Educational Videos

Educational Videos

Video Transcript →

Perhaps the most important female fertility factor is the egg factor, by the time a woman starts menstruating about age thirteen she has half a million egg follicles left in her ovaries. Now an egg follicle is a sac that holds one egg. Every month she is going to release a batch of these egg follicles […] only one of those egg follicles will ultimately grow each month and ovulate and the rest will die. But every month women lose eggs. And with time they run out of eggs and that’s called Menopause.

By the time a woman is thirty she loses ninety percent of her eggs by the time she is forty she loses ninety-seven percent. One thing we test for is called Ovarian reserve, that is how many eggs are left and unfortunately patients and some doctors don’t really know what this means. Ovarian reserve is used by fertility doctors to determine if a woman has low ovarian reserve because those patients make less eggs, therefore they have a lower chance of pregnancy with fertility treatment…the ovarian reserve can be tested in a variety of ways. The best way is to perform an ultrasound when that woman is on her period and count the resting egg follicles in the ovaries.

Other tests for ovarian reserve include blood test for the hormone Anti-Mullerian hormone or AMH and follicle stimulating hormone that’s FSH and estradiol. Overall the key message for ovarian reserve is it’s needed by fertility doctors to counsel women on the chance of success for fertility treatment.

What’s really important is called egg quality that’s different than ovarian reserve. Egg quality basically means the following: the ability of an egg to create a chromosomally normal embryo. Poor eggs create embryos with abnormal chromosomal make up and good eggs create embryos with normal chromosomal makeup. Egg quality impacts the chance of a healthy baby and it is very much age dependent. Women who are in their forties especially have the lowest egg quality and actually by the age of forty-five its very rare to find any quality eggs and pregnancy rates essentially go to zero.

First recommendation I have to couples trying to conceive is to have sex at the right time of the month, the egg only lives one day so having intercourse for the one or two days before ovulation and the day of ovulation is critical for conception. To help women determine when they are ovulating we use ovulation detection kits. When we see women who don’t have regular menstrual cycles it means they are not ovulating […] and reasons for not ovulating could be things such as thyroid problems, excess production of a hormone called prolactin, a medical condition called polycystic ovarian syndrome or just stress weight changes, a lot travel.

We can obtain blood to test for some of these hormones and of course do an ultra sound to look at the ovaries for polycystic ovarian syndrome. So these are simple tests that should be done on women who are not having monthly periods. Sexually transmitted diseases such as Chlamydia and Gonorrhea but not HPV or herpes, can lead to fallopian tube damage and that can be a very significant form of infertility, that requires in-vitro fertilization or surgery to fix.

There are some other conditions that cause fallopian tube blockage, such as pelvic surgery and also endometriosis […] fallopian tube openness or patency can be determined by a test using dye in which we put dye through the uterus and fallopian tubes and take x-ray pictures. One of the most devastating conditions we see is recurrent pregnancy loss, that’s where women are able to conceive and carry the pregnancy until eight or ten weeks and then lose the pregnancy over and over again.bOne of the reasons for recurring pregnancy loss is uterine cavity abnormality such as fibroids, muscle tumors, polyps which are little growth, scar tissue or birth defects that that woman was born with in her uterus. Fortunately we can treat a lot of those uterine factors as it relates to recurrent pregnancy loss using surgical modalities.

One of the most frustrating diagnosis that we give to patients is something called unexplained infertility. This is a diagnosis that is assigned when the semen analysis is normal for the male partner, a woman is ovulating, her uterus and tubes are normal, she is at an age that should have quality eggs but yet they are unable to conceive. Oftentimes couples with unexplained infertility have to consider in-vitro fertilization which takes over each of nature’s steps and tries to fix them and augment the chance of success. Couples who fail to get pregnant sometimes think that they are allergic to each other, there is a mismatch. We don’t believe that actually exists and the reason for that is when we do in-vitro fertilization and put the sperm into the egg almost in all cases we get an embryos and in many cases we get pregnancies.

Video Transcript →

In general, infertility is due to male factors one third of the time, female factors one third of the time and both one third of the time, so men really represent half of overall infertility cases. When we check for male infertility we look at the semen analysis, and that comprises sperm count, motility – that’s how they are swimming and how they are shaped that’s called morphology. If a man has a normal semen analysis, he is probably fertile, but not in all cases. My advice to most men is to live a healthy life meaning eat a normal diet, stay within ideal body weight be moderate in alcohol intake, not smoke and not surround the genital area with prolonged heat exposure such as long distance bike riding.

The use of a male formula vitamin with high amounts of anti-oxidants are also very helpful in maintaining sperm health. One of the biggest no-no’s though is testosterone. Testosterone is basically a contraceptive, if a man takes testosterone he is wiping out his sperm and unfortunately that’s not commonly known. All men with a significantly abnormal semen analysis really should have an evaluation by a urologist to make sure they don’t have other health issues that need to be treated. Some of those causes can be quite serious such as genetic problems, tumors, endocrinal hormonal problems.

