Category: Couple Fertility

Fertility Preservation & Fertility Options After Cancer Diagnosis

fertility preservationRecently, I was thinking about Breast Cancer Awareness Month, and I thought I would take a moment to answer some important questions when it comes to fertility after cancer and about fertility preservation.

Did you know that breast cancer is the most common cancer affecting women with 1 in 8 women developing breast cancer at some point in their lives? It is also the most common cancer among reproductive aged women with about 15% of breast cancer cases occurring before the age of 40. Given how common breast cancer is, it is very likely that you or someone you know will be diagnosed with breast cancer at some point. As a fertility doctor, whenever I hear “cancer,” I always think about life AFTER cancer as up to 91% of women diagnosed with breast cancer are still alive at 5 years. (1)

How does chemotherapy affect fertility?

Well, it depends on the kind of chemotherapy being used. In general, the most common chemotherapies used for breast cancer age the ovaries by about 10 years. The earlier you are when you start the chemotherapy, the more likely you will be able to conceive after chemotherapy, but there is no guarantee. The BEST option to ensure future fertility is to freeze eggs or embryos for use later which is called fertility preservation.

How long does fertility preservation take?

At Vios, we make oncofertility patients a priority and will make sure any cancer patient can get in to see a Vios provider within 24-48 hours. After the initial consult, we can usually start the process growing eggs to freeze or fertilize within 1-2 days of seeing a patient and finish the process in as soon as 2 weeks. We understand the importance of moving forward with cancer treatment as quickly as possible, so we do everything in our power to minimize the delay before moving through with treatment.

What is involved in fertility perservation?

Preserving fertility for the future involves freezing either eggs or embryos for use later through the process of IVF or in vitro fertilization. In a normal menstrual cycle, women start to grow numerous eggs each month and 1 or maybe 2 eggs grow bigger than the rest and are chosen to be ovulated. When we do IVF, we try to get as many eggs as possible to grow and we take them out of the body just before ovulation.

To get the eggs to grow, we give medications called gonadotropins in the form of injections in the belly. There are usually multiple injections a day for about 2 weeks until the eggs get to the point where they are ready to be taken out of the body. An egg retrieval is done under anesthesia (so you are asleep) using a vaginal ultrasound probe with a tiny needle attached. The needle goes through the wall of the vagina and directly into the ovary, so you will not notice any incisions when you wake up. The eggs are floating in fluid in the ovary so we remove the fluid with the needle and give the fluid to the embryologist who identifies the eggs under the microscope.

If we are planning on freezing eggs, we do so within hours of the retrieval. If we are planning to make embryos, we use sperm from the patient’s partner or a sperm donor to attempt to fertilize the eggs. We find out how many eggs fertilized the day after the retrieval and we watch the eggs that do fertilize (now called embryos) for up to 7 days to see if they can make it to become a blastocyst which is the stage where we freeze the embryos. An embryo that makes it to the blastocyst stage has the best chance of becoming a baby, but is not a guarantee of a baby.

Some women/couples choose to do genetic testing of the embryos to see if the embryos have normal chromosomes which further increases the chance the embryo will be a baby, but still does not guarantee success.

What is the difference between freezing eggs and freezing embryos?

When we are doing an egg retrieval, we have the option of removing eggs and freezing them immediately or attempting fertilization and creating embryos. If eggs are frozen, they will need to be fertilized in the future before they can become an embryo and then a baby. In order to fertilize eggs, we need to have a sperm source.

Whenever a retrieval is done, we get a certain number of eggs, but not every egg that is retrieved is a good egg. We can only work with mature eggs. Of the eggs that are mature, we expect about 70% of them to fertilize and about 50% of those eggs that fertilize to make it to the blastocyst stage where the embryo can be frozen or transferred. At each stage in the process, you lose quantity, but gain quality.

When you freeze eggs, we expect about 90% of the eggs to survive when we thaw them. After thaw, we still expect around 65-70% to fertilize and 50% to make it to the blastocyst stage. Now, those numbers are averages and you never know how many embryos are going to make it to become a blastocyst until you attempt to fertilize them. It is recommended that a woman freeze 15-20 eggs for each child that she desires (again averages).

