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Thank you Dr. Nulsen

Retirement isn’t the end of the road…it’s the beginning of clear skies full of adventure. Please join us in wishing Dr. John Nulsen many years of joy and happiness as after 35 years of dedicated service, Dr. Nulsen will be retiring from The Center at the end of this year.

To anyone who would like to send best wishes to Dr. Nulsen, you can do so by sending an email to: [email protected]

(Shhhh…We are also collecting photos for a very special book for Dr. Nulsen; these can also be sent to the same email address.)

If you are a current patient of Dr. Nulsen, you should have received previous correspondence with this news and how to transition to any of our other Farmington-based physicians. If you have any questions or concerns, please don’t hesitate to reach out.

Practice News

There are several changes that will be occurring at The Center for Advanced Reproductive Services [The Center] over the coming months.

Dr. Nulsen
After 35 years of dedicated service, Dr. John Nulsen will be retiring from The Center. Dr. Nulsen will stop seeing new patients as of October 1, 2022 and continue to care for patients currently in treatment through December 16, 2022. Patients of Dr. Nulsen will have the option of transitioning their care to any of our other Farmington based doctors; Dr. Engmann, Dr. Benadiva, Dr. Schmidt or Dr. Grow. To facilitate a smooth and comfortable transition of care, CARS will be offering Dr. Nulsen’s existing patients a complimentary 30-minute virtual consult with their new provider.

Biographies and videos of all our doctors are on our website. Should you need to speak to someone about choosing your new doctor please call Susan Lyko, Farmington Practice Manager at 860.321.7082, EXT 8008 or Jennifer Christensen, Hartford Practice Manager at 860.525.5253, EXT 8105. You can schedule your virtual appointment with your new provider by calling our front desk at 844.467.3483.

Join Us In Saying Thanks

To anyone who would like to send best wishes to Dr. Nulsen, you can do so by sending an email to: [email protected]uconnfertility.com. We are also collecting photos for a very special book for Dr. Nulsen; these can also be sent to the same email address.

Dr. Engmann
Effective November 1, 2022 Dr. Engmann will be moving his practice from the Hartford office to our Farmington location. Current patients of Dr. Engmann may choose to follow him to Farmington or continue on in the Hartford office under the care of Dr. Prachi Godiwala who will be joining the team as of October 1, 2022.

Once re-located to the Farmington office Dr. Engmann will be working with Dr. Nulsen’s nursing team. Dr. Engmann’s Hartford nursing team will be supporting Dr. Godiwala in Hartford.

Dr. Godiwala
We are excited to announce that Dr. Prachi Godiwala will be joining the CARS team effective October 1, 2022 and will be seeing patients in our Hartford office. She graduated from UMASS School of Medicine in 2015 and completed her Ob/Gyn residency at George Washington University. Dr. Godiwala completed a three-year Reproductive, Endocrinology and Infertility [REI] fellowship at The Center and UConn School of Medicine. During this time, she distinguished herself as a compassionate and skilled provider as well as committed researcher and academic.

For Dr. Engmann patients choosing to continue receiving care in the Hartford office, CARS will be offering a complimentary 30-minute virtual consult with Dr. Godiwala. You can schedule this visit by calling the Hartford office at 860.525.8283.

We are here for you
At The Center we appreciate you choosing us for your fertility care. We are committed to supporting you through these changes within our practice. Thank you for your continued support.

ReproTech statement

For those patients who have embryos in long-term storage at ReproTech, we are pleased to share their reassuring statement in regards to the Dobbs v. Jackson ruling:

“On June 24, 2022, the U. S. Supreme Court ruling in the case of Dobbs v. Jackson Women’s Health Organization overturned federal protections for abortion which now provides that each individual state will regulate their own abortion laws. Thirteen states have trigger laws that went, or will go, into effect based on the Dobbs v. Jackson ruling that have abortion restrictions. This has created significant concern and confusion about state’s laws impact on Assisted Reproductive Technology (ART), and we share that concern.

Based on ASRM’s guidance in their Potential Implications for Reproductive Medicine report, ReproTech currently does not expect any impact in the operations at any of our locations. According to the ASRM report, twelve of the thirteen state’s trigger laws that restrict abortion do not appear to include ART in any of their restrictive language. The ASRM document indicates that these states’ trigger laws apply to fertilized embryos in pregnant women, not to embryos in storage that were created with ART. The Utah trigger law is the one exception that has language that could be interpreted to have an impact on ART.

