spend at least 15 minutes writing every day—especially in times of greater stress. If you’re new to journaling and aren’t sure what to write about, try freewriting, which entails writing continuously  to fill a page, without stopping. Write whatever comes to mind, even if it doesn’t seem to make sense.

Robert Greene, MD, FACOG
CNY Fertility Center
e-mail me at rgreene@cnyfertility.com
Call our toll-free number at 800.539.9870 or request a consult here.

Success Stories

17
Jan

Intra-uterine hCG at Embryo Transfer: “Jump-Starting” the Implantation Process

by

Dr Robert Greene - CNY Fertility CenterDuring the IVF process, the emphasis has traditionally been on creating the best possible embryos for transfer. Although this embryo based approach has lead to a steady improvement in pregnancy rates for IVF patients; success rates have reached a plateau during the last decade. It seems appropriate therefore that we now step back and devote similar efforts to bolster implantation by improving the receptivity of a woman’s uterus. Such was the recommendation of a 2006 review article [r1] that suggested in its title that the “…endometrium is a fertility determining factor.” Yet only recently have practical ideas verified how we can optimize the chance for a healthy embryo to implant and grow.
Although most clinics monitor the ultrasound appearance of the endometrium (the lining of a woman’s uterus) this does not always reflect the hormonal, immunologic and nutritional environment where the embryo is expected to implant and grow. In 1998 a study [r2] demonstrated that a small amount of the hormone called “human chorionic gonadotropin (hCG) can be placed into the uterus and trigger a cascade of events that improve implantation. In fact, we now understand that process of “implantation” involves the embryo being “engulfed” as the tissue grows up and around the embryo. hCG promotes that process to take place. This same critical hormone promotes beneficial changes in the uterine muscle and the immune cells in the uterus necessary to enhance pregnancy.
A recent study [r3] measured the effect of putting a small drop containing 500 IU of hCG in the uterus immediately before an embryo transfer. They demonstrated about a 30% improvement in implantation and on-going pregnancy in women that received this treatment. They also tested smaller doses and found no improvement—further supporting that a crucial level of hCG is necessary to induce this measured benefit. As a result of this information, we are encouraging the use of 500 IU of Intra-uterine hCG as part of our embryo transfer routine.
Robert Greene, MD, FACOG
CNY Fertility Center
e-mail me at rgreene@cnyfertility.com
Call our toll-free number at 800.539.9870 or request a consult here.

17
Nov

Fertility Preservation: Some Women Choose to Delay Pregnancy and Sometimes Life Chooses for Them

by

Our society puts a priority on reproduction. That makes sense since it is hardwired into our brain. Unfortunately, that value often results in the assumption that women that choose to wait and begin their family later in life are somehow selfish or narcissistic for “wanting to have it all.” I am pleased to share that a recent report made great strides in dispelling this myth.
A British psychologist recently performed a thorough review [r1] of women’s motivations and situations resulting in “delayed motherhood.” In fact, she even took exception with the term “delayed” because it so strongly suggests that it is a choice that women are consciously making to wait until their late thirties or early forties to become pregnant. Instead, she found that it more often women are responding to their situation. Her research revealed that many women today are having babies later as a result of strategic decision making, extensive negotiations or response to their life’s circumstances. Better still women today have more options to preserve their fertility.
Techniques [r2] are available today to more efficiently freeze and store unfertilized eggs or viable embryos. Embryo freezing has been available for several decades but the efficiency of the process is much greater today. Egg freezing now makes it possible for women to preserve their unfertilized eggs when they are more plentiful and at their healthiest but actually delay fertilization and pregnancy until the time is right. Recently, the technique for freezing unfertilized eggs has been refined so much and the availability of the procedure [r3] has become so readily available that it is no longer considered experimental. So as more women speak out [r4] about their own choices and empower others to do so, it is rewarding to be able to meet their needs with more treatment options.
[r1]Link to http://www.sciencedaily.com/releases/2012/09/120903143056.htm#.UEdNOMzjAq4.email
[r2]Link to http://thegreeneguide.wordpress.com/2011/12/26/to-freeze-or-not-to-freeze-that-is-question-faced-by-many-couples-going-through-fertility-treatment
[r3]Link to http://www.asrm.org/Fertility_Experts_Issue_New_Report_on_Egg_Freezing_ASRM_Lifts_Experimental_Label_from_Technique
[r4]Link to http://www.nytimes.com/2012/10/23/opinion/we-need-to-talk-about-our-eggs.html?_r=1

Robert Greene, MD, FACOG
CNY Fertility Center
e-mail me at rgreene@cnyfertility.com
Call our toll-free number at 800.539.9870 or request a consult here.

