A Holiday PSA: Start Infertility Treatment Now!

We at FIRM always try to encourage our patients to initiate treatment at the end of the year. The holiday season is upon us, and normally the last thing on our patients’ minds is beginning infertility treatment. Typically, people like to wait until the new year to think about having children, or starting down the road of infertility treatment (ever wonder

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why your office has so many September and October birthdays??). And we totally get that.

But as it turns out, now is the very best time to start infertility treatment. Towards the

year’s end, most potential patients have met, or are about to meet, their insurance deductibles. The impact of this is simple: infertility treatment can now be started with the least impact to a patient’s pocket.

Even if you suspect that you might be suffering from infertility, but are not ready to commit to treatment, now is also a phenomenal time to get some of the diagnostic work done. Even if insurance does not cover infertility treatment, they will frequently cover diagnostic work, medication, or infertility monitoring.

Placeholder ImageChristmas and the associated holidays can be a very difficult time for couples struggling with infertility. But we believe, it truly can be the best time of the year. We welcome you to reach out to us if we can help you think through, or talk through any issues or questions you may have.

The Most Wonderful Time of the Year, unless…

It’s almost the end of the year and the start of another busy holiday season. Even in the best of circumstances,the holidays can be stressful.  But if you are dealing with fertility issues the holidays can be even more stressful. For most families, the holidays are child centered. Thanksgiving, Hanukkah, and Christmas stimulate images of sweet children and babies. Of course, there is an unsaid expectation that this is “the most wonderful time of the year”. You may feel lonely, sad and even isolated. Here are some suggestions to help you get through this holiday season.

Be ready for the questions.

Frequently, the holidays can be problematic with some fa

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mily members. Infertility is seldom understood by those who haven’t experienced it. You may get asked by a well-meaning relative “when are you going to give your parents a grandchild?” If you haven’t discussed your infertility with relatives, you are likely to get some variation of this question. This doesn’t mean that you are required to tell family members the details of your infertility struggle. But, it is helpful to have a response ready that you and your partner have discussed. You may even want to practice your answers.

Creating new traditions, and declining others.

Be selective about accepting invitations to parties and holiday celebrations, especially the ones at which you know will make you uncomfortable.  Give yourself permission and the gift of self-acceptance. If it’s too painful to try and continue like nothing is wrong, don’t do it. Remember, you don’t have to say yes.

A new tradition might be a special trip just for you and your partner. Maybe a beach vacation, a ski weekend, or a few nights at a secluded country inn would help to lighten Placeholder Imageyour mood.  Don’t feel guilty about not partaking in all the family events. You and your partner are going through a challenging time, and you need to concentrate on yourself and your partner in order to get through the holidays.

Create your own family traditions; a special ritual that says that you and your partner are a family and that you can celebrateyour love for each other, with or without children.

Remember the reason for the Season.

It may be a cliché, but it does help to change your perspective when you can help others in need. Infertility is all involving, and it’s easy to feel wrapped up in grief. Consider spending some time volunteering in your community. Cheering up others with the holiday blues often has a rejuvenating effect.

Set aside time to share your feelings with each other.

Acknowledge your feelings. Dealing with infertility can take an emotional toll. Talk with each other about your feelings.  Try to capture the essence of the holiday which makes it unique. Participate in activities which bring meaning to you at this time; create the joy intended in celebrating the holiday for its own sake.

PCOS Awareness Month: There is Hope

By Dr. Rinku Mehta

PCOS is a disorder that affects about 10-15% of women in the reproductive age category. It is of higher prevalence in certain ethnicities than others. Although there is not a single gene by itself that has been associated with PCOS, this disorder does have a genetic basis and its manifestations can be affected by other factors. Obesity can make the presentation and manifestations of PCOS more profound. Sometimes even weight loss of about 10% can improve the symptoms and may also result in the woman ovulating more frequently. That being said, lean women can also have PCOS.

One of the basic underlying abnormalities in all women with PCOS is metabolic pathway involving insulin levels. Maintaining a diet low in carbohydrates is fundamental to the management of PCOS. Some women with PCOS will have glucose intolerance andcropped-logo-color1.png may benefit from medications such as metformin to help decrease glucose intolerance. Low carb diet and weight management will also help. The only way to diagnose glucose intolerance is via a two hour glucose tolerance test, not just a fasting glucose level. Without this test, it is difficult to determine who needs medication. Not every patient with PCOS needs to be on metformin, contrary to popular belief.

