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A Q&A With Dr. David Schmidt

WFSB Eyewitness News recently hosted a webchat featuring the Center’s own Dr. David Schmidt. With the opportunity to ask anything fertility-related, the participants had a wide range of questions and concerns. Here’s a transcript:

Question From Tricia

How can I find out how many eggs I have left?

Dr. David Schmidt

Thanks for the question, Tricia. This is actually a common question that we receive, and a very good one. There are several factors that are important in answering the question of how many eggs a woman may have. Women are born with a set number of eggs, or oocytes, which decline over time. A woman’s age, overall health, and certain gynecologic conditions may affect the amount of eggs that a woman has left. A simple blood test called an AMH level (Anti-mullerian hormone) is a simple way to assess a women’s egg supply, prior to other more definitive tests if needed.

Question From Lynette

My husband and I have been trying to get pregnant for about six months without success. I’m 28 and my OB is telling me to relax but I feel like something is wrong. When should I see a specialist?

Dr. David Schmidt

Lynette, this is also a common question that we are asked. Often women in their 20’s have the highest fertility rate, so they are often told to ‘relax’. This can be troubling to couples that wish to conceive now. Although the definition of infertility is defined by the inability to conceive in 12 months without contraception, it does not apply if a woman is over 35 years of age, or if there is some condition that my be contributing to infertility. If there are any known risk factors for infertility, seeing a specialist can occur sooner. We often will see couples that wish to conceive much earlier than a year, if they are having any difficulty at all. You could simply ask your ob-gyn for a ‘second opinion’ with us and we can help!

Question From Alan

I had a vasectomy ten years ago and would now like to have a biological child with my wife. Is it possible to reverse my vasectomy? If so, how difficult/painful is the process?

Dr. David Schmidt

Thank you, Alan. There are 2 main options for you and your wife. A vasectomy reversal is one option, which would require a reversal surgical procedure by a Urological Surgeon who actually specializes in a reversal surgery (not all do). The success of this procedure may relate to the initial procedure itself and when (more successful reversals are seen if done within 9 years of the initial vasectomy). The other option for you and your wife would be to undergo IVF (In Vitro Fertilization) with a simple office procedure for you to retrieve healthy sperm from where it is stored. This would avoid a surgical reversal surgery for yourself, but would require IVF for your wife and a simple, brief procedure for you. IVF success rates are very high, and would be recommended if there are other potential issues leading to infertility for your wife. There are several issues to consider, but we would recommend you seeing a Male Infertility Specialist or us to help you and your wife decide what is best for both of you.

Question From Pam

Where are you located?

Dr. David Schmidt

Our Main office is right in Farmington, CT, directly of Route 84, Exit 37. We are located at 2 Batterson Park Road in Farmington, Connecticut. We also have a main location in Hartford, CT at 50 Columbus Boulevard, Suite 2. You can check our website for directions at or call us at 844-HOPE-IVF. We would be happy to help you!

Question From Maggie

Hi Dr. Schmidt. My OBGYN said that now that I’m in my late 30’s and have been trying to get pregnant for 2 years I should seek help. What would you recommend?

Dr. David Schmidt

Maggie, yes, it would be recommended for us to see you if you wish to be pregnant and have been trying for as little as 6 months after the age of 35. Age can lengthen the time to conceive and time is a bit more critical after the age of 35. Don’t panic however, as we see many patients over the age of 40, and help many of them build a family. The sooner that we can see you and help with your evaluation, the better the chance of success! 🙂

Question From Anna

I’m getting a late start on starting a family- I’m 42- I know a woman’s eggs age but do I still have a chance of getting pregnant on my own or should I seek your help right away?

