Dr. Sonja Kristiansen, Houston Fertility Center (formerly Houston Infertility Clinic)

Dragon Babies In the Making!

2012-01-31T06:30:00.000-06:00

Surely, you've seen this recently? The Chinese New Year has arrived, and this year, deemed The Year of The Dragon by Chinese astrologers, is supposed to be especially auspicious for having babies.

The Wall Street Journal says that "dragon babies" -- those born from now until February 9, 2013 -- are supposed to be strong, smart, and lucky. Quite a combination! What parent wouldn't want those things for their child? Even if you think astrology is nothing more than silly fun...

But here's the modern twist on an ancient tale: Couples are actually taking advantage of assisted reproductive technology to boost their chances of getting pregnant with a Dragon Baby. In the article, one egg donation agency reports they've increased the number of donors with Chinese ancestry to prepare for an expected rise in intended parents.

What we're talking about here is a new kind of family planning, people taking full advantage of the availability and increasing reliability of fertility treatment success, even if there are no fertility problems. "But Dr. Kristiansen," you're wondering, "isn't IVF for fertile people going to extremes?" IVF is the most direct means of assisted conception for many people, but artificial insemination can work as well for some.

So if you want to have a Dragon Baby, you need to institute a plan and aim for conceiving by mid-May of this year. My staff at Houston Fertility Center will be happy to assist -- even if you think astrology is just for fun.

~ Dr. Sonja Kristiansen M.D.

Image: Naypong / FreeDigitalPhotos.net

Infertility E-Books - More Snake Oil?

2012-01-18T07:58:00.000-06:00

The other day I opened an email from a website making helpful claims for women with PCOS. Polycystic ovarian syndrome is very common, not just among infertile women. Untreated PCOS is linked to infertility and to more serious, chronic conditions involving cardiovascular health. There are many well-established websites about PCOS, some that are backed by medical institutions, to which I refer my Houston Fertility Center patients. So I took a quick look at this relative newcomer site to judge its reliability as a patient education resource.

Quick red flag: If the words "cure" or "miracle" appear on a treatment website, be very wary. (I won't credit the site by linking to it in this post.)

Fortunately, there are many other reputable websites that educate and support patients with PCOS. But what I found especially disturbing about this one (and there are others out there) is their tactic of making money from the dissemination of medical information that's already available to consumers for free. That's the miracle of the Internet.

Before you're tempted to spend your money on e-books, email "programs" or newsletters, or even virtual face-to-face counselors who claim to have cures for PCOS -- or any other cause of infertility -- stop and do your research first. Investigate the authors, as well as the company marketing the products and services. Even more importantly, connect with the many available patient groups (like PCOSChallenge) who can tell you what you need to know and offer you support and tested resources, too.

DIY Artificial Insemination Just Adds to Infertility Stress

2012-01-13T10:54:00.000-06:00

Gone are the days of uninformed consumers and all-knowing experts. Now with just a flip of the webpage, you can find step-by-step instructions on everything from remodeling a bathroom to getting pregnant with artificial insemination. DIY conception used to be the only means available for people who couldn't get pregnant "the old fashioned way." It's a real good thing we've come a long way from those days.

But have we? It turns out there's an underground, online market for sperm, where women can access prospective biological fathers for their children without the intervention (and guidance, and screening, and medical and legal protections) of reproductive professionals.

Newsweek's Tony Dokoupil called one related website "a weird blend of Facebook, Match.com and a traditional sperm bank" in this article for ABC News.

"What's wrong with the DIY approach to getting pregnant, Dr. Kristiansen?"

Here's a quick list of why I think you and, more importantly, your potential children are far better off going the more conventional routes to accessing sperm for getting pregnant:

Without standard controls by the Food & Drug Administration and the policies and procedures of reputable clinics like the Houston Fertility Center, you risk transmission of infectious diseases and genetic conditions, to both the mother and child.

Engaging in activity within this level of intimacy, even if sexual intercourse isn't on the agenda, with people whom you've only "met" online is simply not as safe as using professional services.

Agreements made between individuals about level of parental responsibility and involvement in the child's life may not be binding without proper legal representation and execution.

If you've found the whole process of getting pregnant stressful, just imagine the additional burden that comes with using what amounts to be an unknown substance to conceive. Worry about the cost of artificial insemination? It just doesn't compare to worrying about your personal safety and your child's health and future.

Happy Holidays to The Non-Exclusive Club of Kindred Spirits

2011-12-22T12:33:00.001-06:00

Virtually all of my patients at the Houston Fertility Center come in feeling alone, at least at the start of their fertility journey. Occasionally I receive "Dear Dr. Kristiansen" emails, mostly from women who live in fear that their situation, their particular cause of infertility, is rare and untreatable. And the holidays is by far the hardest time of year to have an overwhelming feeling of being left out in the cold. But things are a lot better now than in past years, when infertility truly wasn't something anyone talked about beyond clinic hallways.

In this blogpost for Huffington Post, author Leslie Goldman sums up the thoughts that run through so many patients' minds: "Why not me?!" Just as Leslie found out when she dared reveal her struggles with getting pregnant, there is in fact a huge number of people who are going through the same or similar. She finishes up her post with experienced advice for those who are still trying to conceive: "Drink wine. Lots and lots of wine. And enjoy it while you can."

For this holiday season, I encourage you to let things go a bit. If you're in the middle of an IVF cycle or other treatment, follow doctors' orders, of course, but also take advantage of every single opportunity allowed to enjoy yourself. Any questions about whether it's okay to do this or that in mid-cycle? Just ask. If you're not in the middle of treatment, then try your best to shelve the sense of urgency. Breathe as much as you can, both literally and figuratively. After the holidays, you can get right back on the path (if you want) or start thinking about new roads to travel.

But for now, I wish you all peace.

~ Dr. Sonja Kristiansen M.D.

Why I'm Grateful For My Own Lab: Twins from Stolen Sperm

2011-11-30T12:48:00.001-06:00

In the United States, we're relieved to be free of a strong government hand in private affairs like choosing to use reproductive medicine. Occasionally, though, my inbox is filled with rather frantic "Did you see this, Dr. Kristiansen?!" emails bearing news stories that remind us of why some regulations are necessary.

One such story -- about accusations of stolen sperm and unwanted fatherhood -- is coming out of Houston right now.

A young man is taking a Houston area fertility center to court, saying they never actually had his consent to use his semen for IVF that eventually impregnated a former girlfriend. This news video on Click2Houston.com has interviews of both the man -- now the father of twins -- and a representative of the fertility center.

Stories like this are fortunately rare, but they still play on the fears of fertility patients. It's understandable -- not all fertility specialists use their own labs. In fact, Houston Fertility Center's own in-house, state-of-the-art laboratory has provided embryology and related services for physicians from other clinics for years. Being able to rely on my own lab provides me and my staff with an extra layer of confidence in the fertility services we provide to patients.

While things in general are far more easy-going in the U.S. than in other countries, reputable fertility centers honor both the requirements and recommendations of existing regulatory bodies. This young man's experience clearly demonstrates one reason -- no one should be cornered into parenthood.

Rules about patient consent and the use of tissue (which includes sperm and eggs) can add a layer of cumbersome bureacracy to the IVF process. Now and then, a patient will complain, "But Dr. Kristiansen, some of these requirements seem over the top and unnecessary!" My response? I am grateful to have my own laboratory serving Houston Fertility Center, and for staff who are vigilant in maintaining compliance with regulations for the benefit and well-being of everyone involved.

Things You May Not Want to Hear When You're Trying to Get Pregnant: Stop Drinking Alcohol

2011-11-23T07:00:00.000-06:00

"Anything but THAT, Dr. Kristiansen!" I've heard those very words uttered by patients in my office at Houston Fertility Center a few times. There a number of recommendations I might make for optimizing attempts at getting pregnant -- some of those requests are not welcomed by patients!

Here's one: Stop drinking alcohol.

Now, that's a pretty stringent version of what I actually recommend. That blogpost, "TTC with IVF? Skip the Alcohol Tonight" was published on New Year's Eve 2009. Nothing about the information in the links therein has changed: subsequent research bears out the conclusion that alcohol doesn't do you a bit of good if you're using IVF to conceive. In fact -- and there are plenty of theories but no certain, understandable reason yet -- drinking alcohol might be the thing that tips the conception scales against you.

Most recently, clinical researchers published in Obstetrics & Gynecology, the American College of Obstetricians and Gynecologists' journal, that enjoying as few as 4 drinks per week reduces your chances of IVF success. Interestingly, that holds true for couples as well as women who were surveyed prior to going through their first IVF cycle.

As I said, some Houston Fertility Center patients bristle when I suggest they stop drinking alcohol while trying to conceive. I'm sure the same is true in other fertility specialists' offices. But taking charge of your reproductive health means holding yourself accountable -- a little firm but positive self-talk might be in order. If it feels easier to ponder cutting back instead of quitting altogether, try that instead and use the less-than-four-drinks per week as a gauge. Or tell yourself that you're training for parenthood, a time when the idea of drinking more might seem appealing but is really at cross purposes with your goals -- just like during an IVF cycle.

In the end, you'll want to look back on your trying times and be able to say you did everything you could to have that baby.

~ Dr. Sonja Kristiansen M.D.

IVF Myths: You'll Never Be Able to Afford It

2011-11-21T07:00:00.000-06:00

My take on another IVF myth, written about by Dr. Kathy D. in a blogpost on Pure Natural Mom:

Myth #3. "IVF is expensive and not covered by insurance"

Money is of tremendous concern to everyone today. One of the first questions I'm asked in a patient's initial consultation is, "Dr. Kristiansen, how much will this cost?"

IVF can certainly be one of the costliest services most people will ever pay for, but when you look at where your household spends its money -- often without much second-guessing -- you can start seeing the expense of fertility treatment as one of the greatest investments of your whole life.

And the truth is that not only will many insurance plans cover some, if not all, parts of the IVF process, many employees have better coverage than they think. There are two different decision-makers in the insurance benefits arena: the insurance company itself and the employer who chooses from among available plans for their workers. Besides contacting the insurance company to inquire about your coverage specifics, talk to the staff responsible for managing your employer's insurance plans. I have specialized staff at Houston Fertility Center who can help you work with whatever insurance plan your employer has chosen.

When you consider how much you'll pay for a car, real estate, travel -- none of which can be compared to getting pregnant and having a baby -- the typical price of a single IVF cycle doesn't seem quite as significant. Some clinics like Houston Fertility Center are able to offer price variations throughout the year. For example, right now, we're offering IVF cycles for $9,250, a considerable discount off our usual rate, through November 30th, 2011. As a way of thanking public servants, I also offer discounted services to teachers, police officers, and fire fighters during different times of the year (like summers, so teachers can benefit during their vacation season.)

The important thing -- which Dr. Kathy D. alludes to in her blogpost -- is to not stop short of getting all the facts. You wouldn't base all of your hopes and dreams for your home and lifestyle on a few personal stories heard on the Internet. Find out for yourself if IVF is out of reach. And if it is, we'll help you find options to make it affordable.

~ Dr. Sonja Kristiansen M.D.

Get Your OB On Board: Regular Menstruation Does NOT Equal Fertility

2011-11-10T07:00:00.000-06:00

"Getting your period" is a big event for girls. And many a parent or counselor has tried to console young women's related worries by offering comments that equate menstruation with motherhood. It's understandable that so many of my patients at Houston Fertility Center grew up with the message that if you're menstruating, you can get pregnant.

Your OB/Gyn may even tell you something similar. After all, it's basically true for the average woman with average fertility. But if you're one of the many women who has regular menstrual periods but can't seem to get pregnant, you might be feeling dismissed by your primary care doctor's casually hopeful remarks.

Once you have reason to understand more than the average woman about menstruation, you'll find that the connection between periods and fertility is a bit more complicated. Your OB/Gyn might do a great job of providing you with that in-depth education about the reproductive details of menstruation -- but you'll probably first have to request more explanation. And never hesitate to ask! You definitely won't be the first patient in my office to say with great frustration, "But, Dr. Kristiansen, I have a period every month!"

Your body's menstrual and ovulatory cycles are absolutely linked, but they are also separate. Both cycles are the result of communication between several organs and glands which emit different levels of various hormones, producing a cascade effect that's supposed to be ongoing. There are so many different points along the path where something can go wrong. A small, seemingly insignificant glitch in one spot -- whether it's a gland that produces too much or too little of a hormone, or an organ that isn't responding to its cues -- winds up disrupting the whole fertility process.

Simply put, and as many Houston Fertility Center patients will attest, women can have regular periods and still be infertile, for many reasons -- some structural (as in blocked fallopian tubes), some hormonal (sometimes resulting in anovulatory bleeding, in which no eggs are being released).

It's pretty complicated. And if your OB/Gyn is more OB than Gyn (they're really not all the same!), then their focus in both training and, more importantly, experience may be on helping women manage their pregnancies and deliver their babies -- not on the many things that can go wrong when you're trying to get pregnant.

So if you've heard "If you're having a period, you have nothing to worry about" from your doctor, he or she may not be putting you off or ignoring your worries. It might just not be their area of expertise.

This is the 3rd post in a series called Is Your OB On Board With Baby-Making?
Also see: Get Your OB On Board: Time Is (Almost) Everything

~ Dr. Sonja Kristiansen M.D.

Fertility Treatment & Wellness Go Hand in Hand

2011-11-08T09:25:00.000-06:00

A recent article on Fertility Authority reminds fertility patients to get their flu shots (and be sure you get the shot, not the nasal spray!) The article reminded me about all the preventive health measures that might get back-burnered by patients.

Many new patients at Houston Fertility Center enter fertility treatment territory in great physical shape and feeling emotionally hopeful. Some arrive at their first consultation already dragged out, physically and mentally, by their months or even years of trying to conceive. Naturally, their first question is, "Dr. Kristiansen, what can we do to finally get pregnant?" My first recommendation for all of them is to optimize their fertility at baseline by getting or staying healthy, whatever that means for them.

Once you enter fertility treatment, you could find your calendar newly crowded by the required exams and office consults, by scheduled at-home injections and tests, even by scheduled intimate time with your partner. It's easy to lose track of all the good things you've learned to make a regular part of your day-to-day experience to keep yourself feeling fit and well.

Fertility treatment and preventive health measures are different yet interactive. Many facets of your fertility in general can change, for better or worse, as your overall health changes. So you could say your efforts at maintaining wellness -- balanced, healthy diet, moderate and regular exercise, relaxation activities, managing exposure to toxins -- are even more important during this point in your life.

So do remember your flu shot and all the other good things you do to stay healthy. And if you haven't yet instituted preventive health activities into your life, now's the time. It's an investment not only in your wellness, but your fertility, too.

~ Dr. Sonja Kristiansen M.D.

IVF Myths: You'll Wind Up With a Football Team

2011-10-24T06:00:00.000-05:00

More debunking of myths about IVF, referring to a recent blogpost I found by Dr. Kathy D.

Myth #2. “IVF produces twins, triplets and more”

Bearing in mind that this is a quick blogpost and not a full-on journal article on the subject, Dr. Kathy D. is right about the age of a woman's eggs. But I want to interject that there are many more facets to consider when trying to institute how many embryos should be transferred in an IVF cycle. So in fact, the decision to use single embryo transfer (or SET) is not as clear cut as it sounds.

Age of the hopeful mother is a huge factor, as is her overall health. Possibly the even greater factor we take into account is the grade of the embryo.