We understand that some of our partners clinics may feel it is in the best interest of their patients to begin working with a ReproTech facility in a more IVF “friendly” state. However, ReproTech’s facilities are strategically located throughout the U.S. to provide the highest level of service to your patients. Working with the ReproTech facility closest to you allows us to provide the most convenient and economical service for your patients and reduce shipping distances.

ReproTech is exceptionally positioned and fortunate to have nationwide locations in 5 states that give us the flexibility to continuing providing all cryostorage and dispositions options to your patients. Should the laws concerning disposition of embryos change in one of the states where ReproTech is located, and if any of your patients’ disposition choices are restricted, they will always have the ability to transfer their embryos to one of ReproTech’s other four nationwide locations for disposition.”

 

Feeding Fertility: Using Nutrition to Support Preconception Health

By Ami Chokshi, Integrative Fertility Coach

“If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.” – Hippocrates, 4th century BCE

Our diets have changed dramatically since Hippocrates. There are a multitude of approaches to eating these days including several popular diets, Paleo, Keto, Mediterranean, and Vegan. For women who are trying to conceive, it can be overwhelming to understand what to eat for fertility, preconception, and pregnancy.

We know a great deal about the link between nutrition and fertility because of the Nurses’ Health Study, where almost 18,000 women who were trying to conceive were followed for 8 years. They tracked both lifestyle and diet, and this study has become a watershed for understanding just how important it is to eat to benefit fertility. Those that followed a highly plant-based plan, including fruits, vegetables, whole grains, plant proteins, beans, healthy fats, and 1-2 servings of full-fat dairy had a 66% decreased risk of ovulatory infertility and a 27% lower risk from other causes.1

Additional sources confirm that nutritional and lifestyle adjustments support optimal preconception health. These guidelines suggest both men and women will benefit, so a couple trying to conceive can work together to optimize their fertility health.

Lower Pesticide Foods

A preconception and fertility diet looks similar to the one in the Nurses’ Health Study, but there is currently a greater emphasis on eating foods with a low-pesticide profile, typically found in organic foods, due to a January 2018 study in JAMA Internal Medicine.2

The results found that that “in a cohort of 325 women undergoing infertility treatment with assisted reproductive technology, intake of high–pesticide residue fruits and vegetables was associated with a lower probability of live birth, while low–pesticide residue fruit and vegetable intake was not associated with this outcome.”3

Since buying organic foods can be cost-prohibitive, for produce, aim to purchase organics for those fruits and vegetables that are the most contaminated. The Environmental Working Group (EWG) produces a yearly review and guide of the most pesticide-ridden produce, called The Dirty Dozen, as well as the cleanest fruits and vegetables, called The Clean 15. There are pocket guides on EWG’s website (https://ewg.org) as well as an app for quick access when grocery shopping.

While each year varies, the Clean 15 produce that is safe to be purchased conventionally often includes avocado, non-GMO sweet corn, pineapple, sweet frozen peas, onions, papayas, asparagus, eggplant, kiwi, cabbage, cauliflower, cantaloupe, mangoes, mushrooms, and honeydew melon.

On the other hand, the Dirty Dozen is the most contaminated conventional produce and are often those with thin, penetrable skins, like strawberries, spinach, kale, collards, mustard greens, nectarines, grapes, apples, peaches, cherries, pears, tomatoes, celery, and bell and hot peppers. It’s best to buy organics while shopping from this list.

What is A Fertility Diet?

The best options for a fertility diet are one that includes plenty of vegetables as well as fruits, whole grains, beans, healthy fats, and quality sources of proteins.

While fruit has been demonized recently with current keto craze, fruits offer powerful vitamins and antioxidants that help fight off oxidative stress caused by poor nutrition, emotional stress, and environmental factors. They are best eaten raw and ripe because they are heat sensitive and because the whole fruit contains blood sugar-stabilizing fiber. Examples include wild blueberries, strawberries, raspberries, prunes, and pomegranates. They can be eaten as a whole fruit or added to a smoothie, which preserves the beneficial fiber when blended (not juiced).

