CRM Fertility Journey Description IVF Mon, 24 April 2017 00:00:00 Mon, 24 April 2017 00:00:00 The History of Society and Infertility Throughout the Decades CRM Orlando The Centers for Disease Control and Prevention estimates that nearly one in every eight couples struggles to conceive. And while those odds may not bode well for reproduction, they should, at the very least, provide a kind of safety in numbers for those dealing with infertility related issues. Or do they? If history is any indication, infertility has always been – and remains – such a societal taboo that one survey recently found that more than 60 percent of respondents said they hid their infertility from family and friends, and nearly half didn’t even tell their mothers. Enter: National Infertility Awareness Week Because behind every failed cycle are women and men who have fought tirelessly with themselves and their infertility with daily injections, drugs, hormones, countless blood tests, surgeries and other procedures. Over the centuries – since the dawn of time, really – women who couldn't have children were given many hurtful names and labels that implied that infertility was a shortcoming, a weakness – and women usually suffered for it. Egyptian society treated difficulty with conception as an illness that had to be diagnosed and treated, with recorded documents discussing the treatment of gynecologic disorders. Ancient Greece also recognized infertility as a medical problem necessitating diagnosis and treatment. And where the Byzantine and the Middle Ages made little progress, the Renaissance provided many discoveries in anatomy, marking a period of scientific progress and advancements in the treatment of infertility. But despite the progress made during these times, infertility was almost always the cross of the woman to bear. It was her womb that remained fruitless, so the onus was hers, too. The 19th and 20th centuries, however, made tremendous advances in the diagnosis and treatment of infertility. Those centuries marked the discovery of fertilization – the union of an egg and a sperm – and 35 years after British scientists created the world’s first ‘test-tube baby.” Now, women struggling with infertility are recognized as patients instead of curiosities or the condemned. Little by little – and albeit slowly – the veil of taboo is lifting, encouraging more honest discussions about infertility, its causes, its diagnoses, and its treatments. At the Center for Reproductive Medicine, we want to join your discussions about infertility. We want to help shoulder the burden of your struggles to let you focus on what really matters: having the family you’ve always wanted. Call CRM in Orlando today at (800) 343-6331 to let us help give you every conceivable chance for success. Mon, 24 April 2017 00:00:00 National Infertility Awareness Week 2017 CRM ORLANDO National Infertility Awareness Week starts April 23rd and throughout the week you will see us promoting infertility awareness through social media and at our Orlando area fertility clinics.  The goal of NIAW is to bring awareness to a disease that affects over 7 million women worldwide.  The CDC tells us that  is 15% of couples in America. NIAW is a great opportunity for anyone affected with infertility to communicate a message of hope and understanding.                        Be part of a movement that wants to remove barriers that stand in the way of building families during National Infertility Awareness Week®. Download the facts HERE. Mon, 10 April 2017 00:00:00 Dr. Patel Discusses Oocyte Donation Dr. Sejal Dharia Patel Let’s talk about oocyte donation! Oocyte donation is one of the most successful ways to start or complete a family. Over the last 10-15 years, the number of women who are using donated oocytes has increased to over 1000 thawed donor egg cycles in 2012. For whom is donor oocyte recommended? Patients may have undergone premature menopause as young as 20 or they may have failed multiple IVF cycles related to a low number of eggs or poor quality eggs. Some patient may have a low number of eggs related to surgery from having an ovary removed or multiple surgeries for endometriosis. For others it may be a result of cancer therapy or age or being born with a low number of eggs. How are women who donate their eggs chosen? These women are usually between the age of 21-30. Most women know someone struggling with infertility and often times this is a motivating factor to donate their oocytes. Donors undergo rigorous screening, from genetic screening, mental health testing, a thorough history and physical exam, endocrine testing, toxicology screening and infectious disease testing. Once they have successfully completed all testing and have been provided informed consent, they undergo in vitro fertilization. In vitro Fertilization involves injectible medications to make multiple follicles which are “the shells that house the eggs”. Once their “eggs” are mature,  they are harvested.  These eggs are either frozen via vitrification for future use by a patient or they maybe freshly donated to a patient who is already undergoing endometrial preparation to receive the eggs. What is the difference between using freshly donated oocytes as compared to vitrified oocytes? In the past, most egg donation cycles were fresh. This meant a donor and the recipient would have their menstrual cycles synchronized and over the next 6-12 weeks the donor would undergo ovarian stimulation while the endometrium for the recipient was prepared for transferred. All of the oocytes created by the donor would be given to the recipient. However, if the oocytes were immature or poor quality or the donor had a complication the recipient would have to choose a new donor and go through the process and the cost again. The cost is usually 1.5 to 2 fold higher for fresh oocyte donation vs frozen oocyte donation. With frozen oocytes, the recipient chooses 6 mature oocytes from a donor of their choice (chosen based upon pictures of the donor as a child or adolescent).  As soon as the oocytes are selected, they are shipped to the patient’s clinic and the time from the start of the cycle until the pregnancy test is approximately 6 weeks as the only menstrual cycle to be regulated is that of the recipients. Pregnancy rates are the same between both modalities. What are egg banks? At the Center for Reproductive Medicine, we are part of a national frozen egg bank called My Egg Bank. The egg bank is a national consortium of clinics who all provide services for donors to donate their eggs but also care for recipients who require donor eggs to start their families. The oocytes or eggs from each clinic are made available to all patients within the egg bank. The advantage to a national egg bank is that there is incredible diversity of donors and there are very high standards for the clinics to maintain to be a part of the egg bank.  Oocyte donation is an incredibly safe and efficient option for many patients.  Please reach out to us at the Center for Reproductive Medicine, so that we can provide guidance or information to help you on this journey to parenthood. Tue, 24 January 2017 14:00:00 Quiz: How to Best Relieve Stress CRM Orlando We all know that for ultimate fertility we should stress less – but how? Enjoy this fun & informative quiz to help uncover your unique ultimate chilling technique. Mon, 23 January 2017 00:00:00 New Insights into Endometriosis Related Infertility Dr. Randall Loy Endometriosis is a chronic inflammatory condition affecting 8-10% of women in the general population and approximately 40% of infertility patients.  This enigmatic disease is associated with pain with menstrual periods, intercourse, bowel movements, urination and ovulation as well as with chronic pelvic pain and infertility.  While it has been known for some time that the free fluid within the abdominal cavity (usually in the pelvic “cul-de-sac”) in endometriosis patients may be hostile to eggs and sperm and may play a role in infertility, new evidence suggests that a another fluid may be detrimental to egg development and diminish the likelihood for conception. In a collaborative study performed in England, it was found that egg quality may be severely compromised in endometriosis by the fluid (follicular fluid) in which it develops. Published in Scientific Reports, the study found that the ability of the egg to mature normally was blocked by endometriosis, and that follicular fluid from women with endometriosis could seriously damage egg quality. Endometriosis was found to block egg maturation via increasing oxidative stress, that is, by generating Reactive Oxygen Species (ROS) in the egg, which damaged their DNA. This damage was significant enough to prevent normal egg maturation and fertilization. This in vitro study involved taking immature mouse eggs and incubating them in follicular fluid taken from patients who had known endometriosis. The researchers examined the amounts of oxidative stress generated relative to egg maturation. In short, they found that follicular fluid from women with endometriosis resulted in higher amounts of ROS. The study further suggested that perhaps the damage done to eggs by follicular fluid in these endometriosis patients could be prevented by antioxidants. Two antioxidants were analyzed in this regard: resveratrol and melatonin. Resveratrol, (found in the skins of grapes and berries) and Melatonin, (a brain hormone released during sleep), were added to the fluid and were shown to reverse the negative effects of follicular fluid. Oxidative stress (ROS) was decreased and more eggs matured normally. These research results are encouraging; however, more investigation is necessary before any specific recommendations may be made with respect to the types and dosages of antioxidants and/or other therapies. Journal Reference: Mukhri Hamdan, Keith T. Jones, Ying Cheong, Simon I. R. Lane. The sensitivity of the DNA damage checkpoint prevents oocyte maturation in endometriosis. Scientific Reports, 2016; 6: 36994 DOI: 10.1038/srep36994 Wed, 07 December 2016 00:00:00 Maintaining a Healthy Lifestyle During the Holiday Season Dr Randall Loy The holidays are here, and you know what that means – lots and lots of delicious, irresistible foods and drinks to enjoy!  While it’s tempting, it’s important to maintain a normal, healthy lifestyle – especially if you or partner are trying to get pregnant (Guys, this goes for you too!).  Weight gain is known to cause abnormalities in hormone levels in both men and women that can have a negative effect on eggs and sperm.  Being overweight also puts the cardiovascular system in overdrive, promotes pre-diabetic and diabetic states, and increases cholesterol levels.  So how does one keep it together even through the holidays?  Just follow these tips below… Eat more often.  It’s true!  By eating smaller, more frequent meals you stay full throughout the day and boost your metabolism.   Make sure your diet includes a balance of lean proteins (white meat chicken and turkey, lean cuts of red meat, nuts, beans, etc.), low glycemic index carbohydrates, and healthy fats (nuts, avocado, olive oil).   Eat protein at every meal.  Stop the bad habits!  This means no smoking and limiting your alcohol intake.  Exercise more frequently.  Men, this goes for you as well as exercise has been proven to help sperm production.  Men should stop taking male hormone enhancing drugs which routinely decreases sperm production.  A low glycemic diet is important especially for women effected with PCOS who are prone to making high levels of insulin.  This is because high level glycemic foods allow large swings in blood sugar, which in turn allow sustained elevations in insulin.  Insulin acts as a growth factor in the ovary and releases male hormones, thus lowering chances to conceive.  The Glycemic Index (GI) ranges from 1-100, and the most ideal foods have a GI range of less than 55.  This includes foods such as vegetables, most fruits (watermelon, bananas, and grapes have a higher GI range), oatmeal, peas, carrots, skim milk, and beans.  Examples of intermediate GI foods can include pasta, corn, and ice cream.  Avoid high GI foods such as white bread, white potatoes, and sugared sodas.  While it’s certainly a challenge to go light on the delicious foods and drinks during the holidays, maintaining a healthy lifestyle can have a positive impact on fertility in both men and women.  For more information on fertility treatment options or to schedule a consultation at the Center for Reproductive Medicine in Orlando, please give us a call at (800) 343-6331. Mon, 05 December 2016 00:00:00 National Breast Cancer Awareness Month: Egg Freezing & Fertility Preservation Options Prior to Cancer Treatments CRM Orlando Did you know that breast cancer is the most commonly diagnosed cancer in women and is the second leading cause of death among women?  Or that one in eight women in the U.S. will be diagnosed with breast cancer in her lifetime?   The statistics are startling, but where there is heartache, there is hope.  When detected early (at the localized stage), the 5-year survival rate is 98%.  In fact, there are over 2.8 million breast cancer survivors alive in the U.S. today!  