Several Miscarriages and Infertility

miscarriage and infertility
A miscarriage is one of the most difficult situations a couple can experience. Both parents are left in unimaginable pain and grief. In addition, it can lead to many questions and wondering what went wrong and why the pregnancy didn’t take. However, it can be even worse if there is a situation of several miscarriages.

What Causes a Miscarriage?

Miscarriages are described as the loss of a pregnancy prior to the 20th week. In many instances, the woman might not even realize she is pregnant because she might miscarry before she has even missed her menstrual period. Generally, however, around 15 to 25 percent of known pregnancies end in a miscarriage. Over 80 percent of those occur within the first trimester. A miscarriage can occur after the 20th week of pregnancy, but those are rare.

The majority of miscarriages occur because of chromosomal abnormalities that are not inherited by either parent but that abruptly develop in the unborn baby. Most often, the miscarriage occurs because the baby would not be able to survive. Miscarriages can occur for other reasons as well. They are as follows:

• Hormonal problems
• Uterine abnormalities
• Immune system responses
• Infection
• Diabetes or thyroid conditions in the mother
• Physical problems in the mother
• Being over 35
• Problems with the cervix
• Recurrent miscarriages (three or more)

Are Multiple Miscarriages a Sign of Infertility?

Sadly, approximately four percent of couples end up experiencing recurrent miscarriages. At this point, miscarriage and fertility become a worrisome issue. However, there is hope because there are options for these couples that can help them to conceive and go on to enjoy a healthy pregnancy.

Anyone who has experienced multiple miscarriages will want to get support and answers to their numerous questions. Medicine has advanced considerably over the years and there is the option of infertility and genetic testing that can help couples to regain control over their fertility.

Testing Available for Couples Who Experience Miscarriage

There are certain tests available for couples who have experienced miscarriage. These are as follows:

Genetic Karyotype: Couples who have experienced several miscarriages, generally three or more, who are considering trying to conceive naturally or through in-vitro fertilization (IVF), should consider this type of test. Genetic karyotype testing checks for chromosomal abnormalities that can present the risk of miscarriage and a baby being born with a genetic issue.
PGS (Preimplantation Genetic Screening): This type of test is recommended for people who have a high risk due to a family history of genetic problems like cystic fibrosis or fertility issues and have a history of recurrent miscarriages. It can check for healthy embryos for couples who plan on using IVF so that the embryos can implant and develop in a normal and healthy manner.
Fetal Tissue Testing: This type of testing is done on the fetal tissue after a miscarriage. It is done to determine why the pregnancy didn’t develop and progress normally and can bring couples some answers. It is recommended for couples who have no known risks for miscarriage. Unfortunately, it doesn’t always result in a conclusive answer.

Solutions for Infertility

When it is discovered that you have a correlation with miscarriage and infertility, you can seek help from your doctor to conceive and have a normal, healthy pregnancy. Couples have the following options:

Artificial Insemination: The sperm is inserted into the woman through a tube, which helps with conception when there are issues like low sperm count or problems with cervical mucus. It is frequently used with a medication known as Clomid.
Assisted Reproductive Technology (ART): ART is done by removing the woman’s eggs and directly fertilizing them with her partner’s sperm. After fertilization, one or more embryos are inserted into the woman.
In-Vitro Fertilization (IVF): IVF is a type of ART, but multiple embryos are placed inside the woman.

Remember, if you have experienced miscarriage and infertility, it’s important to not lose hope. There are options that can help you to have the family of which you’ve always dreamed.

Posted in Awareness, Blog

Ovarian Cancer Awareness Month

ovarian cancer awareness month

By Dr. Christine Mullin, M.D.

ovarian cancer awareness month

1.3 % of women in the general population will develop ovarian cancer sometime during their lives.  39 % of women who inherit a harmful BRCA-1 mutation and 11-17 % of women who inherit a harmful BRCA-2 mutation will develop ovarian cancer by age 70. There are other risk factors for ovarian cancer which include a family history of breast, ovarian, and possibly, other cancers; the specific mutation(s) she has inherited; and reproductive history. However, none of these other factors are as strong of a risk factor as the harmful BRCA-1 or BRCA-2 mutation.   BRCA-1mutations may also increase a woman’s risk of developing fallopian tube cancer and peritoneal cancer.  The Ashkenazi Jewish population have a higher prevalence of harmful BRCA-1 and BRCA-2 mutations than people in the general U.S. population. Other ethnic and geographic populations around the world, such as the Norwegian, Dutch, and Icelandic peoples, also have a higher prevalence of specific harmful BRCA-1 and BRCA-2 mutations.