1
Nov

Seafood Allergy and HSG Contrast: A Myth Dispelled

by

In medicine, well intended advice often proves wrong. Sometimes, such recommendations are repeated for years until we lose sight of the where/how the ideas originated. It then takes well documented research to retract the outdated ideas—even then correction is often resisted. An example is the frequently repeated advice that women allergic to seafood should not undergo a hysterosalpingogram (HSG). This rationalization is due to the fear that the iodine-containing contrast that is used to perform the test may provoke a reaction in sensitized patients[r1] .
Food allergies occur in about 4% of the population[r2] . Seafood is among the most common of the foods that people are allergic to. Shellfish and seaweed are the most common foods that contain high levels of iodine. That fact aside, it is difficult to establish how the concern between seafood allergy and iodine first originated. True allergies result when your immune cells react to a protein—not a mineral like iodine—by producing antibodies. These antibodies can then create a reaction upon repeat exposures to the allergen (protein that the person is allergic to). A true seafood allergy is typically a response to a protein called tropomyosin. There is no tropomyosin in the HSG contrast. Therefore, a classical allergic effect isn’t possible.
A recent review [r3] of the medical literature confirmed that the actual risk of a reaction to the contrast is rare. In fact, the odds of a severe reaction were far less than 1% (0.02-0.5%). So given the importance of the information obtained by performing an HSG, most patients benefit from this part of the infertility evaluation.
[r1]Link to http://www.asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/hsg.pdf
[r2]Link to http://www.ncbi.nlm.nih.gov/pubmed/18291306
[r3]Link to http://www.ncbi.nlm.nih.gov/pubmed/20045605

Robert Greene, MD, FACOG
CNY Fertility Center
e-mail me at rgreene@cnyfertility.com
Call our toll-free number at 800.539.9870 or request a consult here.

27
Aug

Fatty Acids can Improve Male Fertility

by

When couples are having difficulty conceiving, studies show that at least 1/3 of the time, there is a contributing male factor. Yet today the bulk of our tests and treatments are directed toward women. For couples that already know that they are dealing with a sperm problem, there are very few good recommendations on what they can do at home to improve their outcome; until now.
Many studies have found that dietary fats can impact pregnancy outcome [r1] in women. More recent data has even helped differentiate that some fats can improve fertility[r2] . But very little of the nutritional intervention has been directed toward men.
Polyunsaturated fatty acids (PUFA) are critical for sperm function and production. These fats are necessary to make healthy sperm as well to optimize their ability to swim. They are called essential fatty acids because you need to consume them in the foods that you eat so that your body can use them to manufacture hormones and other substances. Unfortunately, the typical foods that most of us consume don’t contain them. Instead, many of us eat foods that contain unhealthy fats; a situation that worsens the imbalance between good fats and bad fats.
Now that we know male fertility is improved with PUFA’s, the challenge is getting men to change their diet or take a supplement. Nutritionists have been encouraging men to increase their consumption of fish, flax seed and other foods with healthy oils but only with limited success. Now a group of researchers has found a practical solution[r3] . They had a group of men begin eating 75 grams of walnuts per day. After only 12 weeks they demonstrated an improvement in sperm count, better sperm motility and increased sperm vitality. Better still, they did not experience any increase in body weight or body mass index proving that this recommendation is practical with no identifiable drawbacks. In fact, eating walnuts has also been shown to be heart healthy [r4] and may reduce the risk of prostate problems [r5] as well. So, it’s time for men to “go (Wal)nuts!”
Robert Greene, MD, FACOG
CNY Fertility Center
e-mail me at rgreene@cnyfertility.com
Call our toll-free number at 800.539.9870 or request a consult here.

[r1]Link to http://thegreeneguide.wordpress.com/2012/02/01/high-fat-diet-before-pregnancy-increases-risk-of-gestational-diabetes/
[r2]Link to http://thegreeneguide.wordpress.com/2009/12/15/neither-%e2%80%9clow-fat%e2%80%9d-nor-%e2%80%9chigh-fat%e2%80%9d-but-the-%e2%80%9cright-fat%e2%80%9d-for-better-implantation-and-pregnancy-omega-3
[r3]Link to http://www.sciencedaily.com/releases/2012/08/120815151610.htm#.UC0Xy4S7zMg.email
[r4]Link to http://www.sciencedaily.com/releases/2011/03/110327191040.htm
[r5]Link to http://www.sciencedaily.com/releases/2010/03/100322153953.htm