That is why the month of October - National Breast Cancer Awareness Month – is a great opportunity to not only educate ourselves about the disease but to also bring awareness to our friends and family and stress the vital importance of early detection.  No woman should fight breast cancer alone, and every woman should be aware of the risk factors, symptoms, and steps to early detection, as well as the available options when facing cancer treatments.   One of the main concerns for women with breast cancer, especially for women in their reproductive years, is whether or not she will be able conceive after cancer treatments.  Both chemotherapy and radiation can often damage sperm or eggs, leaving many patients infertile.  Fortunately, egg freezing and fertility preservation are options that give women hope and the ability to conceive a child even after going through harsh cancer treatments.  At The Center for Reproductive Medicine in Orlando, Celebration and Lake Mary we understand the emotional stress that women go through when faced with cancer, especially when fertility may become an issue.  That is why we have partnered with the Fertile Hope, Livestrong ™ program to provide support and assistance for patients that have opted to freeze eggs or embryos prior to cancer treatment.  For more information about this great program, please click here.  If you would like to schedule a consultation to hear more about our egg freezing or fertility preservation procedures, please contact us at (800)343-6331.  Resources: Tue, 25 October 2016 00:00:00 Fertility Preservation: Elective Egg Freezing CRM Orlando You never know where life is going to take you, or perhaps the road you’re currently traveling doesn’t include the immediate desire to start a family, at least not quite yet.  Whatever the reason, more and more women are choosing to stop the biological clock and are opting for elective fertility preservation – a process that freezes eggs in order to have children later in life. As women age, the quantity and quality of eggs decline each year – dramatically declining after the age of 35 and leaving only a 5% chance of conceiving by the age of 40.  With egg freezing, a woman can serve as her own egg donor when she is ready to conceive later in life.  Reasons you may consider Fertility Preservation: Various medical reasons, including cancer treatment *According to the American Society of Clinical Oncology in the Journal of Oncology Practice, “Oncologists should address the possibility of infertility with patients treated during their reproductive years.  Fertility preservation is often possible, but to serve the full range of options, fertility preservation approaches should be considered as early as possible during (cancer) treatment planning.” The desire to start a family later in life Delaying child bearing for personal reasons Avoiding freezing surplus embryos after an IVF cycle At CRM in Orlando, fertility preservation has never been easier with our Egg Freezing Fertility Preservation package.  The first step of the process starts with a physician consultation that includes an in-depth discussion of the patient’s needs and expectations, as well as a detailed description of the procedure.  Once the patient decides to move forward, blood tests and a pelvic ultrasound are performed to assess the number of eggs in the ovaries.  The next step is ovarian stimulation - a two-week process that involves fertility hormone injections (gonadotropins) in order to produce more mature eggs than a typical cycle.  The physician will then determine the exact time to retrieve the eggs which soon after will be frozen and stored.  When a woman decides to attempt a pregnancy, the eggs are thawed, fertilized, and transferred into the uterus.  For more information on elective fertility preservation at our fertility clinics in Central Florida, please call CRM today!  Resources:,, Thu, 14 July 2016 00:00:00 Men’s Health Month: A Closer Look at Male Infertility CRM Orlando June is Men’s Health Month and is celebrated across the country to bring awareness of preventable health problems and encourage early detection and treatment of disease among men.  This month gives us a great opportunity to spotlight a condition that affects millions of men around the world and one of the toughest challenges a man can face - male infertility.  In about 20% of infertile couples, the man is the sole cause of the inability to conceive, and in another 30%-40%, he is the contributing factor.  This is why it is crucial for men to get tested for fertility as well as women.  By discovering male fertility issues early, the better the chances of nixing the problem sooner and achieving a successful pregnancy with their partner.   Most often, male infertility can be attributed to issues with making or moving the sperm.  However, even everyday activities can cause problems.  See below… Causes for low sperm count or abnormal sperm: Varicocele – an abnormal collection of bulging veins above the testicle (Good news! This condition accounts for 38% of male infertility cases and is the most correctable issue.) Undescended testicle Infections in the testicle, the prostate, or elsewhere in the body Chemotherapy or cancer Medicines such as anabolic steroids or anti-seizure medicines Genetic abnormalities Hormone problems Causes for sperm mobility issues: Retrograde ejaculation – semen ejaculates backwards into the bladder instead of out the penis Absence of the vas deferens (the main sperm pipeline) Obstruction anywhere in between the testicles and the penis Anti-sperm antibodies that attack a man’s own sperm on their way to the egg Daily activities that can affect the viability of sperm: Drinking more than 2 drinks per day Tobacco or marijuana use Hot baths and whirlpools Stress Taking testosterone or any over-the-counter androgen like DHEA While this information can be hard to swallow for men suffering from infertility, there is good news.   Most of these conditions can be reversed, HOWEVER, it is critical to have an evaluation by a physician and a treatment plan in place to achieve a successful pregnancy with your partner.  For information on male fertility testing at our Orlando area fertility clinics or to schedule a consultation, please give us a call today! Resources:,, Thu, 16 June 2016 00:00:00 10 Tips to Boost Your Mental Health IVF ORLANDO Since 1949, the month of May has been observed as Mental Health Awareness Month and an opportunity to educate millions of people about mental health through the media, local events, and screenings.  As part of the “big picture” when dealing with fertility issues and treatments, mental health is just as important as your physical health.  So as we head into summer, check out these ten tips that can help boost your mental well-being.  Start your day with a cup of coffee.  Studies show that coffee consumption is linked to lower rates of depression, but remember to stick to just one cup. If coffee isn’t your morning drink of choice, try a cup of tea instead.  Even the non-caffeinated stuff can do the trick.  Plan a vacation.  Did you know that when you have something to look forward to, it can boost your overall happiness for up to 8 weeks?  Go ahead, and book that vacation you’ve been daydreaming about! Get creative.  Experiment with a bunch of new recipes, start a DIY project at home, paint or even just color in a coloring book.  When your creative juices are flowing, your mind is focused and you tend to be in an overall happier place.  Laugh a little.  Laughter is a great way to ease anxiety, so hang with a friend that makes you laugh, see a funny move, read a silly book, or watch funny videos online.  We all have our own quirky sense of humor, so do whatever makes you smile. Dance!  Hit your favorite dance club or simply dance around the house while you do your housework.  Dancing reduces levels of cortisol (the stress hormone) and increases endorphins (the body’s feel-good chemicals).  Take a bath.  Give yourself the gift of a relaxing, warm bath at least once a week.  Add some Epsom salt to soothe aches and pains which in turn will boost magnesium levels and help with depression.  Incorporate omega-3 fatty acids into your diet.  Among their many benefits, omega-3’s have been linked to decreased rates of depression.  Fish oil supplements work, but you can also try adding foods like wild salmon, flax seeds, or walnuts into your diet.  Practice forgiveness.  Put the road rage aside and forgive the guy who totally cut you off.  Studies show that people who forgive have better mental health and are more satisfied with their lives. Go outside for a walk.  Whether it’s a stroll through the neighborhood or a walk in the park, research shows that being outside can increase energy levels, reduce depression, and boost your well-being.  Smile!  When you’re down, the hardest thing to do is smile.  We totally get it.  But keep this in mind, smiling can help lower your heart rate, calm you down, and help you have that all important positive mindset. If you would like more information about CRM in Orlando, please give us a call for more information or to schedule a free consultation.   Resource: Tue, 31 May 2016 00:00:00 #HaveAHeart During National Infertility Awareness Week Center for Reproductive Medicine April 24 - 30 is National Infertility Awareness Week which aims to spotlight a disease that affects over 7 million women worldwide. NIAW allows for anyone affected with infertility the opportunity to communicate a message of hope and understanding. Infertility is a personal journey that that could affect anyone at any age, but is also an experience that so many share.  Check out these facts below… Infertility impacts 1 in 8 couples of reproductive ages. One third of infertility issues are considered “unexplained” infertility. One third of infertility issues are attributed to males. Women between the ages of 20-24 have an 86% chance of conceiving after trying a year. As women age, this percentage gradually falls. Between the ages of 40 – 44, the chances decrease to 36%. CRM is showing our support with our #HaveAHeart campaign. The campaign promotes infertility awareness during NIAW through social media and at our clinics. You may noticed orange represented in our offices to show support for our patient community. The campaign uses the color orange (red = love, yellow=happiness), because it has represented infertility since ancient times. For more information how to become a part of the NIAW movement, click here. If you are struggling with infertility and would like to schedule an appointment with the fertility specialists at CRM, please contact us today. Wed, 27 April 2016 00:00:00 Endometriosis: What You Need To Know CRM Orlando You’ve probably heard of endometriosis, but do you know the signs and symptoms? The reproductive specialists at the Center for Reproductive Medicine (CRM) in Orlando outline what you need to know about this condition. Endometriosis happens when part of the uterine lining, or endometrium, attach to tissues outside of the uterine cavity. These endometrial lesions build up and break down each month, causing inflammation, cysts, and severe menstrual pain. Endometriosis is commonly misdiagnosed, but it is thought to affect over six million women in the US. It is difficult to diagnose in part due to lack of symptoms in most women. While other women will suffer from severe menstrual pain, even before or after their periods. It’s also common to have pain while using the restroom or during sex. Other symptoms could include feeling tired or nauseous, being constipated, or having diarrhea.To learn more about the disease, watch the video below by CRM's Dr. Randall Loy as he discusses the symptoms and causes of Endometriosis.  The worst sufferers could become infertile due to the disease, but endometriosis can be surgically removed or destroyed with a minimally invasive procedure. This makes it extremely important to schedule a consultation with a fertility doctor at CRM immediately if you are experiencing the symptoms mentioned. If it’s found early enough, laparoscopy could treat patients fully and they could go on to achieve pregnancy without any complications. Dr. Loy shares additional information in the second part of his video series on Endometriosis. Wed, 30 March 2016 00:00:00 Dr. Frank Riggall Discusses Ovulation Induction (OI) CRM Orlando The Center for Reproductive Medicine offers a host of treatments for fertility patients. Orlando’s own Dr. Frank Riggall discusses ovulation induction (OI) in the video below. This procedure stimulates the production of mature eggs to help women conceive naturally before more invasive procedures are tested. OI is used to treat infertile patients by assessing the cause of infrequent ovulation. Then doctors can provide the appropriate medication to aid in the development of mature eggs that will then be released. Dr. Riggall explains that the ideal candidates for OI include women who do not have regular menstrual cycles, or those with PCOS or hormonal imbalance. Fri, 29 January 2016 00:00:00 Fertility Struggles During the Holiday Season CRM Orlando With the holiday’s right around the corner, the physicians at the Center for Reproductive Medicine realize that for many infertility patients, it is a stressful time attending numerous holiday gatherings that include children and being asked questions regarding growing their family.  