For men who have moderate abnormalities on their semen analysis we can improve their chances by doing intra-uterine inseminations called IUI also known as artificial insemination. We basically take the semen and wash it and get the best swimmers the A team out and then we introduce those swimmers into the partner’s uterus using a soft guide at the right time of the month.

When men have very severe semen analysis abnormality such as very low count or very low motility we can actually take the sperm and inject it directly into the egg, it’s called the intra-cytoplasmic sperm injection which is known as ICSI. Many men have become fathers because of this revolutionary procedure. It is safe and very effective in fertilizing eggs.

Men who have had a vasectomy and want to have more children can either have a vasectomy reversal or have the sperm harvested directly from the testicle or the holding tank near the testicle called the epididymis and that’s because vasectomy is a procedure where the ejaculatory duct is blocked surgically.

When it comes to the male partner infertility, we have had a long history of overlooking the real impact that men may have on conception and babies. For many years we have trusted the semen analysis as our gauge of male infertility. In fact it is not as reliable as we thought it was. Ten years ago we started looking inside the sperm at the DNA and seeing if the DNA was fragmented and broken up. Turns out that fragmented DNA if in high percentage can impact pregnancy and it can impact embryo development and the chance of pregnancy and even miscarriage. Treatment with anti-oxidants and vitamins actually has shown to be helpful in such conditions.

More recently as the exciting area of epigenetics a phenomena where men through their lifestyle and medical condition put molecules on the DNA of sperm. And those molecules can influence how the genes of sperm work and can impact embryo development early pregnancy loss and even trans generationally children, grandchildren and great grandchildren. So what a man eats, his medical conditions, his lifestyle choices really can impact the outcome of a pregnancy now and for future generations.

So we are now opening up this very exciting era in understanding male fertility and I think we are going to improve the outcomes of pregnancy by improving our assessment of sperm and modifying that man’s health as it comes to sperm.

Video Transcript →

Couples who have tried to conceive for a year with regular timed intercourse should seek fertility evaluation. Now that’s for women under the age of thirty eight, for those over the age of thirty-eight they should seek a fertility evaluation sooner typically after six months.

A fertility specialist is actually called a reproductive endocrinologist and its an individual that has done three additional years of sub-specialty training beyond their four years of OB/GYN training. And they specialize in the use of hormonal injections and the creation of embryos in laboratory, that’s what separates a reproductive endocrinologist from a general gynecologist.

It’s an intimate and long journey and you have to pick the right doctor so, I always encourage patients to interview their doctor and make sure they are comfortable with the care they are receiving.

The term IVF stands for In-vitro Fertilization. It actually means one thing, it means the fertilization of an egg in a lab, but today when we use the term IVF we are really talking about the whole cycle, the whole series of procedures that culminates in the production of an embryo. IVF success rates are very much in line to the age of the egg provider, women in their thirties see birth rates of about fifty percent per embryo transfer, whereas women in their early forties the rate is about twenty-five percent. And that’s really for women up to about age forty three. Beyond that it’s really very low. And so age is a big indicator of IVF success. The other major factor is the quality of the IVF lab and the personnel working in that lab, those are called embryologist. So a skilled embryologist and labs that focus on gentle approaches to embryos really can have an impact on the overall success rate of the IVF cycle.

The side effects relate to IVF are actually quite minimal. Women can feel little local irritation from the injectable hormones, it’s a small needle that’s used to inject the hormones in the fat under the abdominal wall. Women also feel tired and bloated and might have some weight gain during the hormonal injections. But that weight gain typically goes away after the procedure is finished. The greatest risk for IVF is multiple pregnancies and that’s because to accommodate the decline in egg quality, we transfer more than one embryo especially to women over thirty five and over forty.

One new method that can help limit the chance for twins or triplets is called Pre-implantation Genetic screening also known as Pre-implantation genetic diagnosis PGS or PGD. In this procedure we grow the embryos till they are five days old and then take some cells out of the embryo and test those cells to see if the embryo is chromosomally normal. We also find out if it is a boy or a girl and so we can replace or transfer one embryo that is chromosomally normal and essentially eliminate the risk for twins or higher order pregnancies. It’s very effective and very accurate.

Video Transcript →

I have been involved in egg freezing for over a decade and I have seen its popularity rise as more and more women are seeking to complete their professional and personal goals before having a family. Also the technology has really improved this method called vitrification or rapid freeze has eclipsed the older method called slow freeze and now offers us birth rates from frozen eggs that are comparable to fresh eggs.

In our center we have birth rates of forty-five percent per embryo transfer in women in their thirties which is almost identical to the rate we see with fresh never frozen eggs in the same age group. So women today really do have a viable way to preserve their fertility for the future. And that way she can enjoy the pregnancy chances based on the age at which we froze the eggs.

So the way egg freezing works is first for the woman to undergo ovarian stimulation, so she takes hormonal injections to recruit multiple egg follicles. We then take her to the operating room and retrieve the eggs from the egg follicles under anesthesia of course, it’s painless. The eggs are then frozen, eggs don’t change with time so the eggs can be frozen for years when she is ready to utilize her eggs, they are thawed usually a batch of six eggs, sperm is introduced into the eggs at that point to create embryos and then the best embryos are selected and transferred to the woman’s uterus for pregnancy.