Embryos are graded by observing several parameters. For a detailed but patient-friendly description of the embryo grading process, check out this Healthline article.

At this week's annual gathering of the American Society for Reproductive Medicine, the question of how many embryos to transfer was addressed again. It is, indeed, still an unanswered question -- but we're getting closer!

One poster presentation, titled simply "Optimum Number of Embryos to Transfer on Day 3 to Achieve High Pregnancy Rates and Low Multiples Rates Based on Patient Age and Embryo Quality," looked at 717 ART cycles at one IVF center with Day 3 (post-fertilization) transfers and their outcomes. Their conclusions:

Patients < 35 yrs; transfer of 1 Top quality embryo is recommended. Addition of a second embryo for transfer increases twin rate without significantly increasing pregnancy rate.Patients 35-37 yrs; transfer of 2 embryos is recommended to achieve desired pregnancy rate, however, risk of multiples needs to be addressed particularly if Top quality embryos are transferred.(L. Hill, S. LaBrie, P. St. Marie, K. Lynch, E. Tougias, M. Arny Baystate Reproductive Medicine, Baystate Health, Springfield, MA)

Researchers are continually trying to determine the best culture medium, the best time period, the best tools for helping fertilized eggs grow into the healthiest possible embryos, but there are many things out of even the best embryologist's control. Still, conscientious fertility specialists, like the staff of Houston Fertility Center, stay on top of the latest findings and apply them in their labs and clinics.

Whether your specialist is in Houston or New York or any other location, we're all interested in how to make pregnancy a reality for our patients. So success -- a healthy singleton baby -- becomes more quickly achievable all the time.

IVF Myths: It's "Last-Ditch" Fertility Treatment

2011-10-05T11:38:00.000-05:00

When it comes to fertility treatment, IVF (in vitro fertilization) is indeed the most costly and invasive technique available. But it's also very successful -- in many cases, the only thing that works -- for helping men and women who might otherwise not have a chance at having biologically related children.

I recently ran across this blogpost that nicely sums up a few of the myths about IVF. The author, a physiologist and reproductive endocrinology researcher, also has personal experience with using IVF to build her family.

I'm going to write my own responses to Dr. Kathy D's debunking of the myths she calls "most common" through the next few posts.

Myth #1. IVF is a last-ditch effort to become pregnant

She's correct in her responses to this myth! But I'll add that for many patients, IVF is definitely "a last-ditch effort."

For some infertile patients, like those described by Dr. Kathy D., IVF is the only way conception is going to happen. In those cases, heading straight for IVF first is sensible. But for most fertility patients, making the choice to use IVF instead of, say, intrauterine insemination (IUI) is definitely a step that feels like the "final straw" in a series of attempts. In fact, this patient page on "Preparing for IVF: Emotional Considerations" puts it succinctly, saying that for most people, IVF is "the last, best option for having a child."

No experienced, qualified fertility specialist will tell you that IVF (or any other treatment) will definitely result in pregnancy. But it is true that IVF, in particular, helps us get around the greatest number of obstacles and barriers of the most severe nature. So it's no wonder everyone thinks of it as "last-ditch"!

When to recommend IVF for a fertility patient is part of the art (and I don't mean Assisted Reproductive Technology here) of medicine. Some of my colleagues will recommend IVF a little too soon in a patient's fertility treatment journey, while others might wait until it's only going to work with a third-party involved (most often, an egg donor). It takes years of experience on top of specialized training, plus an excellent laboratory team (like the staff I'm grateful to have with me at Houston Fertility Center) to know when a patient's family-building needs will be best served by IVF versus other techniques.

So this myth is actually reality for some patients. And while your attitude and feelings toward whatever medical treatment you choose is important, and timing is a crucial factor in fertility treatment success, in the end, whether it's "last-ditch" or not -- IVF works.

If You're Trying to Conceive, Skip the Triathlon. Try Yoga.

2011-09-27T08:26:00.000-05:00

Along the same lines as there being no magic to getting pregnant, whether with IVF or without treatment, there's also no perfect exercise that will lead to conception.

But... yoga comes close.

Conception (and pregnancy) have much to do with balance. Not too much of this, and just the right amount of that. Your fitness factors, including your weight and body mass index, flexibility and strength, all play roles in keeping your endocrine system humming along.

Choice of exercise is a very personal thing. You should take several things into consideration when choosing the type, level, and frequency of physical exertion you engage in, whether you're trying to conceive or not. For example, running isn't the safest idea for everyone, but for some, it's perfect. Swimming is great, but not everyone has regular, easy access to a pool. The same could be said of biking.

As this article in The Windsor Star describes, yoga is about more than stretching and posing. If done well, yoga can both strengthen and relax your body, which is a state of being that facilitates hormone health.

You may want to avoid the most rigorous forms of yoga (there are many different versions), including the forms that are taught in studios heated above 90 degrees. And if you can find a yoga instructor who knows specific poses that are good for your reproductive organs, that's a bonus. (Here at Houston Fertility Center, we'll help you find one...)

Remember, you're looking for balance through activity.
Put your dreams of being a triathlete on hold until after the baby comes, but don't shelve your body's need to move and breathe.

~Dr. Sonja Kristiansen MD

Building a Family In Tough Times

2011-09-19T10:20:00.002-05:00

The country's economy is struggling so much that women are quite possibly having fewer children as a result. A report published last month by the Centers for Disease Control likens the trend to the Great Depression's fertility rates.

My patients feel the pain. If getting pregnant the old fashioned way is harder now, imagine what it's like to need special fertility treatment in order to have a baby.

In that light, I'm currently offering a big discount on IVF: $7995 through November 30th.

Because Houston Fertility Center has its own state-of-the-art laboratory, I'm able to provide the highest quality reproductive medicine services at more affordable prices. And since this is the time of year when people living in the Houston area are caught between high electric bills (for air conditioning!) and impending holiday season expenses -- it seems like the best time of year to make family-building a reality for so many.

Hang in there!

~Dr. Sonja Kristiansen MD

When Egg & Sperm Don't Hook Up

2011-09-13T09:35:00.004-05:00

It's pretty amazing what is still being learned about the most basic points along the conception trail. The big news recently is about a molecule that helps sperm cells bind to egg cells.

Researchers are calling it SLeX, short for sialyl-LewisX. Their study found SLeX on 70% of the 195 unfertilised eggs tested. If your egg cells don't have SLeX, sperm cells won't connect to it for the mating game. The best news: the authors of the study, who came from Britain, Taiwan, and the U.S., believe this discovery might lead to related infertility treatments in only about two years.

But what about in the meantime? While clinical diagnosis of this condition may be a couple of years away, the treatment for women with missing SLex is already available.

Intractytoplasmic sperm injection, or ICSI, is available for patients whose infertility is caused by lack of SLeX, as well as other causes. ICSI is one of assisted reproduction's most fascinating treatments -- a single sperm cell actually being injected into an egg cell. And while it may sound like science fiction, ICSI is no longer experimental. In fact, ICSI's been around for decades now and used with great success in conjunction with IVF. In 2008, staff of Houston Fertility Center had a related poster presentation accepted for that year's meeting of the American Society for Reproductive Medicine. Our study concluded that patients using ICSI had higher implantation rates.

One of the most incredible uses of ICSI is to treat even the most severe forms of male factor infertility. Since IVF with ICSI requires only one good sperm cell, the treatment has made biological dads out of men who previously had nearly no chance of having offspring.

Developments from our greater understanding of how SLeX can make or break conception attempts might lead to quicker, more direct diagnosis for couples with unexplained infertility. Every little detail makes a difference.

~Dr. Sonja Kristiansen, MD

Cancer & Infertility: The Good Part of the Bad News

2011-08-29T09:25:00.003-05:00

We've known for a long time now that cancer treatment can save lives but also render survivors infertile, even completely sterile. Young people who were surviving cancer more often found their new lives had a huge gap: little to no chance of being a parent in the future.

Spurred by organizations like Fertile Hope and the Young Survivors Coalition, researchers began focusing on fertility preservation techniques and their usefulness for this population. We've come a long way with what we can offer both men and women who want a chance at family-building after they're cancer-free. (At Houston Fertility Center, we offer a number of these techniques and even have a site devoted just to deferring conception by way of preserving fertility.)

Now, it appears as though the numbers of women with infertility resulting from cancer treatment is bigger than we thought. A large survey study by the University of California, San Francisco (UCSF) has concluded that our previous understanding may have given women "unrealistically low assessments of their risks" for infertility.

Some of the salient points of this study:

*Acute ovarian failure (no longer having a menstrual period after chemotherapy) increases significantly with age at cancer diagnosis.

*For women who did not experience loss of menses, incidence of infertility increased significantly with age.

*The younger the woman was when diagnosed with cancer, the higher her chances of early menopause.

Learning that the impact of chemotherapy on fertility is greater than we assumed -- that's the bad news.

The good news? That we now have that knowledge and can let women and their oncologists know that the need for fertility preservation is more prevalent than we used to think.

Putting the Risks of IVF in Patients' Hands

2011-08-19T09:39:00.003-05:00

Australia is home to some renowned fertility specialists. They've also developed a reputation for research on the offspring of IVF, and the most recent information is now being provided in brochure form to patients in Victoria. The brochure is produced by the Victorian Assisted Reproductive Treatment Authority, an Australian institute that helps regulate the use of A.R.T. in that country.

The news about how "The Children of ART" are doing is important to the patients I see at Houston Fertility Center (Here's a link to a related newsletter, now archived on CallDrK.com.) IVF has been helping people conceive babies for more than 30 years now, so current patients can benefit from long-term studies on their development.

So far, the news is overwhelmingly positive, as this brief, related news piece from the Herald Sun explains. One of the biggest hurdles to health for both baby and mom is multiple pregnancy (often a precursor to preterm and premature births), and the fine-tuning of IVF techniques has resulted in far fewer of those. The article also mentions parenting anxiety as being more prevalent in IVF mothers, but I'd wager there are some cultural differences there. Seems to me that in this day and age, most savvy moms have a lot on their plate to worry about, so some anxiety comes with the territory -- no matter how your baby came to be.

The data on a topic as broad as "development of children born from IVF" will always be changing and sometimes debatable. The important thing is that it's out there, that researchers are continuing to explore with long-term studies, and the information is in the patients' hands.

~Dr. Sonja Kristiansen

Get Your OB On Board: Time Is (Almost) Everything

2011-07-25T11:08:00.007-05:00

Being in the right place at the right time can make a difference in your life. It's true for getting pregnant, too. And your OB/Gyn knows how key timing is to pregnancy and delivery.

Does your OB also know how time impacts your ability to get pregnant? If he or she doesn't, you should.

At Houston Fertility Center, I've heard from many new patients their personal reports of months, and sometimes years, full of worry that something is wrong -- all the while being told by their primary care physicians that the best thing to do is de-stress and have patience. Nothing's wrong. Relax and you'll be pregnant in time.

It's true that stress can be a fertility factor, since it wreaks havoc on your hormones, which can result in lessened fertility. But many patients have health conditions that might easily be diagnosed and treated so that conception and pregnancy can occur -- stress or no stress. (And if stress really is your primary fertility problem, there are plenty of recommended steps you can take to change that.)

There's one factor in the fertility equation that treatment can't do much, if anything, about: time and your age. And there's nothing that has a greater impact on your chances for pregnancy.

While we have incredible medical technology that can help women get pregnant all the way into their 40's, the natural fact is that women's fertility levels decline significantly as they get older. That means the older you are when you're trying to conceive, the more effort it may take. It also means your chances of conception get smaller.

Age and time are so important to fertility, experts recommend you consult a reproductive specialist if:

you haven't become pregnant after a year of trying and you're a woman who's younger than 35 years

or

you haven't become pregnant after 6 months if you're 35 to 39 years old.

And women who are 39 years or older should seriously consider talking to a specialist as soon as getting pregnant is a goal.

The American Society for Reproductive Medicine explains details of the age-fertility connection in their related booklet.

Besides the reproductive change that every female body goes through (and that actually begins long before most of us are aware of), many infertility-causing conditions are silent -- no symptoms to cause you concern, all the while the condition becomes a growing barrier to your body conceiving a pregnancy. If you have one of these barriers, which includes structural conditions, trauma, or infections, your own baseline fertility will quite possibly become worse over time.

If you've heard "Everything's fine," a little too often from your OB/Gyn, there's no harm in seeking a second opinion. You might benefit from some easy, inexpensive blood testing or semen analysis, or like some patients learn, it may only take a thorough medical history and brief educational tips on optimizing your trying-to-conceive efforts.

More of my thoughts about timing and conception:

Trying to Get Pregnant After 30 - Time to Panic? - a blogpost about how moving along with your plans is good, but stressing out about it defeats your purpose

Timing Is Everything: When You Want a Baby Later - a newsletter article on using ART to delay conception

a quick intro to Fertility & The Mind-Body Connection

~ Dr. Sonja Kristiansen MD

Is Your OB On Board With Baby-Making?

2011-07-15T06:00:00.000-05:00

When questions about getting pregnant arise, most women first turn to their OB/Gyn. You probably even rely on your OB/Gyn as your primary care physician, especially if you have health insurance. Patients typically count on their OB/Gyns to alert them when it's time to see a fertility specialist.

Unfortunately, though, a lot of woman also find that their OB's may not act very quickly when the patient expresses more than just fleeting thoughts but worries about getting pregnant.

That's why I and many of my colleagues spend at least some of our time educating other physicians about the differences in fertility levels and about how those differences may show up in their otherwise healthy patients.

If you're not yet a fertility patient (and you may never have to be!), here are a few related basic points to look into and discuss with your OB/Gyn if your goal is conception:

How long have you been trying to conceive?

Do you know when your most fertile times are each month, based on your cycle?

Do you have any family members who had trouble getting pregnant?

And if you're in your mid-30's or older and are still thinking "maybe someday"... it's time to discuss plans now with your physician, even if you don't plan on putting it into action immediately.

Knowing when to seek care from a fertility specialist can really make the difference between having a baby or not. If your OB/Gyn doesn't know what to look for or doesn't ask you the above questions, start the ball rolling yourself.

How Do Fertility Patients Feel About Donor Anonymity?

2011-07-11T10:33:00.002-05:00

I work in a medical field that is ripe with controversy at times. There's nothing casual about helping people try to create life. But I try to avoid bringing a sense of alarm to my patients, even when the news headlines are worrisome. I do think there's a place for staying updated, though, when the news is about laws that may find their way into how I practice reproductive endocrinology and how my patients' treatments will be impacted.

The most recent such item is a state law that's about to bump up against the way things are often done for patients who need third-party reproductive treatment. Later this month, the state of Washington will enact a law that chips away at the anonymity of egg and sperm donors.

Now, most fertility specialists and their patients have been sharing medical history from their egg and sperm donors. It makes good common sense in light of what we know about genetic transmission of many things. If you have a baby using an anonymous donor's sperm or eggs, you likely at least want to know if there are potential medical conditions that may show up in your child. But the sharing of identifying information about donors has long been handled case-by-case, depending on the needs and comfort level of the donors and the fertility patients.

The Washington state law requires that anyone who donates eggs or sperm must provide both medical history and identifying information. Also, children born from third-party reproductive techniques will now be allowed to obtain the donor's information from the fertility clinic once the child becomes 18 years old. However, donors can file a disclosure veto with the clinic that prevents the identifying info from being revealed to the offspring; only the medical history is mandated to be disclosed on request.

