Happy moms

It is estimated that up to 54% of couples with infertility experience a high level of stress, anxiety, and depression before and/or during fertility treatment. It is incredibly common to need additional help when going through fertility treatment, which is why I encourage the use of complementary stress reduction techniques with my patients. But sometimes yoga, acupuncture, and mediation isn’t enough and more help is needed. The most commonly prescribed antidepressant is a group of medications called selective serotonin reuptake inhibitors (SSRIs).

A recent study compared women on SSRIs going through IVF to women who were not on antidepressants. They found that the embryo health and IVF outcomes did not differ between the groups. This suggests that, from a fertility standpoint, there is no reason to avoid using an antidepressant if you need it.

Fertility treatment is hard enough. There is no reason to suffer through poorly controlled anxiety and/or depression while going through fertility treatment. If you need additional help, please reach out. The best way to have a happy healthy family is to start with a healthy mom before conception. You are not alone.

Take home points:

  • The diagnosis and treatment of infertility is stressful
  • It’s common to struggle with stress, anxiety, and depression at any phase of treatment
  • Antidepressant use does not impact IVF success rate.
  • Do not hesitate to get additional help if needed

Be Kind to Yourself

One of the best parts of my job, is getting to know individuals and hearing their “story.” I love learning about occupations, interests, and their goals for a family. I spend a lot of time listening to my patients so that I can fully grasp all that my patients have been through leading up to their visit with me.

I have to be honest: I’m saddened by how hard my patients are on themselves. There is so much unnecessary blame and justifying in fertility. For example, a common thing I hear can be something like the following: “I love coffee, but after trying to conceive for so long I gave it up. I miss it but I’m willing to give up anything in order to prove that I’m ready for a family.” Does this sound familiar to you? First off, you can drink coffee. Secondly, please try to be kind to yourself.


Research suggests that kindness and mindfulness will not only help you cope with fertility struggles, but may even improve your outcomes. Unfortunately, this important step is often overlooked in many fertility clinics. I try to address the potential benefits these practices may have with my patients.

As a self-diagnosed perfectionist, I will be the first to admit that I have very high expectations that I set for myself. When I fail to meet a certain goal that I’ve set for myself as a physician or a mom, I beat myself up about it. My advice to you: try kindness instead. Pretend a friend told you the exact same story. How would you react to your friends’ tribulations?

Life is stressful and that won’t change, even once you get pregnant. We can’t control the stressors in our life but we CAN control how we react to them. So please, consider being kind to yourselves and help me support you through this fertility journey.

Daylight Savings Time May Lower Chances of IVF Success for Some: Study

At our center, we have long held that your circadian rhythm–how your biology responds to the day-night cycle–impacts your fertility. This is one of the many reasons we focus on optimizing vitamin D levels, melatonin (when necessary) and paying careful attention to our embryo transfer schedules. In case your fertility center hasn’t figured out how important that this is, check out the following recent study on miscarriage risk associated with time shifts.  https://consumer.healthday.com/infertility-information-22/infertility-news-412/daylight-savings-time-may-lower-chances-of-ivf-success-for-some-study-719514.html

Boosting Pregnancy Rates for “poor responders” to IVF—new hope by applying existing technology

One of the greatest challenges in reproductive medicine is trying to figure out ways to improve pregnancy rates for women that produce a limited number of eggs. Other posts on this blog[u1]  address various steps to try to optimize/improve egg quality[u2] . But new data suggests that the use of intracytoplasmic sperm injection (ICSI) can improve embryo formation and more importantly increase a woman’s chance of becoming pregnant. Traditionally, ICSI has been used to overcome male factor infertility. Over the last several years, some centers have included it in all of their treatment cycles as a means of maximizing fertilization. Some experts criticized this practice since it was based upon a theory rather than clinical proof of an improved outcome. In fact, the American Society for Reproductive Medicine has a Patient Fact Sheet [u3] that describes the guidelines for the use of ICSI (last revised in 2008). Recently a large study attempted to settle this debate on whether or not ICSI should be used in women considered to be “poor responders” to fertility therapy.

One of the limitations of previous studies on “diminished ovarian reserve (DOR)” was the lack of an agreed upon definition of how to diagnose this condition. In 2011 an international meeting was held to form a consensus [u4] on the identification of “poor response to ovarian stimulation.” Their goal was to improve the design of future studies and provide practical guidelines as well as assist doctors in the diagnosis of this condition. To meet diagnostic criteria it was agreed that a woman must have at least two of the following:

  • 40+ years of age or any other risk factor for poor ovarian response
  • A previous cycle producing  3 (or fewer) eggs with a conventional protocol (excludes Mini IVF)
  • An abnormal ovarian reserve test (i.e., AMH [u5] below the age- related norms)