In light of this, we would like to share a few strategies to help you handle these scenarios during this holiday season. Prior to attending parties or events, you and your partner should come up with a response in case anyone asks about your plans to start (or expand) your family. This way you won’t be caught off guard and will be prepared with a thought out response. Remember if there is a particular event that you don’t feel comfortable attending due to questions that may arise, etc., feel free to skip it altogether. It’s totally acceptable to turn down a few invitations to have some time for yourself. Give your time to others. After all, it is the season of giving! It always feels good to volunteer in your community. Choose a cause that is near and dear to your heart that will take your mind off of your routine fertility treatment plan. If it’s too emotional to see pregnant women or small children, make holiday plans with friends who do not have kids, or take a vacation with just you and your partner! For additional information on coping with the holidays, see Dr. Loy’s video: “All I Want for Christmas is a B-A-B-Y: 7 Tips for Coping with the Holidays.” Our Orlando fertility center hopes that all patients enjoy the holidays. If you are struggling with infertility, CRM would love to help you expand your family for future holiday get-togethers. Contact us today! Tue, 15 December 2015 00:00:00 Smoking and Infertility CRM Orlando Did you know smoking could cause fertility issues? The Center for Reproductive Medicine in Orlando shares important stats about smoking and infertility. Wed, 25 November 2015 00:00:00 Cancer Patients Should Consider Fertility Preservation CRM Orlando The Center for Reproductive Medicine (CRM) wants to help cancer patients achieve their dreams of expanding their families. Possible side effects of cancer therapies include infertility, which is why the physicians at CRM provide expedited consultation appointments to those affected by cancer prior to treatment. Chemotherapy, age, and dosage of radiation will have an effect on the level of impact in your fertility. There are no guarantees relating to your fertility while going through cancer treatment, so our reproductive specialists recommend considering fertility preservation before you begin therapy. There are many options for men and women available at CRM to preserve fertility. Depending on your circumstances, you may want to consider in vitro fertilization, embryo freezing, egg or semen preservation, and more! CRM is a proud member of Livestrong’s Sharing Hope Program, which works to increase access of fertility preservation services to cancer patients. Contact us to learn more about Orlando’s most comprehensive program to preserve fertility! Mon, 16 November 2015 00:00:00 What You Need To Know About PCOS CRM Orlando In honor of PCOS awareness month, the reproductive specialists at the Center for Reproductive Medicine (CRM) want to share some important facts. PCOS is a common hormonal condition. It affects about 5-10% of women. There are many possible symptoms. You may notice acne, irregular periods, excessive hair growth, and weight gain all due to an increase of male hormones in women. It is treatable. Though irreversible, doctors can put you on birth control to regulate periods; metformin so you’re less likely to become diabetic; statins to prevent high cholesterol; and/or hormones to combat infertility. Women with PCOS can live a normal life with a variety of treatments. You need to adopt a healthy lifestyle. You may be able to lower the chance of long-term health conditions by eating a well-balanced diet and regularly exercising. If you are having trouble getting pregnant and think you might have PCOS, schedule an appointment with our fertility specialists at the Center of Reproductive Medicine in Orlando today. We can help you conceive the family you’ve dreamed of! Mon, 21 September 2015 00:00:00 4 Things To Know About Egg Freezing CRM Orlando Want to preserve your fertility for when the timing is right? Advances in technology and research now make egg freezing a viable option to delay starting a family! Recently, Time researched egg freezing and uncovered the following: In 2009, 500 women elected to freeze their eggs. In 2013, this number increased to almost 5,000. It’s also been predicted that by 2018, the number of women freezing their eggs will reach 76,000. A “quick-freeze vitrification” egg freezing process improved the success rates among live births from frozen eggs. There has been an increase in egg freezing information and gatherings that allows women to learn more about the process. It is becoming increasingly popular for businesswomen to freeze their eggs. This could be due to the fact that professionals likely have other priorities and wish to start a family later in life. The infertility doctors at CRM have made the fertility preservation process easier than ever. If you’d like to learn more about freezing your eggs, contact the Center for Reproductive Medicine in Central Florida today! Mon, 31 August 2015 00:00:00 Attain IVF Flex Plans Offers Patient Discounts CRM Orlando Did you know that it may take more than one IVF cycle to achieve a pregnancy and take home a baby? At the Center for Reproductive Medicine in Orlando, we understand and offer a special discounted plan to help! Attain® IVF Flex Plans provides patients with multiple IVF cycles for a set fee. IVF cycles can be costly and cause stress, so we highly recommend an Attain program for our patients with limited to no insurance coverage. If you plan on using your own eggs, consider the Core Plan. This plan allows for two egg retrievals and the transfer of all resulting embryos until you have a baby. The next option is the Refund Plan, which offers two or three egg retrievals, and the transfer of embryos until you have a baby. If unsuccessful, this plan provides peace of mind because you will receive a refund of up to 100%. If you will be using a donor egg, CRM offers an Attain IVF Flex Plan for Donor Egg Recipients that allows patients to pre-pay a fixed rate that is also refundable if unsuccessful. Be sure to schedule your initial fertility consultation today to get started. If your doctor then recommends an IVF treatment plan, notify your financial counselor that you are interested in Attain. Mon, 17 August 2015 00:00:00 Facts about Infertility Center for Reproductive Medicine The American Society for Reproductive Medicine, ASRM, has found that at least one in seven couples have fertility problems. The reproductive specialists at CRM in Orlando, Florida share these common issues that can trigger infertility. Infertility affects about 11% of the reproductive age population – that is approximately 6.7milllion women! 25% of women with fertility issues have irregular ovulation, while 12% do not have a “normal” BMI. Those who smoke have been proven to have decreased fertility. Women who smoke are more likely to miscarry. As much as 13% of infertile women may have cigarettes to blame. Women age 25-29 are 78% likely to get pregnant after trying for one year, this percentage decreases to 36% for women age 40-44. Only 3% of infertile couples need IVF or other advanced reproductive technologies. 85-90% can be treated with medications or simpler surgical procedures. Learn more facts about infertility here. If you have been trying to conceive for over one year, have a history of miscarriage, have irregular menstrual cycles, or have any of the other risk factors listed here, contact the Center of Reproductive Medicine to schedule an initial consultation. Mon, 27 July 2015 00:00:00 Male Fertility Myths CRM Staff In honor of Male Fertility Month, the reproductive specialists at the Center for Reproductive Medicine debunk common myths about male infertility. We’re sure you’ve heard them all, so we want to set the record straight to keep you focused on the things that actually will affect your fertility. Infertility is due to the female partner. About 35-40% of infertile couples have an infertile male partner. It’s important to remember that it is no one’s fault, and most infertility issues can be treated with the help of an experienced fertility doctor. Men can conceive at any age. Studies have shown that when the male is over 40, there is a slightly higher risk of miscarriage or chromosomal abnormalities. Consider fertility preservation if you are waiting to conceive later in life. Having more sex will help you conceive. This is only true if you time it correctly. Your partner can only get pregnant when she is ovulating, so have intercourse every other day during her most fertile window. You can continue your regular routine while trying to conceive. This will depend on your “regular” routine. If you are actively trying to conceive, you should avoid hot tubs and saunas as that can drastically increase your temperature and disrupt sperm count. You should also avoid keeping laptops on your lap as well as taking long distance bicycle rides because these activities can cause overheating. Lubricants should speed up sperm. On the contrary, many lubricants on the market today can interfere with sperm motility. Consult your doctor for safer alternatives. You cannot be overweight. While being obese can affect sperm production, many men don’t realize that being underweight also affects your fertility. So try to maintain a BMI in the “normal” range. You’re not getting pregnant because you aren’t relaxed. While extreme stress can take a toll on your overall health, everyday stressors shouldn’t affect your fertility. But if you are truly infertile, even relaxing won’t help. It’s a condition that requires medical treatment. We hope that these facts help you on your conception journey. If you remain unsuccessful after one year, visit one of our infertility centers in the Orlando area. Thu, 18 June 2015 00:00:00 May is Mental Health Awareness Month CRM Staff Infertility affects both men and women mentally, physically, and emotionally.  The ups and downs of the process can lead to high levels of stress, anxiety, anger, depression, marital problems, sexual dysfunction, and social isolation.  These unfortunate side effects make the process that much more difficult, however it’s important to get the support you need so your self-esteem and outlook on life remain as positive as possible.  The month of May is Mental Health Awareness month, and there’s no better time than the present to give yourself a mental check-up or a much needed mental health break!  Your mental health plays just as significant a role as your physical health, especially while you are in the process of trying to get pregnant.  In fact more and more research is being done to link stress and infertility with implications that stress may play a role in 30% of all infertility problems! While it is virtually impossible to go through the infertility process stress-free, there are many ways to manage the stress with relaxation techniques.  Here are some of the more popular methods for fertility patients… Acupuncture Aerobic exercise (may be reduced during treatments) Journaling Listening to music Massage therapy Meditation Self-help books Progressive muscle relaxation Support/educational groups Walking/ hiking Yoga When to Seek Help and Where to Find It There may come a time when simple relaxation techniques can’t ease the emotional pain of infertility.  Learn the warning signs of depression and never be afraid to seek help when it’s needed most.   For mental health resources, click on the RESOLVE’s (the National Infertility Association) Directory of Services.  If there is not a doctor listed in your area, talk to family and friends about referrals and check with your insurance company for doctors listed in your plan. Additional Resources The articles below provide great insight on coping with stress and helpful tips for stress relief during the infertility journey.  Relaxation and Stress Management for Infertile Women Coping with the Stress of Infertility Fact Sheet Coping with Infertility: How Family and Friends Can Help At CRM in Orlando, we understand the ups and downs of the infertility treatment process and are sensitive to our patient’s needs and concerns. Wed, 20 May 2015 00:00:00 National Infertility Awareness Week CRM Staff Infertility affects millions, 7.4 million women to be more exact, and leaves many feeling isolated and alone.  That is why RESOLVE, The National Infertility Association, has chosen the simple, yet powerful message “You are not alone” as this year’s theme for National Infertility Awareness Week, set to kick off April 19th.  Their goal is to bring much needed awareness so those struggling with infertility know there is a community of support when it’s needed most.  Here’s how we can all help spread the word and increase awareness… Take it to Social Media… Post a fact about infertility or family building options in your status update. Share RESOLVE’s Infertility Etiquette page on Facebook or Twitter. If you are comfortable, share your story.   