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.

How to Naturally Increase Fertility

November 15, 2016

Transcript

Patients ask me all the time what are the things they can do naturally to the boost their fertility. The whole body deserves to be taken care of, we’re not just treating one aspect. In order to support fertility, I always recommend a healthy diet and lifestyle to increase fertility: McDonalds and fast foods are not your friend.

I recommend eating organic foods and vegetables as much as possible. If you Google “the dirty dozen,” it will give you a whole list of fruits and vegetables that have high pesticide residue. There is a lot more data coming out saying that our pesticide exposures and environmental toxins are affecting our fertility.

Exposure to chemicals such as phthalates and other pesticides, called endocrine disruptors, can affect our hormonal system. There is now a higher incidence of polycystic ovary syndrome (PCOS) and endometriosis possibly as result, so try to minimize exposure to these products by eating organic and eating as natural and unprocessed as possible.

The other thing I always recommend to naturally increase fertility is at least 30 minutes of moderate paced exercise five times a week. Exercise releases a lot of important endorphins that are good for you overall and boost your mood.

Last but not the least, there is again a lot of data coming out about use of plastics and how those chemicals leach into our food products. As much as possible, avoid using plastics in the microwave, store your food in glass containers, don’t drink from bottles of water that have been sitting in your car for long periods of time.

These are just general common sense things that everybody can incorporate into their daily life to naturally increase fertility.

I Never Thought It Could Be Me: An Infertility Doctor’s Story

November 30, 2016


Dr. Mehta’s infertility journey

I’m Dr. Rinku Mehta, reproductive endocrinologist and medical director at Frisco Institute for Reproductive Medicine. I want to share my story of how infertility and loss don’t discriminate, because I’ve experienced both – and I’m an infertility specialist. I know what my patients are going through. Here is my story.

I always knew that I wanted to have children eventually. However, like many driven and ambitious young people, I was busy building my career in my early 20s and having children wasn’t very high on my priority list. Luckily, I got married at the young age of 24 so I knew that I had time. After all, I figured it wouldn’t be that difficult to get pregnant once I was ready.

I know what you’re thinking, but sadly, yes, that’s what goes through the mind of a 24-year-old. Because when I was at that age and in that mindset, I was under the impression that life was supposed to unfold just as I wanted it to. You see, I had it all planned out.

After graduating from high school I spent three years getting my undergraduate degree, followed by four years of medical school, four years in residency and three years in a fellowship to specialize in my field – all before I was ready to see my first private patient.

Now I look back and laugh at my naivety. Where in all of that, was there time to have children? Thankfully, my family had the good sense to remind me that there would probably never be a good or “convenient” time.

Going through reproductive endocrinology and infertility rotation in residency also reminded me that my “biological clock” was indeed ticking. So at the age of 28, I stopped taking my oral birth control pill and began trying to start a family. Then, nothing happened.

After several months, I consulted with a faculty member and got evaluated. It turned out that I had polycystic ovary syndrome (PCOS) and was not ovulating regularly. So began the road of fertility treatments.

Dr. Mehta's Family

Dr. Rinku Mehta with her husband, Danny, and their two sons.

From Fabulous! to This is not good

We tried a hormonal medication for fertility called Clomid that would help me ovulate and lo and behold, I got pregnant on the second try. I remember thinking, Fabulous! Things could not have worked out better and we were ecstatic.

At this time, I was a third-year OB-GYN resident and my schedule was crazy. I was working long hours and into the night. I heard that our residency was participating in a large, multicenter trial to study first trimester blood test screenings for abnormalities in babies. Intrigued, I decided to participate. During my sonogram, the sonographer left the room and returned with a faculty doctor who had a frown on his face. I was then asked to get dressed and come back into his office. All I could think was, This is not good.

The doctor sat me down and explained that they had seen a thick nuchal fold in the baby. For those of you who are thinking, What is that? don’t worry – I was thinking the same exact thing. He went on to explain that it could mean that there was something wrong with the baby.

The blood tests had also come back abnormal. Since this was a research study, it was unclear how to completely interpret these results. So then came a battery of tests, diagnostics and concern. I couldn’t believe that this was happening to my husband and me. After all, I was only 28 years old and babies were supposed to come naturally to women under 35.

At least that’s what I thought I knew.

