Learn about IVF, PCOS, Endometriosis, Egg Donation and More…
Wisdom from First-Time Mothers Over Age 35
Expert Voices: Interview with Natalie Burger, M.D., Reproductive Endocrinologist
Editor Sharon Munroe had the opportunity to interview Natalie Burger, M.D. about her work with couples.
Sharon: What services do you provide to women?
Dr. Natalie Burger: I am a reproductive endocrinologist — most people know us as fertility specialists. My primary practice is taking care of women and men who wish to become parents. However, I also have specialized surgical and hormonal training to take care of patients with other kinds of reproductive health problems e.g. endometriosis, premature ovarian failure, polycystic ovarian syndrome, PCOS.
The New Year will bring renewed hope for many couples trying to get pregnant. As you resolve to make changes to enhance your fertility (such as maintaining an optimal weight, diet and lifestyle), you may wonder what steps your fertility doctor will take to enhance his or her skills and improve your chances.
Waiting to Start a Family: Options to Preserve your Fertility.
At Texas Fertility we offer many options for Fertility Preservation before chemo and for women who want to postpone child birth, egg freezing and embryo cryopreservation and donor eggs are all options.
It's positively positive! It took the perseverance of a mountain climber, your fertility doctor's tenacity, and nature's ultimate cooperation, but you've arrived. You are pregnant. At the moment, you may want to curl up in a cocoon of privacy. Other than your doctor, it's just you and your partner who know the good news.
Most women who have experienced infertility decide to wait until after the first trimester to share the news about getting pregnant. You may have experienced miscarriage before, or you may just worry about a potential pregnancy loss. About 10 to 25 percent of pregnancies end in miscarriages, and the risk increases with maternal age. Working with a fertility doctor, however, means you have frequent updates on how your pregnancy is progressing.
Managing the Unavoidable Stress of Infertility
By Val Granoff
A dream. An expectation of a lifetime. A baby. Many couples expect conceiving a biological child will be natural and simple, and that will occur without disrupting the privacy of their own lives. What they don't anticipate is that in order to conceive, they will need the help of doctors, medications, and invasive procedures -- and that they may have to begin an emotional roller coaster ride that could last for months or even years. For many couples, navigating such personal, unchartered territory is a life-changing, stressful experience. But the reward at the end of the journey is nothing short of a miracle and one worth investing whatever it takes to achieve this dream. Once the decision to move forward with treatment has been made, managing the stress associated with the process becomes paramount.
When evaluating couples who are having difficulty conceiving, it is not uncommon to find that the male partner may have an abnormal semen analysis. In fact, 40% of the causes of infertility are due to the male. It is very important to take a history from the man. Some men use anabolic steroids for body building and/or recreational drugs, such as marijuana. Steroids suppress the hypothalamic pituitary area lowering the stimulation of the testicle. As a consequence, sperm production can drop dramatically. This is similar to a woman using an oral contraceptive agent (birth control pill). Marijuana lowers the production of testosterone and increases the production of estrogen, a compounding negative effect on sperm production. Likewise, smoking has a detrimental effect on sperm function. If the man is overweight, his excess fat increases the conversion of the male's testosterone to estrogen, again changing that ratio to an unfavorable situation. Fortunately, these adverse effects are usually reversible. Therefore, changing these social habits and improving the man's general health can lead to an improvement in sperm production.
No matter how many months you’ve tried to get pregnant, the last two weeks of the cycle bring the same mixed emotions. Hope surges, crests and plummets with each passing day after ovulation. It’s the Flashback rollercoaster ride that repeats itself month after month.
Obesity is an increasing problem in the United States; women/men of a reproductive age are not excluded from this problem. It is estimated that approximately 31% of white women, 38% of Hispanic women, and 49% of black women in the U.S. are overweight or obese. Many people are aware of the problems that obesity can cause – but many are not aware of the reproductive consequences.
It is pretty much universal…most women hate their period. We call it by many endearing nicknames: "Aunt Flo", "The Monthly Curse," - you get the idea. We all know it is a necessary evil for reproductive health. Let's take a closer look at the menstrual cycle and learn about it.
Winning at the Fertility Waiting Game
French writer Alexandre Dumas once quipped: "All human wisdom is summed up in two words: wait and hope." These words encapsulate what it's like to live and cope with infertility.