This is a first in the United States, but it's not a surprise. Adult donor offspring over the past few years have been gathering to make their needs known. In some countries, donor anonymity is already a thing of the past. America has been slow to legislate these unique and intimate relationships. Those of us impacted by such laws -- fertility specialists, patients, and their families -- will be watching with interest to see if Washington state encounters some of the challenges that have resulted in other nations, most notably a serious decline in the number of available sperm and egg donors. In the meantime, I will continue serving my patients' best interests by providing access to the highest quality fertility care available, including third-party reproductive technology.

~ Dr. Sonja Kristiansen MD

Here's what Huffington Post blogger Naomi Cahn had to say about the new law and its potential repercussions: The Biological Clock -- for Donor-Conceived Offspring?

Disney and I Both Hope You Won't Need My Services

2011-06-27T09:00:00.000-05:00

The other day I saw a headline that really pulled me in -- "Disney/ABC Television Group Sponsors The American Fertility Association's Infertility Prevention Program".

The combined images of Disney and infertility were curious, indeed. When was the last time you thought about Mickey Mouse and fertility problems at the same time? But that odd juxtaposition is actually the result of positive progress in terms of fertility education.

Truth is, as a mother and physician, I hope you don't need the services of a fertility specialist, now or later. But another truth is explained in this recent blogpost on EmpowHer, "STDs and Infertility", where the author, Stacy Lloyd, explains how some young women are destined for infertility down the road. And it's those facts that make me smile when I read about Disney/ABC TV granting funds to the American Fertility Association (AFA).

The AFA works hard to not just support men and women who are struggling with infertility, but also to educate everyone about the realities of normal fertility. When young people arrive at the point in their lives when having a baby feels like the right thing to do, some are shocked to find that, all along and without their knowledge, their bodies have built up roadblocks against conception. Programs like the AFA's "Infertility Prevention Handbook" and their outreach gatherings at a broad variety of venues (even manicure salons!) can spread the message that steps can be taken before infertility is a fact in someone's life.

Since Disney definitely brings to mind "family", I think it's fitting that the corporation supports efforts at keeping couples from having to consult fertility specialists in the future.

You can find out more about the AFA at their website.

IVF Works for Hispanic Women, Too

2011-06-23T12:14:00.003-05:00

Many of my patients may be relieved to hear this piece of research news from a colleague in San Antonio: Hispanic women are just as successful with IVF as are non-Hispanic anglo women.

There's no particular reason to believe otherwise, but a previous nationwide study that compared IVF success rates among women of multiple ethnicities showed that Hispanics were 13 percent less likely to have a baby following the procedure. They were, however, just as likely to get pregnant via IVF as anglo women.

The newer study is smaller and included only patients at one clinic. Also, nearly all the Hispanic study subjects were Mexican-American, unlike the larger, national study. It also showed that while getting pregnant is comparable in terms of percentages, Hispanic women were more likely to miscarry, although the researcher, Dr. Robert Brzyski, says that's likely a chance occurrence.

Of particular interest is the clear difference in cause of infertility between whites and Hispanics. White women had more endometriosis and Hispanic women were more often diagnosed with tubal factor infertility.

Tubal blockages and resulting infertility were the original reason for IVF being invented. As long as other factors aren't impacting a woman's chances for pregnancy success, using IVF to work around tubal factor infertility is very effective.

Like Dr. Brzyski's practice, Houston Fertility Center is in the middle of a richly diverse metropolitan area. With Spanish-speaking staff and educational efforts within the Hispanic community, we provide every opportunity possible to bring home the message to women that infertility is treatable. I'm happy to be able to add this piece of good news to our message.

~Sonja Kristiansen, M.D.

There's Something Special About Fathers-To-Be

2011-06-16T08:34:00.001-05:00

I've worked for many years to help couples finally achieve their dreams of parenthood. As Father's Day approaches this year, I'd like to tell you what I think about the men who come into Houston Fertility Center. They arrive, nearly always with the other half of their team (wives or other partners), sometimes with great anticipation, but more often hesitantly.

I just can't say enough about how important it is that they are there, in my consultation office, sometimes in the exam room (depending on the couple's circumstances), learning how to give injections to their loved ones, sticking their own arms out for blood draws, enduring rather embarassing semen analysis, and just being a part of the team in general.

Hopefully by now everyone knows that infertility isn't "a woman's problem," that it's a situation resulting from many different conditions, statistically dispersed equally between men and women. There's virtually no good reason for a woman to go through infertility testing alone.

And no matter how forward-thinking and sophisticated and educated we are, it's still more difficult for men to discuss infertility -- especially with someone other than their partner -- than it is for women.

So here's to you, guys. Thanks for being part of the process and an active team player. We truly couldn't do what we do for the women you love without you.

If you're into social media, here's a treat for you guys: On Friday, June 17th at 2pm ET, RESOLVE is hosting a special Twitterview (sort of like a Q&A session by tweet) with Alec Ross, blogger at I Want To Be a Daddy.

Here's where you can get all the details on the Father's FriDay Twitterview -- http://www.mydestinationfamily.org/fathers-day-twitterview/

Happy Father's To Be Day,
~Sonja Kristiansen M.D.

Celebrate Fertility Freedom

2011-05-27T11:16:00.004-05:00

The Memorial Day weekend brings to mind time off from work and fun in the sun. It's also a time to remember those who sacrificed so we could enjoy that freedom. If infertility's a part of your life, it might be tough to conjure up this feeling of freedom -- but if you look closer, you'll see it.

Did you know that in some countries, egg and sperm donors are required to reveal their identity throughout the process? Since anonymity is what many prefer, the result of such laws is far fewer donors and fertility patients who must travel internationally just to get pregnant.

Even tighter restrictions exist in other nations where donor eggs are simply not allowed to be used for fertility treatment. Just imagine -- the only options available for these women is adoption, unless they travel to access IVF.

Just as incredible: freezing excess embryos is of questionable legality in some places. Imagine being lucky enough to create many embryos in an IVF cycle, but the law requires you transfer them all, increasing your already upped chances for multiples to dangerous proportions.

The United States continues to demonstrate leadership in the championing of individual rights, and this includes the health care arena. Fertility treatment is a highly personal choice and, so far, it's still very much up to the patient and her physician to decide which treatments to use and when. You can find out about the services we're free to offer at Houston Fertility Center's website, http://CallDrK.com.

Have a great weekend, knowing you're free to choose fertility treatment and make other decisions that are right for your life.

~Sonja Kristiansen, M.D.

15 Is Magic Number?

2011-05-16T15:05:00.001-05:00

Last February, I wrote that there's no magic to getting pregnant. That post was specific to "miraculous" fertility supplements. Well, now the news is full of "magic" again. This time, it's a Magic Number.

It's 15.

What kind of magic does the number 15 do for infertile couples?

A study that looked at 17 years worth of data concluded that 15 eggs retrieved in one IVF cycle renders the best chance of a live birth. Retrieving more eggs than that was linked to higher incidence of ovarian hyperstimulation syndrome.

The study authors failed to clarify that they were looking at conventional IVF cycles, not at cycles using very minimal or no ovulation stimulation medication. They did, however, tease out and present their findings related to the different ages within the study subjects. Specifically, the number 15 (eggs) did not make the live birth chances for women over 40 much better than otherwise. But as this article in the Globe and Mail suggests, a chance of live birth boosted by 4 percent might be inspiring to fertility patients older than 40.

I would remind patients that this is statistics, although well done. I worry about patients hearing these sorts of numbers and feeling stressed because theirs haven't "hit". As with so many aspects to treating infertility, your mileage may vary. We do everything possible to make each cycle safe *and* effective, and always, the outcome -- a healthy baby -- is our focus.

Tis the Season For Donor Eggs: Fresh or Frozen Work

2011-04-21T14:06:00.002-05:00

In our minds, the concepts of fertility and eggs go hand-in-hand -- especially this time of year. Now, there's some very good news for those who want to either preserve their fertility for the future or otherwise have a Plan B in the freezer for subsequent treatment cycles.

Research performed in the nation of Cyprus has concluded that frozen donor eggs are just as likely as fresh to have a pregnant outcome.

Freezing sperm for later use is almost fool-proof, it's been done for so many years. Likewise, freezing embryos has become a far smoother process that ends in success more often than not. Freezing eggs, on the other hand, has been a challenge.

I've spoken often about the use of egg cryopreservation technology -- the tricky nature of the egg cell that makes the freeze-thaw processes so tenuous, and the hope that comes with improvements on the technique. In 2008, I was interviewed by Houston Business Journal about the intersection of related advanced reproductive technology and society. The ASRM has long been pleased to hear of frozen eggs being used for women prior to cancer treatment, but they've been slow to agree on the technique's use for women who aren't preserving fertility in the face of life-threatening illness.

Now, a new subset of patients are given hope by frozen eggs -- women who must use a donor's eggs to conceive a child.

Arriving at "Honey, I think we need to use donor egg to get pregnant" comes only after some serious thought about very tough topics. Women who've gone through menopause prematurely in life -- a huge psychological burden itself -- and older women who've deferred pregnancy find themselves giving thought to what most people don't have to: "I can either have a child who isn't genetically related to me, or not at all."

Using donor egg to get pregnant also adds to the financial burden of these patients, since they are required to meet the donor's compensation needs.

Among other benefits, documentation of frozen donor egg success increases the possibility of egg banks, similar to long-standing sperm banks, which might then make the entire process cost less. More directly for patients, knowing that subsequent cycles using their donor's frozen eggs can be just as likely to help them get pregnant as that first fresh cycle -- that's a huge load of stress taken from the patients' shoulders.

Any bit of hope we can offer to donor egg recipients is a good thing in my book. The news that frozen donor eggs can be just as successful in rendering a pregnancy is very good.

Personal Desires Still Strong During World Crises. And That's Okay.

2011-03-25T08:09:00.002-05:00

As I write this blogpost, I recognize that there are many people in the world trying to survive dire circumstances. And I suspect that many readers who are infertility patients might be experiencing twinges of related discomfort.

For example, the other day I read a Facebook post from someone expressing a sense of guilt over how good her life is compared to people in places like Japan and Libya. She revealed her true feelings: that she was having a hard time enjoying the excitement of an upcoming, hard-earned trip to Disney with her family, because she was so acutely aware of the world's distress.

As you might imagine, her friends responded with comments supportive of her desire to be happy. As one posted, "Nobody in Japan wants you to be unhappy!"

With infertility, the pain you feel is most often hidden from the world. You don't want to be the one who brings sadness into a baby shower. You'd rather friends not see the hurt on your face while they chat about their little one's latest antics. The very fact that you keep grief a secret can compound your sense of isolation, which makes a little pain feel overwhelming.

On the other hand, just as we realize how much worse things can be for others -- as in the case of so much recent news from abroad -- you don't begrudge your friends' pleasure at being new parents.

The bottom line is that we are all human, and we all have drives, the strongest of which is to have a baby. We cannot all feel direct empathy for everyone, but we can strive to understand and be sensitive toward each other. In truth, we really do want everyone else to be safe, happy, and have their hearts' desires.

As many of you are, I am praying for people around the world, for peace and restoration in their lives and communities. I also continue on my personal path toward making life better for myself and for those directly around me, including my patients, because that's where it all begins.

How Many IVF's Is Enough?

2011-03-11T10:19:00.007-06:00

Yesterday I wrote about the importance of perseverance in fertility treatment. And in light of research that says "more IVF attempts equals greater chances of success" plus my concurring with Dr. Rosen's comment that likelihood of success per cycle decreases... here's my explanation of what sounds like conflicting stances:

There are so many facets that add up to IVF success or failure, we potentially learn something each time we use this technique for a patient. I use every tool I have -- the latest research findings, my years of experience in treating infertility, state-of-the-art equipment, highly skilled staff -- and still must approach each patient as a unique situation. Every body is different.

So any treatment cycle is an opportunity for us to find out more about how this body responds to various components of the IVF journey. When subsequent treatments are required, I take what we've learned, adjust the plan accordingly, and continue to observe the results carefully. Try again.

Decreasing success per cycle may not be related to the failure of the IVF technique itself, but to an organic sort of patient-screening dynamic.

For example, a patient chooses to undergo IVF. Her diagnostic workup reveals a potential reason for her infertility thus far, and we believe IVF can help resolve this issue. Her first IVF attempt does not result in a pregnancy, yet through that experience we learn something else about this patient's fertility factors. We decide on parts of the IVF process to change -- we may tweak the medication protocol, or use some additional technique or tool -- and we all try again. If we continue in this manner, the IVF process may wind up revealing even more causes of this patient's infertility with each treatment cycle. In most cases, after paying careful attention to a patient's IVF responses and adjusting the next cycle accordingly, success -- a healthy pregnancy -- is the outcome. For some, the result is coming to terms with the need to move forward, either with a different treatment technique or to adoption or to living child-free.

So in some situations, each procedure adjustment we make whittles away at the possible infertility causes until finally, we determine that IVF either is or is indeed not the answer for this patient. But there may have been no way to determine that fact if IVF had not been tried.

Of course, passing time is one of the biggest factors for decreasing success rates per cycle. Especially for women who are already in their 30's when they start fertility treatment, the natural biology of the female results in fewer chances for pregnancy as her body ages.

To some extent, medical treatment -- not just for infertility, but other conditions as well -- involves taking risks. My fellow practitioners and I always first balance the risk of harm to a patient versus the potential success of treatment. Each patient is different, not only in their body's responses to treatment, but in attitude and ability to move forward. Some are naturally more at ease taking risks, while others are more comfortable risking little. Helping patients make those choices is part of my job.

~ Sonja Kristiansen M.D.

Try, Try Again

2011-03-10T10:39:00.002-06:00

"If at first you don't succeed, try, try again."
I can nearly hear your sighs. One of the hardest parts about infertility and its treatment is the need for perseverance. Many of my patients who are now parents will tell you that even more than peaceful patience, going through infertility treatment and keeping your sanity requires maintaining a heavy dose of "hang in there".

Recently, Australian researchers concluded that the likelihood of IVF success increases with each cycle. This is especially true for mothers-to-be who are older than 35, but even for younger women, going through an average of three IVF cycles boosts success rates up to 58 percent.

Granted, this makes common sense in a way -- the more you try something, the greater the odds you'll succeed eventually. But this isn't the first bit of research that hints at something more: the treatment learning curve and the artful practice of medicine.

of course, as Dr. Rosen points out at the end of the article in BioNews, the likelihood of success per cycle decreases, and eventually an end to treatment attempts may need to be considered for some patients. I'll discuss that seemingly paradoxical point in a future blogpost.

For now, I'll leave you to consider the reality that, yes, for many fertility patients who choose IVF, it takes more than one treatment cycle to get pregnant. As I mentioned in my last blogpost, coming to grips with treatment realities is a kind of loss. Perseverance is a good trait to muster. And when you run out of your own, borrow some from a loved one or friend. Keep trying.

More to come...
~ Sonja Kristiansen

Infertility's Grief: Unwelcome, Yet Present

2011-03-07T12:30:00.000-06:00

We typically think of grief as related to traumatic events in our lives, and mostly, in terms of death. It's not a word that anyone wants to apply to their present or future, and even thinking about grieving in the past is tough.

But grief is often a big part of infertility for most patients.

Even for patients who are quite pro-active and forward-thinking about treatment, where infertility is, so is loss. And with loss, necessarily comes grieving.

