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



April's Journey to Fertility: Educating Friends, Families, and Employers – Part I


April is a CNY Fertility Center patient and has been on her journey to fertility for approximately three years. April will share candid stories and a unique perspective on the fertility challenges many women and couples face. CNY Fertility Center has locations in Syracuse, Albany and Rochester, NY.
Week 63: Educating Friends, Families, and Employers – Part I
I have found that one of the most difficult aspects of going through fertility treatments is figuring out what to tell your friends, family and employers. Early in the fertility game, many of us are able to be fairly vague with our employers and crafty with what we tell our friends and family. However, each unsuccessful cycle is quickly followed by another month of treatments, appointments and missed work and/or social events. I remember having the conversation with our building principal two years ago regarding my need to miss work. In this case, I was upfront, but I was not upfront with everyone as quickly. Let’s face it, my principal has enough professionalism not to ask me how my cycle went or when my pregnancy test will be. He was a safe one to initially share information with, and I find that once you associate the word “infertility” with having to miss work, no one questions you. Really, no employer wants to have that discussion in detail! (Nor should they; I would much rather be at work than having to throw my legs up in stirrups for an internal exam every other day!)
However, the process can last years, and at some point we have to realize our own limits and begin educating others on our own challenges.  My friend Jess recently wrote the following response in our online “support group/yoga e-mail group”:
“I think this process is incredibly isolating, because it makes people uncomfortable and puts you in situations where you are supposed to be super happy for people and few people on the outside of infertility “get” that you can be happy for them but still really sad for you….I wish that people would realize how lucky they are for being able to have an intimate moment with their partner, pee on a stick, see a heartbeat 9 weeks later, and deliver a healthy baby at 40 weeks or whatever, without needles, constant monitoring, constant news that something else is on the fritz with one of your body’s basic functions, blood tests, ultrasounds, procedures, incredible hope and then dashing disappointment. I also wish that it was more “socially appropriate” to be as open and frank about all that we go through to have a baby as it is for people to talk about their ultrasounds and morning sickness and babies’ poopies and what have you. Maybe then more people would “get it.” I am leaning toward total disclosure at this point because I am sick of pretending that everything is ok to the world when really it’s not. And because I deserve the same support and understanding that people give those complaining about their lack of sleep from their newborn, or their sore breasts from breastfeeding, or the nausea that stalks them all day long.”
And isn’t Jess right? Don’t we deserve the same support? I believe one of the main reasons we do not get support from the insurance companies, our friends, our families and our co-workers is because this topic is still somewhat taboo. Of course, I am not jumping at the chance to talk about my egg quality or my husband’s sperm count at any of our family events, but I do feel that we are all on this tumultuous journey for some reason. If in the end, however, I can teach a few more people to be just a little more informed and sensitive regarding a topic that affects approximately 10% of the population, then I can feel just a bit more at peace with my involuntary involvement in this process. And it is a process!
In hopes of educating others,
April all Year

Click here to read all of April’s previous blog articles on her journey toward fertility.


April's Journey to Fertility: Week Forty


April is a CNY Fertility Center patient and has been on her journey to fertility for approximately two and a half years. April will share candid stories and a unique perspective on the fertility challenges many women and couples face. CNY Fertility Center has locations in Syracuse, Albany and Rochester, NY.
Week 40: Creating Families & Parenthood for Me
Sandra Bullock’s Oscar acceptance speech included a thank you to “the moms that take care of the babies and children no matter where they come from.” I was moved by the emotion and sincerity of her statement and immediately began thinking about Parenthood for Me, a nonprofit organization that fundraises to provide grants to those who are either adopting or going through advanced reproductive treatment. Parenthood for Me has recently partnered with CNY Fertility Centers  because both organizations are interested in providing affordable options to couples who want to create a family. In fact, Parenthood for Me will award its first set of grants this June. If you are interested in applying go the website,, to find out more information.
I recently spoke with Erica Schlaefer, the woman who runs Parenthood for Me, because I have read about her own journey to motherhood. (I always find comfort in the automatic camaraderie that ensues between two woman who have shared similar fertility-related challenges and triumphs.) As we chatted, I also learned quite a bit about the upcoming Family Building Dinner and Silent Auction event and wanted to share that information with my readers because this event is not only an opportunity to fundraise but it is an opportunity to celebrate our journeys, to appreciate the lessons we are learning and to gain more knowledge about how we might create our families.
The occasion promises to be an elegant and classy event in a relaxing setting, The Rochester Yacht Club. The event is black tie optional so that guests know to dress up for the evening, although tuxedos and gowns are not at all required. JP from 100.5 will serve as the master of ceremonies for the evening which includes dinner, a silent auction, and keynote address. Silent auction items include electronics, zoo membership(s), gym membership(s), artwork, jewelry, gift certificates, and handmade goods. They keynote address will be given by Sally Bacchetta, adoptive mother and author of the book titled, What I Want My Adopted Child to Know: An Adoptive Parent’s Perspective. Parenthood for Me is completely run by volunteers and because of the significant sponsorship behind the event, the money you spend on the dinner is almost all going toward endowment funding! Attending such an event also raises infertility awareness, which is just as important as raising funds. I hope to see you there!
PS – Next week, I will elaborate on the composition of Parenthood for Me and how you can volunteer your time to this exceptional organization. I have to admit, I am already considering what a seat on the board of directors would be like!
Always Learning,
April All Year
Below are links to April’s past articles in case you missed any of them: Read more


