Fertility Matters

Coverage at Work Program

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:

• PMID23737821
• Pine bark significantly reduces endometriosis

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

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

Ease stress from TTC with self-care

If you are looking for a form of self-care that’s nurturing, grounding, warming, and relaxing – try Abhyanga. Help ease your stress from TTC with this self-care practice you can do from home. Head over to the ink in our bio aead the latest from our Health Coach Ami Chokshi:

3 Things You Can Do if You are Trying To Conceive with PCOS

by Ami Chokshi
National Board Certified Health & Wellness Coach

September is PCOS month, and PCOS-related infertility affects so many women these days. PCOS symptoms often include:

• Irregular periods,
• Weight gain or weight loss resistance,
• Hair growth on your face or body,
• Acne, and
• Dark patches of skin

…. but you already know this if you have PCOS.

So, let’s talk about how you can manage your symptoms to support your fertility journey.

Insulin resistance is often a major factor associated with PCOS, and this means that your body cannot respond properly to the insulin it makes. Keeping your blood sugar steady throughout the day will help you sustain healthy hormone levels, keep your mood even, and support a more regular menstrual cycle.

I work with women who want to maximize their chances of getting pregnant by optimizing their health. These are women who are asking their doctors, “what else can I do outside of treatment.” These are some tips I share with them to get them started…

Step 1: The Winning Food Formula

Food is where I start, and the first step to managing your PCOS is to eat in a way that keeps your blood sugar steady. The winning formula is: Fiber + Protein.

I recommend eating both fiber – in the form of veggies – and protein in every meal. This dynamic duo will keep your blood sugar from spiking in either direction. And, it works regardless of what diet you subscribe to…from vegan to keto. It will keep you from feeling hangry, irritable, or sleepy. And it will help you keep your weight in check. If you are trying to lose weight, remember this catchy phrase…

“Fiber and protein in every meal makes losing weight no big deal.”

You can apply this to your daily meals by:

• Adding spinach to your scrambled eggs,
• Including kale with a low sugar smoothie and a plant-based protein,
• Eating a big salad with chicken for lunch, and
• Covering half of your plate in veggies plus a protein for dinner. 

Step 2: Move Your Mass

Next, incorporating high intensity interval workouts decreases insulin resistance and is the best exercise to mobilize excess body fat.

This can look like a 20 minute HIIT workout from Fitness Blender (check out some the HIIT workouts here🙂

…or 3 sets of the Scientific 7-Minute Workout (here is the app).

If you have had a heavy meals and need a quick blood sugar stabilizer, lace up your sneakers and go for a walk. Even 10 minutes around the block will help lower your blood sugar.

Step 3: Flush it out

Finally, drink your H20.

 I know you know this, and you have heard this a dozen times… But, how often are you doing this? Staying hydrated helps remove excess sugar from your blood through your urine. Half of your body weight in ounces is often the guideline, so if you weigh 150 pounds, aim for 75 ounces of water. Another way to know is to check the color of your urine. Aim for pale yellow.

Hydration isn’t only about drinking water.It also means making sure you have an adequate electrolyte balance. Electrolytes – like potassium, magnesium, and sodium – can be added to your water and are critical for replenishing needed minerals and feeling hydrated. They support chemical reactions that take place in your body for optimal hormone health.

A basic rule of thumb is this: if you have go to the bathroom within 5-10 minutes of drinking water, consider adding electrolytes (or even a pinch of pink sea salt) to your to your next glass.

Stick with these basics and be sure you are sleeping 7-9 hours, and you will notice results…from better energy and weight loss to calmer hormones.

Want help getting started? Check out my free PCOS 7 Day Meal Plan. Simply share your email here, and I will send it (plus additional fertility tips) to you right away!

 

 

 

 

Welcome Reeva Makhijani, MD

We are pleased to announce that Dr. Reeva Makhijani has joined The Center as a Lead Physician. She is also an Assistant Professor in the Department of Ob/Gyn at UConn School of Medicine. She will be seeing patients in the Center’s Branford, New London and Farmington locations. Dr. Makhijani is involved in all aspects of fertility care and family building and has passionate professional interests in fertility preservation, transgender health, oncofertility and third-party reproduction.

According to Dr. Daniel Grow, Associate Fellowship Director at the Center, “Dr. Makhijani has distinguished herself as a compassionate doctor and gifted academic and researcher. We are proud to have her as part of our team. Together, we will continue our commitment to clinical excellence and family building, one patient at a time.”

Dr. Makhijani is Board Certified in Obstetrics and Gynecology and board eligible in Reproductive Endocrinology & Infertility [REI]. Her REI Fellowship was completed at The Center and UConn School of Medicine, joining Dr. Schmidt, Dr. Engmann and Dr. DiLuigi, all of whom were past REI Fellows with The Center and UConn. During her 3-year fellowship at the Center, Dr. Makhijani authored many publications, posters and presentations on fertility.

Dr. Makhijani graduated with her medical degree in 2014 from NYU School of Medicine and completed her Ob/Gyn residency at Brown University/Women & Infants Hospital in Rhode Island where she was administrative chief resident in 2017-18. She has been the recipient of numerous awards and honors for her commitment to teaching and academic excellence.  

To Our New Patients at Our Branford Office

As part of welcoming Dr. Makhijani to the shoreline community, the Center for Advanced Reproductive Services is happy to offer the convenience of ZocDoc to our new Branford patients. ZocDoc will allow you to see doctors’ open appointment times and instantly book your Branford office new patient appointment online.

Ambulatory Surgery Center Achieves AAAHC Accreditation

The Center for Advanced Reproductive Services (CARS) ambulatory surgery center has been accredited by the Accreditation Association for Ambulatory Health Care (AAAHC). Accreditation distinguishes the CARS ambulatory surgery center from many other outpatient facilities through its adherence to rigorous standards of care and safety. Status as an accredited organization means CARS has met nationally recognized standards for the provision of quality health care set by AAAHC. “Accreditation underscores our commitment to providing the highest possible levels of quality care,” stated Paul Verrastro, CEO, The Center for Advanced Reproductive Services. “We are extremely proud to have our efforts recognized with this accreditation.”

While the onsite survey is an important component of the process, ongoing compliance and continuous improvement are part of the accreditation maintenance mindset that a facility should integrate into its daily activities long after the survey has been completed. The intent of accreditation is for organizations to adopt policies and procedures that fuel ongoing quality improvement and self-evaluation every day. Ambulatory health care organizations seeking AAAHC accreditation undergo an extensive self-assessment and onsite survey by AAAHC expert surveyors – physicians, nurses, and administrators who are actively involved in ambulatory care. The survey is peer-based and educational, presenting best practices to help an organization improve its care and services. More than 6,100 ambulatory health care organizations across the United States are currently accredited by AAAHC.

1095 Strong is a transformational movement and call-to-action spearheaded by the AAAHC to equip ambulatory leaders with the best of what they need to operationalize quality practices. The three-year, or 1,095-day, period between accreditations is a critical time when ambulatory health organizations, with help from proven experts, can develop the kind of everyday habits that enable leaders in the industry to provide the utmost in quality care to their patients. Organizations, such as CARS that earn AAAHC accreditation embody the spirit of 1095 Strong, quality every day, an ongoing commitment to high-quality care and patient safety.