The best age for women to consider egg freezing is in her thirties, because she still has viable eggs at that point. Women in their forties have less viable eggs and there is actually not as much data on egg freezing in that age group although we do have a couple of women who have given birth from frozen eggs, when they were in their forties including the oldest egg freezer in the world.

Froze her eggs at forty three and gave birth at forty seven, so very proud of that. But those are anecdotal examples. Women in their twenties have many years of good fertility so to undergo an expensive invasive procedure may not make sense for women in their twenties.

I am often asked if egg freezing is safe, we believe its safe – unfortunately there have only been about ten thousand births from frozen eggs in the whole world. This in contrast to three hundred thousand births from frozen embryos and seven million births from IVF. So far there has not been any increase in abnormalities in children born from frozen eggs and if take the very good history of frozen embryos demonstrating no increase in birth defects or cognitive impairment I think we can state that egg freezing is likely to be just as safe.

The only other way a woman can preserve her fertility is to freeze embryos, that of course is a fertilized egg which means we need sperm. For lot of my patients who are single that’s not what they are seeking because that of course names the father of that embryo. Embryo freezing however has been around for a long time thirty years it is safe, it is effective, in fact we are no recovering almost a hundred percent of frozen embryos from deep freeze. So it’s a really good choice. Compared to egg freezing it’s more reliable because we are not sure if we will get all eggs back once frozen we are not sure how they will work, once fertilized.

When you are doing your research about an egg freezing center and the doctor, you need to make sure that that doctor as babies from frozen eggs of women your age the work is published and that the center has expertise in egg freezing. Unfortunately less than five percent of centers in United States have demonstrated published work showing that they can create babies from frozen eggs. Our center fortunately is in the five percent group. I have been freezing eggs for over a decade now and we are starting to see some of the secondary data points in egg freezing, some of the outcomes of egg freezing.

One thing I have observed is that ninety five percent of the women I freeze eggs on have not come back to use their eggs. So we did a study a couple of years ago to ask these patients you know what’s up! We found that fifteen percent of patients who have frozen their eggs have a baby, the remaining eighty five percent are split into two camps, one sixty five percent of the women still want a baby and are in different points in finding a partner, so they actually want a family not just the baby. The other third have decided maybe not to use their eggs but I have to say overall most women are positive about their experience or happy they froze their eggs to give themselves that option even if they didn’t use the eggs or may not use the eggs in the future.

Video transcript →

Egg donation offers a real chance for a couple to have a child. It’s associated with the highest pregnancy rates in all of fertility care, its also associated with one of the most difficult decision making processes because that woman is giving up her genetic legacy. It’s usually a decision that takes time to reach, usually a decision that is made after trying IVF and other fertility treatments and it’s definitely not a decision that should be taken lightly. So egg donation is often sought by women who have reached a certain age and no longer have viable eggs or for gay men who need an egg donor to have a child.

So once a couple decides they would like to pursue egg donation they seek an egg donor from an egg donor agency and they usually look for ethnic matches, maybe physical characteristics that match the intended mother, also family history, maybe proclivity toward athletics or academics. Interestingly a woman doesn’t have to choose an egg donor based on her blood type it doesn’t matter, it doesn’t impact the outcome at all.

Egg donors are typically women in their twenties who are in college or post-college or just working. It should be known that egg donor agencies are typically run by non-medical personnel so when seeking an egg donor it is important to work with a reputable and good agency that provides you know honest and transparent information.

So once a couple choses a donor the donor has to go through a battery of screening tests. They have to see a psychologist and undergo psychological screening, talk to a genetic counselor and have genetic tests, they have to see the medical doctor – the fertility specialist and have a battery of tests for infectious disease screenings. That’s mandatory put up by the food and drug administration and it has to be done within thirty days of egg retrieval and then the donor is represented by an attorney so that the decision is binding. Once all of that is done then the donor can proceed to egg donation.

Most egg donation cases in United States are done anonymously. There is also an opportunity for the intended parents to have their child meet the donor when that child is eighteen again that is not in all cases but in most cases and its at the pure discretion or sole discretion of the intended parents not of the donor.

In traditional egg donation after a couple chooses an egg donor from the agency and that donor is qualified medically she begins the process of in-vitro fertilization, so the donor takes injections of hormones to help recruit multiple eggs, now interestingly those eggs are only good for one month, that donor would lose the eggs anyway. So very importantly the donor is not affected by the process as it relates to her future fertility.

We then retrieve the egg from the egg follicles in the operating room under anesthesia, the eggs are then provided to the intended parents where sperm is injected into the eggs. The embryo is allowed to develop for five days, and on the fifth day we transfer one embryo to the intended mother. Additional embryos can be frozen and there is no shelf life on those embryos.

A common question I have from intended mothers using an egg donation is what is my role with the baby? And it is true that the hardwiring the DNA of the sperm and egg do influence things like the characteristics of the child but we are learning more about something called epigenetics whereby the womb is a place where that woman, that mother starts to influence the DNA of the actual fetus. Actually putting molecules on the DNA of the fetus and those molecules influence things like personality intellect, nerve developmental issues and probably many more phenomena of human existence, we are just learning about. So really motherhood begins in the womb.