The first loss that comes hand-in-hand with infertility is the dream of how you thought getting pregnant and having a baby would be. That's a loss that virtually every infertility patient must grieve. From there, variations in grieving depend on many things, including how individuals cope with whatever life throws their way.

I've had patients come to me and say, "Dr. Kristiansen, I'm finding it hard to stay positive about our fertility treatment."

To make it through the losses and grief of infertility, the first important step to take is simply acknowledging they are there. Doing so -- looking loss and sadness matter-of-factly -- does not mean you're being pessimistic. Optimistic thinking based on unreality is not helpful for anyone. Optimism that starts from a solid foothold of understanding where you are is the kind of thinking that allows you to put one foot in front of the other toward resolution.

No need to wallow in it, but if you find yourself doing so, be forgiving. Seek help. It's here.

The staff of Houston Fertility Center can refer you to resources that can support you through your grief.

Here are a couple of related items online:

Writer Ryan Jacobson succinctly described the grief of infertility from a personal perspective in this article, "Infertility: I Wish Someone Would Have Told Me"
He also gives very direct advice to friends and loved ones of those struggling through infertility.

While "how-to's" can sometimes oversimplify complex emotional processes, they can also be helpful for breaking down tough stuff into do-able chunks. This is one filled with meaningful steps:
How to Grieve Infertility Losses
By FaithAllen on eHow

Wherever you are in your journey, I and my staff are prepared to meet you.

~Sonja Kristiansen

There Really Is No Magic to Getting Pregnant

2011-02-25T11:17:00.002-06:00

I'd really like to be able to give my patients an easy how-to for getting around their fertility issues. And people who are desperate to finally get pregnant and become parents are easy prey to reputed quick fixes. Fortunately, long gone are the old days of the tonic seller with ridiculous promises. But today's marketing techniques, finely-tuned with psychological research data, can be pretty convincing even to educated fertility consumers.

Take the idea of fertility supplements.

Granted, research studies linking nutrition and fertility have boomed in the last few years. What you eat is indeed a key factor in how you feel and how your body functions, even when it comes to fertility. Every qualified dietitian will tell you that the best source of health-promoting nutrients is food. Supplements are considered a back-up plan, and in some cases, their effectiveness is unproven.

In a Los Angeles Times article, Chris Woolston, aka The Healthy Skeptic, discusses two popular supplements: FertilAid for Men and FertilityBlend for Men. Both are promoted as providing nutritional enhancement for male fertility, specifically, sperm motility and count.

It's a good article that balances the claims of the supplements' makers with commentary by male fertility specialists. The important take-away message that eager-to-be-dads need to hear: supplements can be good for your health, but they aren't miracle cures.

And by the way -- the very same can be said for women, supplements, and fertility.

There's More to Healthy Babies Than Good Eggs

2011-02-23T09:38:00.003-06:00

We tend to focus on the very key component of viable egg cells in assisted reproductive technology. There's no doubt that "good eggs" are needed to make conception and pregnancy happen. A piece of the pregnancy puzzle that doesn't usually get as much attention is the impact of uterine health.

It makes sense, of course, that once an egg is fertilized, the resulting embryo needs a healthy place to implant and grow. The lining of the uterus, known as the endometrium, is that place. In cases of women with average to good fertility levels, the endometrium is primed for implantation by a variety of hormones relaying through her body. It's all part of the menstrual cycle. [Here's an explanation of how the endometrium works.] Timing is crucial -- both in natural and assisted conception -- because the lining is re-created and either used or sloughed off through menstruation on a cyclical basis, approximately every 28 days. If a woman's hormones are imbalanced, the result is sometimes an endometrium that's not ready to receive and nourish a conceived embryo. This can be a type of infertility.

We administer endometrium-enhancing medications -- such as progesterone supplementation -- to some patients, regardless of the assisted reproductive technique they're using to conceive. Ultrasound monitoring is used to view and gauge the health of the uterine lining, just as we use ultrasound to see how well a woman's ovaries are ovulating. Still, there's more to solving the pregnancy puzzle, and researchers have recently unveiled a new potential key.

A study of mice has resulted in the newly discovered connection between a protein called Hand2 and the control of the uterine lining's proliferation. The researchers' findings could eventually lead to more ways for fertility experts to help patients who have endometriosis or previously unexplained infertility.

Answering the question, "Why can't we get pregnant?" requires attention to many variables within each patient's situation. The responsive functioning of a woman's uterus is increasingly becoming the focal point of research. After all, there's a lot more to having a baby then simply creating an embryo.

~ Sonja Kristiansen

Does Race Really Impact Fertility Treatment Success?

2011-02-11T15:16:00.004-06:00

When a single research study looks at tens of thousands of ART procedures, the conclusions can be quite meaningful. Such a study received attention by Reuters this week with the headline "Weight, race tied to fertility treatment success".

Besides bolstering what we already know about weight and fertility, the study published in Fertility and Sterility determined that both failure to achieve a pregnancy and failure to achieve live birth are significantly more likely among non-white ethnicities. This finding was in light of adjusting for body mass index (BMI).

Unfortunately, since limited data was available to the researchers, their final conclusion about the difference in treatment success between white women (the reference group, having accounted for nearly 25,000 of the total 31,672 transfers researched) and black, Hispanic, or Asian women is that more studies are needed to discern reasons: "Future research should focus on clarifying the underlying causes of these disparities."

Having provided fertility care for over a decade now in a very ethnically diverse metropolitan area, here are my thoughts on possible connections between race and fertility treatment success numbers:

First, we know from past research that people from certain communities are not accessing fertility care as often as other groups. Financial reasons may seem to top the list, but the truth is that for some groups, there exist tremendous taboos against infertility treatment. Another related reason -- especially for Hispanic or Asian couples -- is language barrier.

That's one of the reasons Houston Fertility Center is hosting free Spanish-language educational opportunities -- to remove the language barrier as an obstacle to seeking fertility care. We hope, too, that our culturally diverse staff will be able to help curious couples feel comfortable enough to ask questions and find out about their family-building options.

Trying to determine what affects success rates based on ethnicity is not as simple as it may seem on the surface. For example, if the study did not include a breakdown based on how many patients used donor egg or not, we might see their results as skewed. That's because donor egg use is highly likely in older, white mothers-to-be and has an impact on success rate numbers.

I applaud researchers who undertake large-scale studies, and I look forward to future findings that can assist medical professionals like myself in our mission to truly make the finest fertility care accessible. In the meantime, the Houston Fertility Center staff and I will continue to reach out beyond our clinic doors to extend family-building services to all.

Los tratamientos de fertilidad: No hay ninguna razón que el idioma sea una barrera

2011-02-03T11:54:00.007-06:00

Desde la fundación, de Houston de 1836, el ambiente y cultura ha sido enriquecido una variedad de etnias y nacionalidades.

He estado al servicio de los tratamientos de fertilidad necesidades de otros países por muchos años. Ahora, el personal del Centro de Fertilidad de Houston se enorgullece de ofrecer jornadas de puertas abiertas para la gente que quisiera hablar sobre las opciones de creación de la familia en español.

Hemos estado conceintes que huestros pacientes que solo hablan y entienden espanol experiementantan una mayor sensación de aislamiento cuando se trata de la búsqueda de atención médica especializada. HFC siempre ha mantenido personal bilingüe para que nuestros pacientes de la fertilidad puedan ser plenamente informados a los participantes e interactivo en su tratamiento.

A partir de febrero, el Centro de Fertilidad de Houston tendra jornadas de puertas abiertas en nuestra ubicación 9055 Katy Freeway. Individuos y las parejas pueden hablar con nuestro personal sobre los problemas de fertilidad común, ¿cómo se hacen diagnósticos y opciones de tratamiento. Nota que no Habra una evaluacion especifica para cada paciente. Sino que contestaremos preguntas de una manera general. Con el fin de preservar un ambiente cómodo, cada jornada de puertas habiertas sera limitado a sao cinco parejas, de modo RSVP son necesarias. Se servirán refrescos.

Por favor llame al 713-862-6181 para más información y para confirmar su asistencia. La siguiente jornada de puertas habiertas sera el 15 de Febrero, a la 1:30 a 2:30 de la tarde.

No hay ninguna razón que el idioma sea una barrera en obtener atención de alta calidad de la fertilidad. Espero la oportunidad de continuar serviendo los habitantes de Houston en sus tratamientos de fertilidad.

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Fertility treatment: There is no reason for language to be a barrier

Since its founding in 1836, Houston's culture and ambience has been richly flavored by an incredible variety of ethnicities and nationalities.

I've been serving the fertility treatment needs of families from other countries for many years. Now, the staff of Houston Fertility Center is proud to offer regularly held open houses for people who'd like to talk about family-building options in Spanish.

We've known for a long time that our Spanish-speaking patients can experience a greater sense of isolation when it comes to seeking specialized medical care. HFC has always maintained bilingual staff so that our fertility patients can be fully informed, interactive participants in their treatment.

Beginning in February, Houston Fertility Center will host free open houses at our 9055 Katy Freeway location. Indiviuals and couples can talk with our staff about common fertility problems, how diagnoses are made, and treatment options. We should note that evaluations of patients' specific cases will not be discussed at the open house, but we'll be happy to answer questions in a general manner. In order to preserve a comfortable setting, we'll be limiting each open house to only five couples, so RSVP's are necessary. Refreshments will be served.

The next Spanish-language open house will be on Tuesday, February 15, from 1:30 to 2:30 PM. Please call 713-862-6181 for more information and to RSVP.

There is no reason for language to be a barrier to accessing high quality fertility care. I look forward to continuing opportunities to serving the fertility treatment needs of all Houstonians.

Some Folks Will Do Anything to Get Pregnant

2011-01-24T07:00:00.001-06:00

You've probably caught yourself saying things like "I'd stand on my head if it would help me have a baby!" A recently published study from Israel of 219 women going through IVF found that bringing in the clowns can help.

It sounds pretty funny, but this was bona fide research published in Fertility & Sterility, the journal of my esteemed colleagues, the American Society for Reproductive Medicine.

The clinic employed the services of a "medical clown" who performed a standardized routine for each patient on some days. Women who attended clinic on a "non-clown" day were less likely to get pregnant, even taking into consideration factors like age, infertility cause, and the number of embryos transferred.

Like the lead researcher, Dr. Shevach Friedler, says, it's "one of the least hazardous interventions" for IVF patients.

While I'm sorry to say that we don't have a clown on staff here at Houston Fertility Center (yet), we do take pretty seriously the growing body of research that points to connections between stress and treatment success. Besides offering a soothing environment at our clinics with staff members who are sensitive to your worries, we refer patients to massage, acupuncture, and counseling professionals, all of whom specialize in the needs of fertility patients. I'm a believer in the value of learning personal stress management and the positive impact on infertility and treatment.

You never know what people will try next. So the next time you're at our place for an appointment, don't be surprised if you hear laughter. After all, helping people make their dreams come true can be pretty fun!

Is Putting Off Pregnancy The Best Idea?

2011-01-17T09:18:00.003-06:00

An article in the Los Angeles Times recently touted the benefits of the economic recession in terms of women delaying pregnancy.

While I believe that there are certainly advantages (as described by the author) to later-aged motherhood, I think we need to tread carefully when discussing the impact of age on fertility in general.

The majority of women (and men) have no idea what their body's fertility status is until they try to conceive. Unfortunately for some, the news is not only alarming but comes too late for them to take advantage of treatment in an optimal way.

Of the many causes for infertility, many (perhaps most) are not age-related, it's true. But that rosy perspective can work in reverse -- if a woman's not ovulating or if her tubes are blocked, it doesn't matter how old she is: she won't get pregnant without assistance.

While we're looking for silver linings to the recession's dark cloud, let's not throw the baby out with the bathwater.

Your Environment & Your Fertility

2011-01-05T10:01:00.003-06:00

A small-scale study, recently published in Fertility & Sterility, adds to what we know about a woman's environment and the quality of her eggs.

In "Serum unconjugated bisphenol A concentrations in women may adversely influence oocyte quality during in vitro fertilization," the study authors conclude that, during IVF cycles, as levels of bisphenol A (BPA) rose, the number of fertilized eggs fell.

There is no simple test for BPA that can be administered in clinics. So, as with many things that may impact fertility, the best advice I can give patients is to try and reduce your exposure to BPA.

This Mayo Clinic article - What is BPA, and what are the concerns about BPA? - offers a quick list of things anyone can do to avoid BPA.

For more on this study:
BPA can affect egg quality, study claims

Male Infertility Research & Recommendations Long Overdue

2010-12-21T16:47:00.005-06:00

Last month, I wrote about more enlightening research on male fertility and dietary factors. A lot of women may not admit it, but some are perfectly comfortable stepping up and saying, "It's about time!" So far, most research has focused on female fertility and obstacles to conceiving. A recent article -- "The Bad Daddy Factor" -- points to some possible societal reasons why this may be the case.

Article author Emily Anthes goes all the way back to the 1960's to mention the few researchers who were looking at the impact of men's contribution on both fertility and infant well-being. She describes how most of their scientific colleagues weren't equally concerned, so the burden of cause continued to fall mostly in women's laps for decades. The writer goes on to connect this historical lack of aggressive research with society's viewpoints on gender and even politics. The good news: those viewpoints seem to be evolving.

Like my own colleagues, I am thrilled every time I hear about new interest in reproductive research. The more we learn about the causes of infertility, the better able we are to both educate young men about prevention and to treat the later results of lifestyle choices that are not fertility-focused.

On behalf of Houston Fertility Center's staff, my wish this season is that you and yours reap the benefits from advancing research, technology, and compassionate fertility care -- and grow your family with love.

Getting Through the Holidays with Infertility However You Can

2010-12-12T20:38:00.004-06:00

Seasonal holidays are tough on the spirit when you're trying to get pregnant and can't. The Web is full of places you can go to and read or chat with others about ways to cope. Here are a few that I recommend:

Thanksgiving: To Attend or Not To Attend: That Is the Question
The title says "Thanksgiving," but this piece by Lori Shandle-Fox on Fertility Blogs covers all family gatherings with a light heart.

Infertility and Holidays: Don't Just Survive - Thrive!
Tracy Morris on FertilityCommunity covers a lot of different emotional tactics that can help you view holidays from a different perspective.

The Season of Giving
An interview with Kathy Stern of Southwest Surrogacy Associates, LLC about the role of giving in third-party reproductive treatment, during the holidays and beyond.

The Perfect Storm of Holidays: Infertility and Christmas
Melissa Ford taps into a perfect analogy with "The Great Peanut Day". Use it to explain your emotions to those who just don't seem to 'get it.'

Tips for Facing Infertility During the Holidays
On ParentDish, Mary Beth Sammons interviews a woman who's been going through fertility treatment for six years. Her personal advice - "what helps most is 'to know that I'm not alone.'"

There are plenty more out there -- just search for "holidays and infertility" and you'll see that, indeed, you're not the only one.

Another Reason to Be Glad You're in America: Donor Supplies

2010-11-30T06:00:00.001-06:00

Getting pregnant with the help of a third party, either an egg or sperm donor, is a tough decision to make. And how much to share with the resulting offspring about their beginnings is best left to the parents. At least, that's the American stance.

This piece in the Scottish paper, the Daily Record, illustrates how bad things have gotten in the UK since anonymity of donor records was made illegal. So few men step forward to donate sperm there now that the health system is helping out by importing semen from London. Many hopeful parents-to-be are spending time and money to go abroad, to countries where third-party supplies are more plentiful.

