Most Young Women with Menopause-like Condition Retain Store of Eggs
Discovery May Lead to Treatments to Restore Fertility

Contrary to what researchers had previously believed, most young women and girls who experience a menopause-like condition called primary ovarian insufficiency still have immature eggs in their ovaries, according to a study by scientists at the National Institutes of Health.

Primary ovarian insufficiency, or POI, results in a menopause-like condition years before normal menopause begins—sometimes as early as the teens and twenties. Women with primary ovarian insufficiency stop producing normal amounts of reproductive hormones, develop hot flashes, and typically become infertile.

“The discovery that most women with primary ovarian insufficiency have immature eggs remaining in their ovaries raises the possibility of developing treatments for the infertility that accompanies the condition,” said Alan E. Guttmacher, M.D., acting director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), the NIH institute at which the study was conducted.

The findings were published online in Fertility and Sterility. The study’s senior author was Lawrence M. Nelson, M.D., head of NICHD’s Integrative Reproductive Medicine Group.

POI occurs in 1 out of 100 women by age 40. In addition to experiencing hot flashes, women with POI cease having regular menstrual periods. The symptoms may be lessened or relieved by therapy to replace the missing hormones. Although most women with POI are infertile, Dr. Nelson said, about 5 to 10 percent become pregnant unexpectedly at some time after their condition is diagnosed.

The findings expand on earlier research showing that ovulation is possible in this group of patients. Refinement in ultrasound technology allowed the researchers to detect ovarian follicles in three quarters of the POI patients who took part in the study.

For the current study, Dr. Nelson and his colleagues used ultrasound to assess follicle maturation in a group of women with POI. A follicle is a fluid-filled sac in the ovary that gives rise to the egg cell. The researchers compared 97 women who had POI with 42 women with normal menstrual cycles. When the scientists performed ultrasound examinations on the women with POI, they were surprised to discover that 73 percent of the women had ovarian follicles. Moreover, these follicles were capable of producing ovarian hormones.

Dr. Nelson explained that during a normal menstrual cycle, the pituitary gland releases follicle-stimulating hormone (FSH), which causes follicles to grow. While they are growing, follicles release the hormone estradiol, a form of estrogen. The pituitary also produces another hormone, called luteinizing hormone (LH), which remains at low levels during most of the cycle and then surges when it is time to ovulate. This LH surge gives the follicle a signal to break open and release the egg.

The scientists found that in women with primary ovarian insufficiency, both FSH and LH levels are higher than in women without the condition.

“The high LH levels indicate that the pituitary is continually sending the ovaries the message to ovulate.” Dr. Nelson said. “The follicles get the message to mature before they are ready, and so they don’t grow normally, and in most cases, fail to release the egg.”

In women of reproductive age who do not have POI, the ovary produces what Dr. Nelson refers to as a support group of extra follicles. These extra follicles develop along with the dominant follicle—the one that eventually releases the egg. Dr. Nelson theorizes that the extra follicles produce estradiol and other hormones to provide negative feedback to the pituitary. The hormones from the support group follicles regulate the pituitary, keeping FSH and LH blood levels in the normal range. In an earlier study, Dr. Nelson and his colleagues found that most women with POI do not have the follicle support group.

Without the support group, Dr. Nelson said, the solitary dominant follicle fails to mature properly due to the high LH levels. The patients develop what Dr. Nelson refers to as lonely luteinized follicles.
In the current study, women with primary ovarian insufficiency had lower levels of estradiol than women with normal menstrual cycles. But the women’s follicles were producing some estradiol, the scientists found, and they had higher levels of estradiol than did women who had no detectable follicles. They also had higher levels of progesterone, a hormone that follicles produce in response to LH.

“These follicles aren’t inert structures,” Dr. Nelson said. “They are producing reproductive hormones—just not enough.”

Women with primary ovarian insufficiency are usually treated with a patch that releases estradiol to alleviate their menopause-like symptoms. In a few instances, participants in Dr. Nelson’s studies at NIH have become pregnant during their treatment with the estradiol patch. Dr. Nelson hypothesizes that the estradiol supplied by the patch allowed their follicles to mature by suppressing LH levels into the normal range. He is planning a study to determine if, in addition to relieving their menopause like symptoms, the replacement estradiol supplied by the patch will also improve their chances of ovulation.