Due to issues with lack of regular ovulation, many women with PCOS with need assistance in achieving pregnancy. Most of the time ovulation can be induced with oral medications, however in some women that are resistant to oral medications, hormonal injections may be needed.

The good news regarding  fertility in women with PCOS is that they have a very good prognosis of having a successful pregnancy and live birth with the appropriate treatment.

  • Dr. Mehta is a reproductive endocrinologist at the Frisco Institute for Reproductive Medicine with almost two decades of experience in the word of infertility. Dr. Mehta is known of her precision and ability to get her patients pregnant.

Latest Infertility Treatments

By Marius Meintjes, Ph.D.

Technicality Level: Moderate

Advanced infertility treatments are one of the fastest developing areas in medicine. Improved, current technologies, and the emergence of new technologies is a common encounter. The way assisted reproduction was approached but only two years ago are very different from what is being considered state-of-the-art today.

Time-lapse photography now allows us to place a microscope inside of the incubator IVF Pic 10instead of frequently taking the embryos out of the incubator to the microscope for evaluation. Low-light, low intensity photographs are taken minutes apart, creating a video of embryo development. The end result is that the embryos can be cultured without interruption for 6 days, reducing the exposure and resultant stress to the embryos while, simultaneously, embryologists gain more information on embryo development than ever before. Embryo developmental events such as asynchronized divisions, slower-than-normal cell divisions, division timings and abnormal cell divisions can be readily identified. Pregnancy rates are significantly improved due to the lower stress on the embryos and the deselection of compromised embryos.

New vitrification techniques allows for the snap-freezing of embryos, using a special vitrification solution, not much different from radiator fluid in car engines. Previously, one had to freeze an embryo over a period of hours, mitigating cryoprotectant exposure and ice crystal formation. Only good-quality embryos of certain developmental stages could be frozen and, we were happy when 80% of embryos survived. With vitrification, there is no ice crystal formation (glass formation instead), and, any quality- and stage embryo can be cryopreserved.  Most importantly, the survival rate approaches 100%. With a close to 100% survival rate, it now becomes feasible to transfer one embryo at a time, reliably preserve biopsied embryos during the process of preimplantation genetic screening (PGS) and preferably perform frozen embryo transfers in a carefully prepared uterus instead of transferring embryos fresh into a supraphysiological-hormone-exposed uterus. One very exciting development is that vitrification, for the first time, allows for the routine cryopreservation of oocytes (eggs) – this was not possible only a few years ago. Oocyte cryopreservation is a new and essential tool to offer fertility preservation to cancer patients, banking of fertility potential for aging professional women or increasing the options for donor eggs.

PGS is a technique where placental (trophoblast) cells are sampled from a blastocyst-stage embryo and then send to a genetics referral laboratory for determination of the chromosomal count in the embryo. The most common cause of an unsuccessful pregnancy (natural effort or with assistance) is an abnormal number of chromosomes in the embryo (aneuploidy). After biopsy or sampling, the blastocysts are vitrified and safely kept in storage for the two weeks or so that it takes to receive the results. Once we have results, we can warm or thaw only the normal and uncompromised embryos. UntitledTransferring only a confirmed, chromosomally normal embryo, ensures equivalent live birth rates for all patients, regardless of maternal age. This is in contrast to the typical age-related decline in live-birth rates when transferring unscreened embryos. Furthermore, live birth rates are increased and miscarriages are reduced for women 35 years or older.

With the advent of vitrification, and 100% survival rates, it is now possible to transfer a single embryo for most patients in replacement cycles after cryopreservation, instead of in fresh hyperstimulated cycles. This allows for the optimization of the implantation lining of the uterus with a 10-20% increase in live birth rates.

Routinely culturing embryos to the blastocyst stage with the use of low-oxygen culture, time-lapse culture systems and, improved culture media and platforms, now allow for the selection of embryos based on the quality and presence of the baby part (inner cell mass). We will only cryopreserve proven and likely viable embryos and have access to trophoblast cells for biopsy and PGS.

These new developments have significantly increased success rates.  Infertile patients now have access to ever growing and improving technologies which, ultimately, get them pregnant faster and allow us to help a broader spectrum of infertile patients, previously not possible.