On the other hand, when we fertilize the eggs immediately after retrieval and create embryos, we will know how many eggs fertilize, how many made it to the blastocyst stage, and the quality of those embryos which allows us to predict much better the chances those embryos could become babies. While you may need 15-20 eggs for a good chance of a baby, you might only need 2-3 embryos if they are good quality embryos. Embryos also survive the freezing and thawing process a little better than eggs and it is expected that 95% of embryos frozen will survive.

If a woman has a partner with whom she would like to create embryos, it is generally recommended to create and freeze embryos rather than eggs because we will know up front if the eggs fertilized normally and have a better idea of the chance of pregnancy in the future

I have a lot of expenses right now, how much will this cost?

For many women/couples who are interested in infertility treatment, they have time to save up funds in order to pay for the treatment, but this is not usually the case with cancer patients. Moving forward with fertility preservation usually needs to happen rapidly so that cancer treatment is not delayed. Fortunately, there are many programs available to help with the costs. LIVESTRONG and EMD Serono both have programs to help cancer patients obtain fertility medications for FREE. These programs do require an application and verification of the cancer diagnosis, but the applications are processed quickly and do not require too many hoops to jump through. Those programs may not cover all the medications needed for fertility preservation, but they do cover most of them.

At Vios Fertility Institute, we offer deeply discounted fertility preservation treatments. Our financial team can also work with patients on payment plans or loan options depending on the situation. We do not want cost to be the reason someone chooses not to pursue fertility preservation.

Can I just do IVF or fertility treatments after I have my cancer treated?

You can absolutely pursue fertility treatment after cancer treatment, but because the cancer treatment can age the ovaries, you may be less likely to have success if you wait until after the cancer is treated. It is impossible to know for sure how much your fertility will be impacted by cancer treatment. Some women are able to conceive spontaneously after treatment, but others, even those who were very young when they had treatment, may never be able to have genetic children even with aggressive fertility treatment.

There is Hope and Help for Fertility Preservation

If you or someone you know has recently been diagnosed with cancer and has any desire to have a child or children in the future, I encourage a consultation with a fertility specialist BEFORE cancer treatment. You are under no obligation to pursue any kind of fertility preservation treatment, but a fertility specialist can make sure that you have all the information you need to make the best choice for you.

To schedule an appointment at Vios Fertility Institute, you can call 866.258.8467 or reach us on our website at viosfertility.com.

References

  1. Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomized trials. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG). 2005, Lancet, pp. 365:1687-717.

 

Stress and Trying to Conceive

stress and trying to conceiveStress and infertility don’t go hand in hand, but stress can make it more difficult to conceive and even affects men too! So, what is it about stress and trying to conceive?

Having a hard time getting pregnant can be a real stress itself. While staying calm and letting nature take its course is much easier said than done, there’s certainly some truth to it.

Stress Triggers Hormone Production

While the exact link between fertility and stress remain a bit of a mystery, many doctors believe hormones like cortisol or epinephrine that flood the body during stress could play an important role.

What we do know is that stress can affect a part of your brain called the hypothalamus, which regulates your hormones, including the hormones required to release your eggs. Not just you either – it regulates your partner’s testosterone levels, too. So, the real issue is that stress can delay your ovulation AND if your partner is experiencing stress too, it can weaken his sperm.

Doctors may not know the exact links between stress and trying to conceive, but growing research shows that a connection is hard to ignore.

Some studies have found that when stress-reduction techniques were used, some women were able to get pregnant when they couldn’t get pregnant before. Other studies point to the idea that stress (and sometimes “trying too hard”) may play a role in up to 30% of all infertility problems. Additionally, some studies indicate that it’s possible that reducing stress may help enhance proteins within the uterine lining that are involved in implantation and may also increase blood flow to the uterus, which also affects conception.

Signs You May Be Stressed

If you’re trying to conceive and you’re under stress, your cervical mucus may indicate that something’s not right. As you approach ovulation, you would typically have an increase in cervical fluid wetness. However, during times of stress, you may find that typical wetness is disrupted by days of dryness interspersed throughout – almost as if your body is trying to ovulate but is getting thrown off by the stress that is delaying ovulation.