Vegetables, like leafy greens and crucifers, offer much needed minerals and fiber to support healthy blood sugar levels and optimal digestion. 2-3 servings or covering ½ of your plate with vegetables encourages satiety, crowds out junk food, fuels your cells with nutrients, and provides sustained energy throughout the day. It also keeps your mood stable, which is especially helpful when patients are experiencing the stress of several months of trying to conceive. Prebiotic fibers from vegetables help support digestive health and help move bowels and toxins that go with it.

Healthy fats support egg, sperm, and embryo health, provide energy, and protect organs. Some examples of food-based fats to eat include wild-caught salmon (farm-raised salmon should be avoided due to contaminants), nuts (walnuts, pecans, macadamias, almonds), seeds (pumpkin, chia, hemp, sunflower), avocadoes, olives, and coconut. Healthy fats are best eaten as a whole food. Healthy oils like avocado, coconut, olive, and grapeseed, are best when used in smaller amounts, i.e. for cooking, since oils are a processed food. Trans fats, which are often found in donuts, pastries, and French fries, should be avoided entirely.

Organic proteins should be about ¼ of a meal. These include meat, eggs, tofu, tempeh, and beans. Organic is again ideal to avoid the antibiotics and pesticides, that contribute to a greater toxic body burden. Specifically, these include grass-fed beef, free-range chicken, wild-caught salmon, turkey, and smaller, less contaminated fish. Since according to Michael Pollan, “you are what you eat eats,” it’s important to look at what the animal that we are eating is also consuming and source accordingly.

Gluten free whole grains like brown and black rice, quinoa (this is actually a protein-rich seed but often treated as a grain), buckwheat, amaranth, millet, and oatmeal are beneficial staples to a fertility diet. It’s the refined grains, like breads and pasta, that wreak havoc on blood sugar, add to bodily stress, and should be limited.

The focus on gluten free grains relates to how our wheat is produced in the US. The majority of wheat is mostly ridden with pesticides and is genetically-modified to be resistant to glyphosate, which is a carcinogenic herbicide found in Roundup.

How to combine these foods?

When combined appropriately, these foods support optimal blood sugar and prenatal nutrient needs. The aim here is to integrate fiber in the form of vegetables and protein into the three main meals. Typically, ½ of the plate is covered with mostly vegetables and some fruit, ¼ is a protein, and the remaining ¼ would be a healthy fat or a whole grain.

Patients often question how to integrate more vegetables into their meals; here are some examples. Some of these ingredients can be prepped ahead of time to be easily and quickly assembled later.

  • Breakfast: 2 eggs scrambled with 2 servings of your favorite veggies (spinach, broccoli, kale, etc.…); Adding 2 handfuls of spinach to a smoothie
  • Lunch: Make ahead soup with lots of veggies topped with diced avocado, A large green salad topped with wild-caught salmon
  • Dinner: Stir fry of veggies and chicken over steamed cauliflower rice, Dinner bowl with quinoa, sauteed veggies, a grass-fed steak, and a savory chimichurri sauce
  • Snacks: Carrots and Hummus; Celery slices with Almond Butter

Given that 1 in 8 women struggle with infertility, many are often seeking ways to better manage the ongoing stressors related to trying to conceive. Eating to support conception can not only be delicious and nutritious, it can support hormonal and digestive health, blood sugar regulation, a healthy inflammatory response, as well as level energy and better mood.

 

References:

  1. Souter I, Chiu YH, Batsis M, Afeiche MC, Williams PL, Hauser R, Chavarro JE; EARTH Study Team. The association of protein intake (amount and type) with ovarian antral follicle counts among infertile women: results from the EARTH prospective study cohort. BJOG. 2017 Sep;124(10):1547-1555. doi: 10.1111/1471-0528.14630. Epub 2017 Apr 10. PMID: 28278351; PMCID: PMC5568942.
  2. Baudry J, Assmann KE, Touvier M, et al. Association of Frequency of Organic Food Consumption With Cancer Risk: Findings From the NutriNet-Santé Prospective Cohort Study. JAMA Intern Med. 2018;178(12):1597–1606. doi:10.1001/jamainternmed.2018.4357
  3. Chiu Y, Williams PL, Gillman MW, et al. Association Between Pesticide Residue Intake From Consumption of Fruits and Vegetables and Pregnancy Outcomes Among Women Undergoing Infertility Treatment With Assisted Reproductive Technology. JAMA Intern Med. 2018;178(1):17–26. doi:10.1001/jamainternmed.2017.5038

 

Coverage at Work Program

CT is one of only 10 states that has mandated fertility coverage. However, there are many gaps and limitations. In fact, most employers do not realize there is a gap in their benefits plan until it’s brought to their attention. That’s why we are proud to work with RESOLVE: The National Infertility Association to share information about their Coverage at Work program.
 