Now we are seeing pregnancy rates from frozen embryos comparable to those of fresh embryos almost identical so whether a couple chooses to have a fresh embryo transfer or a frozen embryo transfer it doesn’t matter, we see the same pregnancy rate. The good news about having frozen embryos is if the first embryo transfer doesn’t work they have an immediate backup. And of course if the first embryo transfer works and it works sixty-six percent of the time then the frozen embryos could be a second child in years to come.

At Santa Monica Fertility we really specialize in shared egg donation and this is based on my observation that couples have a very hard time navigating egg donation agencies and all the moving parts so we find donors that are excellent donors, proven donors and provide those donors to our intended parents. So with shared egg donation donors go through the same screening process as they would with traditional egg donation but when we get the eggs more than one couple uses those eggs. So for example a good donor will make about sixteen eggs, one couple will get eight eggs and from those eight eggs because it’s a proven good donor we often get three or more of the advanced embryos we call them Blastocyst. Each one has a chance of sixty-six percent in giving rise to a birth. So we transfer one embryo and we freeze the rest. If the couple does not achieve a pregnancy with the first transfer then the second and the third transfers are free. So our program is really built in partnering with patients and donors getting good donors proven donors that make great eggs proven eggs and then assigning a lot of the eggs. And then assigning a portion of the eggs that allows the couple to have multiple chances at a baby. And of course one of the biggest benefits is because more than one couple is sharing the eggs the costs are much less than with traditional egg donation. And we found this program to be very effective, patients like the idea that the doctor is intimately involved in selecting the donor.

There has been a recent increase in frozen donor egg banks and frozen donor eggs are basically eggs that are not used at the time of egg retrieval and frozen for future use. Of course the benefit is they are readily available so couple can obtain the eggs and very quickly thaw those eggs and have a chance at a pregnancy but there are some down sides. Whereas fresh embryos or even frozen embryos have birth rates of about sixty-six percent, the rate we see with frozen eggs is about fifty five percent.

So it’s not bad but it is less than the rate with fresh. We also don’t get as many embryos from frozen eggs as we do with fresh eggs, it’s more variable because the egg were frozen and thawed they are more vulnerable that way. So couples who seek frozen eggs should really work with a clinic that has treated the donor and a clinic where the embryologist themselves have frozen the egg. And with the recent advent of donor egg banks or egg banks that offer donor eggs I caution patients to be careful with that because freezing the egg and caring for the donor somewhere else and then shipping them to a clinic or lab that never worked with these eggs really leads to lower pregnancy rates. And so in seeking frozen eggs which are good option a couple should seek centers where the donor has her care and where the eggs are frozen by the same embryologist who is going to be thawing the eggs for best success rates.

Video Transcript →

Surrogates are women who carry the pregnancy for someone else. In choosing surrogates it is important to make sure they are healthy women typically under the age of thirty-eight that they have had complication free pregnancies, easy pregnancies that they are medically healthy and non-obese, that they haven’t had a bunch of miscarriages for example. And also make sure their living environment and support network is strong because they are going to be carrying a pregnancy and they need to have the support in the event that they have to tend to their own children and… and get through the nine months of carrying the pregnancy for the other couple.

In our program we have someone actually go visit the home of the surrogate and see how the children are being kept and how the living environment is, all those things matter in maintaining compliance and good medical care. We also supplement our surrogates with fresh fruits and (…) other nutritional additives that an intended parent may desire.

The way surrogacy works is two fold, one is we have to create the embryos from the egg and sperm provider and then prepare the surrogate using hormones so that we can transfer an embryo to her uterus. Thereafter she is first seen by the fertility doctor and later on her obstetrician who cares for her until the time of delivery.

Surrogates are typically found through a surrogacy agency and they provide the surrogates and help coordinate all he steps involved in surrogacy from embryo transfer to obstetric care to delivery, they help also coordinate the insurance and the legal aspects as well. So that’s one way patients can find the surrogate we also work very closely with an in house surrogacy that we develop, where all the surrogates are screened by my self and other professionals such as high risk obstetricians and psychologist so that our surrogates are ready to go and can be used right away for couples who are seeking surrogacy pregnancy.

California is one of the most progressive and best places for surrogates, that’s why people from all over the world come to California to use surrogates. Our laws are very proactive and protective of both the intended parents and the surrogate. In fact a legal agreement is entered into before the embryo transfer and then when the surrogate is pregnant early in the pregnancy court papers are filed identifying the intended parents as the true parents.

So the legal framework is really well established in California and really does protect the intended parents as the sole guardian of the baby born from the surrogate.

One of the down sides of surrogacy is the cost, it is very expensive. For domestic surrogacy it’s not unusual for a final cost of seventy five to one hundred thousand dollars. Surrogates are compensated for carrying the baby about thirty thousand dollars, their health insurance is covered, if they don’t have health insurance it could be as much as twenty-five thousand dollars for health insurance. There is legal fees and then of course agency fees. So all together it really does add up for domestic surrogacy.