9
Aug

Potential Benefits of IVF Cycle with FET (Frozen Embryo Transfer) vs Fresh Embryo Transfer

by

One of the most common questions infertility patients going through Advanced Reproductive Treatments (ART) ask is: “will freezing embryos reduce my chance at a pregnancy?” During the first decade and a half of IVF treatment, there was a much lower success rate through Frozen Embryo Transfer (FET). In a recent post, I summarized how the newer technique of “vitrification[r1] ” helped overcome the potential impact of cryotherapy upon embryo quality. And in a separate post[r2] , I described the importance of properly preparing a woman’s uterus prior to placing an embryo. Newer data is showing that due to these combined factors some patients can actually see an improvement in their pregnancy rate by deferring transfer of their embryos from a “fresh cycle” to an FET.
It has long been noted that the highest pregnancy rates are achieved when using an egg donor. Although it has often been assumed that this is due to improved embryo quality, newer data is showing that endometrial receptivity may also be a factor. The largest review to date [r3] recently combined the results of 64 clinical research studies—including 3 randomized trials. They found that freezing embryos and transferring them in a later cycle was associated with about a 30% increase in pregnancy rate. There was no difference in the rate of miscarriage; further reassuring that the process of freezing/thawing embryos maintained their health and viability.
Another important benefit of a freeze-all (or “staggered”) cycle is that it substantially reduces a woman’s risk of ovarian hyperstimulation syndrome (OHSS). So when considering your treatment options with your provider it might be worth considering the potential benefit of creating embryos now that you plan to actually transfer later.
 
Robert Greene, MD, FACOG
CNY Fertility Center
e-mail me at rgreene@cnyfertility.com
Call our toll-free number at 800.539.9870 or request a consult here.
———
[r1]Link to http://thegreeneguide.wordpress.com/2011/12/26/to-freeze-or-not-to-freeze-that-is-question-faced-by-many-couples-going-through-fertility-treatment
[r2]Link to http://thegreeneguide.wordpress.com/2010/10/13/is-your-uterus-ready-and-able-to-support-a-pregnancy
[r3]Link to http://www.sciencedaily.com/releases/2012/07/120704124319.htm

18
Jul

Do You Really Need Bed Rest After an Embryo Transfer?

by

Traditionally, bed rest has been recommended for women after any medical procedure. For instance, after delivery of a baby, women were prescribed 6 weeks of bed rest until it was ultimately proven that that inactivity increased their risk of DVT (blood clots in the deep veins). Even though bed rest had been encouraged with good intentions; it did not result in the best outcome. Nonetheless, it is challenging to reverse widely accepted but unhelpful advice. Now that IVF has been around for over 3 decades, it is time to review how we advise patients going through treatment and reconsider whether bed rest is still advisable.
In the early days of IVF, women were restricted to bed rest for 2 weeks after an embryo transfer. In fact, patients were not even allowed to stand up for quite some time after the procedure. Instead they were transported to a hospital gurney and relocated to a hospital bed—even using a bedpan when required instead of going to the toilet. It gradually became apparent that such severe limitation wasn’t needed. Back in 1997, the first study [r1] appeared suggesting that even a 24 hour period of bed rest was unnecessary. Specifically they demonstrated that even when patients were only limited to 20 minutes of activity restriction; pregnancy rates were comparable.
Subsequently, in 2005 a much larger [r2] and well designed study found that when patients were allowed to get up immediately after their embryos were placed; their pregnancy rates were as good as patients that were asked to lie flat for an hour. Finally, a 2011 review [r3] of all of the published research on this subject confirmed that there is no advantage to bed rest and instead that there may be a disadvantage to being totally sedentary. This isn’t surprising since inactivity combined with high levels of estrogen can promote blood clot formation as well as a rise in insulin resistance. By contrast, exercise reduces inflammation, lowers stress hormone levels and promotes healthy blood flow.
During pregnancy there has also been a reversal of the popular myth that exercise should be limited. In 2008, the US Department of Health and Human Services issued comprehensive guidelines that healthy women should begin or continue aerobic exercise of moderate intensity during pregnancy. In fact, it was confirmed in a well designed study [r4] that both mother and baby benefit from aerobic work outs. Despite the research, it is difficult to dispel advice from popular culture. It was even found in one study [r5] that when IVF patients were advised by their doctors to remain active; most still restricted their daily activity. So as we look for ways to further boost our pregnancy rates and improve the health of the pregnancies that result it is important that we constantly re-evaluate how we guide women following IVF.
Robert Greene, MD, FACOG
CNY Fertility Center
e-mail me at rgreene@cnyfertility.com
Call our toll-free number at 800.539.9870 or request a consult here.
———————————
[r1]Link to http://humrep.oxfordjournals.org/content/12/11/2489.abstract
[r2]Link to http://www.ncbi.nlm.nih.gov/pubmed/15749486
[r3]Link to http://www.ncbi.nlm.nih.gov/pubmed/21300426
[r4]Link to http://journals.lww.com/greenjournal/Fulltext/2012/03000/Exercise_During_Pregnancy__Fetal_Responses_to.17.aspx
[r5]Link to http://www.ncbi.nlm.nih.gov/pubmed/11393126

