Understanding Infertility Treatment & Pregnancy

Infertility is a challenge for any family that has to deal with it.  At New York Fertility Institute, we pride ourselves on explaining the process in detail to our patient’s and on being available through all the phases of pre and post treatment to respond to our patient’s questions and concerns. Below are some issues raised by our patient’s that relate to infertility treatment and pregnancy.

Anti-Müllerian hormone (AMH) is a hormone in females that remains constant in early adulthood until your mid twenties then; AMH begins to decline until it reaches undetectable levels at menopause.

AMH is expressed by ovarian cells and is a measure of ovarian function.

Some use it as a measure of ovarian reserve (function) however, it is still being analyzed and more research is needed. While we may find a patient’s AMH level to be helpful, we do not look at AMH alone as a fertility predicting indicator; it is more of a research tool.

Follicle Stimulating Hormone (FSH) is a pituitary hormone which measures ovarian reserve and response. (The higher the FSH, the poorer the ovarian reserve and response)

We measure a patient’s FSH level on the 2nd or 3rd or 4th day of the menstrual cycle to assess ovarian reserve. Although it is a good measure, there are exceptions and if one only uses FSH as the single parameter, mischaracterization may occur.

The age of the recipient (the individual receiving a donor oocyte) does not impact the success rates of pregnancy and/or delivery. The outcome of the donor oocyte cycle is dependent on the age of the donor, not the recipient. Chromosomal make up is also dependant on the age of the oocyte donor, not the recipient.  At NYFI, we have a reported 70% delivery rate with oocyte donation.

Acupuncture has been shown to be helpful in positive fertility outcomes therefore; it is a modality that we suggest to supplement fertility treatment. Also, we find a relaxing atmosphere with a friendly knowledgeable acupuncturist can be very helpful to a patient’s outcome. Hence we recommend acupuncture treatment with an experienced and trained acupuncturist during fertility treatment.

A patient’s current exercise routine should be continued.  However, there are times when it should be moderated, such as the first trimester of pregnancy. The only times we recommend exercise routine to be modified is during a patient’s ovarian stimulation and immediately after an embryo transfer. Once a positive pregnancy has been established, a moderate exercise level can be resumed.

Caffeine is acceptable in moderate amounts during fertility treatment as well as in pregnancy. In pregnancy, we recommend 1 cup of caffeine per day and decaf as much as desired. Some studies have indicated that if excess caffeine is consumed it can lead to increased miscarriages. Since it is difficult to cut down on caffeine intake immediately, a gradual approach during fertility treatment is recommended.

Gender Selection is a method of controlling the sex of the child not only for the purpose of family balancing, but also for family planning. For example, a couple desiring two children only who already have a boy may want a girl for their second child. In our practice, sperm washing techniques as well as pre-implantation genetic testing is performed for this purpose with a range of efficiency.

Some studies have indicated that DHEA may help patients with elevated FSH levels (an elevated FSH is not desirable). Thus in patients with poor ovarian reserve (high FSH), DHEA may be useful. Also, there is some evidence that DHEA in doses of 25 mg taken three times per day may positively impact miscarriage rates in patients with advanced maternal age.

Antral follicle count is obtained by performing a transvaginal ultrasound in the beginning of a menstrual cycle to measure the size and count the number of follicles in the ovaries. While this cannot be used to assess a woman’s overall fertility, combined with other indicators, it is a reliable method and a good predictor of ovarian response to medication and eventual outcome from fertility treatment.