Not only will you find support from loved ones, you may also inspire others. Share information about RESOLVE’s Advocacy Day and other RESOLVE events. Start a blog about your infertility journey. Get Educated… Learn more about infertility, its causes, and the available treatments. Sign up to receive RESOLVE’s quarterly newsletter to receive important information on infertility from the field’s most noted professionals and from the personal experiences of others. Get Political… Become a Grassroots Advocate and help build state advocacy infrastructure to fight anti-family bills in all 50 states.  Talk to your employer about the advantages to offering insurance coverage that covers infertility and adding adoption benefits for employees. Local Support… Volunteer to represent and support the local infertility community.  Become a RESOLVE sponsor to promote RESOLVE’s efforts to provide support, education, advocacy, and research.  You are not alone, and at the Center for Reproductive Medicine in Orlando, we are here to help!  If you have any questions about infertility or are interested in hearing about treatment options that are right for you, please contact us. Wed, 15 April 2015 00:00:00 All I Want for Christmas is a B-A-B-Y: 7 Tips for Coping with the Holidays Dr. Randall Loy How to answer the awkward questions, "When are you going to start a family?" OR " Why aren't you pregnant yet?" OR "When are you going to make me a Grandma?" -- you know, THOSE questions! Mon, 22 December 2014 00:00:00 Donor Egg Programs: The Center for Reproductive Medicine vs. Donor Agencies Dr. Randall Loy Several weeks ago a 44-year-old new patient from the North Florida who was interested in donor egg IVF asked, “Could you explain the differences between using your Center and using an donor egg agency? Are there any advantages in using an agency?” The second question was quicker. The answer was a resounding “No! There are no advantages whatsoever in using an egg donation agency. In fact, most such agencies add approximately $10,000 to the process without any extra benefits.” The answer given to the patient’s first question is as follows: Relative to most donor egg agencies which are relatively new, non-physician owned and operated “Internet companies,” the Center for Reproductive Medicine (CRM) in Orlando has served patients in the southeastern U.S and many countries for more than 29 years and is one of the leading infertility practices in the country. With six Board-certified Reproductive Endocrinologists, scores of nursing, laboratory and administrative staff, as well as a dedicated donor egg team, our three offices are strategically located to best serve patients throughout the region. Further, CRM is one of just four partners in My Egg Bank- North America, the world’s largest and most successful egg bank. Whether patients have advanced reproductive age, decreased ovarian reserve, premature ovarian failure or genetic abnormalities, we are able to give them a high chance for success using highly qualified and rigorously-screened young healthy donors. CRM Egg Donor Program: Hundreds of egg donors 100% Money back guarantee option Immediate availability FDA screened donors Comprehensive donor profiles Donor photos available Majority college educated Majority with proven fertility Excellent success rates Egg donor coordinators providing individualized care NO DONOR AGENCY FEES At CRM we understand that you have a number of choices. However, if you want experience, expertise, high success rates combined with affordable pricing, please contact Faith Young, Chief Donor Egg Coordinator, at 407 756-1580. Wed, 17 December 2014 00:00:00 Does Lifestyle Affect the Outcome of Infertility Treatment? Dr. Randall Loy Infertility is estimated to affect up to 15% of American couples and is a diagnosis that is often not covered by third party reimbursement. It is therefore especially important to understand the available and current information that certain lifestyle habits may adversely impact fertility, including the success of IVF/ICSI treatments. This brief report is based upon an article by Kristen Rooney and Alice Domar of the Domar Center for Mind/Body Health, Boston IVF, Beth Israel Deaconess Medical Center and Harvard Medical School.[1] The authors performed an extensive review of the medical literature of this summary article and focused on six aspects of lifestyle: body mass index (BMI) – high and low, exercise, diet including supplements, caffeine, alcohol, smoking, and antidepressant medications. BMI: Obesity is a universal problem with increasing prevalence. Obesity, defined as a BMI of 30 or greater, affects 14% of women in the world, and almost 300 million women over the age of 20 are obese. It is well known that obesity is associated with hypertension, heart disease and diabetes but it is also strongly associated with infertility (68% less chance to have a birth in the first IVF cycle than women who e not obese), miscarriage, preterm birth. Underweight women, usually defined as a BMI of less than 19 also have increased fertility problems and miscarriage rates. Although most research on the impact of weight loss does not show a positive relationship between weight loss and pregnancy in IVF patients, weight loss is associated with a higher spontaneous pregnancy rate. In morbidly obese women, bariatric surgery increases egg quality and quantity relative to obese women who do not undergo surgery. Exercise: Moderate daily aerobic exercise is associated with the highest pregnancy rates, no matter what the BMI. Diet/Supplements: Vitamin D supplementation may normalize the serum anti-Muellerian hormone (AMH) levels. Vitamin D, a steroid hormone, itself, may modulate testosterone activity, thereby having a positive influence on pregnancy outcome. Caffeine: The evidence on the relationship between caffeine and fertility is inconsistent but, in general suggests that higher caffeine intake may be linked to lower egg number, fewer good embryos, lower pregnancy rates in IVF patients and increased miscarriage rates. Alcohol: Alcohol should be avoided in IVF. Alcohol usage resulted in fewer eggs, lower pregnancy rates, and more than a twofold increased risk of miscarriage. Smoking: Smoking should also be avoided and is associated with infertility, pregnancy loss, and IVF failure. In general, smokers add 10 years to their reproductive age. Antidepressants: This class of medications increases risks of miscarriage, birth defects, preterm birth, newborn behavioral syndrome as well as other physical and neurological abnormalities in the baby. The authors concluded that lifestyle habits may have a significant impact on pregnancy rates in infertile women. Although adequate research in this area is lacking, there is evidence to support the above lifestyle modifications in infertile women. However, despite patient education efforts, studies in the U.S. and Europe have indicated that infertility patients do not follow the recommended lifestyle modifications. [1] Current Opinion in Obstetrics & Gynecology: June 2014 - Volume 26 - Issue 3 - p 181-185 Thu, 20 November 2014 00:00:00 The Maternal Age Effect: The Risks of Old Eggs Dr. Randall Loy Dr. Randall A. Loy considers pregnancy in women of advanced reproductive age. Mon, 17 November 2014 00:00:00 Donor Egg IVF (Ova Easy) Dr. Randall Loy Dr. Randall A. Loy discusses donor oocyte IVF and a VERY generous donor! Wed, 05 November 2014 00:00:00 IVF : Testing the Embryos (Preimplantation Genetic Diagnosis) Dr. Randall Loy Dr. Randall A. Loy sheds light on the diagnostic testing and genetic screening of embryos. Tue, 28 October 2014 00:00:00 Moderate Alcohol Consumption is Associated with Reduced Sperm Quality Dr. Randall Loy In the first study among healthy young men with detailed information on alcohol intake, modest regular drinking of alcohol could be playing a major role in the abnormal semen analyses reported. In a study published in the British Medical Journal on October 2, 2014, Professor Tina Jensen and colleagues reported on 1221 young Danish men, aged 18-28, recruited for compulsory military service between 2008 and 2012. As part of their medical assessment, the recruits were asked about total alcohol consumption in the week prior (recent drinking), usual drinking (habitual) and binge drinking. Semen and blood samples were obtained from the group to determine semen quality (volume, sperm concentration, total sperm count and percentages of motile and normal appearing sperm) and the concentration of certain reproductive hormones. The average alcohol intake in the week prior to assessment was 11 units among the men who average age was 19 and whose favorite beverage was beer. Almost two-thirds (64%) had binged and 59% had been drunk at least twice in the thirty days prior to assessment. Semen quality decreased with increasing recent alcohol consumption as well as binge drinking.  The higher the number of units drunk, the lower was the semen quality in terms of total sperm count and the percentage of sperm of normal size and shape. This was true after accounting for other lifestyle factors. The effects were present from five plus units per week and beyond; however, the effects were most apparent among men who drank 25 or more units per week. Total sperm counts were 33% lower, and the percentage of normal sperm forms was 51% lower among those who drank 40 units per week relative to those who drank between one and five units. Moderate habitual drinking was also associated with changes in reproductive hormones. Testosterone increased and its carrier protein (sex hormone binding globulin, SHBG) decreased with increasing recent alcohol intake. The authors of this observational study conclude with “given the fact that young men in the Western world have a high alcohol intake, this is a public health concern and could be a contributing factor to the low sperm count reported among young man. It remains to be seen whether semen quality is restored if alcohol intake is reduced, but young man should be advised that high habitual alcohol intake may affect not only there general but also the reproductive health.” Thu, 23 October 2014 00:00:00 IVF : Risks vs. Benefits (Baby!) Dr. Randall Loy Dr. Randall A. Loy discusses the risks of IVF procedures and IVF pregnancies Tue, 21 October 2014 00:00:00 Factors in IVF Success and Failure Dr. Randall Loy Dr. Randall A. Loy discusses reviews the various factors that contribute to a positive or negative pregnancy test result in IVF. Fri, 17 October 2014 00:00:00 First Baby Born after Transplantation of Uterus Dr. Randall Loy The world’s first baby has been born after transplantation of a uterus. This remarkable research, carried out at Sweden’s University of Gothenburg, was reported on October 5, 2014 in the British journalLancet and was headed by Mats Brännström, M.D., Ph.D.  Until this report, eleven human uterus transplantation (UTx) attempts had been performed worldwide but none resulting in live births. This uterine transplantation research began in 1999 and involved animal studies. In rodent models, the Gothenburg team studied rejection patterns of the uterine graft, immunosuppression to avoid graft rejection as well as pregnancies and live-born offspring after UTx. Nine women in the human study have received a uterus from living donors, mostly from close family members and friends. In two cases, the UTx was removed, one for an infection and the second for blood clots in the transplanted uterine vessels. Of the remaining seven, all have had menstrual function and have been attempting pregnancies via IVF using their own embryos. This extraordinary surgery is the first available treatment for absolute uterine infertility caused by either congenital absence of the uterus or the presence of a non-functional uterus. In 2013, a 35-year-old woman with congenital absence of the uterus (Rokitansky syndrome) underwent UTx with a uterus was donated by a living, 61-year-old woman. The recipient and the donor had essentially uneventful postoperative courses. The recipient's first menstruation occurred 43 days after transplantation and she continued to have regular menstrual cycles.  