Coverage at Work is a program designed to help you gain new or expanded benefits to help cover the cost of treatment through your employer-provided benefits.
 
The Coverage at Work resource hub includes an easy-to-follow toolkit, tips for making a plan and asking for coverage, and additional resources to present your employer. Plus, you’ll get access to one-on-one coaching with the RESOLVE team for any questions you or your employer have along the way.
 
Hundreds of thousands of employees have already gained new or expanded benefits for family building – you and your coworkers could join them. But it starts with making the ask.
 
Learn more and download the Coverage at Work Employee toolkit at this link:
 
https://resolve.org/learn/financial-resources-for-family-building/insurance-coverage/getting-insurance-coverage-at-work/
 

Covid Update March 2022

Updated March 16, 2022

Practice Operations

On behalf of The Center for Advanced Reproductive Services [CARS], we hope during these challenging times this letter finds you and your family safe and healthy.  As Connecticut’s daily COVID positivity rate is returning to 5% or less, we are writing to tell you about fertility treatments at CARS currently.

At each CARS office, policies & procedures have been implemented to optimize physical distancing and other mitigation strategies to minimize risk of exposure for patients and staff.

As of March 16, 2022:

  • We are currently running at 100% of IVF and IUI capacity with no cycle restrictions.
  • Maintain social distancing standards for patients and staff by limiting traffic thru building.
  • Maintain personal protective equipment [PPE] and mitigation strategies to limit risk of exposure for patients & staff.
  • 97% of our staff have received their first and second COVID 19 vaccinations and are boosted. Those who are not vaccinated are on a weekly COVID 19 testing schedules.
  • All CARS facilities will continue to require ALL patients to always wear masks.  
  • Partners are welcomed to join patients for onsite visits. Partners must be masked.
  • All patient consults will continue to be remote via TEAMS. For New Patients a nurse will call you prior to your visit.
  • All live appointments will continue to be scheduled only. No walk ins. This includes Quest blood draws.
  • PACU [retrieval & transfer areas] continues to be closed to partners and family members.
  • COVID testing is no longer required prior to IVF retrieval.
  • Men will continue to produce sperm specimen at home unless living > 1 hour away. Community patient service for semen analysis is resumed at this time.
  • Please arrive as close to your scheduled time as possible to control patient traffic thru the offices. Please be aware, for morning monitoring patients will be checked in and brought back based on their scheduled time and not the time of arrival to practice.
  • Patient screening will occur at each clinical entrance:
    • Do you have any cold or flu symptoms?
    • Have you traveled internationally?
    • Temperature.

Travel

The only travel we are concerned with at this time for patients is international travel. If a patient travels internationally we will require negative COVID test 72 hours before or after arriving back to CT.

Practicing medicine, especially fertility treatments, in a COVID – 19 world is very different than a year ago. There are several interventions we are continuing as part of our efforts to keep everyone safe.

Satellite Patients

Satellite patient services are suspended at this time.

COVID 19 Testing for IVF patients

This is no longer required. However, basic screening will continue prior to entry to any clinical area.

Fertility Treatments and COVID 19 Vaccine

We are all excited about the recent developments and promise regarding Covid 19 vaccines. These vaccines have not been extensively studied in pregnant women. As vaccines become more widely available, a practical question has arisen regarding the timing of vaccine administration with respect to certain invasive reproductive care treatments. In general, it is recommended that: Patients scheduled for elective surgery or outpatient procedures, including oocyte retrieval, embryo transfer, and intrauterine insemination, avoid COVID-19 vaccination at least three days prior and three days after their procedure. This recommendation is not because being vaccinated is unsafe, but rather because known side effects of the vaccine may impact intra-operative and post-surgical monitoring. Common side effects after COVID-19 vaccination, especially after the second dose, include fever, chills, fatigue, myalgia, and headaches, which typically occur and resolve within three days. Anesthesia impairs normal thermoregulatory control and may be impacted by pre-existing fever. Additionally, these side effects would make it difficult to determine if a post-procedure fever is related to the vaccine or to a developing infection related to the procedure. Finally, many medical facilities may not allow patients into their facility or proceed with any elective procedure if a patient has COVID-like symptoms, including those that are possible side-effects of the vaccine, even if their COVID-19 test is negative. Practices should notify and encourage their patients to communicate with their surgeons and fertility programs when they become eligible for COVID vaccination. This will help coordinate planned surgical procedures, fertility testing and treatment, and will decrease the chance of inadvertent procedure cancellation.