Because of the high domestic cost of American surrogacy other countries have begun surrogacy programs. In fact India and Thailand are among the most popular destinations for international surrogacy. I have had some experience with patients who have gone to those countries and unfortunately have not seen very good results. There is questions about the quality and the standard of care about how the surrogates are treated, (…) how they are treated during the surrogacy, what nutrition they get, what care they are provided and more recently there has been changes in the laws of those countries that preclude foreigners from utilizing surrogates. Those laws can change quickly, so for couples contemplating international surrogates they really have to do their research and be sure that it’s a safe place to have a baby and that the rules and conditions of surrogacy are stable.

One of the most important things with international patients is really a culturally sensitive language focused communication with International clients because this is their baby developing in the womb of another woman in another country so seeking the right medical doctor, the right team, unified team for communication and providing a seamless process through in-vitro fertilization all the way to surrogacy is critical for success for international patients.

Video Transcript →

I often work with patients who try to improve the chance of a pregnancy by doing things they normally don’t do for example cutting out certain food stuff, having restrictive diet not drinking any alcohol. Not drinking any coffee, gluten free diets, taking a variety of supplements. What is lost in that approach is the fact that the body is composed of different organ systems and they all interact, so the immune system interacts with the nervous system which interacts with the endocrine system and changing one component affects the other components.

We can’t control the whole body with just one supplement, it has an effect. I also think it causes a certain sense of disability in my patients when they feel obligated to do so many things that are unnatural. I think patients should seek healthy living, which means ideal body weight, some exercise, cutting back on alcohol, cutting back on caffeine, taking a prenatal vitamin, finding ways to destress, take some time off work, these are sensible ways to approach fertility.

I have also seen a lot more women seeking acupuncture and traditional Chinese medicines such as herbs, my view point first of all is from someone who is not trained in eastern medicine but of course open minded to it I think acupuncture can be very relaxing and helpful if the patient feels the same. If someone dreads the needles and they shouldn’t do acupuncture.

When it comes to the herbs we are talking about thousands of herbs, each herb having hundreds of components and so I don’t know what’s in those herbs nor do I believe the practitioners of traditional Chinese Medicine know what’s in all the herbs. And so when it comes to western medicine, I prefer to use my hormones and my modalities without influence of traditional Chinese herbs. That is not to say that a patient can’t use the herb for few months before starting western medical treatment. But I think they do have to be cautious about the use of herbs if they are ingesting it and since they are powerful agents.

Video Transcript →

One thing we test for is called Ovarian reserve, that is how many eggs are left and unfortunately patients and some doctors don’t really know what this means. Ovarian reserve is used by fertility doctors if a woman has low ovarian reserve those patients make less eggs, therefore they have a lower chance of pregnancy with fertility treatment.

The ovarian reserve can be tested in a variety of ways. The best way is to perform an ultrasound when that woman is on her period and count the resting egg follicles in the ovaries. Other tests for ovarian reserve include blood test for the hormone Anti-Mullerian hormone or AMH and follicle stimulating hormone that’s FSH and estradiol.

Overall the key message for ovarian reserve is it’s needed by fertility doctors to counsel women on the chance of success for fertility treatment.

Video Transcript →

What’s really important is called egg quality that’s different than ovarian reserve. Egg quality basically means the following: the ability of an egg to create a chromosomally normal embryo. Poor eggs create embryos with abnormal chromosomal make up and good eggs create embryos with normal chromosomal makeup.

Egg quality impacts the chance of a healthy baby and it is very much age dependent. Women who are in their forties especially have the lowest egg quality and actually by the age of forty-five its very rare to find any quality eggs and pregnancy rates essentially go to zero.

Video Transcript →

One new method that can help limit the chance for twins or triplets is called Pre-implantation Genetic screening also known as Pre-implantation genetic diagnosis PGS or PGD. In this procedure we grow the embryos till they are five days old and then take some cells out of the embryo and test those cells to see if the embryo is chromosomally normal. We also find out if it is a boy or a girl and so we can replace or transfer one embryo that is chromosomally normal and therefore essentially eliminate the risk for twins or higher order pregnancies. It’s very effective and very accurate.

Video Transcript →

At Santa Monica Fertility we really specialize in shared egg donation and this is based on my observation that couples have a very hard time navigating egg donation agencies and all the moving parts so we find donors that are excellent donors, proven donors and provide those donors to our intended parents. So with shared egg donation donors go through the same screening process as they would with traditional egg donation but when we get the eggs more than one couple uses those eggs. So for example a good donor will make about sixteen eggs, one couple will get eight eggs and from those eight eggs because it’s a proven good donor we often get three or more of the advanced embryos we call them Blastocyst. Each one has a chance of sixty-six percent in giving rise to a birth. So we transfer one embryo and we freeze the rest. If the couple does not achieve a pregnancy with the first transfer then the second and the third transfers are free. So our program is really built in partnering with patients and donors getting good donors proven donors that make great eggs proven eggs and then assigning a lot of the eggs. And then assigning a portion of the eggs that allows the couple to have multiple chances at a baby. And of course one of the biggest benefits is because more than one couple is sharing the eggs the costs are much less than with traditional egg donation. And we found this program to be very effective, patients like the idea that the doctor is intimately involved in selecting the donor.