In vitro fertilization treatment of the recipient and her partner had been done before UTx and 11 embryos had been cryopreserved. The recipient underwent her first single embryo transfer one year after UTx, which resulted in pregnancy. She was then given immunosuppression using three different medications which were continued throughout pregnancy. Early pregnancy was confirmed in the spring of this year and the patient delivered via caesarean section at almost 32 weeks of gestation due to preeclampsia and fetal stress. A baby boy with normal birth weight for gestational age (3lbs 15 oz) was born. “The mother and child are both doing well and have returned home. The new parents are, of course, very happy and thankful,”  Dr. Brännström stated. This report is a major step forward in UTx can be a treatment for uterine factor infertility. In addition, the study demonstrates the feasibility of live uterus donation, even from a 61 year old donor! Thu, 16 October 2014 00:00:00 The Vitrification Evolution - Revolution Dr. Randall Loy Vitrification, or the quick freezing of cells and tissue, has been available for almost two decades but its relatively recent application to human eggs and embryos has revolutionized the world of IVF. “Vitrification” from the Latin vitreumfor “glass” is the cryobiology technique that instantaneously turns a solution into a solid without ice crystal formation. Upon quick freezing, human eggs, for example, become glassy- like in appearance and can then be stored indefinitely in liquid nitrogen at -321⁰ F. Upon thawing, the survival rates are high, relative to older “slow freezing” techniques, due to the much lower risk of damage to the eggs or embryos from ice crystal formation. (A bit of science: Upon thawing, ice crystals actually expand before they contact back as a solution and this expansion can rupture cells.) Vitrification has allowed for more “freeze all” IVF cycles in which all available oocytes or embryos are cryopreserved to be replaced in a subsequent cycle. The advantages of such an approach may be as follows: - Decreased risk of ovarian hyperstimulation syndrome (OHSS) - Decreased fetal (preterm birth and small for gestational age) and placental (previa and abruption) risks of a fresh transfer - Improved endometrial (uterine) receptivity in a subsequent, more natural cycle - The possibility of more aggressive ovarian stimulation for “fertility preservation” - Decreased multiple gestation (triplets and higher) rates - Easier logistics for third party reproduction, e.g., egg donation, gestational carriers. In fact, this quick freeze technique has made oocyte banks possible. Ask your Infertility specialist if vitrification may be appropriate for your case. Thu, 09 October 2014 00:00:00 IVF: Now in Four Flavors Dr. Randall Loy Dr. Randall A. Loy discusses various forms of IVF treatments. Tue, 07 October 2014 00:00:00 Third Party Reproduction: Many Ways to Make a Baby Dr. Randall Loy In the 1975 solo hit Fifty Ways to Leave Your Lover, Paul Simon’s lyric reads “There must be fifty ways…” and the chorus begins to enumerate the ways. With respect to third party reproduction, there are at least half that many ways to make a baby. The following is an intriguing list of most of the possibilities in the novel world of assisted reproduction and involves donors, recipients, hosts, intended parent(s) and carriers:  1 - Female Recipient using her own egg and anonymous sperm donor (own uterus) 2 - Female Recipient using her own egg and known sperm donor (own uterus) 3 - Female Recipient using anonymous egg donor (AED) and partner’s sperm (own uterus) 4- Female Recipient using AED and anonymous sperm donor (own uterus) 5- Female Recipient using AED and known sperm donor (own uterus) 6- Female Recipient using known egg donor and partner’s sperm (own uterus) 7 - Female Recipient using known egg donor and anonymous sperm donor (own uterus) 8 - Female Recipient using known egg donor and known sperm donor (own uterus) 9 - Female intended parent (IP) using her own eggs and partner’s sperm with gestational carrier (GC  or host uterus) 10 - Female IP using her own eggs and anonymous sperm donor with GC (host uterus) 11- Female IP using her own eggs and known sperm donor with GC (host uterus) 12- Female IP using AED and partner’s sperm with GC (host uterus) 13- Female IP using AED and anonymous sperm donor with GC (host uterus) 14- Female IP using AED and known sperm donor with GC (host uterus) 15 - Male IP using AED and own sperm with GC (host uterus) 16 - Male IP using AED and partner’s sperm with GC (host uterus) 17 - Male IP using AED and anonymous sperm donor with GC (host uterus) 18 - Male IP using AED and known sperm donor with GC (host uterus) 19 - Female IP using known egg donor and partner’s sperm with GC (host uterus) 20 - Female IP using known egg donor and anonymous sperm donor with GC (host uterus) 21 - Female IP using known egg donor and known sperm donor with GC (host uterus) 22 - Male IP using known egg donor and partner’s sperm with CG (host uterus) 23 - Male IP using known egg donor and anonymous sperm donor with GC (host uterus) 24 - Male IP using known egg donor and known sperm donor with GC (host uterus) 25 - Female IP using own eggs and partner’s sperm with intent to use a GC (host uterus) in the future. 25a - Either Fresh or Frozen The options are dizzying and most require FDA screening and eligibility paperwork. In many of the above cases it would be advisable for the intended parent(s) to have legal representation by a healthcare attorney well-versed in adoption, surrogacy and family law. “…it's really not my habitTo intrudeFurthermore, I hope my meaningWon't be lost or misconstruedBut I'll repeat myselfAt the risk of being crudeThere must be fifty ways….”  (Special thanks to Faith Young and Cassandra Fyotek at the Center for Reproductive Medicine in Orlando, Florida for helping with this list.) Fri, 03 October 2014 00:00:00 An Overview of IVF - Thirty Years of Test Tube Babies Dr. Randall Loy Dr. Randall A. Loy reflects on the history and the steps of the IVF process. Wed, 01 October 2014 00:00:00 Online Dating - Chemistry through Genetics. Can Gene Testing Result in the Best Match? Dr. Randall Loy Is there just one perfect match on the face of the earth for each of us? Are the matching parameters of the most popular online dating services enough or is it time to go to the ultimately personal level of DNA? Could a particular gene or group of genes and their expressions determine your predisposition for relational success? If a single “perfect partner” were available in some universal genetic data base, how much would or should such a service cost? How ethical would it be to use or to withhold such genetic information if it were an accurate predictor of success in love? The questions just keep coming! These and other “slippery slope” questions are receiving more attention in recent weeks since the launch of an easy to use genetic testing service to determine compatibility.Instant Chemistry and SingldOuthave joined forces to provide genetic matches to members. Instant Chemistry provides the genetic testing component and SingldOut in an online “D(N)Ating” service that operates under the LinkedIn networking site umbrella to provide “ultimate compatability testing.” Although not the first kids on the block with a genetic test for romantic matches, Instant Chemistry may have real, although very incomplete, science behind it. The direct-to-consumer salivary testing analyzes three Human Leukocyte Antigen (HLA) genes in the Major Histocompatibility Complex (MHC) on the short arm of chromosome 6. The MHC distinguishes us from an immune point of view and is very important in organ transplantation medicine. It seems also to be important in mate selection in lower mammals, e.g., mice, where the little rodents preferentially breed with partners with different MHC genes. Research is always a matter of mice and men, however, and things are not nearly so straightforward in humans. MHC data regarding mate selection among humans are insufficient, controversial and inconsistent. If there is a link with MHC in humans, it is probably mediated by our sense of smell, in that MHC expression is related to the perception of certain compounds in body odors such as sweat.  Clearly, there may be some role of MHC genes in romantic matches but the “science” does not support commercial MHC testing for such purposes at this juncture. Perhaps more to the point, Instant Chemistry also considers the Serotonin transporter gene (SERT gene). Serotonin is a neurotransmitter that is especially associated with emotional satisfaction and the sense of well-being and the most common antidepressants function by inhibiting the serotonin transporter function. Nerve cells communicate by chemicals like serotonin which serve as messengers between one cell and another. The serotonin transporter removes serotonin from the space between nerve endings and terminates its effects. Clinical studies have shown that changes in serotonin transporter metabolism appear to be associated with many different conditions, including depression and anxiety, romantic attraction and love, obsessive-compulsive disorder and certain phobias. Variants of the Serotonin transporter gene (SERT gene) may have greater or lesser satisfaction in romantic relationships than those with the normal SERT gene. Again, the science is woefully incomplete, with few and limited human clinical trials in this area. Although, these two companies have attempted to add another and intriguing echelon of sophistication to online dating, the prevailing clinical data do not support their efforts. However, there are genetic tests of other sorts already offered clinically to determine carrier status for scores of relatively common to rare genetic diseases (autosomal recessive disorders offered by Counsyl or Good Start). Maybe these tests and more involved and expensive single gene testing for disease predispositions will make their way onto online dating web sites during the next years. Such highly specific and personalized genetic information has far reaching implications for more than just romantic matches. With respect to relationships and finding the right match, indeed, we are somewhere between the brief classified ads of the last century and a brave new world with perhaps too much information! Fri, 26 September 2014 00:00:00 Robotic Surgery: Robots in the OR?!? Dr. Randall Loy Dr. Randall A. Loy discusses the role of robotic laparoscopic surgery in infertility. Wed, 24 September 2014 00:00:00 Center for Reproductive Medicine (CRM) participates in the Making Strides Against Breast Cancer 5k Center For Reproductive Medicine Staff October is National Breast Cancer Awareness Month. Each year, the Center for Reproductive Medicine (CRM) participates in the Making Strides Against Breast Cancer 5k and walks to show their support and to help raise money to fight for a cure. This year’s walk is on Saturday, October 25th at Lake Eola Park. To find out more information about this year’s 5k, please visit: Orlando Making Strides 5k Mon, 22 September 2014 00:00:00 Hysteroscopy Surgery Without Incisions Dr. Randall Loy Dr. Randall A. Loy explores hysteroscopy -- minimally invasive, intrauterine surgery. Fri, 19 September 2014 00:00:00 Emotional Aspects of Infertility Dr. Sejal Dharia Patel Infertility can be such a stressful journey for a couple. From the initial diagnosis to a long pathway of oftentimes empiric therapy, infertility can create a significant amount of stress on a patient and her partner’s physical and emotional well being. Stress So what is stress? Stress is a challenge to our body, minds and environment when we do not have the resources to cope with this stress. For an infertile couple, this may be the stress of the diagnosis and the realization that they may not be able to conceive naturally or not having the resources available, whether emotional, physical or fiscal, to attempt conception. This may also be the stress associated with the feelings of loss after multiple miscarriages or the loss and feeling of failure after a treatment cycle when the pregnancy test is negative. Physiologically, stress may cause a release of adrenaline which increases heart rate, blood pressure, respiratory rate as well as increasing blood flow to the major muscles in our body. In an acute event this is helpful; however, chronically, this may cause a loss in the body’s ability to regulate its inflammatory response, and in turn will lead to a variety of medical diseases—including depression. Most importantly, this may further exacerbate infertility and lengthen the overall journey to conception. The best and most thorough research to date has been on the relationship between female distress and in vitro fertilization (IVF) success rates. There have been 14 published studies that have looked at distress levels in women prior, or at the beginning of, an IVF cycle. These studies have been conducted worldwide. Ten of the studies showed that distress levels are indeed associated with decreased pregnancy rates. The more anxiety or depression the women experienced before undergoing IVF, the less likely they were to get pregnant. Stages of the emotional journey Emotionally, infertility encompasses a few stages that most patients will undergo, although each patient’s experience is quite different. Initially, most couples go through a process of denial. They rationalize out why - although it has been three years, they may not have truly “tried” and do not meet the diagnosis of infertility. Or why their initial treatments did not work. They are anxious to admit there may be a problem for which clinical guidance is needed. There are also feelings of anger. Many patients are angry because they may feel vulnerable, helpless or both, often projecting that anger onto friends who offer helpful advice or friends who are pregnant. They may have anger related to their partner or family, resulting in patients distancing themselves from family or friends, or events which remind them of children or their fertility, thereby weakening the support system they truly need. Some patients will go through a stage of bargaining or looking for hope, whether this is with a provider or with a particular aspect of therapy or promises of pregnancy, and could stem from guilt or shame. Ultimately, most patients enter a stage of acceptance where they will understand and embrace their diagnosis, their treatment plan and the possible outcomes. Coping with emotional challenges of infertility Having the knowledge that both stress and the infertility journey in and of itself can be an overwhelming process, it is helpful to know there are tools in the armamentarium of every patient to help them deal with the emotional challenges of infertility. 