We will get thru this together.

Thank you for your continued patience and understanding during this time of uncertainty. The COVID-19 pandemic has changed many things including the way we practice fertility medicine, but one thing that has not changed is our commitment to helping our patients build families. We have been thinking about you during this difficult time and eagerly look forward to safely making your family building dreams come true. If you have any questions or concerns please contact Paul Verrastro, CARS CEO at 860.321.7082, EXT 8005.

Thank you for your continued support.

Four Ways To Manage Endometriosis Naturally

by Ami Chokshi, Integrative Fertility Coach

Endometriosis affects women in their reproductive years and is a condition where the tissue that lines the uterus may be found in other places of the body, like in the abdomen, ovaries, or fallopian tubes.

Endometrial lining typically sheds during a woman’s period, but with endo, it gets trapped in these other areas outside of your uterus. It can also irritate your nerves and cause pain in many women. This can lead to chronic inflammation and an accumulation of scar tissue.

Endo warriors know how painful and stressful this condition can be and how the symptoms can take over your life, including debilitating period cramps, long and heavy flow, fatigue, bloating, constipation, painful sex, and infertility.

These tips may help reduce your symptoms –

Use your fork

Eating a diet that is plant-focused, high in nutrients, low in toxins, supports balanced blood sugar, and removes common triggers like gluten, sugar, and caffeine.

It includes eating a variety of vegetables – like leafy greens, cruciferous veggies like broccoli and cauliflower in each meal – as well as fresh fruits, especially berries.

Stable blood sugar is a critical component in this way of eating, so one way to do this is to combine fiber – through vegetables, whole grains, or additions like ground flax or chia – with a protein in every meal.

Clean up your environment

Because endometriosis is both an inflammatory and immune problem, endocrine-disrupting chemicals and other environmental toxins can worsen it.

Taking a look at your overall environment to make sure you are drinking clean water, breathing clean air, and eating clean food can help reduce the inflammation.

Sometimes the culprit is right in front of you. For example, one of my clients with endo is a hairstylist. When we examined her environment, she was consistently exposed to harmful chemicals from the hair products she was using with her clients. When she switched to cleaner hair products, her symptoms lessened.

To switch up your household products to cleaner ones, check out the Environmental Working Group’s website (ewg.org). This website offers tons of insightful guides to help you switch to cleaner products.

Supplements to Consider

N-acetyl cysteine or NAC is a powerful antioxidant. It supports inflammatory response, may lower tissue damage, and it supports your liver to purge those fertility-mugging toxicants in your system. In a 2013 study, women who regularly took NAC saw a reduction in ovarian endometriosis. This included lowering the severity of pelvic pain and having a less heavy flow.

Another antioxidant that supports endometrioses is pycnogenol, which is a plant extract that comes from French maritime pine bark extract. It offers numerous health benefits due to its combination of organic acids, procyanidins, and bioflavonoids. Over four weeks, Pycnogenol helped reduce pain from severe to moderate.

Fertility Massage

Finally, consider working with a practitioner who is trained in Arvigo massage or a physical therapist who has experience with endometriosis. These therapies can help break up adhesions, and they complement the food and lifestyle changes you are making.

Endometriosis can be all-consuming, so I hope these tips are helpful to reduce inflammation and balance your hormones to support your fertility and desire to get pregnant.

 

Sources:

Covid Update Feb 2022

On behalf of The Center for Advanced Reproductive Services [CARS], we hope during these challenging times this letter finds you and your family safe and healthy.  As Connecticut’s daily COVID positivity rate is returning to 5% or less, we are writing to tell you about fertility treatments at CARS currently.