Dr. David Schmidt

Thank you, Anna. My last question was similar to yours and I would want to reassure you that roughly half of the patients we see, are over 40 years of age. Many women are shocked to hear that the chance of conception for FERTILE couples at the age of 40, is less than 4-5% per month, with appropriately timed intercourse. If there is a cause of infertility other than a woman’s age, it can be lower. There are many treatments however, that can significantly increase your chances of success if we can rule out causes of infertility. We will discuss ALL options for you, but it would be recommended that you be evaluated sooner, rather than later.

Question From Jen

How many months should we try to get pregnant before seeking infertility treatment?

Dr. David Schmidt

Thank you, Jen. It can vary for some couples, if there are obvious issues that could be present. For instance, if a woman isn’t having regular menses approximately every 26-30d, then she may not be ovulating and should seek consultation. If a woman has had a bacterial vaginal or pelvic infection in the past, her fallopian tubes may be blocked or she may have pelvic adhesions preventing pregnancy. Painful menses or pain with intercourse can be a sign of Endometriosis, which can cause infertility. Any condition in the male that may affect sperm quality may require evaluation. These are just some of the considerations they may cause infertility, and any of them would be a reason to seek evaluation now, rather then waiting for 6 month to a year.

Question From Debbie

My friend was saying I need an AMH test ….can you tell me about that?

Dr. David Schmidt

Yes Debbie, an AMH blood test is a simple test that has been more readily available now over the last 6-8 years which can quantify a woman’s egg supply. There are other hormone tests that are also useful, such as a FSH (Follicle Stimulating Hormone) and Estradiol level, but these are most accurate on Day 2 or 3 of a woman’s menses. The AMH level can be drawn on any day of a woman’s cycle, and therefore is an easy, first step to quantifying a women’s remaining egg supply. An internal ultrasound is also a common, painless study that we perform in our office to measure the size of a woman’s ovaries and visualize the resting follicles (or potential eggs), referred to as Antral Follicles. Starting with the AMH level is the easiest 1st step!

Question From Barbara

I tuned in at the end of your interview. What was the vitamin recommended to increase fertility?

Dr. David Schmidt

Vitamin D has been recommended to assess for woman and men, for overall general health. There aren’t many research studies that specifically link Vitamin D Deficiency to Infertility; however, many of us in the North East are already Vitamin D deficient, due to lack of sun exposure (due to risk of skin cancer and being in the North with less direct sun exposure throughout the year). Vitamin D is important for bone heath, your immune system, and may help prevent certain heart disease and certain cancers. We believe normal levels also are important for fertility and pregnancy. It can be screened for with an easy blood test that can be obtained.

Question From Courtney

Is there anything that can be done if the man is the one with the problem?

Dr. David Schmidt

Yes, Courtney. We usually have a Male Infertility Specialist (a Urologist who works with us who has completed a fellowship an advanced training and board certification beyond a general Urologist) evaluate the male partner, but we also usually see both of you as a couple, since treatment may require both of you. It is important for you to be seen as well, since you will carry the pregnancy and your child. 30% of couples have infertility due to a male issue, but another 20% may have multiple factors, even though there is an obvious male issue. Remember a woman’s age is also always a consideration for successful pregnancy and risk of miscarriage. I hope that helps!

Question From Me

I have been trying to get pregnant for few years with no luck. I am going for infertility treatment and next step I I believe is IUI. What is the difference between that and IVF and what are my chances?

Dr. David Schmidt

IUI treatments can often be successful if recommended for the right reason (or indication) and offered to women who are young enough for success and who have an adequate egg supply (or ovarian reserve). IVF treatments are a bit more involved but also are usually more successful, as the treatment option bypasses more barriers to conception, or more types of infertility. You can certainly start with IUI if it was recommended to you, and IVF can be considered if the initial IUI treatments aren’t successful (usually 3 cycles of IUI, depending upon your age and type of issues that you are facing). Good luck! 🙂

Question From Deena

Taking vitamin D was recommended on the clip on television tonight. How much do you recommend taking, or is this on a person by person basis?