1. Relaxation response therapy – relaxation response is a state of deep rest and will counteract the impact of stress on the body. The relaxation response can be induced through a wide variety of relaxation techniques, including progressive muscle relaxation, deep breathing, meditation and imagery. Progressive muscle relaxation involves progressively tightening and then relaxing your muscles, either from head to toe or vice versa. Deep breathing involves breathing slowly from your belly, like sighing deeply. Meditation requires focusing on a word or phrase as you breathe. Finally, imagery can mean a variety of things, ranging from imagining a pleasant safe spot to focusing on your body. 2. Mind Body Program – An integrated program focusing holistically on the patient and originally penned by Dr. Alice Domar. Mind/body techniques include both physical and psychological skills. Physical skills include relaxation techniques, “mini” relaxation techniques and information on lifestyle habits which can impact fertility. Psychological techniques include cognitive restructuring, social support, coping with negative emotions such as anger and guilt, and self-nurturance. 3. Acupuncture – Acupuncture has been shown to help fertility by reducing the effects of stress and balancing the hormones. Some purported benefits include increasing blood flow to the uterus and ovaries, increasing the uterine lining, and decreasing uterine contractility. Most, if not all, the studies of acupuncture's effects on fertility have been looking at the effects of acupuncture on IVF patients. These studies suggest there may be positive effects, although this data is not conclusive. 4. Nutritional/Exercise therapy – Diet is an important aspect of stress management. It is best to cut down on or eliminate sugar, salt, saturated fats, white flour, chemical additives, alcohol and caffeine. Caffeine is a particularly strong offender, and you may be amazed how much more peaceful you’ll feel when you give it up, or at least cut down, on colas and coffee. Other important nutritional and exercise tips include: a)      Get plenty of sleep – many people need eight hours. b)      Allow time in your life for rest and recreation. c)      Get plenty of exercise. Not only does it relieve physical tension, but if it’s aerobic exercise like running or swimming you will actually metabolize norepinephrine and serotonin, the substances your body produces when you’re under stress. You will truly get rid of stress. Consider taking a yoga, exercise, or dance class. 5. Coping techniques – These may be varied depending upon a patient’s personality. However, some examples include: a)      Getting more information about infertility, therapy, and options b)      Give yourself the opportunity to cry and be angry c)      Give your partner the chance to heal and mourn differently than you do d)     Teach your support system how you would like to be supported and, most importantly, take the time to care for yourself during this journey. Ultimately, it is important to be aware of the stress infertility and its journey can cause. It is important to refocus on you and your partner. Utilize your support system when needed and train them to support you as it helps you best. Have tools such as relaxation techniques, exercise, and acupuncture available to you. Know that parenthood awaits whether naturally, through therapy or alternative means. Wed, 17 September 2014 00:00:00 Endometriosis: A Life-Changing Disease Dr. Randall Loy Could you have endometriosis? Do you have pelvic pain or are you experiencing difficulty in achieving pregnancy? If so, do not delay in seeking medical attention and go to a specialist who is well-versed in comprehensive endometriosis management. Carefully document your symptoms (e.g., pain location, quality, timing, activities affected, things that make the pain better or worse…) and take a log of your symptoms charted during the course of a menstrual cycle. Also provide your physician a descriptive narrative of how your life is being affected by your symptoms. Endometriosis is a chronic disease state that affects approximately 10-12% of women of reproductive age throughout the world. Almost half of women with infertility have endometriosis and common symptoms include pain with menstrual periods and/or intercourse, fatigue, heavy menstrual bleeding and daily pelvic pain. Various clinical studies have shown that endometriosis is a pervasive disease and affects all aspects of women’s quality of life and especially with respect to pain and psycho-social functioning. A 2013 systematic review of 42 studies on the social and psychological impact endometriosis which was funded by the UK Economic and Social Research Council [Hum. Reprod. Update (2013)doi: 10.1093/humupd/dmt027] found delays between symptom onset and diagnosis, uncertainty about the course of the disease after diagnosis, significant impact on quality of life and activities such as employment, energy, vitality, socializing, as well as physical and sexual functioning. In addition, to increased rates of anxiety, depression and emotional distress, there was a sense of loss of control over one’s life while dealing with chronic pain. Other feelings which were common among endometriosis sufferers were worry, isolation, guilt, helplessness, hopelessness and the inability to cope. This excellent review by Lorraine Culley and colleagues also highlighted some of the limitations in the materials and methods applied in the 23 quantitative, 16 qualitative and 3 mixed studies included in the analysis. No two studies were exactly alike with respect to methodology making comparisons difficult and resulting in serious information gaps in the literature. There exists a compelling need to study both the interventions of treatment and the ongoing support techniques for affected women and their families. In a corroborative study just published from Monash University in the Journal of Family Planning and Reproductive Health Care (2014; DOI: 10.1136/jfprhc-2013-100853). Lead author, Kate Young and collaborators found that women commonly experienced delays in diagnosis and were more likely to be diagnosed sooner if reporting infertility rather than menstrual issues. Delays were both patient- and physician-related. The study noted that women were often dissatisfied, frustrated and angry with the experiences with their physicians and had concerns regarding the effectiveness and side effects of prescribed medical and surgical treatments. As with the first study cited above, authors concluded that further research is necessary to better understand endometriosis among women of diverse cultural and ethnic backgrounds. Effective treatments are available for endometriosis, so do not delay seeking help from a specialist just because a well-intentioned friend or family member, or even a medical professional told you that “pain with periods is normal” or that “pain with sex is common” or that “just relax and you’ll get pregnant.” Endometriosis is a pervasive, even life-altering disease; therefore, be proactive and take control and, if you are suspicious, find out if you have it and what the best treatment and support options are. Mon, 15 September 2014 00:00:00 Minimizing the Risk of Multiple Pregnancy Dr. Randall Loy The risks of multiple pregnancies are well known and include intense nausea and vomiting, pre-term labor and delivery with the associated risks to the babies (e.g. cerebral palsy), low birth weight, pregnancy-induced high blood pressure, gestational diabetes, increased bleeding risks and cesarean delivery. Despite greater awareness of these and other complications, as well as recent advances in the world of IVF which have improved embryo implantation rates, many patients still insist on a two or three embryo transfer. During the last number of years efforts have been made to define the appropriate number of embryos to transfer in the IVF setting to maximize the chances for a successful single pregnancy while minimizing the risks for twins, triplets and higher order pregnancies. The goal is the single embryo transfer (SET). Recently published inFertility and Sterility(2014;102:345-347) by Zabeena Pandian and colleagues was a summary of theCochrane Reviewon the number of embryos for transfer in the IVF and ICSI setting.Cochrane Reviews( are careful reviews of primary sources of clinical research and are regarded as one of the ultimate standards in evidence-based medical practice. In their review, Dr. Pandian of Aberdeen Maternity Hospital in the United Kingdom, and coauthors considered 14 randomized controlled research studies comparing the number of embryos transferred in 2,165 women. In short, there were no statistically meaningful differences in pregnancy between two SET cycles (either fresh-fresh or fresh-frozen/thawed) compared with one cycle of double embryo transfer (DET). However, as one would anticipate, the multiple pregnancy rate was significantly reduced in the repeated SET group compared with the DET group – approximately 1-3% vs. 14%. There is also no doubt that the single SET cycle is less likely to result in pregnancy than a single DET cycle, approximately 24-33% vs. 45%. The authors’ conclusion is straightforward: repeated SET may well minimize the various risks of multiple pregnancy in the IVF setting without substantially decreasing the live baby rates. The goal of IVF, now, should be to replace the single best embryo into the best uterine environment. Maybe the title should have beenReady, SET, SET, Go! Thu, 11 September 2014 00:00:00 Laparoscopy: Of Belly Buttons and Band-Aids Dr. Randall Loy Dr. Randall A. Loy considers laparoscopy -- a minimally invasive surgical procedure to diagnose and treat certain infertility conditions. Tue, 09 September 2014 00:00:00 How Exercise and Weight Impact Fertility - Size DOES Matter Dr. Randall Loy Dr. Randall A. Loy discusses the right "zones" for exercise and weight to maximize conception success. Fri, 05 September 2014 00:00:00 Fresh or Frozen: Which Embryos Should Be Transferred? Dr. Randall Loy The IVF world is approaching a great fork in the road. Since the first IVF baby was born thirty-six years ago, there have been a number of such branch points along the way, including the means of stimulating follicles, egg retrieval techniques, culture media types, to ICSI or not to ICSI, as well as optimal egg- and embryo- freezing techniques. Although most of the past three plus decades have brought progressive small, iterative changes to the assisted reproductive technologies, certain turning points are momentous and dramatically change the course of IVF throughout the world. The fork in the road just ahead is whether embryos should be transferred to the uterus in the fresh IVF cycle or in a subsequent frozen-thawed (FET) cycle. Stated differently: Should we freeze all embryos and eliminate fresh embryo transfers? The thinking behind freezing all embryos with a future FET cycle is that the embryos are returned to a “more normal” or more physiologic uterine environment. That is, the embryos are transferred into an endometrium that has not been exposed to large amounts of gonadotropins – stimulating hormones such as Follistim, Gonal-F and Menopur. The rationale has been that such an FET cycle may result in better pregnancy rates and decrease risks such as low birth weight and prematurity. Indeed, a review of a compilation of studies published in 2012 revealed that FET pregnancies, when compared to fresh-transfer pregnancies, had significantly decreased risks of preterm birth, small for gestational age fetuses, low birth weight, perinatal mortality, placental abruption and placenta previa. The risks for congenital abnormalities and some other risks did not differ significantly. (1) With respect to FET transfers, there was an increased risk for large for gestational age fetuses as well as cesarean section. In fact, various clinical reports have verified better implantation rates and pregnancy rates with FET over fresh-transfer cycles. Certainly, freezing all unavailable embryos makes sense to decrease the risks of ovarian hyperstimulation syndrome (OHSS), and to allow for preimplantation genetic diagnostic screening or diagnosis. In the context of a rising progesterone level prior to egg retrieval, freezing all embryos is also a common practice. There has been a clear and rather sharp turn toward more FET cycles during the last eight years in theU.S.and, although promising, it is too early to prescribe “freeze all” cycles for all patients even at a given IVF center. Treatment must be individualized and based upon clinical parameters as well as emerging clinical studies. (Translation: We should slow down and consult our navigation system as we approach the fork in the road!) Sources: 1. Maheshwari A, et al. Obstetric and