Different Kinds of Stress

It can be important to note that there is a considerable difference between constant and sudden stress. Your body can adapt to high, but consistent, stress levels. Once your body acclimates to consistent stresses, you will likely still ovulate each cycle. Sudden stress on the other hand, like a car wreck or an unexpected death in the family, is much more likely to interfere with your cycle and delay ovulation.

Everyone is Different

Of course, every woman’s experience with stress and fertility is unique. Some women find that the stress of going on a week-long vacation is enough to delay ovulation. Others have found that a severely traumatic incident like a close death didn’t impact their cycle at all. Some women found that positive stress, like that from planning a wedding, was enough to throw off their cycle. You’ve heard it all before, but everyone is different, and the reasons behind how or why stress impacts fertility may also be very individual.

Work Out What Is Stressing You and Make Positive Changes

Try making changes in your life so that you feel more relaxed and pick up healthy habits that help to reduce stress. Start by making little changes, like meditating or doing yoga for 5 minutes on Monday and work your way up to 30 minutes by the weekend. Give acupuncture a try. Eating healthy is always a given, as is exercising (even a short walk counts). Start keeping a journal. Even take a break if you need to.

Check out apps like Expectful Meditation that offer guided meditation for your fertility, pregnancy, and motherhood journey.

The Good News

The good news is that stress should not prevent you from getting pregnant, it just complicates things and makes it more difficult for some women. If you’re having sex every two to three days throughout your cycle, stress-induced delays to ovulation should not stop you from conceiving. A delayed ovulation simply lengthens your entire cycle.

You can confirm whether you have ovulated by tracking your basal body temperature. You should see a sustained rise about a day after ovulation, indicating the onset of your luteal phase, which lasts until the start of your next menstrual period.

Help If You Need It – Vios Cares About Making Your Dreams of Parenthood Come True

Everyone’s fertility journey is different. At Vios, our team approach focuses on helping you navigate the journey and make your dreams of parenthood a reality. If stress-reduction techniques don’t appear to be helping you conceive, it may be time to seek help.

Contact us today to schedule an appointment. With Vios on your side, we can help you find out if there are other reasons you may not be ovulating and recommend treatment options.

What Sexual Positions Are Best for Getting Pregnant?

A Conception Misconception

best positions for conceptionAccording to the experts, there’re not best positions for conception. In fact, different sex positions aren’t going to make much difference when you’re trying to conceive. Sperm typically reaches its target no matter the position. So just stick with what feels best for you and your partner!

Side Note About the Female Orgasm. Although mutual pleasure is important to a healthy sexual relationship, there is no evidence that the female must have an orgasm to conceive. Gentle contractions in the womb can help to move the sperm along, up into the cervix, but these happen with or without the female orgasm.

Real Advice for Getting Pregnant

Looking outside the best positions for conception, to optimize a woman’s fertility, nothing is better than a healthy lifestyle. Forming healthy habits before conceiving is a key to improving pregnancy and birth outcomes, while also increasing your chances of getting pregnant. But what else can women do to improve their odds of having a baby?

Timing is Everything: Ovulation Calculation

Ovulation refers to the days in a woman’s menstrual cycle when pregnancy is possible and is sometimes referred to as the “fertile window.” As with all things pregnancy-related, this varies from woman to woman and depends on the length of the menstrual cycle.

If you know your average menstrual cycle length, you can work out when you ovulate. Ovulation happens about 14 days before your period starts.

For example, if your average menstrual cycle is 28 days, you ovulate around day 14, and your most fertile days are cycle days 10, 11, 12, 13, and 14. Your egg can only be fertilized for up to 24 hours after ovulation. If it isn’t fertilized, the lining of the womb is shed along with the egg and your period begins, marking the start of the next menstrual cycle.