If you have tried unsuccessfully for one year (six months if you are over 35) to get pregnant, the wait for a diagnosis is over. You are among the one in eight American couples considered infertile. Infertility is a unique disease in that it often suspends patients in monthly wait-hope-despair cycles; the frequent ups/downs of the trying/waiting can exacerbate already existing stress.
A Fertility Doctor's Response to "Relax and You'll Get Pregnant"
What's worse? A root canal or someone telling you yet again: "Relax and you'll get pregnant."
During National Fertility Week (April 24-May 1), Texas Fertility Center supported RESOLVE's 'Bust a Myth About Infertility" campaign. One of the most commonly heard myths (according to Resolve bloggers) is that, to get pregnant, you just need to relax. This is one myth worth talking about with your friends and family. Tell them vacations don't cure infertility. However, targeted fertility testing and effective treatments can lead to success.
Approximately 15 % of infertility is secondary to ovulatory dysfunction. It is very important to figure out what the dysfunction is, as different causes have different treatments. First and foremost comes obtaining adequate information from a patient's history. If a woman is having irregular periods or lack of periods or bleeding all the time, she is likely not ovulating in a normal manner.
Fibroids in Pregnancy
By Devin M. Garza, MD, F.A.C.O.G.
Renaissance Women's Group
Uterine fibroids (leiomyomas) are commonly occurring benign smooth muscle tumors of the uterus. The effect of these tumors on pregnancy, and the effect of the pregnancy on these tumors is a topic of clinical concern.
Although it is estimated that up to approximately 60% of women have fibroids, the incidence of fibroids in pregnancy varies between 1.6 and 10.7 %. This prevalence increases with age and is greater in African-American women.
You're ready to devote your time, emotional reserves, and discretionary income to getting pregnant. Up until now, your physical discomfort has been at the hands of skilled and ultra-competent healthcare professionals. You've endured blood draws, vaginal ultrasounds, and possibly even laparoscopic day surgeries. But that was different. Now it's you or a significant other who will literally stick it to you.
Donor Oocytes vs. Adoption: Is There Really a Difference?
By Dr. Kaylen Silverberg
One of the most difficult discussions that we have with patients concerns what they should do when conventional fertility treatments have failed or are not a good option. While some patients find themselves in this situation after trying to conceive unsuccessfully with ovulation induction or even in vitro fertilization, many more patients are actually presenting to our office at their first visit with a very poor prognosis for success before they even attempt fertility treatment.
What Your Fertility Nurse Wants You to Know
By Jamie Leonard, RN
The fertility process can be extremely overwhelming and we want you to know that we are here for you every step of the way. The staff at Texas Fertility Center truly cares about you and the outcome of your treatment cycle. We also feel the emotional impact of the negatives and positives of the fertility treatment cycle you are pursuing.
You’ve always heard that kids aren’t cheap. To rear a child, birth through adulthood, estimates range from $200,000 to $400,000 when you include a college education. No one expects to heap the cost of getting pregnant to that pile of cash. But, here you stand, poised to make an investment that will lead you to parenthood, and a lifetime of providing for a child’s needs and dreams.
Vasectomies often can be reversed, meaning healthy sperm can be restored to the ejaculate. Vasectomy reversals are performed when the personal circumstances of a couple have changed: remarriage, the loss of a child, or the desire for more children. Any man who has had a vasectomy and is interested in having more children is a candidate for a vasectomy reversal. Vasectomy reversals are highly successful in returning sperm to ejaculate, with rates exceeding 95% in the first five years following vasectomy. With increasing time between the vasectomy and the vasectomy reversal, the success rate slightly declines but continues to remain high. In certain rare instances, the vasectomy reversal is not successful. The options in these circumstances are either to perform a re-do vasectomy reversal, undergo in vitro fertilization with sperm harvested using a procedure such as microscopic epididymal sperm aspiration (MESA), or to use donor sperm.
Lowering the Risk of Multiple Pregnancies
By Thomas Vaughn, MD
It is not unusual for a couple struggling to become pregnant to hope for twins as they proceed through fertility treatments. This is especially true if the couple has not had children. Sometimes they feel that they can have two babies at one time and not need to worry about trying to become pregnant again. However, those couples who have had children in the past usually are more interested in having one baby at a time since they have experienced how much is involved in raising a child. Despite what a couple may think, it is important to realize that it is safer for the mother and her baby to have a singleton pregnancy.