 

Common Causes of Infertility

By Dr. Rinku V. Mehta

The desire to procreate and start a family is inherent in most people, however accomplishing this desire can be difficult for some. Infertility is more common than most people would think. Statistics estimate that 1 in 6, to 1 in 8 couples trying to conceive will experience issues with infertility. This number might actually be an underestimation since so many couples never end up seeking care for various reasons.

iStock_000023354293_SmallWe hear of women, especially teens who get pregnant after just one episode of unprotected intercourse. The CDC reported in a 2011 study that 49% of pregnancies in the U.S. were unintended. Understandably, when couples hear numbers like these, they feel they should have been pregnant after a couple months of trying. On the contrary, humans are actually not very efficient reproducers. If everything was just perfectly timed in a completely fertile couple, the chance of conception per ovulatory cycle in a young woman is only about 15-20%. This probability of conception per ovulatory menstrual cycle decreases with advancing age of the woman.

Age of the woman is the single most important factor in the prognosis of achieving a successful pregnancy.

So when should one seek evaluation and treatment for infertility? The general rule of thumb is that if a woman is under 35 years of age and has been trying for one year without success, it’s time to at least get an evaluation. A basic evaluation for infertility involves assessing the woman’s egg reserve (i.e. egg quantity in the ovaries), check for anatomic abnormalities with a pelvic sonogram and specialized X-ray called a hysterosalpingoram (HSG), check basic hormones and last but not the least, check a semen analysis on the husband.

In about 30% of cases some male factor will be present, and in about 10-15% of cases, male factor will be the predominant cause of infertility. A semen analysis is all that is needed as a basic screen for male factor infertility. If the semen analysis is abnormal then a repeat analysis in 2-3 weeks and further tests may be ordered as indicated.

Headshots_Retouched-005For women over age 35, it is advisable to seek evaluation if not successfully pregnant after 6 months of trying.  This is because advancing age of a woman negatively affects pregnancy rates and it would be better to identify and treat issues sooner than later, especially if more than one child is desired.

In instances when there is a known cause such as prior tubal disease or lack of regular periods or husband with prior vasectomy etc, it is recommended to seek care as soon as ready to start a family. Studies have shown that time to pregnancy is fastest with a specialist. A reproductive endocrinologist is a physician who specializes in treating couples with infertility.

 

  • Dr. Mehta is a reproductive endocrinologist at the Frisco Institute for Reproductive Medicine with almost two decades of experience in the word of infertility. Dr. Mehta is known of her precision and ability to get her patients pregnant.

Unique Fertility Issues of Our South Asian Patients

June 28, 2016

At Frisco Institute for Reproductive Medicine (FIRM) my colleagues and I welcome and embrace patients from a variety of ethnic backgrounds. Many of the patients we see are of South Asian descent from countries including India, Pakistan, Bangladesh, Sri Lanka, Indonesia, The Philippines and Singapore, to name a few.

Like most ethnic groups, individuals of South Asian origin have specific physical and cultural situations that may affect their fertility. We address these sensitivities and distinct situations in a patient and understanding manner, gathering all of the information needed to evaluate their options. We then decide together what the best treatment options are for moving forward and helping them build a family.

PCOS and male infertility

One of the most common reasons for infertility in women of South Asian descent is polycystic ovary syndrome (PCOS). PCOS is an endocrine disorder that causes an imbalance of reproductive hormones in women of reproductive age. Among a variety of symptoms, PCOS can often cause women to have trouble becoming pregnant due to lack of regular ovulation.

Studies show that PCOS is a familial condition, meaning genetic factors play a strong role in its development. Some studies have also shown a greater incidence of PCOS in people of South Asian countries. Having conducted extensive research on the topic of PCOS and its effects on reproductive age women, I understand that the condition has many different manifestations, and accurate diagnosis is very important and necessary to formulate the appropriate treatment regimen.

Patients in these communities often face familial pressure to have children, adding to the stress that infertility can cause. And while these individuals are culturally motivated to have children, they are also cost conscious.
South Asian family

Another common, and often surprising, reason that couples from South Asia have a hard time getting pregnant is due to male infertility. According to the American Society for Reproductive Medicine (ASRM), about 30 percent of infertility is due to male factors and abnormalities in men’s sperm. This is often a shock to patients that I see who didn’t previously know or realize that infertility can be related to male factors. Male infertility is quite easy to test for via a semen analysis and, based on the results, appropriate treatment can be recommended.