15
Jul

IVF Success Rates Reach All Time High: Repetition Can Be the Key

by


The latest review of the pregnancy rate achieved through advanced reproductive techniques (ART) like in vitro fertilization (IVF) is the most encouraging ever. One press release read “Success of Fertility Treatment May Approach Natural Birth Rate.” Considering that many couples that need IVF have no other treatment options; this is an extremely encouraging revelation. Since the first successful IVF pregnancy was achieved in 1977 (resulting in the birth of Louise Brown in July 1978); it is estimated that 5 million babies have been born through this technology[r1] ! With the success rate and the need for treatment increasing, it is important that we consider what else we can do meet the needs of even more couples.
Here is what we now know. Even the most fertile couples have a natural fertility rate of about 20% for any given month. Their ultimate success is achieved through repetition; if not successful one month they can try next month, and the month after that until they are successful. Observation shows that they typically achieve a pregnancy rate of 65% within 6 months and 80% within a year. By contrast, couples that need fertility treatment have to pay for each cycle that they are attempting to conceive which often limits their effort to one or two attempts. New data shows that with persistence, infertile couples can achieve success rates that are as good or better than people that are considered fertile.
Specifically, the New England Journal of Medicine published data summarizing the results of nearly a quarter of a million women[r2] treated at centers throughout the USA. This is the best estimate of the average success since it does not reflect a specific group of women or the experience of one specific IVF center. What they found was very hopeful. Nearly 60% of the women that were undergoing treatment had a baby (live birth). In fact, 30% of the women that underwent ART had a baby following their first IVF attempt! The majority of those not successful on their first attempt; did achieve a success rate as high as or higher than those of fertile patients the same age. In other words, IVF is able to overcome most obstacles to achieving a successful pregnancy except those related to age and its impact upon egg quality. Even though live birth rates were lower when older women used their own eggs; the same study found a cumulative live birth rate of 60-80% when women used an egg donor—regardless of the age of the woman carrying the pregnancy and delivering the baby.
Other studies released the same week [r3] demonstrated that women that were experiencing anxiety or depression before IVF did not have a lower chance for achieving a pregnancy. However, they did find that a failed IVF cycle can exacerbate these problems. This further emphasizes the need to focus on the success rates achieved with repeat IVF cycles. Currently there are about 1.5 million ART cycles being performed globally each year resulting in the birth of about 350,000 new babies. The key to focus on is that success rates are very high but it can take up to 6 IVF attempts for couples with more complicated problems to actually have a baby. Clearly the path to parenthood for couples that need ART is repetition. That is why it is so important to make treatment accessible. Personally, I am proud to work at a center that offers treatment at the most competitive prices [r4] in order to make IVF treatment accessible to all of those that need/want it.
Robert Greene, MD, FACOG
CNY Fertility Center
e-mail me at rgreene@cnyfertility.com
Call our toll-free number at 800.539.9870 or request a consult here.
———————————
Link to http://www.sciencedaily.com/releases/2012/07/120702134746.htm#.T_ME1uhqlZY.email
Link to http://www.nejm.org/doi/full/10.1056/NEJMoa1110238?query=TOC?query=NC
Link to http://www.reuters.com/article/2012/06/27/us-ivf-depression-idUSBRE85Q19120120627
Link to https://www.cnyfertility.com
 

