The Importance of Vitamin D in Recurrent Pregnancy Loss


sunrise_01_406x304A recent article from Human Reproduction, Vitamin D deficiency may be a risk factor for recurrent pregnancy losses by increasing cellular immunity and autoimmunity, highlights the interesting role of adequate vitamin levels during early pregnancy.  Researches have found that a high proportion of women with recurrent pregnancy loss also have a vitamin D deficiency. The study also found that women with RPL and a vitamin D deficiency were also at a higher risk for auto- and cellular immune abnormalities.
So what does this mean for our clients?  It indicates that the simple blood test for vitamin D levels is an important screening factor for potential fertility challenges, especially miscarriage. A lower than normal vitamin D level (very common in Upstate NY!) can often be resolved with simple supplements, or sometimes a stronger prescription dose of vitamin D.
We provide vitamin D level testing at our center, and if you have had a consult within the last few years, we have likely drawn your levels.  However, as these levels may fluctuate over time, we would be happy to redraw these for you.  If you have any questions about your vitamin D level, and how it may positively or negatively impact your fertility, please don’t hesitate to contact us at any time.
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Hexagard May Replace IVIG Therapy for Treating Autoimmune Deseases in the Future


imageIVIG therapy is used by fertility patients who have recurrent implantation failures or recurrent pregnancy losses. IVIG therapy is thought to repress a woman’s immune system, which may be attacking the embryo or fetus, mistaking it for a foreign body. IVIG is made up of human antibodies, derived from washed and processed donor blood. During the treatment, IVIG Therapy is meant to reduce the amount of natural killer (NK) cells in the body, and/or may absorb or block a woman’s antibodies, which are causing the body to attack the pregnancy.
Women who have tested positive for natural killer cells and have experienced multiple miscarriages or implantation failures, may opt for the use of IVIG therapy to increase their chance of conceiving and carrying a pregnancy to term.
During a treatment session, IVIG is introduced to the body very slowly through an intravenous drip in the arm, possibly taking several hours. It is recommended that IVIG be administered prior to embryo transfer, and then two additional times following a positive pregnancy test.
Currently the cost of IVIG therapy is upwards toward $3000 per treatment for medications, and on average $150 for monitoring costs at CNY Fertility. The nursing costs can be submitted to insurance; however, IVIG therapy is seldom covered by insurance.
Because this medication is so costly, and autoimmune diseases affect 9 million UK citizens alone, it’s capturing the attention of public health officials in developing countries. Recently, Professor Richard Please won the Universal Biotech Innovation Prize 2013 for a project that deals with the development of Hexagard, a biomimetic to replace IVIG Therapy which would be much cheaper and approximately 50 times more effective. Read more about Hexagard here.
NOTE: Prices are always subject to change and medication costs can always vary.


Understanding the Grief Process


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.  (Please note this is not just for those who have experienced a miscarriage, grief can occur with everything from the initial diagnosis, to a negative pregnancy test.)
The grief process is different for everyone, and there isn’t a set timeline or protocol to follow.  It is extremely individualized and is completely dependant 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 and 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.  If you would like ideas on how to honor your loss, please visit this article:  Honoring A Miscarriage


Video: Honoring Loss Workshop for Recurrent Pregnancy Loss, Ectopic, and Chemical Pregnancies


Hi!  My name is Lisa Stack, and I’m the CNY Fertility Support Coordinator.  During my Words of Support and Encouragement article, I mentioned the Honoring Loss Workshop that I’m going to be having in the Syracuse location on Wednesday, April 4th from 5:30pm-7:00pm.
This is a great workshop if you have experienced any sort of pregnancy loss either recently or in the past.  We welcome everything from chemical pregnancies and ectopic pregnancies, all the way through to early-pregnancy loss, recurrent pregnancy loss, still born, and then even losses after birth as well.  This is a nice, broad-spectrum of loss, but I think we can all relate to very similar feelings and sentiments.
I also encourage partners to come as well.  This is a very laid-back event where we will be sharing a great, healthy meal together and really talk about our experiences, if you’re willing to share.   You can always just sit back and listen.  We’re going to be supporting each other in ways that have helped us in challenging moments such as holidays, friends and family members conceiving, getting through what would have been the birth date of the child.  I also have many other coping tools to get you through the grief process.
The grief process really takes time, and we really need to be patient with ourselves.  What really helps is sharing your story, and sharing your story with others who can understand because it can be challenging to try to speak to others and share with others who have never experienced a loss.  It’s really challenging to convey those emotions, to convey the hurt that you may have experienced.  I think it’s very important to get together with a group of women and men that have shared the same losses, and can understand your emotions, and can give you good feedback and good support because they’ve been there as well.
Again, this is a very laid-back event, very relaxed.  There isn’t a very strict structure, you can talk if you want to, you don’t have to, and you can always just listen.  We’ve had great responses in the past from clients who have attended.  I hope that you’re able to come and get some great benefits as well.  Afterwards, I will do a follow-up video and article if you weren’t able to attend so you can get some of the take-home messages that we discussed.
If you have any questions or you’d like to RSVP, please feel free to email me at, and I hope to see you there on Wednesday!  Have a great week!
Lisa Stack, Support Coordinator


Reproductive Dysfunction


Hi this is Dr. Rob talking about reproductive dysfunction, infertility, the inability to conceive and recurrent pregnancy loss. All these things affect our ability to conceive and deliver a healthy baby.