“The body needs estradiol both to prepare the lining of the uterus to support pregnancy and also to regulate FSH and LH levels in a feedback loop,” Dr. Nelson said. “We hope to test whether giving estradiol via a skin patch to women with primary ovarian insufficiency will tamp down their LH level, allow the follicles to mature at an appropriate time, and help women with this condition to ovulate.”

Dr. Nelson thinks that the one-quarter of the women in his study who did not have follicles that could be detected by ultrasound may simply have been observed at a time when the follicles were not growing. If the women were examined on another occasion, follicles may have been visible, he said. With POI, ovarian functioning appears to be intermittent and unpredictable. So the fact that the researchers were unable to detect follicles in some of the women during the study doesn’t preclude that on another occasion the women would develop follicles large enough to be detected by ultrasound.

In previous research, Dr. Nelson and his coworkers reported that women who experience a delay in diagnosing POI have an increased risk of low bone density.

“It’s really important for women with POI to get a diagnosis as soon as possible so they can begin treatment,” he said. “Lack of reproductive hormones may result in bone thinning and, possibly, bone fractures, later in life.”

Other authors of the study were Ziad R. Hubayter, Vaishali Popat, Vien H. Vanderhoof, Obioma Ndubizu, and James F. Troendle, also of NICHD; and Diane Johnson, Edie Mao, and Karim A. Calis, of NIH’s Clinical Center.

The NICHD sponsors research on development, before and after birth; maternal, child, and family health; reproductive biology and population issues; and medical rehabilitation. For more information, visit the Institute’s Web site:

http://www.nih.gov/news/health/apr2010/nichd-26.htm

“What if I redefine what it means to be a mother?”

“What if I redefine what it means to be a family?”

“What if I let go of the doubt, the worry, the fear or self judgment for one day…one week…the rest of my life?”

“What if I become an advocate for infertility research and treatment?”

“What if I lived in the moment rather than living in an uncertain future?”

“What if my story could help one person?”

These profound questions touch every couple on the fertility journey. Unfortunately most couples feel alone in this journey, as it is kept a secret. I ask – why should infertility be the hidden secret? There is nothing shameful in this journey and if more couples spoke up uneducated people (usually the one who had no problems conceiving) could see infertility as a disease. First, by speaking up you could help a couple struggling with fertility issues. Secondly, fertility treatments should be covered by insurance and this will only happen if couples demand change. Thirdly, with speaking up it allows society to grow and redefine what is a family/mother/father. We are the people with the power to change the fabric of society and reweave it for the better.

http://www.beautifulcervix.com/welcome/

Check out the high protein and fiber - that will balance out the sugars and carbs.

Well one of the things I miss on the gluten free diet, is eating granola. All that delicious granola sold at grocery stores is out of bounds. Recently I came across Go Raw Grow Live Granola.

Go Raw Granola comes in different flavors – plain (white packaging), slightly sweeter (red packaging) and chocolate (brown packaging). I have enjoyed the slightly sweet and chocolate flavors. The plain package is too plain and tastes like cardboard. The granola is tasty, crunchy and sweet. I’m posting the nutritional facts from the revise of the package. Though this product is very high in carbohydrates, it is also very high in protein and fiber, two components that slow absorption and control blood sugar levels. No additional sugars are added to the product and the sweetness comes from the fruit and spouts. A small bowl of this product is filling and gives you energy that lasts. If you have diabetes or PCOS you will want to avoid this product due to the high carbohydrate level. Most common granolas do not contain fiber or high levels of protein, thus you will experience the sugar rush and still feel unsatisfied later. Thus is product is useful for individuals looking to fuel up in the morning with a healthier alternative.

One disadvantage to the Go Raw Live Granola is the price – about $12 to $14 for one package. Yet a bowl of this product is a great breakfast meal or afternoon snack.