For patients at Houston Fertility Center, we collaborate with highly reputable agencies that have both sperm and egg donors available and waiting. The level of interaction between fertility patient and donor can vary with the agency and, most importantly, with the needs of all parties involved.

The U.S. may still have quite a few unsettled issues in the healthcare arena, but we can at least rest assured that supplies for third-party reproductive care are just fine.

Weight Issues & Fertility Not Just a Woman's Concern

2010-11-23T09:39:00.003-06:00

Here we are again -- the end of year holidays. This time can have a real double whammy effect on people trying to conceive. First, there are the joyous gatherings... with babies everywhere. Then, there's the abundance of food, much of it rich and not-so-nutritious. You know, the kind that's so much fun to enjoy too much of...

Why is food a problem for people trying to get pregnant?

By now you've probably heard about the impact that weight has on a woman's fertility -- both too little and too much weight can result in ovulation disorders. Also, overweight women increase their surgical risks even for procedures as commonplace as egg retrieval. But there's more research now that says men need to keep an eye on their fatty food intake, too.

At this year's meeting of the American Society for Reproductive Medicine, researchers presented evidence that men with the highest intake of saturated fat had 41% fewer sperm than those who ate less. Also, men who ate more omega-6 and omega-3 polyunsaturated fats, specifically, had better sperm motility and morphology.

There is some good news on the research front for men who are overweight. The low testosterone levels that apparently go along with high BMI (body mass index) do respond positively to clomiphene citrate (Clomid).

But on this eve of one of our country's biggest binge-eating holidays, I'd recommend having a double helping of the carrots and lay off the gravy a little bit.

Also see:

When Fertility Really Is About Your Diet

Weight & Fertility (from my April 2007 newsletter)

Fertility Treatment for Cancer Patients Is Reality. Even If They Don't Know It Yet.

2010-11-18T09:17:00.004-06:00

Houston is a major destination for people battling cancer. The city's medical center is renowned for providing the most advanced cancer care available, and patients come from around the world to access life-saving science and techniques. Besides the facilities in the centrally-located Texas Medical Center, there are also cancer treatment centers in outlying areas around Harris County where patients are receiving the benefits of cutting edge research put into clinical practice.

More cancer patients are surviving and going on to live healthy, happy lives. But many forms of cancer treatment result in infertility. Fortunately, the technology exists now to take steps to preserving a person's fertility for the future. Freezing embryos and freezing eggs top the list of techniques proving successful. And for patients who have types of cancer that are transmitted genetically, the technology is available to screen embryos for the related genes.

I've networked for several years now with organizations that assist cancer patients, groups like Livestrong's Fertile Hope program, the Young Survivors Coalition, and the Susan G. Koman Foundation. Speaking to groups about fertility preservation is always eye-opening for them and for me. I continue to hear the same sense of surprise and sometimes regret from participants who wish they had known before undergoing cancer treatment. I wish they had known, too.

If you know someone who's struggling with cancer, let them know that infertility doesn't have to be part of the result. Help me and other reproductive endocrinologists make fertility treatment available to cancer patients, by spreading the word about the hopeful possibilities.

Also see:

Women Want Working Options for Motherhood
On Lindsay Nohr Beck's presentation at ASRM 2009.

Fertility Preservation and Oncology
My thoughts about Jane Brody's column on how oncology is still behind the curve in addressing their patients' future fertility needs.

Why I Attend the Meetings of American Society for Reproductive Medicine

2010-10-21T10:47:00.003-05:00

One of the reasons I felt compelled to move from straight OB/Gyn work to reproductive endocrinology-infertility (REI) is because of the constant advances in science. I find it exciting to apply techniques that have developed along a continuum from creative brainstorming on how to meet patients' fertility challenges all the way through validation in labs and clinics.

I'm heading to Denver this week with some of my Houston Fertility Center staff to attend the 66th Annual Meeting of the American Society for Reproductive Medicine. ASRM is always a great place to catch up with colleagues from around the world and hear about the latest ways to treat our patients. This year promises to be even more enjoyable as we'll be honoring two pioneers of IVF, Dr. Howard Jones, who performed America's first IVF procedure, and Professor Robert Edwards, who recently was awarded the 2010 Nobel Prize in medicine for his development of IVF.

Bestowing accolades on esteemed professionals is just part of the reason for gathering. More importantly, I look forward to returning to Houston Fertility Center with new ideas to share with patients on clearing their family-building hurdles. Sometimes, even a simple treatment can be years in the making. Once new technology is available, a whole new group of once-infertile men and women can find themselves parents, and that's why I do what I do.

When It Comes to Cancer, We're All On the Same Team

2010-10-01T09:12:00.002-05:00

Did you know that many women who survive cancer are unable to have children later? That's because life-saving cancer treatments can result in complete sterility. Fortunately, cancer survivors are increasingly speaking out about what they want out of life after illness. I've been privileged to offer these women fertility-sparing options so they can choose life both ways.

This Saturday, October 2nd, one of my sons is running in the 2010 Komen Houston Race for the Cure. A couple of years ago, I spoke to a gathering of women who form the Education Committee of the Susan G. Komen for the Cure Houston, the nation's premiere advocacy and research organization. The questions from this particularly well-informed audience led me to realize that more general public education is needed.

Cancer survival increases steadily. Fertility treatments to allow survivors to become parents is available. What is still slowly developing is a pipeline of patient information and referral. Too many women find themselves on the infertile side of cancer treatment asking why they hadn't heard of fertility preservation before it was too late.

The Komen Foundation has funded great strides in research to help women survive cancer and go on to have fulfilled lives. I urge you to do what you can to continue supporting their mission. And spread the word yourself to friends affected by cancer: fertility preservation is not experimental science. It is medical care that is currently available.

Fertility Drug Company Offers IVF Miracles Education Funding

2010-08-16T09:45:00.003-05:00

Once you've finally cleared your fertility hurdles to have that miracle baby, life's little related expenses start adding up fast. Educational costs aren't far behind those first birthday parties (and by the way, the staff of Houston Fertility Center really loves those party invitations!)

Since 2004, Ferring, manufacturer of fertility medications, has offered a chance at getting a little help to fund your child's academic needs. Houston Fertility Center patients who used Bravelle or Menopur can enter their essay in the My Little Miracle contest by December 31, 2010. This year's theme: If I Knew Then What I Know Now. The prizes: education funds of up to $10,000!

All the details can be found here, where you can also read the previous winners' entries for inspiration.

I'm honored to know my patients' miracle stories first-hand. I know some of them will make outstanding entries in the Ferring My Little Miracle contest.

Kneads Houston Brings Fertility Massage to Houston Fertility Center

2010-07-26T10:23:00.005-05:00

You'll never hear me suggest that a fertility-challenged woman should "just relax"! There definitely are connections, though, between how a woman's body handles daily stress and how her reproductive system functions.

The mind-body connection to fertility is no longer new information. What IS new are the approaches to helping women find ways to relieve stress, soothe their bodies, and thereby enhance their ability to get pregnant.

Also new: Houston Fertility Center's connection with Kneads Houston. I asked Magen Weishut to talk a little about the services available to HFC patients:

What do you think about the connection between stress, fertility, and massage?

Fertility and pregnancy can be very stressful, and massage can significantly decrease your anxiety level. High stress levels alter signals to the brain's hormone center. As a result, the brain may not send out the reproductive hormones necessary to tell the ovaries when to release an egg, delaying ovulation.

Since stress has been shown to interfere with getting pregnant, it makes sense that reducing stress, through massage, improves odds of conceiving.

Is this a special 'kind' of massage for fertility?

The main goal of fertility massage is to get the full body relaxed, so the body can function at a more efficient rate. Fertility massage focuses on cleansing the body, enhancing the blood, opening the breath, and relaxing and integrating, respectively.

From the clients point of view, the main difference between a massage they may have had before and what they will recieve with us is massage of the abdomen. Massaging of the abdomen helps the circulation to the ovaries, uterus, and other organs.

The specialized therapists from Kneads Houston will see our patients either at Houston Fertility Center locations or home or office -- just ask!

European Women Happy to Freeze Eggs for Future

2010-07-09T13:01:00.001-05:00

According to two studies presented at the annual meeting of the European Society of Human Reproduction & Embryology (ESHRE), European women are embracing the idea of egg freezing as a means of having more reproductive control over their lives.

A small Belgian study of women average age 38 years found that half of them planned to freeze their eggs to lessen the pressure they feel to find the best parenting partner. Most foresaw using their eggs for conception after age 40.

A larger study in the UK saw eight in 10 medical students would be willing to freeze their eggs so that career growth could continue to take a front seat.

Women in the U.S. are also warming up to the idea of using assisted reproductive technology even when infertility isn't an issue in their life. Advances in the technology have made egg freezing with IVF more affordable and even covered by some women's insurance plans.

http://www.bioedge.org/index.php/bioethics/bioethics_article/9085/

Why We Like Beautiful Babies

2010-06-22T16:40:00.001-05:00

I've chosen to be a sponsor for the Beautiful Babies contest, a national contest where parents can submit their babies' photos and win up to $5k (not to mention just the simple thrill of bragging rights!)

It may seem awkward, the Houston Fertility Center connecting to a competition where the thing our patients long for -- a baby -- is being celebrated. But I like to think of it as a healthy way to interact with the world. After all, babies -- all babies -- ARE beautiful. That's why we strive so hard to have our own. Aside from their extreme "cuteness factor" we're geared instinctively to appreciate our own offspring over any other of our lives' creations.

The other side of our sponsorship is that after all these years serving infertility patients, many people who come to our Center now are doing so to have another baby. We have a wall full of happy faces, and we thought this would be a delightful way for our patients, past and present, to share their joy (and maybe win big!) It's a lighthearted contest where friends and family are asked to vote for their favorites.

If you'd like to join in the fun, you'll need to submit your child's photo by this Friday, June 25. You can find out more details through this link. http://kiah.tribunepromotions.com/babies/

How Old Is Too Old?

2010-06-22T09:33:00.001-05:00

Recently, a local colleague of mine was quoted in the media about having an "an age cutoff" for fertility treatment, specifically IVF. I thought I'd enter the field to air my own thoughts on the question of "how old is too old" for becoming a mom.

In my practice at Houston Fertility Center, I don't use any particular age to determine whether a woman is "too old" to use IVF. Mother Nature will determine when a patient's body is unable to conceive. So we explore the same related variables -- egg reserve, uterine health, hormone levels -- with every patient.

Our primary emphasis is on the health of the hopeful mother-to-be.

As for IVF using donor eggs, which allows women with low ovarian reserve to become pregnant, I find that women in the age range of 48 to 50 are starting to think again about the impact (of carrying a pregnancy) on both their health and the outcome for the baby. We presently don't have enough data to clearly determine all health issues for women over 50 years old who become pregnant. Research has clarified, however, that children born to mothers in their later years have a higher risk of a number of health conditions.

As with virtually every other facet of the conception picture, a woman's age must be taken into consideration, but primarily in the context of her present health condition.

For more of my thoughts on a woman's age and her fertility, see these blogposts, too:

The Other Side of the Age & Fertility Message

Trying to Get Pregnant After 30 - Time to Panic?

ASRM Embryo Guidelines Should Improve Overall Picture for Fertility Patients

A Little Education For Concerned Onlookers

2010-05-24T06:00:00.000-05:00

This quick-hit on MomLogic provides a good sampling of the things that
women who are struggling to get pregnant do NOT want to hear. Might be a
nice link to post on certain friends' Facebook walls...

10 Things Never to Say to a Woman Trying to Conceive

Could Your Fertility Problems Be Related to Diet?

2010-05-20T06:00:00.000-05:00

May is Celiac Disease Awareness Month, so it's a good time to put the word out about how this rather invisible disease might impact a woman's fertility.

The Celiac Disease Foundation has a list of symptoms that could be considered if you're wondering.

The National Foundation for Celiac Awareness offers excellent primer info on the possible connections between the disease and infertility.

Generally, my fertility-focused advice to people diagnosed with celiac disease would include the recommended dietary changes plus any additional fertility treatments, depending on other factors like the woman's age.

Birth Control Pills: Not Necessarily The Culprit

2010-05-17T06:00:00.004-05:00

The 50th anniversary of "the birth control pill" has come and gone recently (on Mother's Day, how coincidental!) and an article in U.S. News & World Report focused on the impact that oral contraceptives have had on our world.

Interestingly, the writer stated that, among other results, the pill is responsible for an "epidemic" of infertility.

It turns out that the author is referring to how the use of the pill resulted in delayed childbearing in our society -- on a grand scale, not in terms of individual women. More women are able to put off getting pregnant until it better suits their life, as a direct result of the pill. There's hardly anyone who would call that a bad thing!

But I do have patients who come to me, worried that their years of trying responsibly to not get pregnant have worked against them now that they want to have a baby.

The truth is that studies consistently indicate no direct connections between using oral contraceptives and later infertility. I know that a lot of women, especially those who are diagnosed with unexplained infertility, are still hesitant to believe what research tells us on this point. And to be sure, once they're in my office, it's rather moot.

It's normal to think back to what you might have done differently. It can also aid in diagnosis (and possibly treatment) to review your history thoroughly, looking for answers to your own baby-making dilemma. But dwelling on this particular "common sense" connection (between oral contraceptive use and later infertility) that continues to be denied as fact-based by researchers... just isn't helpful for you. We also have to be careful not to discourage young, responsible women from making smart choices for their reproductive lives.

Safe Versus Affordable: Are Couples Forced to Choose?

2010-05-04T15:08:00.001-05:00

This article on Australia-based News-Medical.Net reports that increasing numbers of twins and triplets are being born as a result of the global economic crisis.

The increase (in Australia) is due to more infertility patients requesting the transfer of more than one embryo in each IVF cycle. Essentially, in an effort to save money, couples are trying to boost their odds of pregnancy per cycle.

This is an unfortunate state of affairs, since studies have for a long time pointed to several related facts, including the bottom line that multiples and their mothers are at greater risk for numerous precarious health conditions.

Because of the many complex variables at play in each IVF cycle and in each woman's own reproductive condition and functioning, some patients must undergo more than one IVF cycle before successfully achieving a healthy pregnancy. In some cases, one treatment cycle is all that's required.

Now that the combined work of embryologists and reproductive endocrinologists has arrived at a point of making single embryo transfer a viable option for many, and certainly transferring only one or two more embryos to counteract some infertility-causing conditions, my recommendation for struggling couples is to take advantage of seasonal discounts when available.

Rather than boosting your odds per pregnancy, which in turn may boost health risks for you and your hoped-for baby, I encourage patients to time their treatment around clinics' occasional specials. For example, Houston Fertility Center is currently offering IVF for $7,950 per cycle, until June 30, 2010. We've long offered summer price cuts so that patients who typically vacation during summer months can fill their off-time with baby-making. (It's especially popular with teachers, we've learned.) At the discounted rates, if getting pregnant requires more than one cycle of IVF, you'll still be receiving affordable treatment and at a much safer embryo transfer rate.

I know the anxiety that many patients feel, about time passing, about affording treatment, and about possibly never having a baby. But I also know that all of my patients, to a person, want a healthy baby over everything else. Boosting the odds of pregnancy by narrowing down to one IVF cycle with too many embryos is not the safest way to fulfill their dreams.