At work, I was Dr. Mehta

Throughout this process, my husband was an amazing pillar of support. I also learned an important personal lesson of detachment at this time. While my personal world was in shambles, with evenings spent trying to research what could be wrong with my baby and shedding endless tears on my couch, at work I was Dr. Mehta.

I had a job to do, patients to care for and my personal issues could not be allowed to interfere. Detaching from life outside of work allowed me to do my job well and not fall apart.

Ultimately, we lost our baby girl when I was about 21 weeks pregnant. To this day, I still do not have the words to express the pain I felt. I felt like my heart would burst with sadness. I also saw my husband cry and I didn’t know how to take away his pain.

But we healed, with time. Six months later, we decided to give it another try. We used Clomid treatment and once again, got pregnant. This time however, as illogical as it may sound, I decided not to have any tests done.

I didn’t want to know if there was a problem with my baby. I had decided that I was going to take my chances and trust in God. And I got lucky.

At 30-weeks pregnant, my water broke and I was admitted to labor and delivery – the very same facility that I used to see patients at, and I endured many of the same experiences that my patients in preterm labor do. My son was born at 32 weeks.

He spent two weeks in the neonatal intensive care unit (NICU). Mainly because he was about 3 pounds and couldn’t maintain his body temperature or suck from a bottle. When I walked into NICU for the first time and saw him, his head was shaven and he had IVs in his scalp and monitors all over him. I broke down and sobbed, asking, “Why do these things keep happening to my family?”

During this time, the NICU staff was incredible and my little baby boy was able to come home after two weeks. [Side note: caring for a premature boy at home is an entirely different story that I’ll save for another blog at another time].

That same premature little boy is now 14 years old and weighs 150 pounds. We endured a lot in those early years, but things got better. When I was in the last year of my fellowship training in reproductive endocrinology and infertility, we decided to try and have another child (four years after having my first son).

Full disclosure, I’d be lying if I said I wasn’t scared, especially given the difficulties we’d had before. But we went for it.

Taking pregnancy tests like a crazy person

I tried about eight cycles of Clomid, even though I was supposed to stop at four, and had no luck. Then I took a hysterosalpingogram (HSG) test to make sure that everything was fine with my anatomy. It was.

One of my fellow co-workers took on the role of being my doctor, and we started a treatment that included a daily injection of a follicle stimulating hormone (FSH) and intrauterine inseminations (IUI). Once again, this treatment did not work.

At that time, I remember taking pregnancy tests every day, like a crazy person, even though I knew it was too early for them to be positive. After two failed cycles, I was ready to try in vitro fertilization (IVF) but decided to give our previous treatment another shot. Surprise! I got pregnant.

This pregnancy took a more normal course, but my second son was also born premature. At 36 weeks my placenta abrupted. Luckily I was already in the hospital and the baby was delivered safely, despite a few nerve-wracking moments. My second son was able to come home with me the next day. He is now 9 years old.

My husband decided to put his career on hold and become a stay-at-home-dad to take care of our children when they were young. Now that my oldest son is 14 and the youngest is 9, my husband is finally starting to pursue his career dreams at age 43. We still miss having our daughter with us and wish that she were here, but life goes on and we are grateful for the family that we do have.

I am telling about my fertility journey in order to bring light to the fact that although I’m a doctor, a fertility doctor at that, all of the things that my patients are going through, I’ve gone through. While anyone can be suffering from infertility or other issues, it’s not always their way to share or show their pain.

You are not alone. I know how you feel. The biggest advice that I could give you is to seek care early and to hang in there. Things don’t always work out the way that we imagine they will, but we have to improvise and move on.

Share your story and give encouragement to other couples who may be in the same boat.

Tips for Getting Pregnant: New Year’s Resolutions for Your Fertility

December 28, 2016


FIRM-photo-happy-pregnant-couple-getting-pregnantIs 2017 the year you are hoping for a baby? Getting a family started is a natural New Year’s resolution. And for people who are trying to conceive, or wondering if they might have infertility issues, it’s almost a given.

I’ve compiled very useful information and links from our website on things that you can do yourself to achieve that resolution to get pregnant and have a baby. (Tip: start by checking out causes of infertility.) Some things in this blog involve getting your body right, some tips will help you get your mind right.