perinatal outcomes in singleton pregnancies resulting from the transfer of frozen thawed versus fresh embryos generated through in vitro fertilization treatment: a systematic review and meta-analysis. Fertil Steril 2012;98:368-77. Wed, 03 September 2014 00:00:00 Intrauterine Insemination (IUI) Dr. Randall Loy Dr. Randall A. Loy reviews the various aspects of therapeutic insemination. Thu, 28 August 2014 00:00:00 Vitamin D Levels and IVF Success Dr. Randall Loy Vitamin D may play various roles in human reproduction and several recently published studies indicate that vitamin D levels are predictive of implantation and ongoing pregnancy rates in in vitro fertilization (IVF). Vitamin D is really not a “vitamin” but a small family of steroid hormones that increase the  absorption  of  calcium, magnesium, phosphate, iron and zinc from the intestine and which also have effects on many other organ systems. Vitamin D is either consumed, as in certain fortified foods, e.g., dairy products, or synthesized from cholesterol in the skin, when there is sufficient sun exposure. A January 2007 article in the New England Journal of Medicine revealed that the majority of American women may be Vitamin D deficient. Receptors for Vitamin D are present in the human uterus, ovary and placenta and low levels of vitamin D in pregnancy are associated with pre-eclampsia, gestational diabetes and intrauterine fetal growth retardation. When bound to its receptor, the active form of vitamin D (calcitriol) seems to be involved in estrogen production and implantation. In fact, calcitriol may regulate several genes involved in implantation. A prospective study of 173 women undergoing IVF in Toronto revealed that women with sufficient vitamin D levels (> 75 nmol/L) had significantly higher pregnancy rates in IVF than women with insufficient levels (>75 nmol/L). Women with sufficient levels had a 52.5% clinical pregnancy rate compared to a 34.7% rate among those with insufficiency. [CMJ Open, 2013 Jun 28;1(2):E77-82]. Another investigation, published inHuman Reproduction, measured vitamin D levels in 388 patients who underwent IVF/ICSI and a single embryo transfer. Clinical pregnancy rates were significantly lower in women with vitamin D levels < 20 ng/ml compared with those with higher concentrations (41 vs. 54%). When controlling for all potentially confounding factors, vitamin D was independently associated with lower clinical pregnancy rates [HumReprod, 2014 Sep;29(9):2032-40]. In a newly published study from Milan, researchers found that women who had sufficient that levels of vitamin D (>20ng/ml) were significantly more likely to produce higher quality embryos and were more like to achieve a clinical pregnancy than women who were vitamin D deficient (<20ng/ml). This prospective study examined 154 women who were vitamin D deficient and 181 women who had sufficient vitamin D blood levels. The clinical pregnancy rates were 20% and 31%, respectively. Interestingly, a subgroup analysis showed that the group of women with the highest levels (>30ng/ml) had the highest chances of pregnancy (J Clin Endocrinol Metab2014 Aug 14:jc2014 1802). It does appear, then, based upon these and a number of studies between 2005-2010 that Vitamin D plays a key role in human reproduction, maybe involving embryo quality as well as at the uterine lining, where it may facilitate implantation of the embryo. Vitamin D is readily available, inexpensive and has few, if any side effects and may improve one’s fertility potential. However, there are no adequate clinical studies on vitamin D supplementation and IVF outcome. Tue, 26 August 2014 00:00:00 The Conception Diet Dr. Randall Loy Dr. Randall A. Loy discusses the foods to eat to increase your chances of having a baby. Wed, 20 August 2014 00:00:00 Binding “Mr. Right”: How Sperm Get into the Egg Dr. Randall Loy How do swimming sperm cells and ovulated egg cells recognize each other and bind together? Despite substantial research, this question has been somewhat of a mystery for the past thirty plus years. The answer,  just in, may be a certain protein in the egg shell or zona pellucida.  The zona pellucida (Latin, “clear zone”) is the outer egg layer that surrounds and protects the egg as well as the embryo until it hatches out as a blastocyst (day 5-6 embryo). This soft, glassy layer binds sperm, allows one to enter and then blocks out all others. It appears that sperm bind to specific sugars associated with a particular zonal protein. In the human there are four zonal binding proteins, known as ZP1, ZP2, ZP3 and ZP4. Sperm-egg binding abnormalities are especially seen among infertility patients and are thought to be a reason for unexplained infertility as well as failed ovulation induction and intrauterine insemination (IUI) cycles. In fact, approximately 8-10% of couples who have had three failed IUI cycles may have gamete binding abnormalities, especially if the semen count and/or percentage of normal forms are abnormal. Intracytoplasmic sperm injection (ICSI) has largely overcome this problem of binding abnormalities and should be a consideration in patients with unexplained infertility and multiple failed IUI cycles. A recent study inThe Journal of Cell Biology(June 2014 DOI:10:1083/jcb.20140025) recently identified the protein in the zonal pellucida that sperm recognize and bind: ZP2. In this investigation, sperm did not bind the zona pellucida if it was missing ZP2. The researchers from the National Institute of Diabetes and Digestion and Kidney Diseases also found that sperm could not bind eggs if ZP2 was missing a critical region near the beginning of the protein. The entry one sperm through the zona causes the release of an enzyme that severs ZP2 in that critical region, thus preventing other sperm from entering. In the IVF setting we sometimes see a failure of this mechanism, especially in pre-mature or post-mature egg cells, and two or more sperm gain access to the egg nucleus. The answer, then, to “How does one bind ‘Mr. Right?’” is ZP2! Mon, 18 August 2014 00:00:00 The Hysterosalpingogram (HSG) Dr. Randall Loy Dr. Randall A. Loy discusses the hysterosalpingogram and what not to do when the lights go out! Fri, 15 August 2014 00:00:00 Career Now, Baby Later - Freezing Your Eggs Dr. Randall Loy There comes a time in a woman's lifetime -- most commonly in her mid 30s – when the biological clock alarm begins ringing and ringing loudly. The average age of our patients at the Center for Reproductive Medicine is 34 years, which means, of course, that many patients are in their mid to late 40s. Oftentimes these patients have been pursuing education and careers and have not been on the “mommy track.” Then, whether secondary to their own clock or curious friends and family, the question arises: “If you’re going to have a baby then when?” This singular question can produce considerable internal and external stress and sometimes panic. Now there may be the solution: fertility preservation via egg freezing. Fortunately or unfortunately, men do not have the same biological clock or reproductive constraints. Although there are definitely changes in the fertility potential and sperm genetics in the older male, in the female, there is a precipitous decline of egg quantity and quality after age 37 and by age 42, there may be fewer than 1000 eggs left (of the 1 million endowment at birth). Of these remaining eggs perhaps 90% are genetically abnormal. For this reason, more and more of our patients are electing to preserve their fertility via freezing eggs. The average age of the patient who electively freezes her eggs is 37 and down from age 39+ just several years ago. Typically she has a great job and ample money and may or may not have found “Mr. Right” yet. Many patients feel that by freezing their eggs they have stopped the biological clock and can then enjoy their careers and/or do their due diligence in finding the right partner. The whole notion of being able to “freeze time” is actually liberating and may be the biggest single advance in reproductive medicine since the introduction of the birth control pill. Although egg freezing has been available for approximately 30 years, it has not been successful until recent times with the advent of vitrification, a flash freezing technique that produces a glass-like appearance of the egg. Formerly, the so-called "slow freeze" method produced ice crystal formation in the egg that frequently produced rupturing of the egg cell upon thawing. With vitrification, the freeze-thaw viability rate is greater than 90% in the best labs. What if a woman has already missed the window of opportunity to freeze her eggs and to preserve her fertility, e.g. >42 years of age? Then she may wish to use frozen eggs from an anonymous, young donor. The Center for Reproductive Medicine has great expertise in fertility preservation as well as Donor Egg IVF and is a partner in My Egg Bank, the world largest and most successful egg Bank. Egg freezing, whether for preservation of fertility or with the usage of a donor, provides a brand-new way of approaching life and a way to enjoy one’s career today with the option of babies tomorrow. Wed, 13 August 2014 00:00:00 Laboratory Testing: The Usual Suspects Dr. Randall Loy Dr. Randall A. Loy of the Center for Reproductive Medicine reviews the most common laboratory tests in reproductive medicine and the difference between a "Pheromonologist" and an Endocrinologist. Thu, 07 August 2014 00:00:00 Could Exposure to Plastics Today Affect Your Great Grandchildren? Dr. Randall Loy If you are having a difficult time becoming pregnant, some very common household plastics may be playing a role. Three plastics (phthalates) were found to increase time to pregnancy by 20% in couples in which the male partners had high urinary concentrations of monomethyl phthalate, monobenzyl phthalate and monobutyl phthalate. This study, from the National Institutes of Health (NIH) and other institutions, included 501 couples who were recruited to participate in the Longitudinal Investigation of Fertility and the Environment (LIFE) study. Published in Fertility and Sterility in February 2014, the authors looked at levels of Bisphenol A (BPA) and 14 different plastic-related compounds as well as the time it took for couples to achieve a conception. “Our study shows that exposure to certain phthalates can reduce the chance of conception for otherwise healthy couples,” said the study’s first author, Germaine M. Buck Louis, PhD of the National Institute of Child Health and Human Development. Phthalates are actually “plasticizers,” substances added to plastics to increase their flexibility, transparency and durability. Phthalates are everywhere: adhesives and glues, electronics, building materials, personal hygiene products, medical devices, detergents, packaging, children's toys, waxes, paints, printing inks, medications, food products, and textiles. BPA is a chemical used to make certain plastics such as the ubiquitous polycarbonate plastic. Clear and nearly shatter-proof, polycarbonate is found in baby bottles and water bottles, sports equipment, medical and dental devices, dental fillings and sealants, CDs and DVDs, eyeglass lenses and household electronics. Phthalates have hormonal actions and are known as “endocrine disruptors.” Plastics can counter androgens (“male” hormones such as testosterone) and levels of phthalates in infertile men are related to low androgen levels, low sperm counts, abnormal sperm forms and increased sperm DNA damage. It could be that phthalate levels in men adversely affect reproductive success by epigenetic effects (markers that turn genes on and off but do not affect DNA). If DNA is the hardware, epigenetic factors are the software that tell genes what to do and when.  