DNA (from a blood or saliva sample) is needed for mutation testing. The sample is sent to a laboratory for analysis. It usually takes about a month to get the test results.  When an individual has a family history that is suggestive of the presence of a BRCA1 or BRCA2 mutation, it may be most informative to first test a family member who has cancer if that person is still alive and willing to be tested. If that person is found to have a harmful BRCA1 or BRCA2 mutation, then other family members may want to consider genetic counseling to learn more about their potential risks and whether genetic testing for mutations in BRCA1 and BRCA2might be appropriate for them.

Several options are available for managing cancer risk in individuals who have a known harmful BRCA-1 or BRCA-2 mutation. These include enhanced screening, prophylactic (risk-reducing) surgery, chemoprevention, and In Vitro Fertilization with Preimplantation Genetic Diagnosis. Screening includes clinical breast examinations beginning at age 25 to 35 years and a mammogram every year, beginning at age 25 to 35 years.  No effective ovarian cancer screening methods currently exist. Some groups recommend transvaginal ultrasound, blood tests for the antigen CA-125, and clinical examinations for ovarian cancer screening in women with harmful BRCA1 or BRCA2 mutations, but none of these methods appear to detect ovarian tumors at an early enough stage to reduce the risk of dying from ovarian cancer.

Prophylactic surgery involves removing as much of the “at-risk” tissue as possible. Women may choose to have both breasts removed (bilateral prophylactic mastectomy) to reduce their risk of breast cancer. Surgery to remove a woman’s ovaries and fallopian tubes (bilateral prophylactic salpingo-oophorectomy) can help reduce her risk of ovarian cancer. Removing the ovaries also reduces the risk of breast cancer in premenopausal women by eliminating a source of hormones that can fuel the growth of some types of breast cancer.

Moreover, women of reproductive age desiring future fertility, can chose to freeze their eggs prior to prophylactic removal of their ovaries in order to preserve their fertility. For women with a partner, desiring pregnancy, they can chose the option of In Vitro Fertilization with Preimplantation Genetic Diagnosis where we can test the embryos for the harmful BRCA gene in the embryo so that we can prevent this gene from being passed on to their offspring.  Such amazing technology has helped many women have healthy children without the BRCA gene allowing their children to have a reduced risk of both ovarian and breast cancer.

 


Dr. Christine Mullin, M.D.

Dr. Christine Mullin, M.D.

Dr. Christine Mullin joined the Northwell Health Fertility team after completing her subspecialty training in Reproductive Endocrinology and Infertility at the NYU Fertility Center of the New York University School of Medicine. She is the Director of the IVF Program and Director of the PGD/PGS Program at Northwell Health Fertility.

 

 

Posted in News, Ovarian Cancer

Why Everyone’s IVF Journey Is Different

in vitro fertilization
In-Vitro Fertilization is the process of fertilization that involves manual extraction of ova and sperms then manually combining them in the laboratory. The formed embryo is then transferred into the uterus for development. It is a form of assisted fertilization for couples and individuals who struggle to conceive naturally.

Although the process involves similar procedures and mechanisms, everyone’s IVF journey is different. This can be explained by several factors discussed below.

Every Embryo is Different
Every sperm, ovum and the resulting combination (embryo) is different. Therefore, every IVF is different because they use different eggs and sperms. The DNA in the eggs and sperms is unique, which makes each embryo unique. The development of the embryos is also different because of this. As a result, the successes, challenges and experiences for the different people or even the same person with different embryos will also be different.

The Outcomes of IVF are Different
The success rates of IVF differ. This is influenced by several factors such as age of the mother, ovarian reserve, infertility diagnosis and lifestyles. Body mass index has been shown to adversely affect pregnancy. Since different women going through IVF have different lifestyles, they are affected by these factors differently. This makes their IVF journeys different.

The Procedures and Medications Vary
Some of the women undergoing IVF go for the short protocol while others go for the long protocol, depending on their bodies. The short protocol is faster as it is started between the second and fourth day of the natural cycle. Injections are carried out for eight to fifteen days with egg collection following immediately. Five days of egg development follow where the egg is transferred. This is followed by two weeks to tell whether the procedure was successful.

On the other hand, taking birth control pills is a must in the long protocol. This makes the entire process 2 to 4 weeks longer. Therefore, women who undergo long protocol experience a different IVF journey from those under the short protocol.