What are signs of gluten sensitivity? Well some very common symptoms can be caused by gluten, such as: bloating, constipation/diarrhea, fogginess and sleepiness after eating, abdominal cramping, skin rashes and many more. I believe the best rule of thumb is trying out the 80/20 gluten free rule. That means eating 80% of your diet from gluten free products, fresh fruits/veggies and protein. The other 20% coming from gluten products when the situation does not provide the flexibility, such as eating out or eliminating that last favorite product. If after a month you feel increased energy, less bloating, consistent bowl movements and stable blood sugars, more than likely you might be sensitive to gluten. At this point you might want to try a complete gluten free diet and see if your health improves. Generally most of my clients feel a hundred times better on the 80/20 gluten rule.

How does gluten potential effect fertility? When the gluten sensitive body digests food containing gluten three common components happen:

1) Gluten molecules stick to the gut lining causing inflammation.

2) Inflammation/destruction of the gut lining causing mal absorption of basic nutrients, such as Vit D, B and iron resulting malnutrition.

3) Inflammation of the gut activates the immune system. Over activation of immune systems causes miss signaling and autoimmune disorders. I often wonder could POF or the poor responder be caused at some level by antibodies attacking the ovaries or reproductive hormones. I have yet to find information supporting this idea, but researchers are only starting to understand the power of the immune system.
The above items can lead to imbalances in the body, thus infertility.

What does it mean to go gluten free? lNothing fancy here, just simple little modifications can make a big difference. As time passes I will post more information about this topic.

What’s the hardest part of the gluten free diet? I found substituting gluten products in my kitchen’s pantry to be the hardest. Even my clients feel overwhelmed by this, since gluten is in almost everything. With time I have learned a lot (and still learning) but I want to pass this knowledge on. I will post the products I am buying and give mini reviews as a tool for my clients and women reading this blog to integrate these small changes for improved well being (and of course improved fertility).

Almost three months later, I have not looked back and don’t miss the gluten products I gave up. Developing new habits and dealing with uneducated friend’s weird comments at restaurants has been difficult. Yet the power of this simple step is never ending, treating your body with respect, recognizing its need for support and making the steps to heal it.

What is fructose?

Fructose is a special crystalline sugar that is super sweet. Sucrose and HFCS (high fructose corn syrup) both contain fructose. White sugar is just as bad as HFCS. Raw cane sugar is just as bad as white sugar.

There is no difference between HFCS and sucrose. Both are equally bad, since they both contain the molecule fructose. Fructose (if seen on a list of ingredients) is purely fructose and produced in a lab.

Why is fructose, sucrose, sugar or HFCS bad?

They contain a molecule called fructose. Fructose does not suppress our appetites or promote insulin secretion. More importantly it is completely metabolized in the liver leading to byproducts such as direct fat storage (in liver and general weight gain), high cholesterol and high blood pressure. These health issues have a profound effect on reproductive health. Plus we are not even aware of all the hidden components at this point.

All sugars are not created equally. Fruit has sugar, but also contains fiber, which reduces the rate of absorption thus reducing the insulin response. It increases the speed of intestinal contents to tell the brain to stop eating and reduces hunger. The bigger problem is coming from all the processed foods in our lives, which contain no or little fiber.

If you have an hour and half, play the following link. It’s a wonderful explanation of how sugar is metabolized in the body. Dr. Lustig is an entertaining lecturer who discusses the reality behind the consumption of sugar in the modern diet. Everyday products contain HFCS and most women are not even aware of it. He indicates that most breads contain sugar and especially HFCS. Have you looked at what’s contained in most yogurts – HFCS! Take a moment and look at the list of ingredients. Yes, even dried fruit can contain HFCS. Not so healthy.

Don’t get me wrong. Sugar is not evil. Its power is reliant on how much of our diet is focused on sugary products or the hidden sugars in “healthy products”. Everything in moderation. Unfortunately, most women are not aware of the issue.

In the end, the metabolic issues caused by sugar – even on a minimal level are powerful, such as:
An over burdened liver cannot detoxifies hormones out of the blood
Unstable insulin levels can promote poor follicular growth
Minimal fat gain can allow hormonal storage.