Video transcript →

I am a licensed marriage and family therapist, and my specialty is in infertility counseling. I work with lots of individuals, couples, who are experiencing infertility and struggling with infertility. I help them prepare for their journey, cope with their journey, explore options, support them through the entire process. When they are faced with the possibility that they may not be able to have children or that it’s going to be very difficult, it can create feelings of failure, feelings of inadequacy. For many it can create feelings of depression, hopelessness, anger, sadness, confusion and create so much anxiety and worry about what is their future going to be like.

Some women really feel that this is something that they’re supposed to be able to do. That their bodies are suppose to be able to get pregnant and carry a child. And when they’re dealing with the fact that they can’t, it becomes a very difficult thing. I have many clients that will say that they feel broken. Many men who are experiencing infertility will often say they burry themselves in work. Sometimes they suppress the emotions or find themselves very irritable because there is so much of this process and this journey that they are unable to control. With infertility, unfortunately we don’t necessarily have concrete answers where we can say “yes, treatment compliance is going to lead to positive treatment outcome”. That’s not always the case. For many men and women, that inability to control the situation can become a very devastating and difficult emotion.

The feelings of loss when a woman is told in order to conceive they need an egg donor, that’s a very significant and probably one of the more difficult phases of their fertility journey. So for many couples when they get to the point of surrogacy or egg donation, there may be a combination of excitement and hope, but also an ongoing sense of loss. There may also be a sense of vulnerability in this process. So helping Egg Donors and Surrogates understand the mixture of emotions that accompanies the arrangement between Intended Parents and their Surrogate or Egg Donor I think is very important.

Disclosing and sharing with their friends and family can be very helpful because they all have a good outlet to talk and deal with some of their stressors. Other times it can create other difficulties in their journey because sometimes family members or friends may have their own ideas about how fertility should be handled. Although their intentions may be good, sometimes the advice that they give are hurtful. Couples are often going through infertility, going through treatment, for sometimes months and month or years at a time. So the focus often should be on preserving that couple to ensure the stress of infertility, the various stressors, the psychological, the sexual, the emotional, and physical, doesn’t create too significant of a distance between the couple. To help them keep healthy communication, identify what coping skills are hurting them and what healthier coping skills that they should practice and use to help them get through their infertility.



Video transcript →

Acupuncture and traditional Chinese medicine have been proven to regulate hormones and regulate the central nervous system. Those are two of the most important things when you’re going through pre-conception care and trying to get pregnant. There’s a huge stress component, which it helps to decrease stress. Acupuncture acts to help encourage homeostasis in the body and more effective function in the system, Cellular function and systematic function. What’s nice about it is western medicine will measure the blood work and give us some specific information about maybe the estrogen is too low or an issue with egg quality, or there is something going on with the lining. Acupuncture can help the body make more estrogen or less estrogen. It just brings it into homeostasis.

So say someone is coming in for three or four months of preconception care and their ovulation is off. They’re having really irregular periods or really painful periods with lots of clots or dizziness, or issues that don’t make sense on western level, but for us gives us more information. As we can make those periods better and as ovulations stronger and regulate their system and become more healthy, that’s a sign that we’re doing the right thing and prepping them for a healthy pregnancy. I recommend it to anybody that has major health issues or mystery illnesses.

Acupuncture is a great thing to do for people that have any issues related to fertility. Whether that’s advance maternal age, egg quality issues, lining issues, uterine factor. Also male fertility, if the sperm is having issues herbs and acupuncture can help regulate that in about 2-3 months and improve the chances of not only pregnancy but not having a miscarriage. Because of epigenetics having a healthier and happier baby in the long run. If it’s a egg quality issue, a lining issue, an ovulatory issue, hormonal issue, there’s specific foods and strategies that we can use. There’s a lot of new supplements today that can help but a lot that can hurt. So we need to know what patients are taking because they might actually be hurting themselves when they could be getting pregnant more quickly. Preconception care is pretty helpful. It’s not just coming in and changing your diet for two weeks and getting acupuncture and jumping into the process. It’s really taking care of yourself for getting that egg prepped and getting your body prepped and optimizing fertility as much as possible so if you do decide to do IVF, your chances and outcome are better.

It’s good to get educated, know the stats and know the science behind it. It’s good to have cautious optimism. Having a realistic perspective and expectation. If you really want to do it, commit to three months of preconception care and really optimize everything as much as possible so you have higher chances.

Video transcript →

I started on my IVF journey and I didn’t have any fertility issues. I just had time that wasn’t on my side. I knew the longer I waited the less chance I would get a good quality egg and so IVF was a way for me to try and help speed things along. So that was it. I did three transfers. The final transfer, which is actually my son Panos who is one as of July 6th. It’s amazing to see your child develop every week when you go in for your follow up appointments. It’s a true miracle.