Emotional Differences
Since the IVF procedure is not a guarantee to pregnancy, there are different emotional attachments and experiences for different women. The success rate is between 20 to 35 percent. When the first attempt fails, the couple may feel discouraged. Other couples may be on their fourth or even fifth attempt without success. Being used to this routine makes them able to deal with it than the first timers, especially those who are more hopeful. The different emotions are also dictated by how informed the couples are and their expectations on the whole procedure.

Although the IVF principles are common in all IVF procedures, different couples have different experiences when going through IVF. These differences are as a result of differences in embryos, outcomes, emotions and expectations. The procedures and medications also vary among the women making the entire journey unique for each couple. Despite these differences, some similarities may be seen with different couples bringing in assurance.

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Posted in Uncategorized

Does Weight Affect Sperm Health?

sperm health and weight

Our very own fertility expert, Dr. Avner Hershlag, comments for an eye-opening piece from HealthDay on how men’s weight gain affects their sperm health.

“About one-third of men in the United States are obese,” said Dr. Avner Hershlag, chief of Northwell Health Fertility in Manhasset, N.Y.

America is getting fatter and fatter, despite the proliferation of new diets and exercise routines. And about one-sixth of children and adolescents are already obese, Hershlag noted.

“Along with the growing obesity trend, there has been a steady decline in sperm quality,” Hershlag said. “The findings in this study, while not specifically related to infertility, represent a trend towards a decline that is worrisome.”

Read the full article here.

Posted in News

What is Male Fertility and What Can My Family Do About It?

male infertility
Male fertility can be difficult in any relationship or marriage. However, it can be beneficial for both men and their partners to be aware of the details regarding the condition and the options available for those who suffer from it. With this said, here is a primer for women about this unfortunate condition.

What Does it Mean for a Man to Be Infertile?

The condition is actually quite self-explanatory. A man who is considered to be infertile is unable to impregnate a female without medical assistance sometimes due to a very low or relatively non-existent sperm count. This can be an issue for women, as being unable to have a child with their partner can derail the relationship and cause a strain between two partners. This can also psychologically trouble the man as many believe that being able to father a child is inherent to manhood as a whole.

What Causes It?

Firstly, women should inform their male partners that their infertility is definitely not their fault. There are many causes of infertility in men that are simply out of their control. One of the most common causes is increased temperature within the man’s testes. This can be caused by tight-fitting clothing or even working with hot objects on the lap for a very long period of time. If the testes are unable to cool themselves, it can cause permanent damage to sperm count and the interior of the testes. Infertility can also be caused by various injuries and even types of cancer.

Can Affected Couples Still Conceive?

Luckily, for many cases, the answer is yes. Men who have intact reproductive systems can obtain medical assistance that can allow them to father a child. There are many methods of medical assistance with this goal including medication that can increase sperm count and testosterone levels, surgery that repairs damaged or malformed sections of the reproductive system, or even more well-known procedures like artificial insemination and in-vitro insemination. In addition, couples who fear that male infertility may be an issue in the future can have the man’s sperm frozen for later use.

In short, male infertility can be a problem, but there are viable solutions. You should not let infertility get in the way of a blissful and successful relationship. If you or your male partner is or may be suffering from some sort of male infertility, it is recommended that you seek out the assistance of a fertility clinic where experienced professionals can show you the options available to you. Even if you thought parenthood was never on the table, there is a good chance that fertility experts may be able to help.

Posted in Infertility

The Truth About Fertility Drugs and Your Childs Development

Dr. Hershlag put patients at ease with his analysis of a new study that claims that the sons of women who use fertility drugs are shorter.  He feels that “there is not solid evidence” of such a link and adds that height is a very complex trait, and is influenced by genes, environment and diet more so than a fertility drug taken prior to conception.  Read the full article here.

Posted in Avner Hershlag, Study

Preimplantation Genetic Diagnosis (PGD) May Be Your Best Way to Have a Baby

Preimplantation Genetic Diagnosis
The decision to attempt to add to your family is often a joyous one. However, for some families, trying to have a baby may be more complicated. Some families have a history of genetic diseases. Other families may already have a baby with a genetic problem. In that case, many people must think long and hard about their next steps. Fortunately, there is help in such circumstances. Science today can help parents have healthy children. New procedures have been developed that can help parents find their healthy embryos and then implant them in a woman’s womb. This procedure is called Preimplantation Genetic Diagnosis. Over the past few years, the procedure has helped thousands of couples bring a healthy baby to term. It might be right for you if you fall into certain categories.