Have you heard? Herbal supplements can increase your fertility 330 percent. You can get pregnant in 60 days, guaranteed. Feng shui tactics, including displaying pomegranates or pictures of elephants with their noses down, will result in a baby.
These claims pop up in a Google search for infertility cures.
Vaccination Guidelines for Women Considering Pregnancy
By Natalie Burger, MD
As you are contemplating pregnancy – either with or without the assistance of fertility treatment – it is important to maximize your health so that you can improve your chances of having a safe and healthy pregnancy. One thing to consider is how protected you are against a variety of forms of illness for which there are vaccinations. The Centers for Disease Control and Prevention (CDC) have established standard recommendations for vaccinations in women contemplating pregnancy.
“Let’s try and make a baby.” Those whispered words used to thrill you, but now uttering them kills the mood faster than black socks and boxer shorts. As you learn to recognize your uterus on screen, fertility treatment takes the magic out of lovemaking. Not at first, but over time … as each attempt becomes medically prescribed, timed and evaluated.
Getting Fertility-Ready for 2011
By Lisa Hansard, MD
Now that the holidays are winding down and we look forward to the New Year, the timing could not be better to become “fertility ready”. What this means is getting information, getting motivated, and getting a plan.
What kind of information is available? Reliable? Important?
Infertility can make you feel helpless and out of control, but you can make life-changing choices in the New Year. Texas Fertility Center encourages you to make purposeful changes, or start whittling away at your bad habits, to make 2011 your best year yet.
Uterine fibroids are the most common benign uterine tumors. Approximately 30-50% of women have uterine fibroids. They are among the most common incidental findings of the female reproductive system. Fibroids can have a significant impact on fertility.
1 in 8 couples in the U.S suffer from infertility, and there are many different causes. Tubal factor infertility affects approximately 20% of women who are having issues with fertility. Normal fallopian tubes are extremely important since fertilization (union of the sperm and egg to form an embryo) takes place in the tube. When the egg is released from the ovary at the time of ovulation, it is picked up by the finger-like projections at the end of the fallopian tubes. The egg then travels to meet the sperm within the fallopian tube. After fertilization, the fertilized egg is now called an embryo, and it travels through the fallopian tube into the uterus to implant and result in a pregnancy.
The most critical diet change that will improve your response to fertility treatment is to start your day with a full-fat protein breakfast which is eaten within an hour of waking. Let me count the benefits:
Hormone surges, daily injections and failed cycles will make you feel downright grinchy any time of the year, but add relatives, high expectations and a holiday centered around a pregnant woman and you have a recipe for rotten eggnog.
It may be your first holiday season with infertility, or just one more year of unfulfilled dreams. Women suffering with secondary infertility wonder why adding a sibling seems as impossible as flying reindeer.
If you're not sure how to endure 12 days of Christmas or 8 nights of Hanukkah, Texas Fertility Center offers you 10 Ways to Survive the Holidays
Day 3 or Day 5 Embryo Transfer. So Why the Controversy?
by Kaylen Silverberg, M.D.
One of the most common questions that patients have about IVF concerns the differences between doing an embryo transfer on Day 3 or Day 5 following retrieval. Most of our patients are very comfortable reading the medical literature – either in journals or on the Internet, and they seem to all want Day 5 transfers, as they believe that there are studies that say that this will give them a better chance of having a baby. In fact, if you look at basic statistics that compare pregnancy rates between Day 3 and Day 5 transfers, it does look at first blush like Day 5 results are better. So why the controversy?
The Road Less Traveled: Why Women Choose Egg Donors, Surrogacy, Adoption
"If there was any other way love, don't you think I've tried to find it?"
Those lyrics from pop singer Celine Dion may as well be about her six attempts at In Vitro Fertilization (which resulted in her 9-year-old son and in-utero twins). Dion told People magazine last February: "I'm going to try until it works."
Causes of Sexual Difficulty in Women
By Sandeep Mistry, MD
Causes of sexual difficulties in women can take many different forms. Whether from lack of libido, problems with arousal, lack of orgasm or pain with intercourse; sexual problems often lead to psychological and emotional distress. Most women presenting for sexual complaints will have a combination of medical and psychological causes and an evaluation by both a physician and psychologist may be necessary for the best outcome.