I knew that when it comes to fertility and preparing your body chemically and physically for an actual pregnancy, that Acupuncture would be highly effective. So I decided I would give it a shot. You feel like your toxins are being expunged out of your system. The process itself is actually extremely relaxing and can put you in a sleeplike trance. It’s extremely enjoyable actually. For me, IVF was as much as taking the miracle of conception and helping to speed along the ability to get pregnant.

I think you just have to realize it’s a numbers game. That’s what really resonated with me when Dr. Jain said it truly is a numbers game. Don’t expect that it’s going to work the first time. If it does, great, but if you just have realistic expectations you won’t be so discouraged. That’s why I knew if I stayed at it, it would work.

Video transcript →

After dating for a while, and being in love with each other, and thinking this would be be a great thing to do we decided to give it a try. And it just wasn’t happening. So it took a couple years and we finally realized this is not happening, so Julie decided to investigate getting some help. That’s how it all started.

Once we switched to donor eggs, the chances of me having a viable pregnancy increased. It didn’t work the first two times. So we had done three transfers with my own, then two more with the donors, and every time I came in he said, “You’re going to get pregnant”. After two times, the last time we did it we were done. I was like I can’t do it anymore and he said okay I’m going to put two more in this time. That’s Maple and Zenzy. It’s beyond words , they’re such a blessing. We got two for one. Two completely different babies in one pregnancy. I was here, this is 3.5 miles from my job. I was coming here on my lunch breaks. They really took care of us on all levels. It was the whole journey, even the failures; the whole journey was a pleasure. It was a pleasure to come here.

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Initially I had a friend who had been an ovum donor. I hadn’t ever heard about it. I didn’t know it was a thing that anyone did. So I did my homework. Once I met Dr. Jain and I worked with the team here, I didn’t want to work with anybody else. Every month, women take something for granted that comes easily to many of us. There are women out there, and even single men out there who would want to be a father. It’s something they would give anything to have and I think its’ a huge gift that you can give someone. That’s why I’ve continued to do it over time.

I’ve even met Intended Parents and I always make sure to tell the coordinators here “make sure you let them know that I would love to meet them if they would like to meet me”. I leave that open and that has been a huge gift to me. I think it’s really special.

There is one Intended Parent, he has twins now. Single Father. He is the best dad. He’ll send me pictures still of them on their back patio in their little kiddy pool and their shovels and buckets in the sand. Seeing that with him, it just solidifies it for me. He has set so much aside in his life, the way his life used to be, so he can be there for his children.

When I met my husband, I had already started this process where I had been an ovum donor before he and I had met. He asked me, “do you feel like you’re giving away a piece of your family?”. I said, “no this is their family that they deserve to have and when I am ready I’ll have a family of my own”.

I’m expecting my first, so I’ve started my family now. I may donate again in the future, I’m not sure, but my husband and I were ready to start a family. We’re very excited.

Video transcript →

I started on my IVF journey and I didn’t have any fertility issues. I just had time that wasn’t on my side. I knew the longer I waited the less chance I would get a good quality egg and so IVF was a way for me to try and help speed things along. So that was it. I did three transfers. The final transfer, which is actually my son Panos who is one as of July 6th. It’s amazing to see your child develop every week when you go in for your follow up appointments. It’s a true miracle.

I knew that when it comes to fertility and preparing your body chemically and physically for an actual pregnancy, that Acupuncture would be highly effective. So I decided I would give it a shot. You feel like your toxins are being expunged out of your system. The process itself is actually extremely relaxing and can put you in a sleeplike trance. It’s extremely enjoyable actually. For me, IVF was as much as taking the miracle of conception and helping to speed along the ability to get pregnant.

I think you just have to realize it’s a numbers game. That’s what really resonated with me when Dr. Jain said it truly is a numbers game. Don’t expect that it’s going to work the first time. If it does, great, but if you just have realistic expectations you won’t be so discouraged. That’s why I knew if I stayed at it, it would work.

Video transcript →

Our fertility journey has been going on now for almost 3 years now. It started a year after we got married. We were having problems getting pregnant and so we went to our first doctor and started the process of fertility treatment. First step being IUI. We tried that for a couple rounds with no success. Then we moved on to the Invitro (IVF) treatment and we went through 10 rounds of IVF. We got pregnant twice, but had two miscarriages. At that point we were two years into the fertility treatment and we weren’t having any luck, so we made the decision to move on to Surrogacy with Dr. Jain. We found a great surrogate and we got pregnant on our first try and are pregnant now with twins.

When we moved on to Dr. Jain, we felt like he really cared. We felt like he was extremely compassionate, and he was absolutely willing to take the time with us to discuss our questions no matter how ridiculous they may have been. When we did get to the Surrogacy piece, Dr. Jain was so gentle about it. I of course was freaking out about the whole idea, but Dr. Jain was so wonderful at presenting the idea to us and allowing us to process the idea. Moving forward, he and his staff were incredible when it came to helping us chose a surrogate and supporting us through that process. In choosing a Surrogate, it was important for us to be a big part of the process. We wanted someone local if possible, because we wanted to be able to attend the Dr.’s appointments. We wanted to be there for the surrogate if she needed anything and of course when she delivers, we wanted to be sure to make it for the delivery. We were lucky enough to get a surrogate who is extremely willing to have us be apart of the experience and help guide us through the experience.