The recent study [u6] referred to in this blog post followed over 1000 IVF patients that had failed on a previous cycle and met the new criteria for “poor responders.” These patient/couples completed nearly 3000 total cycles of IVF with ICSI. They found that including ICSI—despite a normal sperm count—improved the ongoing pregnancy rate by 40%. Another noteworthy fact is that this study was performed in Israel where IVF is a fully covered health benefit for all citizens. This made it possible for patients to continue treatment without concern of cost thereby removing a “selection bias.” The potential benefit of ICSI—in the absence of a male factor—does make sense. Some studies show that women with DOR have a thicker coating on the egg making it more difficult for a healthy sperm to enter. Selecting a sperm for use in ICSI may also reduce the possibility of an abnormal sperm fertilizing an otherwise limited number of healthy eggs. Whatever the reason, most women with a poor response to fertilization are immediately directed to use donor eggs. However, this study found that ~35% of these “poor responders” achieved a successful pregnancy within 5 to 7 IVF attempts. The bottom line is that couples that would otherwise have been discouraged from completing a second attempt went on to have a baby at least 1/3 of the time.

So discuss with your doctor whether or not you may benefit from including ICSI in your next IVF cycle. In doing so, be careful to ask if there is an additional charge for this service. At CNY Fertility[r7]  Center, we are pleased to offer this augmented fertilization technique to all of our patients as part of the standard IVF cycle (included in the standard fee). Now we have more data supporting this recommendation.

Robert Greene, MD, FACOG

CNY Fertility Center

e-mail me at rgreene@cnyfertility.com

Call our toll-free number at 800.539.9870 or request a consult here.

“Delayed Pregnancy”—an update on women’s choices and fertility preservation

Our society puts a priority on reproduction. That makes sense since it is hardwired into our brain. Unfortunately, that value often results in the assumption that women that choose to wait and begin their family later in life are somehow selfish or narcissistic for “wanting to have it all.” I am pleased to share that a recent report made great strides in dispelling this myth.

A British psychologist recently performed a thorough review [r1] of women’s motivations and situations resulting in “delayed motherhood.” In fact, she even took exception with the term “delayed” because it so strongly suggests that it is a choice that women are consciously making to wait until their late thirties or early forties to become pregnant. Instead, she found that it more often women are responding to their situation. Her research revealed that many women today are having babies later as a result of strategic decision making, extensive negotiations or response to their life’s circumstances. Better still women today have more options to preserve their fertility.

Techniques [r2] are available today to more efficiently freeze and store unfertilized eggs or viable embryos. Embryo freezing has been available for several decades but the efficiency of the process is much greater today. Egg freezing now makes it possible for women to preserve their unfertilized eggs when they are more plentiful and at their healthiest but actually delay fertilization and pregnancy until the time is right. Recently, the technique for freezing unfertilized eggs has been refined so much and the availability of the procedure [r3] has become so readily available that it is no longer considered experimental. So as more women speak out [r4] about their own choices and empower others to do so, it is rewarding to be able to meet their needs with more treatment options.

Robert Greene, MD, FACOG

CNY Fertility Center

e-mail me at rgreene@cnyfertility.com

Call our toll-free number at 800.539.9870 or request a consult here.

The Right To Know: use of laparoscopy to help diagnose unexplained infertility

One of the most challenging aspects of infertility care is helping couples understand why they have not yet become pregnant. About 20-30% of couples will have no definitive diagnosis after completing a standard infertility evaluation[r1] .  In today’s fast-paced treatment paradigm, some patients prefer to move forward with treatment without further clarification. Although oftentimes appropriate, this strategy should not be applied to every patient/couple. Laparoscopy and hysteroscopy are minimally invasive, out-patient surgeries [r2] that can provide a diagnosis and sometimes even offer improved pregnancy rates if scar tissue or endometriosis is found and treated at the time of surgery.

Women with infertility are about eight times more likely to have endometriosis than women that have been pregnant. Treatment of endometriosis can not only reduce pain but also improve pregnancy rates as well. In fact, a large, randomized meta-analysis[r3]  of the available research found that treating endometriosis was associated with about a 60% increase in the chance for a successful pregnancy. Additionally, if there is scar tissue preventing the egg from reaching the fallopian tubes this can also be identified and treated. So consideration of diagnostic surgical procedures can be beneficial. The challenge is in deciding which patients should pursue this option further.

A more recent study [r4] investigated the usefulness of these diagnostic surgical procedures from a financial perspective. They found that laparoscopy was cost-effective in improving pregnancy rates/outcomes based upon many factors including the potential impact of endometriosis. Finally, they also found that undergoing diagnostic surgery was associated with a lower rate of patients “dropping out” of fertility treatment before becoming pregnant. This suggests that having all of the information available prior to treatment is preferred by some couples experiencing infertility. In summary, if you are having trouble conceiving and want more information, minimally invasive surgery may be your best next step.

Robert Greene, MD, FACOG

CNY Fertility Center

e-mail me at rgreene@cnyfertility.com

Call our toll-free number at 800.539.9870 or request a consult here.