If it is Right For You

You might be a candidate for this procedure if there is a known genetic condition in your family. Some people know that a genetic condition that can cause abnormalities has afflicted a number of their relatives. Other people may have taken a test and found out they are a carrier for a disease such as Cystic Fibrosis that can lead to a decreased lifespan and other serious complications. Some people may carry a chromosome right now that does not compromise their own ability to function but that can cause problems in their offspring. Many couples arrive at the decision to attempt this procedure because they have had a prior baby with a serious genetic condition.

The Procedure

Preimplantation Genetic Diagnosis is a complex procedure. A woman must start the procedure at least several weeks before her menstrual cycle begins. During this cycle, the couple will take fertility medications. The object of such medications is help the female partner produce more eggs during a given cycle. After her eggs are harvested, they are fertilized with a her partner’s sperm. Then, the embryologists examine the fertilized eggs under a microscope and test them. An embryo that does not contain genetic defects is implanted in the woman’s womb. If there are other, healthy embryos they are typically frozen and stored. This way, if the procedure does not work the first time, the couple can simply try again with the frozen embryos.

A Healthy Family

This procedure can be a lifesaver for couples who want to have a family of their own but have been unable to do so in the past. Couples can now avoid passing on genetic problems to their children. Technological innovation allows the participants to select only healthy embryos. For couples who know they have a problem, the procedure can help them have a baby. It can also help them have more than one baby as many couples freeze their healthy embryos. A couple that successfully completes the procedure and has one child can then have any other healthy embryos implanted. The screening helps provide the couple with healthy eggs that should implant and grow.

Posted in Preimplantation Genetic Diagnosis

Donating Your Eggs: How You Can Change Someone’s Life

become an egg donor
Egg donation is a method that can provide women with infertility issues, the opportunity to conceive. Women can volunteer to donate their eggs to help those unable to conceive.

What is Infertility?

Infertility is the inability to achieve pregnancy. Infertility is a problem that affects nearly 10% of women of reproductive age. Infertility is the inability to conceive a child on their own. There are many factors that can cause infertility, such as genetic disorders and treatments for other illnesses.

How can infertility affect women?

Women who are infertile can have serious psychological repercussions due to infertility. It can pose issues to the self-esteem and cause them to feel as if they are less of a person. It can also be stressful on relationships and can lead to depression. Fortunately, there are methods to help women with fertility issues to conceive.

Who can donate eggs?

Any woman between the ages of 21 to 32 years old can be a potential candidate for egg donation. It is preferred that she be of a healthy weight and BMI and be a non-smoker. Physical and emotional health is also important, as this process can be difficult. Ideal candidates for egg donation should also be free of any chronic medical conditions or genetic diseases.

How does the process work?

First, there is a screening process that will consist of several tests and consultations to ensure the donor is in good mental and physical health for the procedure. Once approved, the donor will be selected for a cycle that suits her schedule. The donor’s cycle will be matched with the recipient by use of birth control. Once the cycles are synchronized, injectable medication will be administered to stimulate multiple egg development. When the ovaries are ready, egg retrieval will occur. This is a minor procedure that is performed under anesthesia and lasts approximately 20 to 30 minutes. A follow-up exam will be performed within a week or two after the procedure to ensure all is well.

How much does it cost to donate eggs?

The only cost to those considering donation is the cost of their time and they must have transportation to and from the facility. All medical tests during the screening process, as well as treatments during the donation process, will be covered. In addition, there will be a tax-deductible payment at the end of the procedure to compensate for the donors time and effort.

In addition to the compensation, each donor will have the opportunity to help another individual fulfill their wish to be a parent. This generous contribution can bring a lot of joy and fulfillment to another person’s life.

Posted in Uncategorized

Do Birth Control Pills Limit Your Pregnancy Chances?

Do birth control pills affect fertility?

Have you ever used birth control pills before? One of the many questions you must have asked yourself is whether it affects your fertility. In the U.S, about three in four women under 30 years, who are sexually active, use some kind of birth control. Many of them worry about the effects of birth control on fertility. The most affected are those diagnosed with infertility, thanks to the loads of misinformation that prevails today.

If you are a woman diagnosed with infertility, you must have thought that your previous use of birth control pills must have somehow affected your chances of getting pregnant. One thing you may not understand is that contraceptives are simply synthetic versions of the hormones you already have in your body.