One Infertile Woman's Secret

2010-04-22T10:50:00.001-05:00

The blog, RH Reality Check, most often focuses on political hot buttons in the reproductive health arena. But in this touching blogpost by writer and activist Robin Marty, we see how deeply intimate the infertility experience can be.

Regardless of her profession and whatever image she must present in that world, a woman who struggles to have a baby has a richly secret identity, too. Here, the writer discusses what it's like to interact with a relatively fertile world when your interior is crying out with longing.

As National Infertility Awareness Week approaches, Marty's story is a poignant reminder of the role that sharing with like-minded people, whether online or in person, can play in the life of an infertile woman.

Summer in Texas Means Heat -- & Babies

2010-04-13T10:54:00.002-05:00

I've noticed in my years of practicing reproductive medicine that given every other factor, there does seem to be a calendar-based trend to conception. So I'm happy to find out about studies that point to what we've seen in our practice here in sub-tropical Houston. It appears that summer is a great time to try and conceive with IVF.

In this study, published in Human Fertility (Vol 9, No 4, 2006), the researchers looking at more than 2,700 IVF/ICSI cycles saw "significant improvement in assisted conception outcomes performed" in summer months.

They're not exactly sure of what causes the boost but they propose it may be related to production of melatonin, a light-inhibited hormone that regulates sleeping and waking cycles.

This bit of information turns out to be in many patients' favor, since summer is the traditional season to take time off from work for vacation.

We've always encouraged our patients with seasonal jobs, like teaching, to take advantage of those stretches on the calendar when they're likely to be less stressed and busy on a daily basis. IVF treatment is carefully timed, so fitting it into a more relaxed schedule is beneficial -- lessened stress has also been linked to better fertility treatment outcomes.

Not only do I consult with patients to determine best times to schedule fertility treatment, I've started offering discounts timed specifically so they can take advantage of summer months.

Another Dietary Connection to Fertility: Fish Oil

2010-03-31T12:06:00.000-05:00

Add another notch to the belt of fish oil purveyors. A study recently published in Human Reproduction found that diets high in omega-3 fatty acids were less likely to develop endometriosis.

Endometriosis is a common, painful, and very demoralizing female medical condition. Long before it causes infertility in many patients, the "stray" endometrial tissue that is the hallmark of the disease makes everyday life a cycle-related struggle. Very painful periods are a common sign of endometriosis, and unfortunately, the related complaints of many teens and young women are dismissed.

Untreated endometriosis can continue undiagnosed for years until a woman finds out as a result of infertility. Accurate diagnosis is only accomplished with diagnostic laparoscopy. Many times during that diagnostic procedure itself, treatment can also be performed, in the form of removing the endometrial growths.

Research to learn more about the beginnings of endometriosis is ongoing. With this new information about links between diet and the disease's occurrence, women may be able to take a more active role in preventing this and other potential debilitating conditions.

Is Ovarian Transplant For Real?

2010-03-01T15:13:00.002-06:00

The journal Human Reproduction reported last week on a Danish woman who has now become pregnant and given birth twice as a result of one ovarian tissue transplant procedure.

Ovarian tissue transplant is one of the most experimental methods for rescuing a woman's fertility prior to her undergoing sterility-causing treatment for cancer. The more usual ways to "set aside" a woman's fertility for later use are to freeze either embryos or egg cells.

Dr. Stinne Holm Bergholdt, 32, had cortical tissue from her one ovary removed and cryopreserved before going through chemotherapy for bone cancer. She survived cancer and used the frozen tissue, after transplanting it on to her existing ovary, to successfully conceive first one child (in 2007) and then another in 2009.

There have been only a few successful pregnancies resulting from ovarian transplant, and most of those have been among women who were twins. Being twins removes much of the tissue rejection risk inherent in the transplantation of any organ. Anti-rejection medications are required for tissue transplant procedures, though patients should be informed that they don't provide guarantees of success and aren't covered by insurance.

The thing that makes Dr. Berholdt's case newsworthy is that she's the first to have a second pregnancy with the same tissue, and spontaneously (that is, without medical assistance.)

Without much larger numbers of ovarian transplant patients to observe, it's nearly impossible to derive much from Dr. Bergholdt's story that would be of value to most infertility patients. There are so many variables of fertility for each individual person, it's simply impossible to gauge why this one was so successful.

The plausability of using transplanted ovarian tissue for most women is still an unanswered question.

The Other Side of the Age & Fertility Message

2010-02-19T14:02:00.003-06:00

Just on the heels of a study declaring that 30-year-old women have lost most of their 'good' eggs, comes a report out of the UK that women in their 30's and 40's are winding up "accidentally" pregnant because they thought their chances at pregnancy were up.

The claims being made by the British Family Planning Association (FPA) are that messages about women's age and fertility are "overplayed" and leading to something like reverse anxiety. The organization, with a mission of enabling informed sexual health choices, is heading up a new public information campaign to remind women that unless they're willing to get pregnant without trying, contraceptives should be used until after menopause.

One of the messages in the FPA campaign: "Fertility. You'd be surprised how long it takes to disappear."

Menopause is defined as not having a period for at least a year. Perimenopause is what we call the years leading up to that final menstrual period. Perimenopause can last from a couple of years to more than five, and some women are fertile throughout that time.

I'm in agreement that women should remain vigilant about their chances for pregnancy until they are clearly no longer fertile. However, to imply that the messages being sent (about women's age and the natural decrease in fertility) are anything other than appropriate is itself an overstatement.

Translating Molecular Science: Marijuana Use Slows Down Sperm

2010-02-06T10:43:00.001-06:00

This article in Scientific American is rather complex reading but reveals some important findings. One of the items in the piece, about study results just published in the journal Cell, is tucked in at the very end -- which is too bad, because it's a tidbit of data that even the least technical reader can grasp.

According to researcher Yurij Kirichok of the University of California at San Francisco, "Marijuana likely activates sperm prematurely, leaving them burnt out in a matter of hours."

Importantly, this study was not about marijuana's effects on male fertility. Rather, the researchers were investigating molecular components that impact how and when a sperm cell gets moving. Besides pinpointing a molecule (Hv1) that activates a resting sperm cell, they also found a few more pieces to the puzzle linking marijuana and male infertility, via endocabbinoids.

Too much medical geek talk? Just simplify it to what we typically recommend: avoiding toxins of all kinds can enhance fertility.

Trying to Get Pregnant After 30 - Time to Panic?

2010-01-29T18:48:00.001-06:00

Good Morning America featured a Scottish study that concluded by the time a woman is 30 years old, she's already lost 90 percent of her eggs.

That's enough to make the typical young woman panic.

We've always known that female fertility is more dependent on age than any other variable. This study points to a sharper decline in fertility than we like to believe.

Before everyone rushes to assisted reproductive treatment, though, let's remember that stress can negatively impact fertility.

Next, it's easy enough to have a consultation and do a quick work-up to determine your baseline level of fertility. That won't provide the definitive answer as to whether or not you will have a baby later, but it can certainly help a woman determine if she has an unexpected, silent infertility condition. Then, a plan of action can be put together to promote her future fertility.

Panic won't help you get pregnant. A little foresight and action can.

"iPhone Baby" Not So New; More Fertility 101 Needed

2010-01-26T13:44:00.002-06:00

Here's an eye-catching piece: an article about a young woman who finally conceived after years of infertility -- all because of an iPhone app.

Essentially all that happened here was good (and successful -- congratulations!) use of an old TTC standard done up in new technology. The app she downloaded was one of apparently several that counts a woman's cycle days and flags her when she should be at her most fertile.

Keyword here is "should"...

One of the most common reasons that some women don't get pregnant easily is ovulatory disorder. There are plenty of ways that a woman's ovulation can become disrupted, out of sync, or cease altogether. The important thing to know is that very often, the woman has no symptoms to clue her in to her body's fertility problem. Simply having a period, even regularly, doesn't necessary mean ovulation is occurring on target.

So, yes, timing is crucial in trying to get pregnant. But for a 30-year-old to have tried unsuccessfully for *four years* and still only then resort to counting the days in her cycle... that tells me our fertility educational efforts aren't getting out there like we hope, whether or not the technology is a calendar on the wall or an iPhone app.

TTC with IVF? Skip the Alcohol Tonight

2009-12-31T09:35:00.001-06:00

As 2009 comes to a close, we at Houston Fertility Center would like to wish everyone a healthy and fertile 2010!

And as a physician, please allow me a little nagging space before the celebrating begins: alcoholic beverages can negatively impact both your overall health and fertility.

It's true.

Now, complete teetotaling may not be necessary for everyone, but if you're about to invest in IVF treatment, you might consider a sober New Year's Eve.

This article on ConceivingConcepts.com refers to a study that even pointed to specific types of alcohol that seem to stand in the way of success for patients going the IVF route to pregnancy.

Taking advantage of Internet searches this week for "all things Party", The Harvard Gazette points to a full related article on London's Guardian that was written earlier this year when the research results were first publicized.

The study was large (over 2,500 couples interviewed before IVF treatment) and the results were striking.

Besides, if you're just about to undergo fertility treatment, now may be a good time to get used to the little sacrifices that parents make. Keep looking to the future!

ASRM Embryo Guidelines Should Improve Overall Picture for Fertility Patients

2009-11-30T15:50:00.004-06:00

This year, the American Society for Reproductive Medicine took an expected step forward to increase the safety and health of prospective IVF moms and their future babies. They issued guidelines stating specifically that women under age 35 should have no more than two embryos transferred per IVF treatment cycle.

The goal is to prevent multiple pregnancy, which is full of risks to both mother and babies.

The patient's prognosis, not just her age, should also be taken into account. In cases of a woman younger than 35 having optimal chances at pregnancy, the ASRM further recommends that single embryo transfer be considered.

Other ASRM embryo transfer recommendations, by which Houston Fertility Center adheres, are:

Patients 35 to 37 years old with good prognosis -- 2 embryos
Same age group with less optimal prognosis -- up to 3 embryos (or up to 2 resulting from extended culture)

Patients 38 to 40 years old with good prognosis -- up to 3 cleavage-stage or 2 blastocysts
Same age group with less optimal prognosis -- up to 4 cleavage-staged or 3 blastocysts

Even in cases of patients who typically have the least optimal chances of pregnancy -- women 41 to 42 years old -- no more than 5 cleavage-stage or 3 blastocysts should be transferred.

Balanced Media Reporting Highlights Balanced Infertility Treatment Approach

2009-11-18T10:36:00.001-06:00

It's hard enough for infertility patients to find well-founded facts on the Internet, but confusion can really swirl when the marketing of books or products by physicians becomes involved.

This piece by Tennessee Valley's NBC affiliate, WRCBtv, does the right thing with a strong attempt at clearing the air over one fertility expert's book.

I wouldn't go so far as to refer to Dr. Sami David's book as "controversial" (as the title of the WRCB piece implies) but his stance -- that possibly "as high as 50 percent" of IVF procedures are unnecessary -- can be quite misleading taken out of context.

The WRCB team accordingly interviewed another local IVF specialist who introduces the idea of "a balanced approach" to fertility treatment.

Infertility A Blessing in Disguise?

2009-10-28T12:36:00.001-05:00

Here's a way to re-frame things: Michele Olson of thinkmarriage.org suggests that infertility could actually be helpful to couples.

In this article from the Wausau Daily Herald, she offers tips on how to think about fertility challenges so that your relationship not only doesn't crumble, but improves.

Economy Makes Saving Embryos Tougher Decision

2009-10-22T14:05:00.003-05:00

A recent study found that there is indeed an expected correlation between the United States economic downturn and people's choices regarding their frozen embryos.

In other words, presumably the cost of maintaining frozen embryos has pushed patients to think harder about whether or not to keep them on ice in perpetuity.

Last December, I referred to The Embryo Dilemma which was front-and-center in the media at the time. Single embryo transfer is absolutely the answer for some patients, whereas for others, it simply won't provide their desired outcome.

ART research has focused on the fine-tuning of techniques that will allow fewer IVF-created embryos to be transferred and still create a healthy pregnancy. Still, many patients will end up with extras.

The options -- aside from cryopreservation storage or discarding -- for unused embryos at Houston Fertility Center:

*If couples let us know before their eggs and sperm are combined for fertilization via IVF, we can perform the FDA-required testing for embryo 'adoption' to be an option.

*We will assist couples in making their embryos available for research at approved institutions.

It's imperative that patients using IVF to create embryos discuss -- in advance -- all of the options with their partners and any others they typically consult for life's big decisions.

Safer Fertility Treatment Must Be Made Available

2009-10-14T11:10:00.003-05:00

The New York Times' recent series on "21st Century Babies" provides a distressing glimpse into an unpleasant side of reproductive medicine.

Besides being the Medical Director of Houston Fertility Center, I am a mother -- and one who is especially sensitive to NICU issues. My first-born spent the first week of his life in the NICU.

It was several days before we knew if he would live. Although he was not a twin, I cannot imagine how awful it would be to wonder if two or three of your children would die before coming home, or have long-term sequela.

Because of this heightened sensitivity, and because assisted reproductive techniques have become so finely tuned, I encourage single embryo transfer in indicated situations.

The NYT series, by Stephanie Saul:

The Gift of Life, and Its Price

Grievous Choice on Risky Path to Parenthood

Experts weigh in on the subject on the blog
The Trouble with Twin Births

Surrogacy The Final Stop In the Journey For Some

2009-10-09T13:29:00.001-05:00

The Wall Street Journal has published a detailed article on the growing prevalence of international surrogacy as a way to build American families. The piece describes the incredible lengths that some couples will go through to have a child, heart-rending stories in some cases. It also brings up some of the concerns about connecting cross-culturally to resolve infertility.

To be sure, using a "third party" -- whether through donated sperm or egg, or gestational surrogacy -- requires more contemplation than other forms of fertility treatment. In situations where the donors are from relatively impoverished circumstances, hopeful parents-to-be must wrestle with the realities and potential consequences of their choices. With international medical care of any kind, some of the gravest issues can become mired in the differences between laws and health care technology and provision.

International medical care may be less expensive, but there are other costs. All parents must choose between rocks and hard places in "the parenthood."

How Do My Patients Want Their Loved Ones To Think About Infertility?

2009-10-08T14:00:00.004-05:00

Every now and then I run across unusually good advice to friends and loved ones of infertility patients. This Q&A by Dr. Miriam Stoppard on UK's Daily Mirror is one such piece.

Titled How can I help my daughter cope with not having children?, Dr. Stoppard's response explains both succinctly and thoughtfully some of the emotions that infertile people experience. She also describes in understandable terms a healthy frame of mind that family and friends can adopt toward loved ones to lend respect to the individual's experience and journey.

This is a nice one to clip and pass around.

When Fertility Really Is About Your Diet

2009-10-06T11:10:00.004-05:00

No woman wants to be told she needs to lose weight, least of all my patients who have struggled (sometimes for years) with trying to get pregnant. Whether we decide their fertility treatment will include fertility medications, IVF, IUI, or some other assisted reproductive technology, the best starting point is a healthy body -- and for many, that means coming to a more optimal weight.

This article in the Belfast Telegraph describes a rather novel approach to meeting the challenge of weight versus fertility, specifically as it relates to polycystic ovarian syndrome (PCOS), one of the most common causes of female infertility.

Are there similar programs in the United States?

Another Step Forward Toward Fertility Preservation

2009-10-02T14:17:00.002-05:00

A drug used to treat ovarian cancer (cisplatin) promotes egg cell death by way of a particular enzyme. The good news: a drug used to treat a different (but related) disease, chronic myeloid leukemia (CML), protects egg cells from cisplatin's killing effects.