Potential Benefits of FET: why more IVF patients should consider FROZEN over FRESH embryo transfer

One of the most common questions infertility patients going through Advanced Reproductive Treatments (ART) ask is: “will freezing embryos reduce my chance at a pregnancy?”  During the first decade and a half of IVF treatment, there was a much lower success rate through Frozen Embryo Transfer (FET). In a recent post, I summarized how the newer technique of “vitrification[r1] ” helped overcome the potential impact of cryotherapy upon embryo quality. And in a separate post[r2] , I described the importance of properly preparing a woman’s uterus prior to placing an embryo. Newer data is showing that due to these combined factors some patients can actually see an improvement in their pregnancy rate by deferring transfer of their embryos from a “fresh cycle” to an FET.

It has long been noted that the highest pregnancy rates are achieved when using an egg donor. Although it has often been assumed that this is due to improved embryo quality, newer data is showing that endometrial receptivity may also be a factor. The largest review to date [r3] recently combined the results of 64 clinical research studies—including 3 randomized trials. They found that freezing embryos and transferring them in a later cycle was associated with about a 30% increase in pregnancy rate. There was no difference in the rate of miscarriage; further reassuring that the process of freezing/thawing embryos maintained their health and viability.

Another important benefit of a freeze-all (or “staggered”) cycle is that it substantially reduces a woman’s risk of ovarian hyperstimulation syndrome (OHSS). So when considering your treatment options with your provider it might be worth considering the potential benefit of creating embryos now that you plan to actually transfer later.

Robert Greene, MD, FACOG


BIRTH SPACING and Secondary Infertility **

Timing may be important for couples experiencing secondary infertility. “Birth spacing” refers to planning the ideal interval between pregnancies. Along with thinking about how far apart you want your kids to be in age, you need to think about hormone balance. It takes time after childbirth for your nutritional status to improve enough to support another pregnancy. It takes time for your body to reestablish hormone balance as well. But if you wait too long, your reproductive hormones may fall out of balance. A recent analysis of 67 studies looking at the outcomes of more than 11 million pregnancies demonstrated that the ideal interval between pregnancies is between 18 months and 6 years. Waiting fewer than 18 months resulted in a much higher chance of preterm birth or having a baby with low birth weight. Women that waited less than 6 months also had a higher risk of miscarriage. Couples, especially those who remarry, might want to keep the 6 year mark in mind when planning to expand their family together.


IVF Success Rates Hit All Time High—but repetition is often the key ingredient to achieving pregnancy

The latest review of the pregnancy rate achieved through advanced reproductive techniques (ART) like in vitro fertilization (IVF) is the most encouraging ever. One press release read “Success of Fertility Treatment May Approach Natural Birth Rate.” Considering that many couples that need IVF have no other treatment options; this is an extremely encouraging revelation. Since the first successful IVF pregnancy was achieved in 1977 (resulting in the birth of Louise Brown in July 1978); it is estimated that 5 million babies have been born through this technology[r1] ! With the success rate and the need for treatment increasing, it is important that we consider what else we can do meet the needs of even more couples.

Here is what we now know. Even the most fertile couples have a natural fertility rate of about 20% for any given month. Their ultimate success is achieved through repetition; if not successful one month they can try next month, and the month after that until they are successful. Observation shows that they typically achieve a pregnancy rate of 65% within 6 months and 80% within a year. By contrast, couples that need fertility treatment have to pay for each cycle that they are attempting to conceive which often limits their effort to one or two attempts. New data shows that with persistence, infertile couples can achieve success rates that are as good or better than people that are considered fertile.

Specifically, the New England Journal of Medicine published data summarizing the results of nearly a quarter of a million women[r2]  treated at centers throughout the USA. This is the best estimate of the average success since it does not reflect a specific group of women or the experience of one specific IVF center. What they found was very hopeful. Nearly 60% of the women that were undergoing treatment had a baby (live birth). In fact, 30% of the women that underwent ART had a baby following their first IVF attempt! The majority of those not successful on their first attempt; did achieve a success rate as high as or higher than those of fertile patients the same age. In other words, IVF is able to overcome most obstacles to achieving a successful pregnancy except those related to age and its impact upon egg quality. Even though live birth rates were lower when older women used their own eggs; the same study found a cumulative live birth rate of 60-80% when women used an egg donor—regardless of the age of the woman carrying the pregnancy and delivering the baby.

Other studies released the same week [r3] demonstrated that women that were experiencing anxiety or depression before IVF did not have a lower chance for achieving a pregnancy. However, they did find that a failed IVF cycle can exacerbate these problems. This further emphasizes the need to focus on the success rates achieved with repeat IVF cycles. Currently there are about 1.5 million ART cycles being performed globally each year resulting in the birth of about 350,000 new babies. The key to focus on is that success rates are very high but it can take up to 6 IVF attempts for couples with more complicated problems to actually have a baby. Clearly the path to parenthood for couples that need ART is repetition. That is why it is so important to make treatment accessible. Personally, I am proud to work at a center that offers treatment at the most competitive prices [r4] in order to make IVF treatment accessible to all of those that need/want it.

Robert Greene, MD, FACOG

CNY Fertility Center

e-mail me at rgreene@cnyfertility.com

Call our toll-free number at 800.539.9870 or request a consult here.