April's Journey to Fertility: Week Thirty Four


April is a CNY Fertility Center patient and has been on her journey to fertility for approximately two and a half years. April will share candid stories and a unique perspective on the fertility challenges many women and couples face. CNY Fertility Center has locations in Syracuse, Albany and Rochester, NY.
Week 34: Empowerment
When I recently searched for synonyms for the word control, I found the following terms: manage, organize, run, have power over, be in command of, direct, cope, supervise. Immediately, I realize I feel most at ease when I am effectively coping with life’s daily challenges, managing my workload efficiently and keeping organized. Although I may not admit I like to be in control, I like to be in control! (I am sure my husband is nodding his head as he reads this.)
Since navigating through fertility treatment can leave me feeling as if very little is within my control, finding ways to feel personally empowered is important. In order to establish and maintain that feeling, I ask questions – many, many questions when I am with the doctor or acupuncturist, empowering myself at the fertility center.
Achieving that sense of satisfaction and empowerment can sometimes be a creative and engaging process, too. For example, I try to be inventive and diligent at work. Having my own classes allows for me to use my management and creativity skills, empowering myself at work.  Exercising empowers me by invigorating my spirit and energy.  We are currently remodeling everything from the floors to the closet in our office, making me feel empowered at home. Even though there is one specific area in which we feel out of control, we certainly can feel empowered to take charge of other aspects of our lives.
Many couples feel frustrated, alone and out of control during fertility treatment, but learning communication and coping strategies helps both members of a couple feel empowered and in charge. Kristen Magnacca will be offering her Love and Infertility workshop this coming Saturday at the CNY Syracuse location. My husband and I have attended three of her workshops. We always leave knowing there will be an end to this journey and that our marriage is able to survive this challenge. I would encourage you to attend this workshop. Whether you are attending one of Kristen’s workshops for the first time or as a refresher, you will leave with coping strategies and a refreshed outlook. For those of you who are shy and have yet to attend a workshop, do not worry. Kristen will make you feel comfortable and does an excellent job of meeting each individual’s and couple’s needs. Not to mention, Kristen has been through the challenges of infertility herself and has made it to the other side. Her stories and strategies are relevant and effective.
Whatever you do to empower yourself, my intention for you is that you achieve a sense of control and satisfaction.
Peace and blessings,
April all Year Read more


Embryo Transfer – Day 3 versus Day 5


CNY Fertility Center has locations in Syracuse, NY Albany, NY and Rochester, NY. CNY Fertility offers affordable fertility treatments including low cost IVF (In Vitro Fertilization). Patients often have questions about the day that their embryos will be transferred back to their uterus following their IVF procedure. This article is a quick summary of the history and advantages of both Day 3 and Day 5 embryo transfers.
Until about 10 years ago, all embryos were routinely placed in the uterus on day 3 of the cycle. Embryos are then at the 6-8 cell stage.

(8 celled embryo – Day 3)
Culture methods then emerged which allowed healthy embryos to continue developing to day 5, the blastocyst stage which has several attractive features.  Most importantly it allows some of the embryos which are doomed to failure due to internal defects to fall by the wayside as they arrest and do not continue to develop. Thus the more hardy embryos are self selecting and the rate of implantation of each embryo is higher.  Culturing embryos out to the blastocyst stage reduced the number of embryos that were transferred back as well, reducing the incidence of multiple gestations.

(Blastocyst stage embryo – Day 5)
Initially it seemed as this was applied in IVF practice, that the ability to choose the more robust embryos by self selection in this manner would raise pregnancy rates. In a common scenario, the choice if a patient had 5 embryos available for transfer, all about equal in quality on inspection under the microscope, the option would be to replace 3 embryos on day 3 or two on day 5. It was hoped that the day 5 embryo transfer would yield higher results for the IVF patient. This has not turned out to be the case. It is however true that the number of triplets is reduced by use of the day 5 strategy, which is an important option to consider when the risk of multiples is paramount.