Researchers in Italy have published their interesting conclusions in the online edition of Nature Medicine (see a HealthDay News report on the Medline website.)

So far, these are initial studies performed with mice, but the call by cancer patient advocates for such research is loud enough that follow-ups shouldn't be far behind.

Fertility Preservation and Oncology

2009-04-22T12:33:00.003-05:00

In this New York Times piece, Jane Brody quotes the University of North Carolina's Fertility Preservation Program as estimating that a mere quarter of U.S. oncologists address fertility issues with their patients prior to infertility-causing chemo or radiation treatments.

It's encouraging to see someone as widely read as Ms. Brody helping put the word out about fertility preservation. However, she was a tad off the mark in her reference to the obstacles of cost and timing.

In fact, rather than the "tens of thousands of dollars" that Brody says fertility preservation will cost cancer patients, fertility specialists can assist women with egg freezing for roughly half that amount. Simply freezing sperm costs even less. Creating embryos and then freezing them is the most costly option, but patients should consider that the transfer and resulting monitoring (and related fees) will be delayed by a few years. Additionally, many reproductive experts are aligning with Fertile Hope's Sharing Hope program to further alleviate the financial burden for eligible patients.

Timing is particularly important to oncologists and their patients. Contrary to Ms. Brody's comment about appointment scheduling taking "months," some fertility specialists are especially vigilant about getting cancer patients in within days of their diagnosis.

Kudos to Jane Brody and the New York Times for continuing to spread the word. It is this sort of attention from highly respected media outlets that will eventually encourage more oncologists to make fertility preservation part of standard patient care.

Women Want Working Options for Motherhood

2009-04-06T12:41:00.000-05:00

At last November's ASRM meeting, some of us had the pleasure of listening to Lindsay Nohr Beck, the founder of Fertile Hope, present the patient's perspective on egg freezing. A podcast of that presentation is now online and available.

I think you'll find Lindsay's remarks (and the photos of her beautiful children) to be meaningful. The point she consistently boils down to is that women want the option to freeze their eggs, and they want it to work.

TV Reflecting Hopeful New Reality

2009-03-31T10:59:00.002-05:00

Especially after hearing from my staff (who atttended the annual Young Survivors Conference in Dallas last month ) about the mix of hope and anguish that young women with cancer express about their future motherhood, it was reassuring to see the very popular TV show, Grey's Anatomy, work the forethought of fertility preservation into a current, compelling storyline.

A young woman must undergo intense and immediate treatments for invasive cancer. Her colleagues and friends think ahead for her and automatically include the OB team in her treatment plan.

In this related scene, the cancer patient's boyfriend reveals the understandable and expected emotions involved as people struggle to muster hope amid fears:

Men, Infertility, & Cancer

2009-03-26T22:28:00.001-05:00

A large study published in February's Archives of Internal Medicine links testicular cancer to men who are seeking fertility treatment.

The researchers analyzed data from over 22,500 men in couples who sought fertility treatment between 1967 and 1998. After comparing against cancer registry data, the study authors concluded that the men were 1.3 times more likely to develop testicular cancer, and that those with male factor infertility were 2.8 times more likely.

Rather than believe that infertility treatment is the culprit, the researchers feel it's more plausible that the men have something else in common, for example, exposure to certain environmental toxins or faulty DNA repair, that increases their risks of both infertility and cancer.

There are times when seeking a diagnosis for fertility problems can result in other seemingly unrelated health conditions turning up. This study is another example of how a body's reproductive function can sometimes serve as a red flag indicator for overall health.

Concerns About the Octuplets' Conception

2009-02-02T09:28:00.001-06:00

The birth last week of octuplets -- eight babies from one pregnancy -- is widespread news. For those of us whose work is all about helping creating new life, the news is bittersweet.

As strong as the yearning for a child can be, virtually no one believes that multiple pregnancies and births are the optimal situation for either the parents or the children. I do occasionally encounter hopeful parents-to-be who get excited at the prospect of completing their family with two or three children in one pregnancy. More babies than that, however, present far more soul searching opportunity than most people encounter in a lifetime.

Details of the California octuplets' conception are now being shared publicly, with the babies' grandmother reporting that her daughter (the mother) indeed used IVF. Reproductive experts would find the transferring of eight or more embryos into a woman's uterus after conception by in vitro to be medically unethical. High-order multiples (more than twins) are most often the result of unchecked use of superovulation medication and possibly intrauterine insemination.

The responsible use of ovulation medication includes monitoring to check on the drugs' effects and, sometimes, canceling a cycle if too many eggs became available for fertilization whether by IUI or intercourse. The reason for such cancellation is to ensure the health of the patient and to avoid a pregnancy with high-order multiple babies.

With IVF, there was a time when fertility experts routinely transferred up to five embryos, depending on the cause of infertility and, notably, the woman's age and health condition. But because of how different facets of the IVF process have improved, that practice is no longer necessary. Now, we routinely transfer only two or three embryos per IVF cycle and even a single embryo when the patient would have a good chance at pregnancy with only one.

Everyone is breathing a sigh of relief at the relatively good condition of the eight babies and their mother. Still, reports about the mother's family-building goals and that she was assisted by a still-unnamed fertility expert leave us all dismayed and concerned.

Coping With a Ticking Clock When You're Single

2009-01-28T13:55:00.003-06:00

As I was exploring the Internet for fertility-related news the other day, I came up with this link to a psychologist's thoughts on single women and their biological clocks.

In "Tick-tock goes your biological clock" on Examiner.com, Dr. Paulette Kouffman Sherman makes some insightful comments on how single women might approach their natural drive to have a baby. I was frankly surprised to see that she included egg freezing as one of the alternatives to quickly tracking down a mate. Apparently, word is really getting out beyond the infertility world that we have turned a bend in family planning.

If you're single and wondering about whether fertility treatments might be your answer to quiet a clanging clock, please feel free to inquire. Don't lose precious time simply by failing to educate yourself.

Upcoming Seminar on Fertility Preservation

2009-01-09T09:46:00.004-06:00

On Monday, January 19th, I will be speaking to a public audience on the topic of egg freezing for fertility preservation.

Hosted by the Young Survivors Coalition, a non-profit breast cancer support and advocacy group, my primary focus will be on the potential for women who are newly diagnosed with cancer to protect their eggs from sterilizing effects of chemo or radiation therapy.

Our primary goal is to continue getting the word out there, so that pre-cancer treatment fertility preservation considerations are standard of care in the oncology field. I welcome attendance at these presentations by patients and professionals alike.

I like to present in a casual Q&A style, so please feel free to come with your questions.

The location will be one of the facilities of The Rose, an organization committed to helping all women be adequately screened for breast cancer.

When: Monday, Jan 19th, 6:30 PM
Where: The Rose, 12700 North Featherwood, Suite 260 Houston, Texas 77034

View Larger Map

This presentation is made possible in part by Fertile Hope and Organon, a part of Schering-Plough Corporation.

The Embryo Dilemma

2008-12-15T09:58:00.003-06:00

Recent news reports brought up again the ongoing questions surrounding embryo creation via IVF. Actually, the questions aren't so much about the creation side of things as they are about disposition of extra embryos.

As reproductive medicine specialists, we have focused mostly on the best ways to help individuals and couples conceive biological children. Success is very often a matter of numbers: the more eggs a woman ovulates, the more sperm a man has available, the more embryos created... the greater their chances at getting pregnant.

For years now, we specialists have been boiling down the science and finely tuning the techniques toward the ultimate goal: how best to unite only as many eggs and sperm necessary to create only as many embryos needed to make one healthy baby.

Single embryo transfer is a true possibility for some patients, but almost a pointless, expensive protocol for others.

At this point, it remains common for IVF patients to wind up with at least some "extra" embryos -- that is, too many embryos to transfer within the same treatment cycle -- so the question of what to do with the surplus continues to be answered.

In the study recently published in Fertility & Sterility, more than 1,000 infertility patients were surveyed about the choices they've pondered and made to address their own embryo surpluses.

Among other things, the survey results reveal a broad consensus of disappointment -- with the options offered at various clinics and with the level of pre-IVF information made available to them.

Fertility treatment centers are like any medical practice: filled with professionals who are people first. Different practices have varying policies based on many factors, including the personal beliefs of the professionals. Another component that steers clinic policies is the availability of resources.

Patients and professionals need not have all their beliefs in common, but there are sometimes "bottom lines" that patients use to make their choices about which fertility practice to turn to for assistance with getting pregnant and about which treatments to use. In the past, some practices were so results-driven, so focused on success rates, that even crucial issues like the disposition of surplus embryos were side-stepped or, at least, addressed with as much brevity as possible. The dilemma of extra embryos is very real and can no longer be seen as ancillary.

I'll discuss specific related options for patients of Houston Infertility Clinic in a follow-up blogpost.

Finding Gratitude

2008-11-27T08:00:00.001-06:00

With understanding of your struggles to achieve one of life's simplest joys, my Thanksgiving wish for all of you is to find treasure in the smallest things. Some of my staff and I will be hopefully helping a few patients do just that as we transfer some embryos to hopeful mothers on Thanksgiving morning.

I am grateful for the opportunities to play a role in the creation of families.

Our Presentation at ASRM: More Pieces of the Pregnancy Puzzle

2008-11-26T10:00:00.001-06:00

We were pleased to have our poster presentation accepted into this year's meeting of the American Society for Reproductive Medicine. The title -- Differential Relationship Between the Total Number of Oocytes Retrieved and the Implantation Rate in IVF and ICSI Patients -- may sound dry, but our results were positive news for patients who need IVF to have a baby.

The Houston Infertility Clinic staff, in conjunction with the Department of OB/Gyn at the University of Sydney in Australia, examined 351 IVF cycles. In each case, patients were using their own eggs and non-frozen embryos. We looked at:

the number of eggs retrieved
number of embryos transferred
results of clinical pregnancy tests

Next we compared those cycles that included ICSI and those that used "conventional" IVF for insemination. These two groups were then split up into three sub-groups, based on the number of eggs that were retrieved (either 1-10 eggs, 11-20 eggs, or 21-40 eggs.)

It might seem a simple question of statistical odds that the more eggs you produce, the better your chances, but...

Here's the good news: We concluded that, at least in our hands, patients using ICSI who were in the 11-20 egg group had the highest implantation rate. Patients using "conventional" IVF w/o ICSI had higher implantation rates when they were in the subgroup producing the most eggs (21-40 eggs).

It's important to note that quality of eggs -- rather than quantity -- is the more important measure. Patients shouldn't be discouraged if their bodies aren't producing a high number of eggs. As our study indicates, the use of ICSI seems to make a noticeable difference in outcome.

On a related note -- in some cases, women's ovaries will produce far fewer eggs than everyone hoped for in an IVF cycle. Different clinics have different policies; many are, frankly, guided by heavy concern about success rate statistics.

Our policy is that if a patient wants to move forward and retrieve the one follicle that her ovary brought forth, we will respect her wishes and do our best to render highest quality care toward the best possible outcome.

We want every patient to have a fighting chance at getting pregnant.

Write About Your Experience: Infertility Haiku Contest

2008-11-05T13:21:00.001-06:00

The new business called My Fertility Plan has started something unique - a poetry contest about infertility.

They're inviting everyone to submit haiku poetry until November 24, 2008. Entries will be judged by a panel of people in the infertility treatment business and some who blog about it. Your haiku can fall into either a serious or humorous category, but must be in the proper format, syllable-length-wise. For details, see their related webpage.

My Fertility Plan Blog: Your Conception Action Plan

Article in Houston B.A.B.Y. Magazine

2008-11-03T10:21:00.005-06:00

[Edited 11/26/08: We now have a copy of the article in PDF format on our BabyLater.com site. Read it here...]

I'm featured in an article for Houston B.A.B.Y. Magazine, a publication of Houston Family Magazine. The October issue is available in digital format here (click on the cute baby face cover), and you can find print issues at Krogers, and in OB/Gyn and pediatrician offices.

The article is called "From Cancer to Parenthood: Reproductive Expert Helps Survivors Create New Life" and includes a pretty interesting photo of Dr. Stoddart in the lab.

I'm glad the feature highlights my efforts at bridging the gaps between oncologists and reproductive specialists. Patients are the prospective losers if the facts about fertility preservation aren't immediately available at that very first discussion about cancer treatment. Making those physician-to-physician connections well in advance of patient need will be the key to enabling more survivors to become parents later.

Please feel free to share this article with your physicians and friends.

For easy sharing by email and for printing, I recommend this: find the article on page 16, click on the article title words "From Cancer to Parenthood" to display the article in easy-print format. From there, you also have options to post the article on your Facebook, MySpace, and other favorites. (Technology is great, but tricky at times...)

More Local News Coverage of Egg Freezing for Fertility Preservation

2008-10-31T14:49:00.003-05:00

I received a last-minute request earlier this week from Elizabeth Lee, reporter for 39 News. Since I had two surgeries and an IVF to perform that afternoon, she and her video team made their way to the lab in central Houston for some interesting cryo shots after catching me at our Sugar Land office.

We talked about egg freezing and using the technique to preserve future fertility for women diagnosed with cancer, as well as for young healthy women who are worried they may not find "Mr. Right" before their egg cells age.

You can see the video on the 39 News website.

You Asked For It: Losing Hope, Considering a New Treatment Plan

2008-10-21T11:32:00.004-05:00

A question from Robin, in response to "Are Simple Fertility Treatments Pointless?"

I've had three IUI's. Two after clomid and the last after injections of follistim (very expensive - my insurance doesn't cover). Is my only other option now IVF? It is not an affordable option for me. I'll be 38 Monday.
I'm losing hope.

My response:

First -- I hear your feeling of hopelessness, and my hope is that I can help you feel otherwise.

It would be unwise for me to advise you specifically, since I don't know your medical history or current patient information. The treatments you've been through already -- intrauterine insemination (IUI), clomiphene citrate (Clomid), and injectable FSH (Follistim) -- are prescribed for a number of different infertility causes. Since I don't know your diagnosis, I can't comment on the efficacy of these treatments for your individual case.

Obviously, though, you are wise to start considering new treatment plans to resolve your infertility, get pregnant, and have a baby.

Truthfully, IVF is not easy to afford for most patients. Not many of us start out trying to get pregnant with enough money in the bank to cover infertility treatment. There are ways to make the treatment process more affordable.

That said, it may not necessarily be time to talk IVF. There may be other pieces to the conception puzzle that are still missing. If you'd like to schedule a consultation with me, my staff will be happy to take your call.

Another Great Day Houston

2008-10-20T13:34:00.002-05:00

Following last July's show, I was asked to visit Great Day Houston again to talk more about fertility-sparing treatments for women who wish to delay conception.

Tune in to Great Day Houston with Deborah Duncan - Tuesday, October 21
at 9 AM Central on KHOU-Channel 11. Or watch online by clicking the Live Video link from http://www.greatdayhouston.com/ during airtime.

The techniques to retrieve and freeze egg cells for future conception are primarily offered to women who have just been diagnosed with cancer. We're working on collaborative relationships with cancer specialists and other professionals who can quickly refer patients for fertility preservation before they undergo sterility-causing cancer treatment.

As long as patients are willing to educate themselves and be fully aware of the process involved, women without cancer can also utilize fertility preservation technology to have a baby later.

Learn more about fertility preservation (for women and men) at http://babylater.com.