Sugar degrades the fabric of our health – by moderating sugar consumption our overall health and fertility can improve.

Interested in Dr Lustig’s lecture? Here’s the link:

So here’s a very brief rundown of Dr L discussion:
Sucrose is cane or white sugar. Sweet index of 100. Contains one molecule of glucose and one molecule of fructose.

HFCS derived from corn. Sweet index of 120.

You would think that you would use less of hfcs than sucrose as it’s sweeter..but they are not. The same amount of hfcs is going into products as when sugar was used even though hfcs is sweeter.

HFCS is 55% fructose.
Sucrose is 50% fructose.

We are not eating more, but eating more sugar.

Fructose is not glucose.
Fructose does not suppress ghrelin
Acute fructose does not simulate insulin or leptin.

Hepatic fructose metabolism is different
Chronic fructose exposure promotes metabolic syndrome

Soda like coke contains sugar, salt and caffeine. Caffeine is a mild diuretic makes you pee free water. Salt will make you thirsty. The sugar covers up the salt. The coke makes you thirsty to drink more.

Carbohydrates raise cholesterol. To make low fat products taste good, they add sugar. Fructose is mostly added for palatability (especially in low fat products) and as a browning agent.

Fiber can help us properly digest sugar. It’s mostly removed in products to decrease cooking time and increase shelf life. In fruits they contain fiber to balance out the sugar.

Sucrose and HFCS are the same. Both bad.

Fructose is not glucose. Fructose is 7 times more likely than glucose to form Advanced Glycation End Products (AGE’s). It does not suppress ghrelin. Does not stimulate insulin or leptin. Metabolized in the liver. Chronic exposure promotes metabolic syndrome.

Glycogen is the stored form of glucose. Glycogen is non toxic.

Citrate byproduct from the creb cycle. De nova lipase genesis. Sugars get made into fat called vldl which is bad and causes heart disease and obesity.

Ethanol is a carbohydrate. It is a toxin. The only difference with ethanol and fructose is that ethanol affects the brain. It is an acute toxin. Fructose is long term toxin.

Ethanol produces more citrate in the liver as it is broken down. Though both fructose and ethanol activates junk 1 – which damages the liver.

Sucrose – all the fructose contained in sucrose will be metabolized in the liver. Why? Because it’s the only place that can metabolize fructose and generates all sorts of problems. Fructose does not activate insulin. During the process of metabolizing uric acid is produced. The uric acid goes in the blood and can cause gout or more commonly HYPERTENSION. Sugar fluids will cause hypertension. Allopurinol is a drug to treat gout but studies have found that it lowers hypertension in adults. One of the byproducts of fructose cause the activation of lipase storage mechanisms – thus weight gain. Up to 30% of the calories of fructose will end up as fat. You are not only consuming a carbohydrate, but consuming fat. High sugar diet is a high fat diet. Some of this fat will not enter the blood stream (ie high cholesterol) but stays in the liver. Junk 1 will cause insulin receptors to be inactive in the liver. On top of this, you don’t know you are full.

What can you do?
Get rid of sugared liquids – only water and milk.
Eat your carbohydrate with fiber
Wait 20 minutes for a second portion.
Buy your screen time minute for minute with physical activity.

Why is exercise important?
Not because it burns calories – ie the idea of calories in and out.
Because it improves skeletal muscle insulin sensitivity.
Because it reduces stress, and resultant cortisol release
Because it makes the TCA cycle run faster and detoxifies fructose, improving hepatic insulin sensitivity. Burn off the byproducts before it can be made into fat.

Volume 93, Issue 2, Pages 423-427 January 15, 2010
Human embryo twinning with applications in reproductive medicine
Karl Illmensee, Ph.D.ab, Mike Levanduski, M.S.ab, Andrea Vidali, M.D.a, Nabil Husami, M.D.a, Vasilios T. Goudas, M.D

Mammalian embryo splitting was first achieved in the mouse system by investigating the developmental potential of blastomeres isolated from early preimplantation embryos at the 4- and 8-cell stage. Further studies in the mouse showed that 65% of embryos split at the 2-cell stage and transferred to foster mothers developed to term. Moreover, transfer of embryos derived from 2-cell embryo splitting gave rise to healthy offspring very similar in size and morphology to control live-born mice originating from normal embryos. The investigators concluded that experimental embryo twinning did not interfere with normal adult development.