Going Beyond the Basic Fertility Tests
by Thomas Vaughn, MD
When a couple has had normal results for the basic fertility testing (as outlined so eloquently by Dr. Natalie Burger in the previous newsletter), the couple will need to make a decision as to whether to complete the diagnostic evaluation with a laparoscopy or proceed to one of the treatments for unexplained infertility. The three treatments for unexplained infertility include: clomiphene/intrauterine insemination (IUI), injectable medication (Gonal-F or Follistim)/IUI, and in vitro fertilization(IVF). Remember - even though a reason may not have been determined for the cause of the infertility, this does not mean that there aren’t treatments available that are quite successful.
Managing the Unavoidable Stress of Infertility
By Valerie Granoff, LCSW
A dream. An expectation of a lifetime. A baby. Many couples expect conceiving a biological child will be natural and simple, and that will occur without disrupting the privacy of their own lives. What they don’t anticipate is that in order to conceive, they will need the help of doctors, medications, and invasive procedures -- and that they may have to begin an emotional roller coaster ride that could last for months or even years. For many couples, navigating such personal, unchartered territory is a life-changing, stressful experience. But the reward at the end of the journey is nothing short of a miracle and one worth investing whatever it takes to achieve this dream. Once the decision to move forward with treatment has been made, managing the stress associated with the process becomes paramount.
When Work Gets in the Way of Working toward Fertility
Do you feel like you’re moonlighting as a fertility patient? What once was a fulfilling occupation -- a job and title that gave you identity and purpose -- now gets in the way of doctor appointments and the all-encompassing task of becoming a parent.
Your work may suffer because of your other full-time job. The one that requires you to work overtime, for no pay and at the mercy of a tyrant named Flo. You find concentrating on deadlines and daily tasks difficult. Absences start to stack up.
A Guide to Fertility Testing By Natalie Burger, M.D.
When you have your first visit with your fertility specialist they will review your medical history along with your partner's history for clues as to why things are not working. For some folks, the reasons will be obvious, while other couples may not have a clear reason for infertility based on history alone. Fertility testing can help identify potential problems and guide your fertility specialist in recommending the most appropriate and efficient treatments for success.
The Road to Fertility: What to Expect During Your IVF Cycle
It’s go time! An IVF cycle is like starting a new job. There’s the stress and excitement of tackling a new experience, plus the challenge of learning the “jargon” and committing to daily tasks that will involve your time and energy.
This is an important time to take care of yourself. Reducing stress through physical activity (i.e. yoga) or acupuncture can be helpful for some. Surrounding yourself with supportive friends and family can also help you to deal with the stresses of fertility treatment.
Approximately two out of three of adults and one out of five children in the United States are either overweight or obese. These individuals are at high risk for numerous chronic diseases. In recent times, the increase in obesity has been dramatic. By 2012, it is estimated that three out of four Americans will be considered overweight or obese. The risk factors and causes of obesity are diverse and include a wide range of genetic, metabolic, behavioral, and lifestyle factors. The health and economic consequences of obesity are potentially devastating for the individual and this country as we go forward with national healthcare reform.
One of the most difficult choices facing patients is whether and when to move from one step of the fertility process to another. Agreeing to see a fertility specialist and choosing to pursue a treatment plan is often a decision that is reached by couples after much discussion and struggle. If one particular intervention does not result in a successful pregnancy, how do you decide what to do next?
Infertility can make you feel powerless. Doctors can use medical intervention to overcome your physiological barriers to pregnancy. However, as a couple, you want to take action…Regain control..Make a difference.
There are both proven and what we call "subclinical," (suspected but not detected) reasons for infertility. To increase your chances of conceiving, above all we recommend adopting a healthy lifestyle. Eat a whole-food diet, maintain a healthy weight, avoid cigarettes, alcohol and illegal drugs and nurture your spiritual and mental health. It's a simple plan, proven influential in a myriad of research studies.
Kelly Pogson of Austin IVF
Fertilization is a complex process that requires many steps. Sperm must have the ability to reach a mature oocyte (egg) and bind with the oocyte. In turn, the oocyte must block polyspermy (an abnormal situation where more than one sperm enters the oocyte). Finally, the sperm and oocyte must form pronuclei. Intracytoplasmic sperm injection, or ICSI, can overcome many of these obstacles.