A Sexy Schedule

It’s important to note that research indicates that a lot of women (even ones that use ovulation tracking apps) tend to guess when they’re ovulating incorrectly. For this reason, it is recommended to have sex every other day during the fertile window. And having sex more than that won’t hurt your chances. Because sperm can live for up to 5 days after being ejaculated into a woman’s body, you can actually get pregnant from having sex before you ovulate. That’s why it’s possible to get pregnant if you have unprotected sex while menstruating. If you ovulate shortly after you finish your period, the sperm may still be alive and can fertilize the egg.

Healthy Lifestyle Choices

Reaching a healthy weight, eating a balanced diet, creating and sticking to an exercise routine that works for you, and kicking bad habits before pregnancy can reduce or may even eliminate the risks of some birth defects that occur early in pregnancy. For more info, check out our blog article on Natural Ways to Increase Fertility.

Symptoms of Infertility & When to Seek Help

Infertility is defined as the inability to conceive within 12 months if you are under 35 and the inability to conceive within 6 months if you are over 35. Extensive research shows that most couples (about 85%) will achieve pregnancy within one year of trying. Only an additional 7% of couples will conceive in the second year. That’s why we generally recommend seeking the help of a reproductive endocrinologist as early as possible.

Additionally, there are various scenarios when we recommend a fertility evaluation regardless of how long you’ve been trying to get pregnant:

  • Infrequent or absent menstrual periods
  • A history of pelvic infection or sexually transmitted diseases
  • Surgeries on the reproductive organs
  • Known uterine fibroids or endometrial polyps
  • Known male factor semen abnormalities
  • Problems with erection or ejaculation
  • Male partner undergoing testosterone treatment
  • Repeated pregnancy loss or miscarriage
  • Family history of genetic disease
  • Female partner approaching her mid-thirties and wants to multiple children

Help If You Need It – Vios Cares About Making Your Dreams of Parenthood Come True

Infertility is a disease of the reproductive system that affects the body’s ability to reproduce. If you are unsure or think something might be wrong, come in for simple fertility testing to get a “pulse” or baseline of your fertility health. After all, knowledge is power!

While each patient is different, an initial workup includes blood work, an ultrasound to measure eggs (or ovarian reserve), and a semen analysis. Some additional test can be included, depending on a patient’s specific history.

At Vios, our team approach is to educate and bring awareness to your fertility health while helping you navigate the journey and make your dreams of parenthood a reality.

Contact us today to schedule an appointment, discuss your options, and take control of your fertility health.

Natural Ways to Increase Fertility

natural ways to increase fertilityHave you been trying to get pregnant or are you just starting to try? If want to give your body the very best chance of conceiving, there are important, yet natural ways to increase fertility that you can do on your own and feel amazing in the process.

A Bit of Fertility Info

In the U.S., 10-15% of couples experience trouble getting pregnant or carrying a pregnancy to term. That number sounds small, but it equates to millions of men and women.

Why? One reason is that humans are the most inefficient reproducers of all mammals. A perfectly healthy 20-year-old couple, with perfect eggs and sperm, a 28-day menstrual cycle, open fallopian tubes and an unobstructed uterus only has a 15-20% chance of getting pregnant in a given month.

With all of this in mind, our goal at Vios Fertility Institute is to educate and bring awareness to your fertility health, while at the same time eliminating the stigma of “infertility.” By understanding how your body works and your goals for family building, you and your partner can take control of your fertility health early-on for the best chance of conceiving and a healthy pregnancy.

How to Boost Your Fertility Health

Stop smoking. Did you know that up to 13% of infertility might be caused by smoking? If you and/or your partner smoke, even as few as five cigarettes a day can lower your ability to get pregnant. It prematurely ages eggs and diminishes egg count, not to mention what it’s doing to the rest of your body.

Proper nutrition. Balanced nutrition is another one of the natural ways to increase fertility. One major factor for optimum health is controlling your insulin with a balanced diet. This is vital to the production of hormones and other bodily functions necessary for fertility.

It is also very important to note, once pregnant, ideal dietary intake is even more critical for the growth of your unborn child. If you follow these simple, common sense rules, you can begin to optimize your health with the best food choices and hydration.