In farm animals, embryo splitting has successfully been established for several livestock species. In sheep, 36% of embryos split as 2- and 4- cell embryos developed to term after transfer to recipient females. In cattle, embryos split into individual blastomeres at the 4-cell stage could develop to term, giving rise to multiple monozygotic healthy calves. Bisected or biopsied early bovine embryos gave pregnancy rates similar to those obtained from intact control embryos. Thousands of twin calves resulting from embryo splitting have been born worldwide, and there have been no reports of abnormalities in the offspring due to the splitting procedure. Embryo twinning was therefore proposed for safe and efficient applications under commercial field conditions. Furthermore, cryopreserved split bovine embryos after their time-separated thawing and intrauterine transfer gave rise to healthy monozygotic calves of different ages. In the goat, monozygotic twin kids were produced from bisected early embryos. In addition, split embryos that were transferred to genetically identical females could develop to term in allogenic pregnancies, being genetically identical twins to these foster females (9). In the pig, split embryos were capable of full-term development giving rise to healthy twin piglets (10). In the horse, from split embryos created via blastomere biopsy at the 2- or 8-cell stage, healthy monozygotic foals were delivered at term pregnancy.

In nonhuman primates, however, embryo splitting has given only inferior results without leading to twin babies. The splitting of rhesus monkey embryos at the 8-cell stage resulted in one live-born monkey. Embryo twinning in the rhesus monkey has also been attempted by blastomere separation at the 2- and 4-cell stage and has led to two twin pregnancies but with no birth of monozygotic twins. Further investigations are needed to reveal the reasons for these limited results. Genetically identical rhesus monkeys would be very useful for the study of human-related twinning and tissue transplantation and may serve as a model system to investigate the epigenetic effects caused by the maternal environment during pregnancy.

Human embryo splitting carried out on genetically abnormal embryos has so far been presented only in a preliminary report. These embryos were obtained from IVF cycles and were donated for research. They were split at early cleavage stages, coated with artificial zona pellucida (ZP), and cultured in vitro. However, these split embryos were arrested in development after a few cell divisions at the most. In a commentary referring to these preliminary experiments and to embryo splitting in general, the merits of these attempts were acknowledged for future applications in reproductive medicine (16).

With regard to human embryo splitting, the Ethics Committee of the American Society for Reproductive Medicine (ASRM) considered favorably research on embryo splitting and stated in its report “since embryo splitting has the potential to improve the efficacy of IVF treatments for infertility, research to investigate the technique is ethically acceptable”. According to these recommendations, we have first established efficient blastomere biopsy for embryo splitting in the mouse as an experimental model system.

Our objectives for this current study were to apply the newly developed technology to human embryo splitting to evaluate its efficacy at different early embryonic stages (splitting efficiency) and to determine the best success rates of twin embryo development to the blastocyst stage under in vitro culture conditions (developmental efficiency).

Discussion

This study documented that it is possible to effectively split human embryos by blastomere biopsy. A significantly increased rate for embryo twinning was observed for the more advanced embryos split at the 6- to 8-cell stage than for those split at the 2- to 5-cell stage. When embryos were split at the 2- to 5-cell stage, it was not apparent which of those would have the potential to progress to the 6- to 8-cell stage or beyond. Of course, a similar argument could also be considered for the 6- to 8-cell embryos concerning their prospective developmental capacities. Further investigation is necessary to explain why embryo splitting at the 6- to 8-cell stage gave superior twinning results.

In general, split embryos hatched in advance of nonsplit embryos, suggesting an “assisted hatching effect.” This was facilitated by the ZP opening that was required for blastomere biopsy. It has been proposed that assisted embryo hatching may provide a beneficial effect for facilitating embryo implantation in patients with advanced age, with repeated implantation failures after several IVF or ICSI cycles, or with cryopreserved-thawed ET cycles.