Dr. David Schmidt

The amount of Vitamin supplementation that is recommended is based on your Vitamin D levels and if you are even deficient. Start by taking a woman’s multivitamin or prenatal vitamin daily, and the vitamin D supplements can be added if you are deficient. Vitamin D3 1,000-2,000 IU is what is commonly recommended for a woman who is deficient, with higher doses only if your levels are low. It is not safe to take more than 1,000-2,000 iu total per day when you are pregnant, which is why we recommend assessing your levels now prior to pregnancy. I hope that helps. Sorry, if I didn’t get to explain that in detail on tonight’s short segment!

Question From Linda

What is the age of the women that you give fertility treatments?

Dr. David Schmidt

We see patients of all ages, but most of our infertility patients are between the ages of 18 and 44. Women who are younger than 18 are often seen by a pediatric gynecologist, along with our consultation for certain Endocrinology or Gynecologic conditions. Infertile patients or patients with Recurrent Miscarriages are often seen up to the age of 44 or 45. It becomes very difficult for a woman to conceive with her own eggs after the age of 44, so many of those woman conceive with the help of donated oocytes. Woman can conceive with high success rates using donated eggs, even up to the age of 50, since the chance of conception and delivery is dependent upon the age of a woman and her eggs. Unfortunately, many eggs become abnormal genetically in a woman’s mid 40’s, which can lead to miscarriage. Seeing you sooner will always give us the most options for you.

Question From Tracy

I was diagnosed with PCOS in my early 20s. I’ve never really tried to get pregnant but does my diagnosis automatically mean I will have fertility problems?

Dr. David Schmidt

Tracey, PCOS, and lack of regular ovulation, are 2 of the most common issues that we see in our practice. It does not always cause infertility, because there are many easy options available to help you ovulate, when you are ready to conceive. Many women with PCOS also suffer from insulin resistance, or obesity, or may have a family history of Type II diabetes. This does not mean that you necessary face these issues, but we usually recommend following a healthy lifestyle with a healthy diet and exercise for now prior to trying to conceive. This will increase your chances of conception when you are ready to conceive, whether you need treatment or not. Checking an AMH level will also reassure you that your egg supply is fine, prior to trying to conceive (woman with PCOS often have a high, healthy normal amount of eggs when compared to women of similar age). I hope that answers your question to some degree.

Question From Jan

Is there a long wait to get in for treatment? Once I get in, how long does fertility treatment usually take?

Dr. David Schmidt

Thank you Jan! Although we are a very busy Center, we go through great lengths to get patients into our office quickly, in order to start a customized assessment to offer the best options based on your particular needs and issues. We have 6 physicians at 3 main offices with other satellite offices for patient convenience. Once you are seen, the evaluation usually takes just 1 menstrual cycle, and a follow up appointment is usually scheduled at the time of your 1st visit, so that we can help you as soon as possible. We also try to reverse any issues so that you may be able to conceive more readily on you own, or more quickly with assisted reproductive technologies (ART). Some patient also benefit from Minimally Invasive Surgery (laparoscopy) which we specialize in as well.

Question From Dee Dee

I recently had an IVF appointment at your center. There was so much information to take in. Can you tell me again the difference between a day 3 and day 5 embryo. Thank you

Dr. David Schmidt

Yes, Dee Dee. We are sorry, and we understand we give quite a bit of information at your 1st visit. Please understand it is intended to provide as much information as possible to help you though this journey. Understand that we will answer your questions as you are seen 🙂 Patient can have embryos transferred at day 3 or day 5, both of which have been done in the past with great success! Over the past 10 years, IVF culture conditions and laboratory conditions have improved IVF success rates around the world, and we have been able to achieve higher implantation rates with Day 5 embryos, if they are available. Often patients can achieve similar pregnancy rates with day 3 embryo, but the same high pregnancy rates can be obtained with fewer day 5 embryos. This reduces the risks of multiples while maintaining high pregnancy rates. Your physician will help guide you for the best options for you.



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