  • First – cut out as much processed food and fast food as possible. Not only do they contain chemical additives and useless calories, they contribute to unhealthy glucose fluctuations, added body fat, and a sluggish metabolism.
  • Eat more fresh vegetables like a variety of lettuces, broccoli, cauliflower, collards, chard, cabbage, kale, and brussels sprouts, as well as squash and sweet potatoes. These foods support egg quality and health.
  • Snack on fruits like blueberries and cherries that are high in beneficial flavonoids and have anti-inflammatory properties.
  • Eat lean meats that are as natural as possible (grass-fed, free-range, organic). Extra protein is beneficial for minimizing some pregnancy complications. Nuts and eggs are also good protein sources.
  • Get plenty of healthy fat from olive oil, coconut oil, olives, avocados, ghee, and organic meats like grass-fed beef and pork. Good fats help your cells stay healthy, produce needed energy, and aid in ovulation. This may be contrary to what you’ve done in the past, but it is important for a healthy pregnancy (and a healthy life).
  • Drink plenty of filtered water and avoid sugary drinks and sugar-free chemical substitutes. Hydration is vital to a healthy body and pregnancy.

Avoid caffeine and alcohol. The jury is still out on whether caffeine affects fertility. Recent research shows that a minimal amount (1-2 cups of coffee per day) is safe, however, we recommend avoiding it if you can. Drinking alcohol has been proven to increase the time it takes to get pregnant and reduce the chance of having a healthy baby. For men, it can cause impotence and affect the quality of their sperm.

Vitamins and supplements. If you’re trying to conceive and have any health issues, it’s best to discuss what vitamins and supplements will be safest and most effective for you with your doctor.

If you are relatively healthy and want to try supplementing on your own, we highly recommend starting months before you get pregnant, especially with folate and selenium, additional Omega-3s such as krill oil or cod liver oil, as well as vitamin D3, vitamin C, B vitamins, and Zinc. Prenatal vitamins are a good way to get just what you need to boost your system.

Weight. Too much body fat (more than 28%), as well as too little (15-18%), can impair your ability to get pregnant. Too much fat produces too much insulin along with a host of other hormonal and stress-induced negative effects on your body. Losing just 5-10 pounds can make a difference. Too little body fat can inhibit ovulation.

Exercise. Getting adequate exercise is another of the natural ways to increase fertility. Keep up what you’re used to if it doesn’t fall into the “intense” category. If you’re not one for organized exercise, several hours per week of light activities such as walking, riding bikes, and gardening will help.

Lifestyle factors. A high-stress career or lifestyle, long working hours, lack of sleep, and an absence of self-care will take their toll. All of these contribute to a large hormonal imbalance and fluctuations that create a fight-or-flight cycle that limits your body’s ability to focus on anything but survival.

Try to make time for yourself. Meditate daily, take a long hot bath, or just curl up with a book instead of being in constant motion. This will allow your body to relax and function at more optimal levels.

You Can Raise Your Fertility Chances Naturally

These guidelines will not only help increase your chances of fertility, they can ease PMS symptoms, PCOS, and pain from endometriosis; heavy periods, and many other health-related issues. You may even lose weight, see improved insulin levels and better hormonal function, have a more positive attitude, and realize a host of other wonderful benefits.

Many Fertility Treatment Options

If you are under 35 and have been trying to conceive for one year, over 35 and have been trying to conceive for 6 months, or have irregular periods or no periods, then we recommend you schedule an appointment with one of our caring, experienced fertility physicians at Vios Fertility Institute.

Infertility treatments come in many forms, so don’t hesitate to contact us today and start learning about your options.

How to Treat Infertility

how to treat infertilityIf you are experiencing infertility, you are not alone. Many people wonder how to treat infertility, especially if they’ve received the diagnosis. You aren’t alone. One in eight couples experience trouble getting pregnant or carrying a pregnancy to term. Infertility is defined as being unable to achieve pregnancy after one year if a woman is under 35 years of age, and after six months if a woman is over 35 years of age. While published statistics tend to focus on the woman, it is important to note that infertility diagnoses are split evenly between men and women and there is an abundance of resources and support that are available to you.