Splitting of 6- to 8-cell embryos resulted in more developing embryos in comparison with the number of embryos available before splitting. The numerical increase of embryos obtained after splitting would have obvious clinical advantages for patients enrolled in IVF programs. Embryo splitting in ART may be applicable and considered for those patients termed as “low responders” with only a few oocytes retrieved after controlled ovarian stimulation. However, embryo splitting should only be considered if the embryos are of high quality and reach the 6- to 8-cell stage after IVF, as our study indicates. In this case, embryo splitting may increase the likelihood for obtaining a pregnancy since more embryos could be made available for intrauterine transfer. Embryo splitting would not be of practical benefit for patients with poor-quality embryos that do not develop to the 6- to 8-cell stage by day 3 postfertilization. Relevant to this crucial transition during early embryonic development, it was documented at the molecular level that maternally derived mRNA stored during oogenesis is used for protein synthesis from fertilization to the initial blastomere divisions. Thereafter, a new wave of embryonic mRNA is synthesized and is responsible for continuation of embryogenesis. From these data on gene-expression profiling of early embryos it seems reasonable to consider the 6-cell stage as most optimal for embryo twinning.

For couples with few embryos of good quality available during one IVF cycle, embryo splitting may yield additional embryos to be cryopreserved for subsequent transfer, potentially increasing the likelihood of a pregnancy and even providing time-separated twins. The Ethics Committee of the ASRM has stated in its report that “splitting one embryo into two or more embryos could serve the needs of infertile couples in several ways. As long as a couple is fully informed of the risk of such an outcome, there would appear to be no major ethical objection”. It has previously been postulated that embryo splitting at the blastocyst stage may be of benefit for patients with only one or few normal embryos obtained by IVF techniques. Indeed, duplication of embryos by microsurgical splitting to improve the chance of pregnancy should not cause a medical or ethical objection since monozygotic twins can occasionally occur in natural conception as well as in IVF cycles. Although there is a concern that embryo splitting may result in unequal cell distribution to the twin embryos, such distribution does not seem to interfere with normal development. There is evidence for the unequal allocation of cells to the twin embryos, leading to some genetic and phenotypic differences among healthy monozygotic twins.

In our present study, we have established efficient techniques for human embryo splitting to create developing twin embryos, although they originated from genetically abnormal (triploid) embryos. We are currently conducting a randomized controlled prospective study under Institutional Review Board approval to further corroborate and extend these findings. In the future it should be anticipated that such novel twinning technology will find clinical use in reproductive medicine.

So many of my clients define themselves by the number they are given by Western medicine.  This number game involves age, FSH, antral follicle count or AMA results.  Number readings can feel like a heavy burden in this journey to conceive. One of my clients, K. experienced the number game.  She wanted to reach out to other women in the number game and convey her experience.  At one point during her treatment process, she realized numbers are just numbers and don’t indicate failure or success.  The power of moving beyond the definitions of a number representing fertility or how much abundance we have  – can be freeing – allowing many different perspectives to open in our lives.

Numbers, most of us look for them everywhere.  Where we placed for our age group in the running race, our class rank, the percentage of people that passed the exam, etc. Hearing these numbers never overly concerned me until I heard a number that changed my life. Three months ago my fertility doctor told me that my FSH level was 14.6, which meant a much more aggressive approach than our originally discussed fertility plan.  I was then told that at best (assuming I made it into the IVF cycle) I had a five to ten percent chance of having a baby of my own. 

This news was devastating and all I could do was wrap my thoughts around that 5-10% number.  If I were a gambler and was given those odd I certainly would not place a bet. I couldn’t seem to move my thinking beyond that 5-10% and a part of me thought “with those odds, why bother?”. My optimistic husband continuously reminded me that we still had a chance of having our own baby.  I continued my fertility cycles and began acupuncture. 

In the beginning, I saw acupuncture as “a way to help me get pregnant”. After my fist session I realized it was so much more than that.  I began looking inside myself and realized this journey was helping me move into a state of health and wellbeing. My thoughts moved away from the 5-10% chance and instead focused on feeling better mentally, physically and spiritually.