At each CARS office, policies & procedures have been implemented to optimize physical distancing and other mitigation strategies to minimize risk of exposure for patients and staff. As of February 18, 2022:

  • We are currently running at 100% of IVF and IUI capacity with no cycle restrictions. We continue to carefully track CT COVID -19 data, internal mitigation systems and our inventory of PPE.
  • Maintain social distancing standards for patients and staff.
  • Maintain personal protective equipment [PPE] and mitigation strategies to limit risk of exposure for patients & staff.
  • 97% of our staff have received their first and second COVID 19 vaccinations and are boosted. Those who are not vaccinated are on a weekly COVID 19 testing schedules.

Effective Friday, February 18, 2022

Continued restrictions:

  • All CARS facilities will continue to require ALL patients to always wear masks.  
  • Partners are welcomed to join patients for on site visits. Partners must be masked.
  • All patient consults will continue to be remote via TEAMS. For New Patients a nurse will call you prior to your visit.
  • All live appointments will continue to be scheduled only. No walk ins. This includes Quest blood draws.
  • PACU [retrieval & transfer areas] continues to be closed to partners and family members.
  • Anesthesia guidelines for IVF retrieval remain unchanged.
  • Men will continue to produce sperm specimen at home unless living > 1 hour away. Community patient service for semen analysis is resumed at this time.

Other restrictions:

  • Please arrive as close to your scheduled time as possible to control patient traffic thru the offices. Please be aware, for morning monitoring patients will be checked in and brought back based on their scheduled time and not the time of arrival to practice.
  • Patient screening will occur at each clinical entrance:
    • Do you have any cold or flu symptoms?
    • Have you traveled internationally?
    • Temperature.

To achieve this a thermometer will be relocated at each clinical entry way. Whoever brings patient into clinical area will screen patient according to aforementioned.

Travel

The only travel we are concerned with at this time for patients is international travel. If a patient travels internationally we will require negative COVID test 72 hours before or after arriving back to CT.

Practicing medicine, especially fertility treatments, in a COVID – 19 world is very different than a year ago. There are several interventions we are continuing as part of our efforts to keep everyone safe.

Patient Visits

  • All patients visiting CARS must be scheduled at a specific time. This includes morning ultrasound and blood monitoring, and Quest blood draws throughout the day. No more walk ins of any kind.
  • If you need to change the time you are scheduled for your monitoring blood work or ultrasound, please contact the front desk.
  • All new patient visits, IVF consultations [1B] and established subsequent office visits continue to be telehealth via Microsoft TEAMS.
  • Semen analysis appointments for CARS patients will be scheduled and patients asked to produce at home. Specimen collection kits will be provided to patients in advance via a repository by front doors at each office. Male partners must personally deliver semen specimens to practice. Community semen analysis service is resumed at this time.
  • Please stay in contact with us and call your nurse or financial services representative [FSR] when you intend to start a cycle.  Your physician team will review your personal case and follow up with next steps.
  • All patients undergoing care are required to provide an active credit card on file so we can run co-pays, deductibles, etc so front desk and financial staff are protected from handling credit cards, money, checks, etc.

Health Screening

Patients are asked about symptoms and travel history upon entry into clinical areas and temperatures are being assessed. All patients and partners must wear a mask at all time when in our offices. If you have a mask at home [homemade cloth masks are fine] we ask that you use it or one will be provided.

Satellite Patients

Satellite patient services are suspended at this time.

COVID 19 Testing for IVF patients

We are requiring IVF patients have at least one COVID 19 negative test between Baseline and day of Retrieval [preferably stim day 4/5]. Our staff will provide you with testing site options and instructions on the day of Baseline. Any patients testing COVID 19 positive during an IVF cycle will be managed on a case per case basis.