Environmental and cultural factors

Cultural factors, social norms and environment can all impact a particular population’s approach to fertility treatments. For example, many of my patients from South Asia maintain a “traditional” household where the male partner works outside of the home and the female partner supports the home and/or raises children. As a result, South Asian women who I see are usually apprehensive and a little shy in nature, which can make it more difficult to discuss fertility issues openly.

Studies also show that women of South Asian descent seem to undergo longer periods of infertility before seeking treatment. I see many South Asian patients who are in their 30s and have tried for five years to get pregnant with no success.

Often, infertility treatments are not covered by insurance, however many people do have diagnostic coverage. We always recommend at least get the testing done to determine the cause of infertility and then decide on whether or not to pursue treatment before it’s too late with respect to the negative impact of advancing age on fertility. It’s important to remember that infertility treatment is entirely elective and patients never have to do anything they are not comfortable with. At FIRM, our job as physicians is to educate our patients on their options and give them our recommendations. Ultimately the decision lies with the patient.

Knowledge is power

I often find that one of the greatest barriers to fertility care for South Asian couples is lack of knowledge about infertility and treatment. First and foremost is the fact that fertility is finite. The number of viable eggs that a woman has in her lifetime declines rapidly as she ages, so the younger the patient, the better the prognosis for a successful conception and live birth. I always advise patients – particularly South Asian patients who tend to put off treatment anyway – not to wait too long before seeking fertility care.

The goal of fertility treatment is to help couples achieve successful conception as soon as possible. That being said, depending on the individual’s situation, we typically recommend starting with simple strategies first and then moving to more aggressive treatments if simple modes have not worked.

Remember, time is of the essence!

If you’re older than 35 and have been trying to get pregnant for over 6 months with no luck, it’s important to take a more aggressive approach and seek counsel. I always recommend that couples gather as much information as they need to evaluate their options and then decide together on what treatment, if any, they are comfortable moving forward with.

The Amazing Variation in IVF Cost Around The Country – and Around Texas

October 10, 2016


I often get calls from friends or acquaintances asking for advice about in vitro fertilization (IVF). One of the things that has always struck me is how different IVF cost can be based on where you live.

For instance, a basic IVF cycle in Atlanta, New York and San Francisco without intracytoplasmic sperm injection(ICSI) or preimplantation genetic screening (PGS) is about $15K on average. Although this is a high price tag, understandably these are some of the most expensive places in the country to live in, with respect to cost of living compared with our neck of the woods in Texas.

That being said, it also amazes me how widely IVF cost varies in the same region. For instance, within the DFW metroplex itself, cost varies from as low as $8K for IVF to $12K in the same city.

Between Dallas, Houston, Austin and San Antonio, the average IVF pricing is the lowest in the DFW metroplex.

IVF is definitely something you do not want to “bargain hunt” for. However, given that we have one of the best IVF laboratories in the country and our patients see their own physician for every visit/sonogram, I find it hard to justify how some of our neighboring clinics can charge so much more.

Frisco Institute for Reproductive Medicine’s IVF pricing is definitely below that of many of our local competitors.

Our philosophy on IVF cost

“We have always had the philosophy of making things affordable for patients to the best of our abilities, so that financial stress is not the only factor keeping a couple from building their family.”

Cost is a big consideration but so is quality of care, where we really excel.

  • Our lab has some of the most advanced technologies being utilized.
  • Our scientific director Marius Meintjes is world renowned in his expertise in human embryology and is an invited speaker to many IVF conferences around the world as well as within the United States.
  • We see some of the most complex cases and other infertility doctors in the city have referred their difficult patients to us for our expertise.

I would encourage patients to do some research on what is available in their vicinity before making the commitment to do IVF at any clinic. Some important questions to have answered before committing to a clinic:

  • Do you get to see your own doctor at each visit, or is your care done by nurses and sonographers or doctor of the day?
  • Do you get your questions answered in a timely manner?
  • Is the staff pleasant and easy to work with?
  • Do you trust that your doctor and clinic are giving you the best care possible?

No clinic can guarantee a baby, even with IVF. But it is our promise to give you the best science and technology available – and to do it with compassion and care.