It takes the average couple at least six months to become pregnant. Before seeing a specialist, it is recommended that couples try on their own first. For couples where the woman is under 35, it is recommended that you try for one year. In couples where the woman is over 35, it is recommended that you try for six months.

While these are general guidelines, there are situations where immediate consultation is warranted. If you have irregular or no menstrual cycle, are experiencing heavy, painful periods, or abdominal pain you should schedule an appointment immediately. If you are approaching your mid-30’s and want to have several children a fertility consultation will allow a specialist to project your chances of conceiving at an advanced age based on when you would be trying to conceive subsequent children.

Fertility Treatments

Diagnosis comes before treatment. Read our blog article Common Infertility Diagnoses for more information on common diagnoses couples receive, or visit our Diagnostic Testing page to understand what different testing entails.

Our physicians work with you to understand your goals and develop a plan to meet them. Infertility treatments can take on many forms, and while most people think “IVF” when someone says, “infertility treatments,” there are many varying degrees of how to treat infertility.

From the basic treatments to the more advanced treatments, there are several different options with several varying protocols that can be tailored to your specific situation to help you grow your family. Treatment paths can also include the use of 3rd party reproduction options or those looking to preserve their future fertility for social or medical reasons.

Basic Infertility Treatments

Timed intercourse is the simplest answer to how to treat infertility that a couple can receive. With a limited timeframe for fertilization to occur, it is important to have intercourse at the appropriate time. Monitoring occurs to track approximately when you will ovulate, so you have a greater potential for fertilization.

If a woman’s menstrual cycle is irregular, she may not be ovulating on a consistent basis or even at all. Ovulatory disorders are one of the most common causes of infertility and account for infertility in 25% of couples. If a woman is not ovulating, we can use a combination of ovulation induction (fertility) medications to help grow follicles and time the release of the egg so that intercourse can be planned to increase the chances of fertilization.

Intrauterine Insemination (IUI), formerly called artificial insemination, is accomplished by placing highly concentrated sperm directly into the uterus to increase the chance of conception by increasing the number of sperm that reach the fallopian tubes. An IUI is the first step in fertility treatment for many couples. It is a less costly and more conservative fertility treatment option that works for a lot of couples. This form of treatment is commonly used for couples with unexplained infertility issues, ovulation disorders, mild endometriosis, and mild male infertility issues with sperm or erectile dysfunction.

Advanced Infertility Treatments

In vitro fertilization (IVF) is an assisted reproductive technology in which eggs are retrieved from a woman and inseminated with sperm from a man in a laboratory to create embryos. After closely monitoring embryo development, one or multiple embryos are transferred to the uterus of a woman. Since the first successful procedure in 1978, over 5 million babies have been born worldwide through IVF treatments. In vitro fertilization is the most common fertility treatment utilized by patients today.

Fertility preservation is an option individuals or couples can choose for social reasons (waiting to have children) or when medical treatments or procedures may harm one’s fertility. Fertility preservation options include egg freezing, sperm freezing, or embryo freezing. Women and men may consider fertility preservation for medical reasons for one of the following circumstances:

  • Cancer Diagnosis – For women and men who have been diagnosed with cancer, egg freezing, sperm freezing, or embryo freezing are options that can protect one’s eggs and sperm prior to chemotherapy, radiation or surgery, all of which can be toxic to both eggs and sperm.
  • Premature Ovarian Insufficiency (POI) – For women who have been diagnosed with premature ovarian insufficiency, early menopause, or have a genetic predisposition to early menopause, fertility preservation is another option to preserve viable eggs or embryos for future use.
  • Autoimmune Disease – Women with chronic autoimmune diseases such as rheumatoid arthritis and lupus may choose fertility preservation due to medications that they need to use, that could potentially harm the ovaries and cause infertility.

At Vios, Conception is Our Life

At Vios, we are here to make your dreams of parenthood a reality. We work with you to show you your chances of success utilizing different treatment plans based on your specific medical situation. During your consultation, we will discuss your goals for family building, your medical history, and review needed fertility testing to determine the best treatment path for you.

To understand what infertility treatments may be best for your situation, contact us today to schedule a consultation.