IUI with Clomiphene, a First Line Treatment for Infertility


This information is provided for couples who may just be starting out in fertility treatments and are trying to conceive using IUI with clomiphene. CNY Fertility Centers provide infertility services including low cost IVF (In Vitro Fertilization) for couples who are starting or continuing their families in Albany, New York, Rochester New York and Syracuse, NY. In addition to our local services we work with patients from across the country and world offering affordable IVF and fertility treatments.

Unexplained infertility is when a couple can’t conceive although the woman is ovulating, and her fallopian tubes, uterus and partner’s semen results come back normal after testing. Some of the women have had endometriosis diagnosed and treated, thus are not truly unexplained, but do fit into this category in terms of an approach for treatment.

Clomiphene is inexpensive, and acts in women who already ovulate to stimulate production of several eggs during a treatment cycle. Clomiphene causes the brain to misinterpret blood estrogen levels. This induces the pituitary gland to produce a surge of the follicle stimulating hormone or FSH. The result is the production of more than usual numbers of follicles, each with one egg.  Intrauterine insemination (IUI) places more sperm into the uterus and then the fallopian tubes than could ever reach through intercourse. Thus more bullets are shooting at more targets.

The combined use of clomiphene and IUI has been shown to nearly double the results compared to using clomiphene alone to improve pregnancy likelihood (Guzick, 1998). The master student of IUI, Dr Richard Dickey and colleagues in 2002 compiled a large series in New Orleans and reported almost 10% success per cycle.

The distinguished Boston IVF group in a study led by Dr. Alan Penzias recently confirmed a cycle success rate of 11.5% (Dovey, 2008) from over 4000 cycles of treatment. The patients were ovulatory and some of the men had low sperm counts.  The success of treatments cumulatively over up to four cycles, was successful in 24% of patients under age 35. Age specific pregnancy rates per cycle ranges from 12% under age 35 to 4% over age 40. Corresponding decreases in overall success were seen according to age. Only one patient was successful (1.8%) of the 55 women treated over 43 years of age.

The study verified findings by others who found that 90% of success is found in three or four cycles. Those who are not pregnant by then should move to gonadotropin and IUI or IVF therapy.

At RBA in Atlanta, Dr Massey and colleagues found that the addition of a chemical called PAF to the sperm wash dramatically improved success rates (Roudebush 2004) to nearly double those without it. This is a reasonably simple method which more clinicians might use.

Those who are concerned with cost effective treatment for infertility continue to believe that clomiphene and IUI are a good treatment for younger patients who are trying to conceive, and fit the criteria outlined.

Selected References
Dovey S et al Fertil Steril 2008:90:2281-86
Guzick, DS et al Fertil Steril 1998;70:207-13
Dickey RP et al Fertil Steril 2002;78:1088-95
Roudebush WE et al Fertil Steril 2004;82:52-56


Low Cost IVF in the United States


CNY Fertility Center, founded and directed by Dr. Robert J. Kiltz, with offices across New York State, offers low cost fertility/infertility treatment that include IVF, ICSI, PGD, Cryopreservation, Donor Eggs, and much more. Although fertility treatments are offered worldwide, wide variations are noted in different countries in regard to quality and availability. Medical tourism is becoming a popular means for consumers to find state-of-the-art medical care around the globe. We have integrated both Eastern and Western medicine to provide our clients with a holistic approach to their reproductive care. It is our goal at CNY Fertility Center to become the center of choice both across the United States and to our friends abroad.

Our mission is to provide comprehensive reproductive services in a compassionate, honest and friendly environment at a low cost to our clients. In 2010, Dr. Kiltz has created financial plans to minimize the stress on our clients on their journey to build their family. We offer multiple cycle discounts as well as IVF refund programs. Couples interested in donor eggs will also find that we offer exceptional rates in comparison to many other programs and we as well offer both multiple cycle discounts and refund programs for couples/recipients who are interested in pursuing donor eggs.

As our centers grow to offer services across the United States and around the world, we will strive to meet your needs. We understand the inconvenience of leaving your home for medical care and we will assist you in any way we can to make your stay in New York as comfortable and as convenient as possible. We will provide you with continuous support throughout your journey. Our staff is here for you and it would be our pleasure and our honor to help you build your family.