[Edited 10-31-08 to add link to view video here...]

Spreading the Word About Fertility Preservation

2008-10-15T06:59:00.004-05:00

Last week, I had the pleasure of meeting with and speaking to the Educational Committee of the local Susan G. Komen Foundation group.

What a thriving organization! Just a few days after their annual Race for the Cure®, with participants this year numbering over 26 thousand, the women who lead Komen's educational charge gathered again in an office crowded with boxes of materials and mementos.

Lorianne Classen, a Health Education Specialist with M.D. Anderson Cancer Center and Komen volunteer, remarked that the meeting was particularly well-attended that evening, likely because of interest in our topic: fertility preservation.

Judging from the many raised hands with questions, including several from survivors and their loved ones, I'd say that interest in the concepts of preserving fertility for use after surviving cancer was indeed very high. Good questions. Poignant situations.

I left feeling very positive about sharing the realities of how women and men can take action to preserve their fertility before engaging in life-saving cancer treatment. I also came away seeing the need for education *now* is possibly greater than I thought.

As I emphasized to the Komen Education Committee, timing is crucial in this matter. I'll be continuing my pursuit of pre-need connections among oncology specialists and their patients -- through http://babylater.com -- so that the information about real hope for having a family isn't only wistful hindsight for cancer survivors.

For more information, visit the Houston affiliate of the Susan G. Komen for the Cure.

Are Simple Fertility Treatments Pointless?

2008-09-29T09:30:00.001-05:00

A few weeks back, the news was all about a UK study that pronounced simplistically that Clomid with IUI is ineffective for treating infertility. Of course, we know there's more to it than that.

Part of the problem is the media's often too quick with inaccurate, alarmist headlines. They may need to squeeze too much info into too small a space. It also may be that a lot of reporters just don't understand the complexities of infertility treatment.

If such a thing as a "magic pill" to promote pregnancy existed, the whole world would be entirely different. The truth is that clomiphene citrate (Clomid is only one of the drug's brand names) works for some, but not for most. The same might be said of intrauterine insemination (IUI).

A number of large studies, both single-center and collaborations of different fertility clinics, have demonstrated the limits of clomiphene citrate (CC), with and without IUI.

Should patients completely bypass this treatment option?

Contrary to what headlines would imply, there's simply no one answer for everyone. A thorough diagnostic process is a must, even in cases that -- once the results are in -- will call for very minimal medical assistance.

For each and every fertility patient, time is valuable. All should keep in mind that infertility treatment does not get easier or less expensive as the woman ages. I strongly advise against spinning your wheels (and spending your money) on too many cycles of CC/IUI.

Technorati Tags: infertility treatment,infertility research,clomid,iui,studies,effective medicine

Hurricane Ike Not a Problem For Patients' Fertility Needs

2008-09-16T17:31:00.001-05:00

Hurricane Ike may have paid a visit to Houston, but I'm happy to report that Houston Infertility Clinic did not lose power. That means our staff is available. We were able to perform a scheduled egg retrieval on Monday, just two days after Ike roared through the Gulf Coast.

Additionally, our cryopreservation units never ceased functioning.

Ironically, though Hurricane Rita in 2005 didn't result in as much widespread damage to Houston, Houston Infertility Clinic was without power for a week after that storm. We prepared in advance (just as we did last week for Ike) by conducting embryo transfers earlier than scheduled to allow patients to evacuate.

This time, patients who were in mid-cycle were still able to stay on track.

Thank you to my staff for the dedicated extra efforts toward ensuring the safety of our patients' treatment cycles and the embryos they create.

Might be interesting to see if any babies named "Ike" are born in mid-2009!

Technorati Tags: hurricane ike,infertility clinic,cryopreservation,frozen embryos,hurricane rita,texas,weather

A Key to Ovulation Found In Brain

2008-09-05T12:11:00.001-05:00

According to this Reuters article at Revolution Health, intriguing research being published in the Journal of Neuroscience points to a protein molecule in the brain as being essential to kick-starting ovulation.

Explaining the origins of infertility to patients isn't always easy. Often by the time I see someone in my office, they're frustrated, sad, and sometimes angry about all they've tried unsuccessfully to have a baby. They come to me wanting relatively simple answers to "why?" and "how?" Unfortunately, I can't always give those simple answers.

Keeping up with research in medical fields on the outer edges of reproductive endocrinology can sometimes increase my reference list, so to speak, to help patients grasp all the possibilities that may apply to their situation.

This latest research finding is one of many that are building to a more complete understanding of how the tiniest parts of the brain can have very big consequences in a person's life.

Technorati Tags: infertility,ovulation,brain research,kisspeptin,journal of neuroscience,medical studies

Fertility Patients' Rights To Be Treated & Keep Their Jobs

2008-08-21T13:45:00.001-05:00

In an encouraging step forward, a Federal appeals court in Illinois has ruled that women undergoing IVF should have their employment protected in the same way as pregnant women, through the Pregnancy Discrimination Act.

I’m an involved mom -- besides my busy practice, my family keeps me running. I have the utmost respect for women who are trying to manage work and family with the added stress of infertility treatment. Our office has always maintained very early hours for the primary purpose of facilitating pre-work appointments for patients. I opened my Sugar Land office when I realized how many southwest area patients were squeezing ultrasounds and exams at our central Houston office into their schedules.

The court’s ruling is a first. It’s still quite possible that employers could be less than understanding about patients needing to come in late or leave in the middle of the day so they can follow their physician’s prescribed treatment. But at least a precedent has been set, and it’s one that can be cited if a patient encounters challenges at work.

Wall Street Journal article: Women Battling Infertility Find a Friend in the Court

Technorati Tags: pregnancy discrimination,federal legislation,infertility treatment,patient rights,ivf

Spread The Word: Great Day Houston

2008-07-28T11:02:00.003-05:00

On Tuesday, July 29, Houston Infertility Clinic will be featured on Great Day Houston with Debra Duncan.

The show will include interviews with patients Karen and Cliff Nickel (and their two adorable daughters), as well as new patients Reece and Tracy Klepacz who kindly share with the audience their infertility struggle of many years. Plus, the Klepacz' allowed Great Day Houston crew to film their recent egg retrieval here at Houston Infertility Clinic.

Also included will be interviews with an egg donor from Prime Genetics and Chris Axelrad, Clinic Director of The Axelrad Clinic for Natural Fertility Enhancement & Women's Health. They'll be joining me to talk about the many varied solutions to all types of infertility conditions.

Tune in on Tuesday, July 29th at 9 AM on KHOU Channel 11 for Great Day Houston. If you miss the show, you can watch online on their homepage.

[Edited 8-15-08: You'll find full video online here.]

Technorati Tags: infertility treatment,tv show,interviews,patients,doctors,egg retrieval,medical

You Asked For It: Treating PCOS

2008-07-22T16:19:00.001-05:00

In an earlier post, Christy asked about PCOS and its treatment. Polycystic Ovarian Syndrome is a complex diagnosis that is relatively easy to treat.

Here are my responses to Christy's questions:

How do you treat [PCOS]?

PCOS is sometimes referred to now as "metabolic syndrome" because the term more accurately reflects the entire condition. For example, not all women with PCOS have ovaries with many cysts.

The goal of treatment is ovulation. Treatment usually consists of oral medication (clomiphene citrate, more commonly referred to by one of its brand names, Clomid).

In the past, another drug, Metformin, was frequently administered in conjunction with Clomid. A couple of years ago, a large study found no advantages to using Metformin strictly for the purpose of getting pregnant. (I wrote about that finding in my November 2006 newsletter.)

How effective is Clomid? Does it work every month?

Clomid is generally effective within the first three cycles of use. Depending on several factors, I may prescribe the medication be used in conjunction with intrauterine insemination (IUI) or timed intercourse.

If a patient is Clomid resistant, what is the next protocol?

If a patient's ovaries are resistant to Clomid, the next step is often gonadotropins, which are administered by injection. Patients who also have abnormal glucose/insulin levels will be prescribed Metformin.

As a side note, it's important that women with PCOS are made aware of the links between that and more serious health conditions like heart disease and diabetes. I encourage all of my patients to make healthy lifestyle changes as needed, not only to increase their chances for pregnancy, but to promote overall better functioning of their total body.

Technorati Tags: pcos,polycystic,metformin,clomid,womens health,getting pregnant,fertility treatment

You Asked For It: Predicting Ov with PCOS

2008-07-10T12:12:00.004-05:00

One of my readers asked me to discuss PCOS, in conjunction with my earlier comments on using ovulation predictor kits at home.

It's true that PCOS and several other ovulatory disorders can make home ovulation prediction a very inaccurate process. If you're determined to use at-home testing kits, try to look at the results as information that is helpful but that may not be giving you the full picture of your ovulatory function.

A very important point here: regular menses does not necessarily mean you are ovulating during every cycle. Women with PCOS come with a range of cycles -- from amenorrhea (completely absent periods) to wildly irregular cycles to fairly consistent menstrual periods.

In short, when a woman has PCOS or other ovulatory disorders, menstruation and ovulation may be different, seemingly unrelated events. You can't always use "Aunt Flo" as an indicator of how well your ovaries are working.

Advances in fertility science spawn new issues - Houston Business Journal:

2008-07-05T10:13:00.003-05:00

I was interviewed by the Houston Business Journal's Nicole Bradford at our Sugar Land office for this article on egg freezing. It's in their July 4th issue's special section on Health Care. [Edited 8-15-08: The full article is now online and readable by non-subscribers.]

Advances in fertility science spawn new issues - Houston Business Journal:

This photo of a metaphase II oocyte was taken by our Lab Director, Dr. Neil Stoddart, and used on the front page of the July 4 issue of Houston Business Journal.

Technorati Tags: egg freezing,houston business journal,interview,media,dr sonja kristiansen interview,infertility clinic

My Opinion: On DIY Fertility Testing

2008-06-09T11:06:00.001-05:00

There was a lot of news attention a few weeks back about a new at-home fertility test. I'm frequently asked for my opinion on such tests by both patients and the media.

While it's certainly understandable in this age of the Internet that empowered, educated patients want to take their health and wellness into their own hands, the distributors and manufacturers of DIY tests often fail to accurately inform consumers about their products' limitations. So I'm glad when people come forward to find out about the bigger picture.

In this case, the test claims to be "a breakthrough test for ovarian reserve" when in actuality, it's a collection of analyses that clinicians have used for many years now. I suppose the "breakthrough" aspect is that folks can use it at home. But should they?

Consumers need to weigh the cost-benefit ratio -- yes, even for health care. I know that I consider numerous aspects before making a substantial purchase, and I'm positive that my patients do, too.

Like other home tests, The Plan Ahead test claims to address two issues common to the topic of getting pregnant: privacy and cost.

It's true that performing a test "at home" is more private than a consultation in my office and a blood draw in the exam room. But in the case of this particular test, the consumer is still required to have their blood drawn by a participating physician. The cost benefit -- in this case, just under $400 -- of such a test is debatable.

There are so many more variables that add up to successful conception and pregnancy that home tests do not and cannot address. Ovarian reserve - a term that refers to a woman's egg supply -- is but one of numerous components that make someone fertile. Likewise, patients sometimes are unable to get pregnant or maintain a pregnancy because of underlying health conditions that will not be detected by home testing.

So the cost of doing-it-yourself in this case could mean that you miss an important diagnosis of an undetected condition. DIY fertility diagnosis can also cost patients crucial time in their journey toward getting pregnant.

While I may sound biased, I think it just makes common sense to go ahead, make sure your bases are covered, and have a consultation with a specialist from the start.

Technorati Tags: infertility testing,ovarian reserve,fertility,plan ahead,diy,health care,at-home tests

POF: Future Help On the Horizon?

2008-05-22T13:17:00.001-05:00

In my experience as a fertility specialist - and as a mother - by far one of the most traumatic diagnoses to render to a patient is one of POF, premature ovarian failure.

A POF diagnosis can ring with emotionally painful finality in a patient's mind. It means, in effect, premature menopause, sometimes as early as the woman's 20's. However, I am grateful to have alternatives to present in many cases. For many women with POF, the use of donor eggs with IVF can result in successful pregnancy.

Today there is even better news, even if only of the long-range type. Scientists have found more evidence of genetic connections to the incidence of POF. What this means is that the future may possibly hold a test that can tell very young women of their chance for having POF.

Presumably if a young woman with healthy eggs tests positive for the gene mutation, she could have her healthy existing egg cells retrieved and cryopreserved for later use.

I look forward to every additional opportunity I'm given for presenting a fulfilled future to women with POF.

Oocyte-specific gene mutations cause premature ovarian failure - Baylor College of Medicine

Technorati Tags: premature ovarian failure,pof,infertility treatment,premature menopause,egg freezing

In the End, Treatment Not For Everyone

2008-05-22T12:44:00.001-05:00

We are lucky to live in a time when assisted reproductive technology can assist so many with making their dreams come true. Still, some people do indeed arrive at the conclusion that they've pursued treatment to a different end.

This article on Canada.com (Choices that will bear fruit) provides a well-balanced illustration of two different end-of-treatment options. In both cases, numerous attempts with fertility treatment did not result in pregnancy. One couple chose to build their family through adoption. The other is remaining child-free.

When pursuing a goal as heartfelt as having a baby, it's difficult for anyone to look at the 'what-if's' -- some may even call it defeatist thinking. In fact, there comes a time for some fertility patients when all options must be at least put on the table for viewing, if not actively chosen at that time.

What this article does not have the time or space to detail are the no-doubt lengthy journeys through complex emotions that these couples went through toward their decisions. Hopefully and most likely, they had the emotional and informational support of their fertility treatment team in the process. After all, while we reproductive endocrinologists focus on creating new life, our goals as physicians are to provide healing for our patients. Sometimes that means knowing when to say "when."

Technorati Tags: infertility treatment,adoption,child-free

Leftover Sperm: Too Much of a Good Thing?

2008-05-20T11:41:00.001-05:00

In some ways, Canada's a lot like the States. Their "rules" about reproductive medicine are almost as wide open as here in the U.S. -- so far. In this article from The Canadian Press, fertility specialists discuss the increasing problem of "abandoned" frozen sperm.

The freezing of sperm cells is now a fine-tuned technology. Much of the credit for that goes directly to the little cells themselves, of course: sperm cells are simply built in a way that helps them survive the freeze-thaw process and come out intact enough to fertilize an egg. Eggs, on the other hand, have proven trickier to get through that journey for later use, but we're far better at it recently than ever before (thanks mostly to the Italians, who were given few choices by their intervening government!)

Sperm cells that were frozen for nearly 30 years have been successfully thawed and used with IVF to result in healthy babies. We haven't been freezing eggs that long yet, so there are some unanswered questions on the female side of delayed conception.

Men who froze semen samples in the past don't always come forward later to use their sperm. So now, some cryopreservation facilities are finding themselves with forgotten stock. So many years have gone by now, these older labs are literally running out of storage room. The technicians and administrators find themselves in a bit of an ethical and pragmatic dilemma. This article points to Health Canada, the country's Federal department in charge of health care, as being in the process of creating some related guidelines.

It will be interesting to see how Canada deals with the problem.

Also interesting -- the article notes that frozen eggs are typically not abandoned, and says a possible reason may be the far different procedures that are required to acquire sperm versus egg cells.

Technorati Tags: frozen sperm,canada,cryopreservation,fertility,ivf

The Canadian Press: Sperm banks seek men who have forgotten 'little swimmers'