Embryo Culture Systems
By Hank Werland of Austin IVF
An embryo culture system is the specific combination of environmental conditions, technical equipment, and particular nutrients that embryos require for optimal growth. Perhaps the most important factor in the growth of embryos in the laboratory is the embryologists' ability to maintain a stable environment within the laboratory. In order to optimize this "environment", we must tightly control all conditions affecting the embryo – including light, temperature, humidity, and the concentration of gases that each embryo is incubated within. Even minor variations in these conditions can have a devastating effect on embryo growth and development.
Polycystic ovary syndrome (PCOS) is a reproductive endocrine disorder that affects approximately 5-10% of reproductive age women. While years of research have been conducted to try to determine the etiology of this syndrome, it continues to remain an enigma. To our best knowledge right now, PCOS may have a multifactorial etiology involving genetics, environmental factors as well as fetal and childhood exposures. While PCOS can have a wide spectrum of manifestations and symptoms, the common denominators are menstrual irregularity, increased male hormone actions, insulin resistance and a characteristic appearance of the ovaries on sonogram. While many women with PCOS are obese - and this may exacerbate the symptomatology - thin women can have PCOS as well.
Getting away from it all? Vacation strategies for sticking with your infertility regimen
After weeks of planning your days around treatments, it's finally time to treat yourself to a great escape. Don't worry. You can take a vacation without letting a fertility regimen divert your rest and relaxation.
The most important item to add to your packing list is the Texas Fertility Center phone number. As always, our team remains on call, accessible by phone 24/7 for emergencies, and during office hours from 8:30 am to 4:30 pm for routine questions.
How do you respond when well-meaning friends say hurtful things disguised as advice?
Like: "Just relax and you'll get pregnant!"
Tell the:"well-meaning adviser" that couples who get pregnant on cruise vacations aren't infertile; infertility, like diabetes or high blood pressure, is a diagnosable disease that requires treatment. If you are one of the almost eight million couples* in the United States who is infertile, a long weekend will probably not resolve your condition – anymore than it would resolve diabetes or hypertension.
Acupuncture and Stress Relief
By Sarai Stapleton, L.Ac., FABORM of Axis Acupuncture
"You're trying too hard. Just relax and it will happen." Ever heard that from family or friends? Well, theoretically they weren't that far off, but no one has found a magic switch in your brain that you can flip and suddenly feel cool as a cucumber and stress free, so their well-meaning advice is highly impractical.
"Trying too hard" may play a role in up to 30% of all infertility issues. We humans are designed to deal with a certain amount of stress, but it is chronic stress that seems to hinder our fertility.
Understanding Embryo Grading
By Rita Fields of Austin IVF
As embryologists, one of the most common questions that we get from patients is "What do the grades of my embryos tell us about my chances of becoming pregnant?" The answer to this question is not a simple one. The objective of this article is to explain how we grade embryos and what those grades mean as far as an embryo's potential for development.
A Guide to understanding your
insurance benefits for Infertility
The most important thing to remember
when you are talking about infertility
with your insurance is you will most
likely know more than the representative
who is trying to help you.
Unfortunately, misinformation can be a
common occurrence when it comes to
coverage for infertility services.
Researching your benefits through all
available resources can help to affirm
that you have received correct
information or identify coverage your
insurance company may have missed.
Painless Genetic Screening of Parents
for Inheritable Disease now Available
The American College of Medical Genetics
and the American College of Obstetrics
and Gynecology have recently recommended
that all couples of reproductive age who
are attempting to conceive be offered
pre-conceptual genetic testing. The
purpose of this testing is to identify
those couples who are carriers of a
variety of conditions that could affect
their children. Testing potential
parents for genetic diseases is not a
novel concept, but recent advances in
technology have made testing simple,
painless, and affordable.
Not everyone celebrates the arrival of
Mother’s Day. While most infertile
couples will recognize their own
mothers, Sunday, May 9 represents a
holiday that they’d like to temporarily
strike from the calendar. This year, why
not shift the focus from mothering
babies, to babying yourself? Find an
activity that you seldom make time for,
but thoroughly enjoy at venues where you
won’t likely encounter throngs of
children and their mothers: art
exhibits, coffee houses and stage
theaters, for example. You’ll even find
discounted tickets for those Sunday
Texas Fertility Center serves the following areas: Austin, Bryan, Buda, Cedar Park, College Station,
Dallas, Fort Worth, Georgetown, Houston, Hutto, Killeen, Kyle, Leander, New Braunfels,
Pflugerville, Round Rock, San Antonio, San Marcos, Taylor, Temple, Waco, US and