If you are interested in exceptional, quality care, in a warm environment, at a low cost, please visit our website at If you have questions regarding any aspect of the services offered at CNY Fertility Center, please do not hesitate to contact us at (518) 690-0700. Our staff is available 24 hours per day, 7 days a week, to answer any of your questions. We look forward to working with you.

Justine Taylor, RN, BSN
Nurse Manager and IVF Coordinator


April's journey to fertility: Week five


Fertility SymbolApril is a CNY Fertility Center patient and has been on her journey to fertility for approximately two years. April will share candid stories and a unique perspective on the fertility challenges many women and couples face.

Week five: The right path for us

In examining our approach to becoming parents, we knew that making an appointment with another fertility specialist was an absolute necessity. After unsuccessfully going through multiple IUI cycles, we were at a loss as to what the next best step was, but felt that consulting with CNY Fertility Center might offer a different perspective.  Fortunately, our consultation with Dr. Kiltz was helpful and refreshing. During the hour long visit, Dr. Kiltz did not focus solely on my cycle or my husband’s sperm count. Instead, he focused on the fact that the possibility of our becoming parents was far more likely to happen than not and that our journey to parenthood had to involve what was best for us. We left the appointment feeling relieved for numerous reasons. First, we had a doctor who was listening to us and trying to thoroughly address our emotional and physical needs. Secondly, we left with a short term plan which included a series of different blood tests, continuing alternative treatments (acupuncture, massage, herbal remedies, etc.), initiating lifestyle changes (daily gratitude lists, meditating, yoga, etc.) and my undergoing a laparoscopy and hysteroscopy surgery.
I remember believing that surgery was the next best step. When there is no explanation for what is wrong with you, when your husband’s “numbers” are fantastic, and you have failed many assisted cycles, all you want is an answer (other than a baby, that is!). I felt that the surgery might offer some explanation. I knew it would be an invasive procedure, but that it only required small incisions (as long as there were no significant issues with my reproductive organs) and that this exploratory operation could be productive, depending on what the doctor found. The closer surgery date became, the more I knew that the doctor was going to find something that would provide an explanation for us. I do not know how I knew – call it intuition or call it coincidence, but I just knew.  The first question I asked when I awoke from surgery was, “Did he find anything?” The nurse, who was phenomenal in terms of meeting my post-surgery needs, stated that I had a “spattering of things going on,” and explained that the doctor removed endometriosis, scar tissue and a fibroid. I remember silently thanking God and smiling because I felt as if we now had several more puzzle pieces to lay into place.
I feel so much more hopeful now that we are working with a fertility center that meets our needs a bit more personally. My post-surgery follow-up visit was about 45 minutes and we discussed the likelihood of achieving pregnancy and exactly what my chances of conception look like at this point (not too bad, I might add!).  After discussing how my husband and I could continue to stay positive and spiritually “intact,” we decided to simply relax until my two month follow-up, at which point we would discuss our overall “fertility plan” with the doctor. As of today, our plan is in rough draft form and developing our plan has been an emotional process, but I am determined to become a mother, and I have to be able to ask the tough questions and seek out the necessary answers.
My intention for you this week is that you would begin to ask yourself some of the tough questions and consider what resources you have that will assist you in best developing your own plan. I promise to discuss our plan more elaborately next week. Until then, keep persevering.
Miracles and blessings,
April all Year
Below are links to April’s past articles in case you missed any of them:
Week four: Our fertility treatment “break”
Week three: Deliberate choices
Week two: This moment
Week one: My story


A Call to Advocacy


family-handsDr. Rob and the rest of the CNY Fertility Family encourage you to visit the advocacy website listed below to add your name to the list of supporters for HR 697 Family Building Act of 2009.  This is such an important cause that touches more lives than you may think.  HR 697 is a bill that would require all insurance companies to include fertility treatment coverage in their plans if they also cover obstetrical services.  This would enable thousands of Americans to pursue fertility treatments that otherwise would be paid for out of pocket.  Most importantly, this bill gives each American the chance to have the family they have always dreamed.
Please visit the following website to include your name in a letter sent to your Congressional Representative:
Sign your name!

For more information on the cause here is the advocacy homepage: Find out what you can do to help!