5
May

Women: Cancer Treatment and Fertility Preservation

by

The good news is that more women are surviving cancer; the bad news is few are counseled about future fertility.
Women are surviving cancer today in record numbers. Now that oncologists have made such great strides toward effective treatment, we need to focus more on helping women prepare for their life beyond cancer.  Unfortunately, many of the most effective cancer treatments can damage a woman’s ovaries leaving them infertile or even induce premature menopause.
In 2006[u1] , the American Society for Clinical Oncologists published guidelines on discussing “fertility preservation” with cancer patients. At that time they estimated that about 55,000 cancer patients per year were 35 or younger and should be offered options to prevent lifelong infertility. One of the concerns expressed by the panel at that time was that the cost of fertility preservation was prohibitive. Since that time, many organizations have taken steps to remove financial barriers by providing compassionate care options; making treatment widely accessible. I am pleased to work at such a center [u2] and have therefore had the good fortune to help many cancer patients in planning their future families.
Recently, a group of women that had survived cancer treatment agreed to participate in a study[u3]  investigating whether or not they had been counseled about fertility preservation prior to undergoing cancer treatment. Unfortunately, even though these women were between 18 and 40 years of age; only 61% had been counseled. They did find a more recent trend toward counseling then when the study began a decade ago. Most importantly, the women that had received counseling were far less likely to harbor regrets; even if they did not choose to freeze eggs or embryos prior to cancer therapy. In fact, women that discussed their options with a fertility specialist were most at peace with their decision and demonstrated the highest quality-of-life scores. So if you or someone you know has recently been diagnosed with cancer, consider scheduling a consultation with a reproductive endocrinologist. It’s a decision that will be appreciated over time.
Robert Greene, MD, FACOG
CNY Fertility Center
e-mail me at rgreene@cnyfertility.com
Call our toll-free number at 800.539.9870 or request a consult here.

9
Apr

Popcorn: Mindful Food Choices Can Boost Fertility

by

One of the best ways to boost fertility and have a healthy pregnancy is to make careful food choices. Nothing is more intimate than to swallow something and then digest it so that it becomes part of you. Yet most of us give little thought to what we eat. In today’s fast paced lifestyle it’s critical that we also find tips that are practical so that people can incorporate healthy changes with less effort. That’s why when a good study comes along, I feel compelled to share it.
Last week a study [u1] was presented at the American Chemical Society that revealed the potential health benefits of popcorn. Researchers found that popcorn contains more concentrated healthy antioxidants than fresh fruits and vegetables. Whole grains contain a group of chemicals called polyphenols [u2] which are able to capture free radicals and therefore protect your DNA and the proteins in your body from damage. More noteworthy, since these polyphenols are not soluble in water, they are more concentrated in dehydrated foods like uncooked popcorn so you get more of them with fewer calories. These are the same chemicals that make wine, tea and chocolate of interest to healthy conscious foodies.
What prompted researchers to investigate popcorn is that now that we know grains contain high concentrations of healthy chemicals and dietary fiber. In fact, popcorn is a completely unprocessed whole grain. As a result, one serving provides people with more than 70% of the minimal recommended daily intake. That’s more than most people in the US get on a daily basis! So that’s another health benefit of this easy to find snack.
It is important to pay attention to how popcorn is prepared since that can be its downfall from the wellness promotion aspects. Using too much oil or covering it with the unhealthy fake butter—a.k.a. “movie theatre style”—are the worst ways to prepare a serving of popcorn. Air popped popcorn is best since it is lowest in calories. Microwave popcorn often contains unhealthy trans fats as well as more calories. A healthy compromise is to cook popcorn on the stove in healthy canola/olive oil blend; about half the calories and the addition of some healthy omega-3. Enjoy!

Robert Greene, MD, FACOG
CNY Fertility Center
e-mail me at rgreene@cnyfertility.com
Call our toll-free number at 800.539.9870 or request a consult here.

20
Mar

Journaling & Fertility: A Powerful Step Toward Achieving Your Goal

by

A recently published study [r1] reminded me of the importance of taking time to think about goals and values. A group of women at college were given a writing assignment. Half were told to spend 15 minutes writing about a value or goal that was important to them while the others were told to write about a value that may be important to someone else. They were also weighed at the time of the class. Upon returning 4 months later, the women that had undergone self reflection by writing about themselves experienced an average of 3 ½ pound weight loss while the other students had a 2 ¾ pound weight gain—typical of new college students. This finding does not surprise me as I have long advocated that my patients begin journaling to help them in achieving their goal of becoming pregnant. Here is an excerpt from my book PERFECT HORMONE BALANCE FOR FERTILITY[r2] where I explain a bit further:
Journaling is one of the most effective tools for managing emotions and relieving stress. Writing is more powerful than talking because it calls for more introspection, and it helps you carefully identify your feelings and reactions. Many people have reported that journaling brings physical benefits along with emotional relief. Studies show that by journaling regularly, your words begin to reflect a greater sense of optimism, your memory improves, you become more effective in your daily activities, and you’re less bothered by intrusive thoughts. Try to spend at least 15 minutes writing every day—especially in times of greater stress. If you’re new to journaling and aren’t sure what to write about, try freewriting, which entails writing continuously  to fill a page, without stopping. Write whatever comes to mind, even if it doesn’t seem to make sense.

Robert Greene, MD, FACOG
CNY Fertility Center
e-mail me at rgreene@cnyfertility.com
Call our toll-free number at 800.539.9870 or request a consult here.