A new study underway at the University of Massachusetts Amherst led by environmental health researcher Richard Pilsner seeks to understand if epigenetic modifications may be secondary to exposure to plastics. Epigenetic factors can be inherited on top of genetic (DNA) inheritance and are shaped by environmental exposure such as smoking, air pollution and toxins. Such environmentally-induced epigenetic modifications could be manifested for generations to come so it may be possible that those plastic water bottles today could affect one’s great grandchildren someday. Tue, 05 August 2014 00:00:00 Semen Analysis - Boyz Under the Hood Dr. Randall Loy Dr. Randall A. Loy considers the first test in the infertility diagnostic evaluation: the Semen Analysis (as well as ways not to provide a specimen!). Wed, 30 July 2014 00:00:00 What to Expect at the First Visit with an Infertility Specialist Dr. Randall Loy Dr. Randall A. Loy of the Center for Reproductive Medicine in Orlando, Florida discusses the first appointment with an Infertility Specialist (and one life-threatening question!) Tue, 22 July 2014 00:00:00 CDC Releases National Action Plan for Infertility Dr. Randall Loy Just this week, the Centers for Disease Control and Prevention (CDC) released the final version of its National Public Health Action Plan for the Detection, Prevention and Management of Infertility. It is a primer on infertility definitions and statistics as well as a white paper on "where do we go from here?" with respect to infertility.The National Action Plan, seven years in the making, identifies opportunities for reducing infertility in the United States. The CDC and non-governmental organizations, including the American Society of Reproductive Medicine (ASRM) worked together to draft the document. Written from a public health perspective, the goals of this effort are to better prevent, detect and manage diseases that lead to infertility.Ultimately, the National Action Plan is a call to action for Federal, state, and local agencies; associated scientists; health care professionals; insurance providers; employers; industry; nonprofit organizations; and organizations representing people with infertility.To learn more about infertility prevention, treatment and support, the National Action Plan is available at Fri, 18 July 2014 00:00:00 What is a Reproductive Endocrinologist? The Tale of Two Brothers Dr. Randall Loy Dr. Randall A. Loy of the Center for Reproductive Medicine in Orlando, Florida explores how an infertility specialist differs from an OB/GYN and how to choose the right doctor. Thu, 17 July 2014 00:00:00 Fertility Drugs Not Tied to Long Term Breast, Ovarian, and Uterine Cancer Risks Dr. Randall Loy The results of a large and 30 year-long follow up study presented on June 30, 2014 at the Annual Meeting of the European Society of Human Reproduction and Embryology (ESHRE) suggested that there is "little evidence" that the use of fertility medications used for stimulation of the ovaries increases the long-term risk of breast or other gynecological cancers. However, the prolonged usage of clomiphene citrate was associated with an increased risk of breast cancer in women who had used clomiphene for twelve or more cycles.Dr. Louise Brinton of the US National Cancer Institute was the principal investigator of this study involving 12,193 women who were treated for infertility between 1965 and 1988 at five sites in the United States. Follow up lasted until 2010, with evaluation based upon an extensive questionnaire and records from US death and cancer registries. A total of 9,892 women were followed for their cancer outcomes. Most previous studies which had suggested a possible link between fertility drugs and breast, ovarian and uterine cancers were small studies with shorter follow up periods and without adequate controls. Because of the size and long-term nature of this particular study, it has greater statistical power than previous such studies.Only 10% of this study population had been treated with gonadotropins [human menopausal gonadotropin (hMG) and/or purified follicle stimulating hormone (pFSH)] and most of these were in combination with clomiphene citrate. In the hMG and pFSH group there is no association with cancer risk except in those women who never conceived. In short, the Brinton study does not support a strong relationship between the usage of fertility drugs (mainly clomiphene citrate) and breast or gynecological cancers. Although this study is reassuring, further studies, mainly involving the usage of gonadotropins and especially in the IVF setting are certainly warranted. Tue, 15 July 2014 00:00:00 Coping with Infertility on Mother's Day Center For Reproductive Medicine Staff With Mother's Day 2014 nearly upon us, the fertility specialists at Center for Reproductive Medicine in Orlando want to remind you that this is a time to celebrate and hope for the new life yet to come, and not a time for despair.  Faced with a day that is particularly difficult to navigate on an emotional level, it is not always easy and is, in fact, hard for many who are coping with infertility to maintain a positive outlook.  We recognize this and it is our job as fertility specialists, not only to help you find a successful fertility treatment plan, but also to ensure you have the right tools to help you cope with the emotional stresses that accompany infertility. To help keep a positive outlook on your Mother's Day, we've put together a few tips and resources that we hope, will enable you to emerge Monday morning refreshed and smiling. Focus on Celebrating the People Who Have 'Mothered' You Over the Years Over the years, from the time you were a child through adolescence and on into your 20's and 30's, your mother, grandmother, aunts, and the other moms who held you accountable when your mom wasn't around to see, have all shaped you and contributed to the mom you will one day be.  Celebrate those who have prepared you for motherhood. Plan Ahead, Do Something Fun with Your Spouse Some of the best medicine is knowing you can lean on each other for support.  There are so many options for planning a fun day to celebrate each other, like hiking, taking a walk on the beach, packing a picnic lunch, or visiting a museum - most importantly, be generous with your time for each other. Join a Support Group There are many local and online groups that will create a supportive community to help see you through the day.  Support groups can meet your needs on many different levels, from knowing what comes next in treatment to knowing you're not alone. Know You Can Talk to Someone and Get Support The National Infertility Association has set up a RESOLVE HelpLine so that when you feel overwhelmed and alone, you know there is someone you can talk to. As you consider or continue fertility treatment options, we urge you to check out the RESOLVE website at or one of our previous blog posts Dealing with Infertility and Holiday Stress for additional tips and further reading on how to approach Mother's Day this year.  An infinite store of optimism awaits you! Fri, 09 May 2014 00:00:00 How to Deal with Unexplained Infertility Dr. Sejal Dharia Patel A negative pregnancy test again. My aunt went into the bathroom and cried for six hours. After every IVF cycle, we all grieved her loss of implantation; we grieved over her social isolation, and her depressed spirit. There was no happiness, only hopefulness after the transfer until the first spot of blood or the negative pregnancy test and then back to the bathroom for more tears.Infertility is depleting. It represents many losses, such as, the loss of fertility and reproductive ability, the loss of an embryo, the loss of a pregnancy with miscarriage, and/or the loss of a child and biological offspring with a stillborn or neonatal death. Thus, grief is a normal reaction. However, when the loss is of a potential, not an actual loss, the couple may not realize they are allowed to grieve. However, without the ability to grieve the impact on the patient and her partner can be grave: from social isolation, marital discord and ultimately depression.Infertility and miscarriages evoke emotional losses that are overwhelming to patients but may be classified into four main phases: the initial phase (shock, surprise, denial); the reactive phase (frustration, anger, anxiety, guilt, grief, depression, isolation); the adaptive phase (acceptance) and a resolution phase (planning for future solutions).As a patient undergoes the four main phases, influences of the event itself, the patient's personality, cultural factors and social support from close family and friends can all influence their grieving process and their ability to cope.Coping mechanisms will vary from patient to patient, however a few tips to keep in mind that will help as your transition through your four phases include1) Do not blame yourself-Negative thinking patterns can only make matters worse. Remember that infertility is not your fault. Concentrate on your future.2) Work as a team with your partner-Do not blame one another for the difficulty encountered3) Educate yourself-This will eliminate the unknown and the associated speculation.4) Set limits on how long you are willing to try and decide on what you are willing to pay. This will help you and your provider create a customized plan for you that help you reach your goals.5) Get support from professionals and others with infertility problems to help you through your infertility journey. Programs such as the Mind-Body Program through Alice Domar, PhD have been shown to improve outcomes.6) Feel comfortable avoiding activities which are focused on pregnancy or births (i.e. baby showers)7) Balance optimism and realism-Realize that infertility is a journey. For most there is success, however, for some there is not and one should be prepared.8) Take care of yourself by pursuing other interests.As you look to the community to help and support you, look for psychologists who have experience in infertility counseling. Take the time to look for support groups where you can relay your experiences, learn from others and create a support structure with those who understand. Finally look to books to help.One resource is Alice Domar's book on Conquering Infertility, which provides some guidance on what they need most from stress relief, support and hope. Another great resource is "I never held you: Miscarriage, Grief, Healing and Recovery by Ellen Dubois and Dr. Linda Backman.For my aunt, in her last IVF cycle, she conceived and nine months later, a beautiful baby girl. However, the crying, the guilt and the anger my aunt and I never forgot. Mon, 04 March 2013 00:00:00 Dealing with Infertility and Holiday Stress Dr. Randall Loy The holidays are all about family gatherings, religious observances, shopping, parties, entertaining, familiar traditions and high expectations but the "hopes and fears of all the years" inevitably bring stress. The other family members with babies and friends with their children and the not infrequent, painful question "When are you two going to have a baby?" are separate and additive stressors. Many infertile couples feel marginalized or incomplete and suffer in silence. Signs of this stress may include feeling anxious, worried, irritable, and, possibly, sad or depressed. Some might experience eating or sleep disturbances, or other physical complaints such as headache, fatigue, muscle tension and abdominal pain and there may be the urge to self-medicate with excess alcohol or drugs.Seven Tips for Couples Coping with Infertility During the Holidays:1. Dignify your feelings. It is normal to feel sadness or grief. You should express your feelings to loved ones and it is OK to cry. Opening up to others and telling your story is good for the heart. Let your family and friends know what you need from them.2. Simplify. Do not be concerned with others' expectations of you. You do not have to attend every holiday function to which you are invited, especially if there will be pregnant women or children present. Invest your time wisely.3. Maintain Boundaries. You do not have to disclose the details of your infertility journey to anyone who asks. Have a standard answer prepared for the sincere, inevitable question about your beginning a family. If you feel uncomfortable with further infertility questioning, change the subject of the discussion or excuse yourself to get more food or beverage. Decide how you will respond to the children and babies at the parties and family gatherings you will attend.4. Remember the Reasons for the Season. Recall what the holidays have meant to you and what you are celebrating. Think of less fortunate others and how can you can focus on them and their stories, their pain, their problems. Helping others will help you. Consider what you have enjoyed in past holidays and invest your energies in those activities. Participate in those rituals that have the most meaning to you and your family.5. Make New Friends: Socialize with friends who do not have children. If being around the children among your family and friends is too difficult you may want to take a year off from the usual traditions and take a holiday vacation. Consider a ski trip or cruise with other couples from your support group, or a mission trip with your church or synagogue.6. Take A Breather. While spending time with people who really care about you, take some time for yourself. Take at least undisturbed 15-30 minutes per day alone to refresh. Find something that reduces your stress (meditation, prayer, exercise, soothing music, a pet, deep breathing) by clearing your mind. Attend religious services and community gatherings (concerts, plays, tree-lighting ceremonies). If stress becomes overwhelming, get professional help. Speak to your physician, mental health counselor, minister, priest or rabbi.7. Develop a Plan for the New Year. All of the festivities will soon be over and January 2, 2013 will be here. Decide that you will avoid the post- holiday let down by daily aerobic exercise and a healthy lifestyle. Make some clear decisions regarding your fertility care for the new year and consult with your doctor to discuss your action plan.One final word about the holidays. There may, in fact, be well-meaning family and friends who will breach etiquette and who will give infertility advice, e.g., "Just relax!" or "You need to take these fertility supplements I heard about" or "I've been 'researching' infertility on the internet, have you tried taking _____?" Politely tell them that you are already seeing an infertility specialist and that they will be among the first to know when they can buy you some baby booties! Thu, 15 November 2012 00:00:00