Finally, compiled a beautiful video to pass on to friends and family, to make them aware of what needs to be done: Watch the video!
If you are interested in reading the actual bill, it can be found here: Read the bill!
Please consider signing your name to the Family Building Act of 2009, and make the dream of a family possible for everyone.
Lisa Stack


Understanding Grief


We often experience many moments of joy with the help of Dr. Rob and the rest of the CNY Fertility Family, whether it be in Syracuse, Rochester, or Albany.  However, sometimes there are low moments of pain and grief.  This is unfortunately natural in the world of fertility and creating families.  Although we would love for the joy to stay, we unfortunately cannot control what happens.  So what do we do when we experience a loss?  We have to grieve.
The grief process is different for everyone, and there isn’t a set time line or protocol to follow.  It is extremely individualized and is completely dependent on the needs of those experiencing pain.  According to the Kübler-Ross model, there are typically 5 stages experienced during the grieving process:
1.    Denial: This occurs with the initial shock of the situation.  It may occur when you first hear ‘I’m sorry but the test was negative’ or when you first discover you need help creating your family.  Naturally we will say to ourselves, or even out loud ‘No, it can’t be.’ or ‘I know you are wrong, check again’.  Our mind resorts to denial initially to protect ourselves from the reality of the situation.  We find ourselves grasping for any sort of flaw in what we are being told, in order to prove to ourselves that it isn’t true.  Once the denial lifts and we begin to absorb what has happened, we tend to recognize our loss and the impact it will have on our lives.  In the case of a miscarriage you may begin to think of what the child’s life would have been like, and the plans you had made for your family.  This leads us to the next stage in grief, anger.
2.    Anger:  After denial of the situation and the beginning realization of the loss, it is common to feel angry.  Angry with yourself, those around you, and quite often God, or whatever spiritual being you associate yourself with.  The anger comes when we realize our plans have been changed, and we will not have the life we imagined before the loss.  During this stage it is common to feel angry towards those that are closest to you, even your spouse.  You may feel they are not grieving properly or at all. This is ok, they may be in a different stage than you, or they may manifest their feelings differently.  It is extremely important to realize that they are grieving, and they are in pain, it is just not the same as yours.  It is also important to note that men and women often experience a drastically different grief process.  After the anger subsides it is common to begin the stage of bargaining.
3.    Bargaining:  Often bargaining occurs with the self, or with God.  You may find yourself saying ‘Just let me have my child back’ or ‘Please just tell me what I can do to fix this situation’.  Although we know we cannot change what has happened, this is another defense mechanism of the mind, body, and spirit to make absolutely sure there is no reversing the situation.  This is similar to denial in that we are not ready to accept the loss.
4.    Depression:  During the fourth stage, depression, we begin to realize and acknowledge the loss.  This is the most painful stage and it can feel like it will never end.  Often we can experience not just emotional and spiritual pain, but actual physical pain as well.  This stage is the acknowledgement of the loss, and the recognition of the emptiness felt.  It is often accompanied by crying, feelings of abandonment, and wanting to withdraw from others.  This is an incredibly important time of the grief process and it is not recommended to ‘cheer the person up’ or try and distract them with other things.  To truly mourn the loss, it is important to feel the depression, as difficult as that may be.
5.    Acceptance:  Once the depression lifts, you may feel a lift in your spirits as well.  It is not that you have forgotten what has happened, or that you are any less upset about the loss.  Instead, acceptance signifies that you have grieved, and felt each step of the grieving process and now you are looking for hope and a way to remember while moving on at the same time.  Common ways to describe this stage are ‘I can’t change what happened, I have to learn to live with it’ or ‘I will never forget, but I need to be able to live as well’.  This is a time where you may want to be alone again, and that is OK.  It can be difficult to navigate these new feelings of ‘being OK’.  You may feel guilty about trying to conceive again, or about taking some time for yourself.  This is a stage of balancing grief, with life.  While you may accept what happened and feel a little more comfortable about moving on with your life, it does not mean that you have forgotten, or that the pain will go away.  You will still feel the pain of loss, however it will not be as intense as it was in the beginning, and you will be able to place it in better perspective now that you have accepted the situation.
While you are reading through the above stages, they may appear to make sense chronologically.  However, remember that everyone grieves differently and in different stages.  You may experience depression before anger, or you may skip a step completely.  However it occurs is right for you.  The important part is that you feel each step.  As painful as it is, that is the only way to fully acknowledge and accept the loss you have experienced.  You will also be able to mend the relationship with yourself, your spouse, family, and God (if this is appropriate) while you grieve, because unfortunately relationships can suffer as well during a loss.
If you are experiencing a loss please constantly remind yourself that your grieving process is unique, and is best for you.  Also, remember that we are always here for you and you have a large family here at CNY to support you.
Please visit our online message boards at to meet other patients experiencing similar situations to yours.  We also have our monthly support groups at each office location.
If you would like to talk more about loss and the grieving process please don’t hesitate to contact me, I am available via email and phone.
Take care of yourself,
Lisa Stack