Fertility Treatments and COVID 19 Vaccine

We are all excited about the recent developments and promise regarding Covid 19 vaccines. These vaccines have not been extensively studied in pregnant women. As vaccines become more widely available, a practical question has arisen regarding the timing of vaccine administration with respect to certain invasive reproductive care treatments. In general, it is recommended that: Patients scheduled for elective surgery or outpatient procedures, including oocyte retrieval, embryo transfer, and intrauterine insemination, avoid COVID-19 vaccination at least three days prior and three days after their procedure. This recommendation is not because being vaccinated is unsafe, but rather because known side effects of the vaccine may impact intra-operative and post-surgical monitoring. Common side effects after COVID-19 vaccination, especially after the second dose, include fever, chills, fatigue, myalgia, and headaches, which typically occur and resolve within three days. Anesthesia impairs normal thermoregulatory control and may be impacted by pre-existing fever. Additionally, these side effects would make it difficult to determine if a post-procedure fever is related to the vaccine or to a developing infection related to the procedure. Finally, many medical facilities may not allow patients into their facility or proceed with any elective procedure if a patient has COVID-like symptoms, including those that are possible side-effects of the vaccine, even if their COVID-19 test is negative. Practices should notify and encourage their patients to communicate with their surgeons and fertility programs when they become eligible for COVID vaccination. This will help coordinate planned surgical procedures, fertility testing and treatment, and will decrease the chance of inadvertent procedure cancellation.

We will get thru this together.

Thank you for your continued patience and understanding during this time of uncertainty. The COVID-19 pandemic has changed many things including the way we practice fertility medicine, but one thing that has not changed is our commitment to helping our patients build families. We have been thinking about you during this difficult time and eagerly look forward to safely making your family building dreams come true. If you have any questions or concerns please contact Paul Verrastro, CARS CEO at 860.321.7082, EXT 8005.

Thank you for your continued support

Important Covid Update

We have made important updates to our Covid policies effective today, Wednesday, December 29th, 2021.

Practice Operations

On behalf of The Center for Advanced Reproductive Services [CARS], we hope during these challenging times this letter finds you and your family safe and healthy.  As Connecticut is experiencing a surge in COVID-19 cases and hospitalizations, we are writing to tell you about fertility treatments at CARS currently.

At each CARS office, policies & procedures have been implemented to optimize physical distancing and other mitigation strategies to minimize risk of exposure for patients and staff. As of December 29, 2021:

  • Due to COVID related staff shortages we are limiting IVF volume for the month of January. IUI will be unaffected. We expect to be back to 100% IVF capacity by January 23, 2022. We continue to carefully track CT COVID -19 data, internal mitigation systems and our inventory of PPE.
  • Maintain social distancing standards for patients and staff.
  • Maintain personal protective equipment [PPE] and mitigation strategies to limit risk of exposure for patients & staff.
  • 97% of our staff have received their first and second COVID 19 vaccinations and are boosted. Those who are not vaccinated are on a weekly COVID 19 testing schedules.

Effective Wednesday, December 29, 2021

Continued restrictions:

  • All CARS facilities will continue to require ALL patients to always wear masks.  
  • Effective immediately partners, children, guests, etc will not be allowed into our buildings. For retrieval patients CARS staff will call or text you when patient is ready to be picked up and meet you in front of building
  • All patient consults will continue to be remote via TEAMS. For New Patients a nurse will call you prior to your visit.
  • All live appointments will continue to be scheduled only. No walk ins. This includes Quest blood draws.
  • PACU [retrieval & transfer areas] continues to be closed to partners and family members.
  • Anesthesia guidelines for IVF retrieval remain unchanged.
  • Men will continue to produce sperm specimen at home unless living > 1 hour away. However, we will only provide semen analysis to CARS patients. Community patient service for semen analysis is suspended at this time.

Other restrictions:

  • Please arrive as close to your scheduled time as possible to control patient traffic thru the offices. Please be aware, for morning monitoring patients will be checked in and brought back based on their scheduled time and not the time of arrival to practice.
  • Patient screening will occur at each clinical entrance:
    • Do you have any cold or flu symptoms?
    • Have you traveled internationally?
    • Temperature.

To achieve this a thermometer will be relocated at each clinical entry way. Whoever brings patient into clinical area will screen patient according to aforementioned.

Travel

The only travel we are concerned with at this time for patients is international travel. If a patient travels internationally we will require negative COVID test 72 hours before or after arriving back to CT.

Practicing medicine, especially fertility treatments, in a COVID – 19 world is very different than a year ago. There are several interventions we are continuing as part of our efforts to keep everyone safe.