To conceive naturally a couple should synchronize sexual intercourse with the woman’s ovulation cycle in order to get the sperm to the egg at the appropriate time, which facilitates getting pregnant and having a baby. A woman will generally ovulate 12-14 days prior to the beginning of her menstrual cycle and will have the highest chances of conceiving with intercourse in the five days prior to ovulation, rather than afterwards.

Find more helpful details at the conceive naturally page. It’s very helpful to know how to predict ovulation, track a menstrual cycle and use an ovulation predictor kit.

Fertility as a state of mind

Tying to conceive a child can be emotionally stressful for a couple. Stress may contribute to infertility in up to 30 percent of all couples struggling with infertility.

Stress can end up creating a vicious circle for people who are looking to get pregnant: they’re stressed and they don’t get pregnant, they don’t get pregnant so they’re stressed.

We try to make it as easy as possible to reduce stress for all Dallas-area (and beyond) couples struggling with infertility by offering a free support group lead by our Fertility Counselor Reen Myburgh. This is a safe environment for people to express their fears, worries, frustrations and dreams. This group is not only for our patients but for anyone who is looking for support during their fertility journey.

In addition, we assist our patients with stress management of the fertility journey by offering in-house counseling, rare if not the only one in the Dallas area. We know it is very important to manage your stress in a healthy way while trying to achieve pregnancy. Reen can assist you with how to go about that, taking into consideration your unique circumstances, needs and preferences.

Since stress affects each person differently, relieving stress may also be different for each couple or person. Some ways to relax on your own while trying to get pregnant include:

We will be glad to give some advice on pursuing these practices.

Prime your body for getting pregnant

Both the husband and wife need to care for their bodies while trying to get pregnant. You can optimize your body for pregnancy by looking at your diet, exercise routine and lifestyle choices.

Maintaining a healthy weight is important for fertility, and that involves a healthy diet and moderate exercise. Overweight or underweight women may experience a decrease in fertility. Obesity in men can also affect the quality and count of sperm. For more information on obesity and fertility read our New Year’s resolution blog from 2015 for additional tips.

Also, watch this video on how to naturally increase fertility with diet and exercise tips. Those include avoiding fast food chains and seldomly thought of environmental toxins.

balanced diet is important for both men and women who are trying to conceive. This includes foods with a natural source of B vitamins and foods rich in iron and protein from plants, such as beans and lentils.

For men, a diet high in zinc may enhance sperm quality. So eat those pumpkin seeds, crabs, oysters and cashew nuts. To increase sperm concentration, it is recommended to eat a diet high in Vitamin B12, which includes egg yolks, sardines and lamb.

For women, supplements can play a role in increasing the chance for timely ovulation and the quality of the egg. It is important not to take supplements without talking with your fertility doctor first. Some possible supplements to aid in getting pregnant are:

  • Coenzyme Q10
  • The hormone DHEA
  • The amino acid L-arginine
  • Omega-3 fatty acids
  • Vitamin D.

Moderate exercise is also important while trying to get pregnant, but it is key not to overdo it. A woman who exercises too much can suppress her ovulation. The recommended amount of exercise is no more than 45 minutes of intensive cardio workouts, five times a week.

Lifestyle choices such as smoking, drinking alcohol or irregular sleep patterns can negatively affect your chances for pregnancy. Women who smoke are impeding ovulation by altering their estrogen levels and affecting egg quality through inhaled toxin exposure. Men who smoke can see a negative impact on their sperm function.

Alcohol’s direct link to infertility has not been determined. But once a woman is pregnant, alcohol has been linked with birth defects. Because of this, it is recommended for a woman to avoid alcohol if she is trying to get pregnant.

Irregular sleeping patterns interfere with natural daily rhythms, which, in turn, will also affect monthly rhythms. Interfering with monthly rhythms or cycles may impede ovulation and also may affect the quality of the ovulated egg.

When to get help from a fertility doctor

If you have been trying to get pregnant for a year with frequent, unprotected sex and no success, it is time to consider pursuing help from a fertility specialist. If you are over 35, you should seek help after six months if you have not become pregnant. When it comes to reproduction, older couples have less time to pursue fertility treatment; therefore, it is wise to seek help a little faster.

Take our quiz to see if it is time for you to make an appointment with a fertility doctor.