I went through two unsuccessful IUI cycles and learned that I was a poor responder to the drugs.  My doctor decided to set me up for an IVF cycle with the understanding that I needed to produce at least 4 follicles to continue the cycle.  Here I was again, focused on a number.  I tried hard to block that number from my thoughts and reminded myself to focus on the things within my control. In the beginning of the cycle I only had three follicles. As my mind wandered towards the thought of only three follicles, I would stop and pull away.  Getting caught up in the numbers was only wreaking havoc in my mind. This was an unnecessary stress that I could avoid by pulling away from the thoughts. I went in for another ultrasound on a Friday and once again had only three follicles. Thankfully my doctor decided to give me the weekend before canceling my cycle.  Miraculously three days later a fourth follicle developed meaning that I had made it into the IVF cycle. The doctor retrieved all four follicles, and transferred one embryo.

I learned of our second miracle when I received the congratulations you’re pregnant phone call. We all face numerous challenges throughout life. For me, this most recent challenge has taught me not to focus too much attention on the numbers.  Often times as patients we might feel compelled to hear the number…. “What chance do we have?”.  But please remember that it’s just a number and that you have every chance as long as your body, mind, soul and spirit are in good overall health.

If you have already have a diagnosis, such as high FSH, blocked tubes, fibroids, endometriosis you will want to find a clinic with a specialized doctor for your situation.  Remember to ask your referring doctor if the clinic has experience handling your type of diagnosis.  If you decided to use the clinic referral, go to their website and read about their doctors training/experience.  If you have endometriosis, pick the clinic doctor who has the most experience with the diagnosis.  When calling to make your appointment, know which doctor to request since you cannot assume the clinic will book your appointment with your pick.

Why is it important to visit clinics which specialize in your diagnosis? 

Specialized clinics have doctors well versed in all protocols for the diagnosis and the possible problems that might arise to guide you through the process.  Let’s use the diagnosis for “high FSH” as an example.  Clinics specializing in “high FSH” have unique protocols for stimulation and are willing to proceed to retrieval when the client has less than 4 follicles. A clinic accustomed to treating “unexplained infertility” that does not target “high FSH” could be using standard protocols resulting in a possible poorer response and a cancelled cycle or will not proceed to retrieval when the client has less than 4 follicles. 

When comparing the above clinics two very important decisions come into light:

Are you comfortable if a cycle gets cancelled even if there are follicles produced but not enough for retrieval?

Will you permit a cycle go to retrieval with less than 4 follicles when fertilization might not occur?

Due to the varying treatment policies, IVF effects can lead to different results and understanding all the possible outcomes is important.  Each diagnosis has its own set of treatment questions and a specialized clinic should be proactive and approach you with these difficult questions before they arise (but as mentioned before educate yourself).  Treatment results are based on two components – the couple’s ability to respond to treatment and the doctor’s knowledge in treating your situation.  You have every right to seek out an optimal treatment protocol for the best results.

When it comes to a friend’s I notice two potential problems:

1) Your friend got pregnant on first cycle of IUI/IVF and LOVES their clinic.  When your friend has the great experience of conceiving on the first cycle, their journey with a clinic was short and not complicated.  With multiple cycles many patients start to feel like a widget in the machinery.  Some clinics are worse than others and the friend’s clinic might be one of these places.  Remember your friend is on a high from her pregnancy test and may forget any problems she encounted.  Ask the friend about their experience getting appointments, having blood work or ultra sounds.  Where their appointments on time or did they wait?  Did the doctor react to quickly change a protocol if needed?  Pick your friend’s brain for the possible forgotten information. 

2) Your friend does not have a similar diagnosis as yours.  If your friend has unexplained infertility, but you have high FSH – the clinic might not be the right match.  As mentioned in the previous article clinics should match your diagnosis.  If you want to buy a house with updated kitchen, you wouldn’t want to waste your time looking at homes needing remodeling.

In the end friends faced with fertility challenges can be excellent source of support.  Take in their knowledge and use it as a platform to build your own library of information. 

Next week, we will be discussing picking a clinic to match your diagnosis.