A 20% delivery rate per month is normal. After one year it may drop down to the 5-10% per month range and after two years it may drop to 1-5% per month range, but it doesn’t drop to zero! Keeping at it, I’m finding, is the key to all of this and I believe that stress, anxiety and fear are some of the major causes of reproductive dysfunction.

I believe in treating the patient as a whole entity, not just treating their reproductive organs. The mind, body and spirit play a huge role in each person’s day to day wellness and quality of life. Incorporating things like yoga, meditation, acupuncture, and maya abdominal massage are some steps from eastern treatments which work toward healing and normal reproductive function. Certainly it’s also important to look at western medical treatments for things such ovulation failure, pelvic adhesions, endometriosis, tubal factors, uterine factors such as uterine fibroids or intrauterine adhesions and diminished ovarian reserve from age factor infertility. All these can all affect egg function and implantation.

Let us not forget the male and sperm factors. There are two important halves to healthy reproductive function, and sexual dysfunction for many of us, can begin with the very basic inability to come together at the right time. There may be an inability to deposit sperm in the right place. There is also the question that if the sperm is properly placed, is the semen of normal count, motility and function?

In reality it all comes down to function, even though everything looks normal, regular cycles every 28 days, a normal hysterosalpingogram that documents that the fallopian tubes are open and the uterus is normal. A semen analysis that documents that there are at least 20 million sperm with 50% motility and the morphology is fantastic and normal. It’s all about the function of our organs (including the brain!), and the gametes. With unexplained factor (idiopathic) infertility there are unknown components preventing conception. It could be a genetic or chromosomal issue, a immunologic factor or a hormonal issue. We can treat these all with eastern and western treatments. We should start with the mind in all of these. With visualizing exactly what we want, we want – a baby, a family. There is an instinctual natural drive for these things. We do harbor fear, anxiety, worry, regret, guilt and judgment. Through yoga, meditation, acupuncture, massage, herbs, support group, connecting positively with other women and sharing stories, often sharing our pain, we can let it go.

I believe that journaling each and every day, a simple five minute journal entry, is helpful. Just write down how you are feeling. Then continue with working on the positive mantras of the day with meditation, which is really important. It can help. Studies by Ali Domar, of the mind body institute at Boston IVF have shown an increased success for patients who included a mind-body-spirit regimen with fertility treatments. Randine Lewis has shown with eastern treatments, significant improvements in outcomes that often do not require shots or pills or surgeries, both for the male and the female.

The fertility evaluation should start with sharing your story with your practitioner, whether it’s a Reproductive Endocrinologist, an OBGYN, family doctor or a Traditional Chinese practitioner. Share your story, or even if it’s with your partner or friend, share your story. There is guidance, there is assistance there.

Some blood work may be important for both the male and female. Patients may benefit from testing hormone levels, looking at immunologic factors, karyotyping and chromosomal factors. Performing a hysterosalpingogram to look at the fallopian tubes and uterine patency can add to the diagnostic picture. A pelvic ultrasound can be performed to look at the uterus, ovaries, ovarian reserve and fibroids. Additionally a laparoscopy and hysteroscopy could be recommended. These are operative procedures to look into the woman’s pelvic organs and uterine cavity. Through these procedures we are able to look for adhesions which may affect the transport of the egg and sperm. Both hysteroscopy and laparoscopy are out patient procedures, often done in the office.
Endometriosis is an infertility factor which we believe is the implantation of the glands from the endometrial cavity, either coming directly out of the fallopian tube or just spontaneously growing on the reproductive organs, causing inflammation and scar tissue and sometimes diminishing ovarian reserve. Via the laparoscopy, endometriosis and adhesions can be removed and increase a couple’s odds of delivering a baby.

It may be that the cycles are regular, the fallopian tubes are open and the semen analysis is normal. It may be as simple as trying a few timed clomiphene citrate cycles with intrauterine insemination, which will bump your delivery rate from about 1-5% per cycle to 5-10% per cycle. There are some side effects from medications. Clomid has an anti-estrogenic effect and can often cause some emotional upheaval, some depression, anxiety, PMS type symptoms, or premenstrual syndrome.

There are many options available to couples experiencing infertility, both invasive and non-invasive, Eastern and Western, and each offers some benefit to the patient guiding them closer to parenthood. I believe that doing something is always better than doing nothing, especially when trying to create a family. For more information about any of our services you can call CNY Fertility Center and CNY Healing Arts and speak with our highly knowledgeable staff.
Have a spectacular day!
Dr. Rob