How Does Birth Control Affect Fertility?

Fact: The fact is that no scientific evidence proves that birth control pills affect fertility. Birth control pills have hormones called estrogen and progesterone. They signal the brain to stop production of the follicle stimulating hormone (FSH) and luteinizing hormone (LH), which are responsible for the maturity of the eggs, and later ovulation. These hormones also cause the environment in the uterus to be hostile for the sperm to survive. They also cause the uterine lining to remain thin, making it non-receptive for implantation. As a result, this limits the conditions necessary for the formation of an embryo. Therefore, birth control is the most effective and reversible method to avoid unplanned pregnancies. Once you discontinue the use of birth control, normal ovulation cycle resumes, meaning it does not make you infertile.

Despite the fact that birth control does not affect fertility, it may delay your chances of getting pregnant by up to one year. During this time, many women undergo a lot of emotional distress thinking that they are infertile. Couples may go through some medical procedures like IVF, which is costly and emotionally draining. However, the good news is that eventually, such women will regain their fertility.

Here is the scoop: after long periods of using the pill, certainly, you will need some time to restore your ability to conceive. The time is for the hormonal action to wear out. You need not worry about the period of impaired fertility since your reproduction system is trying to resume normal functioning. In this case, the cervix will be trying to regain mucus production. The mucus is responsible for making the environment suitable for the sperm to fertilize the ovum. Alternatively, you can also use supplements like L-Arginine to make the process faster.

In a nutshell, there is no cause for women to worry when using birth control. Also, infertile women should not think that birth control may have affected their infertility whatsoever. This is because no scientific proof shows that birth control affects the fertility of a woman. The only thing that takes place is that it may delay pregnancy chances by up to a year (this may differ from one woman to another). The reason for this is that the cervix takes some time to regain normal mucus production. The good news is that eventually, the normal ovulation cycle will resume. Remember, it is always wise to seek the assistance of your health care provider at any given point.

Posted in Infertility Contributing Factors

Staying Positive After A Miscarriage

Pregnancy is supposed to be the happiest time of a woman’s life and of a couple’s relationship. Sadly, for some, the pregnancy doesn’t make it to full term, resulting in a miscarriage. This can be the result of a myriad of medical conditions. Modern medicine is advancing daily to successfully reduce the chances of a miscarriage, but there are aspects of this devastating loss which too often go untreated. There is an emotional trauma that settles over the couple, especially the woman, during the aftermath.

When this tragedy befalls a woman, it is only natural that she goes through the five stages of grief. These stages are denial, anger, bargaining, depression, and acceptance. During this time, it is important to keep a strong support system of family and friends to help share in the pain. You don’t have to carry it alone. You have people who love and care for you. Depression can be the most difficult of these stages since it is the last one to endure before acceptance.

Recovering from depression can take time, but you will see the bright days ahead. There are different options available to treat depression. The most common option is to take antidepressants. If you’d rather try a more natural treatment for your depression, you can also sign yourself up for sessions of psychotherapy to help you cope with your emotions.

During this difficult time, it is also common to feel stressed. A stillbirth can be classified as a traumatic event that causes extreme stress. If you find yourself feeling highly stressed or suffering from anxiety attacks, it would be beneficial to seek professional counseling. Sharing your feelings with family and friends can help immensely as well. Some healthy activities to help you cope and relieve stress would be yoga classes, jogging, taking up a creative hobby, or learning an instrument.

While you’re dealing with all of the stress and grief, it’s easy to neglect yourself. Almost all women who miscarry begin to blame themselves and succumb to a feeling of failure. This results in low self-esteem and refraining from self-care. It is important to know that you are not to blame. This tragedy does not diminish your value as a person, as a woman, or as a partner. You should do something for yourself at least once a day to keep your spirits lifted and learn to love and cherish yourself again.

A miscarriage doesn’t just affect the woman. It can also affect the partner. They also lost a child. It is crucial not to lose sight of the love you have for one another. Surviving a stillbirth requires the communication and presence of both partners. Don’t repress your emotions. You need to share during this difficult time. Cry to one another, lean on one another, and, most importantly, grieve together to properly heal.

On the journey of life, there will be many difficult times. Some times won’t just be difficult. They’ll be devastatingly traumatic. No matter how dark of times you encounter, always remember that as long as there is life in you, there is hope.

Posted in Depression, Women's Health