My advice to someone who is seeking surrogacy is to keep an open mind. I know that it’s very scary but it’s a beautiful process. It’s a unique process and if you keep an open mind and go with it, you’re going to be so happy. Dr. Jain’s staff and himself are so supportive. Any kind of questions you have, he will be able to answer, the staff will be willing to answer, and the surrogate will be willing to answer. It’s neat to have such an amazing team going through this process. So don’t be scared.

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At my 20-week ultrasound when they’re measuring the baby and making sure everything’s okay, the intended parents came down and were in the room. It was amazing. It was the most amazing thing ever seeing the reaction on their face to see their baby on the monitor. It was great. It made all of this completely worth it. A couple of the requirement s to become a surrogate are, I believe you have to be under 35, you have to have your own children already, and you can’t have previous complications with prior pregnancies. But those are just a few, so it narrows the field down. Other than it being for someone else, it’s been very similar to my own pregnancies. I get to go to own doctor for all of my checkups. I get to go to the same hospital where I delivered my children. Having Julie every step of the way, I have her cellphone number, I have her work number, I know I can call or text her anytime with anything. She always gets back to me and she’s made me feel zero pressure at all. I’m happy with my family situation. I have my little girl and my little boy. I don’t have any interest having any more of my own. So I feel 100% comfortable with the situation. I’m just the incubator for nine months, and I’ll be ready to hand her over so they can complete their family.

Video transcript →

The term IVF stands for In-vitro Fertilization. It actually means one thing, it means the fertilization of an egg in a lab, but today when we use the term IVF we are really talking about the whole cycle, the whole series of procedures that culminates in the production of an embryo. IVF success rates are very much in line to the age of the egg provider, women in their thirties see birth rates of about fifty percent per embryo transfer, whereas women in their early forties the rate is about twenty-five percent. And that’s really for women up to about age forty three. Beyond that it’s really very low. And so age is a big indicator of IVF success. The other major factor is the quality of the IVF lab and the personnel working in that lab, those are called embryologist. So a skilled embryologist and labs that focus on gentle approaches to embryos really can have an impact on the overall success rate of the IVF cycle.

The side effects relate to IVF are actually quite minimal. Women can feel little local irritation from the injectable hormones, it’s a small needle that’s used to inject the hormones in the fat under the abdominal wall. Women also feel tired and bloated and might have some weight gain during the hormonal injections. But that weight gain typically goes away after the procedure is finished. The greatest risk for IVF is multiple pregnancies and that’s because to accommodate the decline in egg quality, we transfer more than one embryo especially to women over thirty five and over forty.

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More recently as the exciting area of epigenetics a phenomena where men through their lifestyle and medical condition put molecules on the DNA of sperm. And those molecules can influence how the genes of sperm work and can impact embryo development early pregnancy loss and even trans generationally children, grandchildren and great grandchildren. So what a man eats, his medical conditions, his lifestyle choices really can impact the outcome of a pregnancy now and for future generations.

So we are now opening up this very exciting era in understanding male fertility and I think we are going to improve the outcomes of pregnancy by improving our assessment of sperm and modifying that man’s health as it comes to sperm.

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For men who have moderate abnormalities on their semen analysis we can improve their chances by doing intra-uterine inseminations called IUI also known as artificial insemination. We basically take the semen and wash it and get the best swimmers the A team out and then we introduce those swimmers into the partner’s uterus using a soft guide at the right time of the month.

When men have very severe semen analysis abnormality such as very low count or very low motility we can actually take the sperm and inject it directly into the egg, it’s called the intra-cytoplasmic sperm injection which is known as ICSI. Many men have become fathers because of this revolutionary procedure. It is safe and very effective in fertilizing eggs.

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There has been a recent increase in frozen donor egg banks and frozen donor eggs are basically eggs that are not used at the time of egg retrieval and frozen for future use. Of course the benefit is they are readily available so couple can obtain the eggs and very quickly thaw those eggs and have a chance at a pregnancy but there are some down sides. Whereas fresh embryos or even frozen embryos have birth rates of about sixty-six percent, the rate we see with frozen eggs is about fifty five percent.

So it’s not bad but it is less than the rate with fresh. We also don’t get as many embryos from frozen eggs as we do with fresh eggs, it’s more variable because the egg were frozen and thawed they are more vulnerable that way. So couples who seek frozen eggs should really work with a clinic that has treated the donor and a clinic where the embryologist themselves have frozen the egg. And with the recent advent of donor egg banks or egg banks that offer donor eggs I caution patients to be careful with that because freezing the egg and caring for the donor somewhere else and then shipping them to a clinic or lab that never worked with these eggs really leads to lower pregnancy rates. And so in seeking frozen eggs which are good option a couple should seek centers where the donor has her care and where the eggs are frozen by the same embryologist who is going to be thawing the eggs for best success rates.




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