Patient Visits

  • All patients visiting CARS must be scheduled at a specific time. This includes morning ultrasound and blood monitoring, and Quest blood draws throughout the day. No more walk ins of any kind.
  • If you need to change the time you are scheduled for your monitoring blood work or ultrasound, please contact the front desk.
  • All new patient visits, IVF consultations [1B] and established subsequent office visits continue to be telehealth via Microsoft TEAMS.
  • MD clinic visits on site will be limited to ultrasounds, procedures, emergencies and clinical follow up appointments for telehealth patients.
  • Every attempt will be made for onsite visits to be as efficient as possible. There will be limited on-site counseling and instructions. Discussions can occur immediately following your visit with a call from your car or we can call you later when you’ve arrived home. Our doctors and nurses will have access to Microsoft TEAMS for video conferencing.
  • Semen analysis appointments for CARS patients will be scheduled and patients asked to produce at home. Specimen collection kits will be provided to patients in advance via a repository by front doors at each office. Male partners must personally deliver semen specimens to practice. Community semen analysis services is suspended at this time.
  • Please stay in contact with us and call your nurse or financial services representative [FSR] when you intend to start a cycle.  Your physician team will review your personal case and follow up with next steps.
  • All patients undergoing care are required to provide an active credit card on file so we can run co-pays, deductibles, etc so front desk and financial staff are protected from handling credit cards, money, checks, etc.

Health Screening

Patients are asked about symptoms and travel history upon entry into clinical areas and temperatures are being assessed. All patients must wear a mask at all time when in our offices. If you have a mask at home [homemade cloth masks are fine] we ask that you use it or one will be provided.

Satellite Patients

Satellite patient services are suspended at this time.

COVID 19 Testing for IVF patients

We are requiring IVF patients have at least one COVID 19 negative test between Baseline and day of Retrieval [preferably stim day 4/5]. Our staff will provide you with testing site options and instructions on the day of Baseline. Any patients testing COVID 19 positive during an IVF cycle will be managed on a case per case basis.

Fertility Treatments and COVID 19 Vaccine

We are all excited about the recent developments and promise regarding Covid 19 vaccines. These vaccines have not been extensively studied in pregnant women. As vaccines become more widely available, a practical question has arisen regarding the timing of vaccine administration with respect to certain invasive reproductive care treatments. In general, it is recommended that: Patients scheduled for elective surgery or outpatient procedures, including oocyte retrieval, embryo transfer, and intrauterine insemination, avoid COVID-19 vaccination at least three days prior and three days after their procedure. This recommendation is not because being vaccinated is unsafe, but rather because known side effects of the vaccine may impact intra-operative and post-surgical monitoring. Common side effects after COVID-19 vaccination, especially after the second dose, include fever, chills, fatigue, myalgia, and headaches, which typically occur and resolve within three days. Anesthesia impairs normal thermoregulatory control and may be impacted by pre-existing fever. Additionally, these side effects would make it difficult to determine if a post-procedure fever is related to the vaccine or to a developing infection related to the procedure. Finally, many medical facilities may not allow patients into their facility or proceed with any elective procedure if a patient has COVID-like symptoms, including those that are possible side-effects of the vaccine, even if their COVID-19 test is negative. Practices should notify and encourage their patients to communicate with their surgeons and fertility programs when they become eligible for COVID vaccination. This will help coordinate planned surgical procedures, fertility testing and treatment, and will decrease the chance of inadvertent procedure cancellation.

We will get thru this together.

Thank you for your continued patience and understanding during this time of uncertainty. The COVID-19 pandemic has changed many things including the way we practice fertility medicine, but one thing that has not changed is our commitment to helping our patients build families. We have been thinking about you during this difficult time and eagerly look forward to safely making your family building dreams come true. If you have any questions or concerns please contact Paul Verrastro, CARS CEO at 860.321.7082, EXT 8005.

Thank you for your continued support.

New research on obesity & infertility

Women with obesity receive inconsistent counseling about the impact that their weight can have on fertility and about weight loss strategies before they begin infertility care. This was a key finding of a research project conducted at CARS with the results presented at the ASRM Scientific Congress & Expo.

The study, conducted by Dr. Margaret O’Neill and Dr. John Nulsen noted that obesity is an increasingly important contributor to infertility among women of reproductive age. It also has been associated with increased maternal morbidity and reduced fecundity. Obesity reduces infertility treatment success as well, the researchers said, requiring complex workup before treatment begins.

Despite these obstacles and risks, few doctors regularly engage in weight counseling. Women with obesity, then, often seek infertility treatment before being advised to lose weight or counseled on how best to do so.

https://bit.ly/3aZSH6k

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