Fertility Matters

Wall of Hope

This week is National Infertility Awareness Week. Typically, the Center would be incredibly busy with events designed to recognize this special week. This year, we all feel a sense of loss, particularly as this was always a fun opportunity to interact with so many of our many wonderful patients.

One of the events we had planned this year was the unveiling of the 2020 Wall of Hope. Since we couldn’t make it happen, Janine Fazzina Boudo, a former patient and photographer at Bella Blue Photography, put this montage together for us.

Wishing everyone a very happy National Infertility Awareness Week.

 

Covid-19 and How It Is Affecting Us and Your Care

By John C. Nulsen, MD
Medical Director, Center for Advanced Reproductive Services
Professor of Obstetrics and Gynecology

This is an unprecedented and challenging time, made all the worse by the fact that we do not know when the COVID – 19 pandemic will subside and come under control. As we move through this threat, please know that you are not alone. As part of a medical community, we are focused on how to best help quicken the resolution of this pandemic, so that we can get back to serving you as quickly and as safely as possible. These efforts focus on helping to bend the viral transmission curve to assist in ensuring our region’s hospitals and ICUs are not overwhelmed and have the necessary equipment and personnel, and on helping to ensure that our services to you continue uninterrupted. 

ASRM Guidelines

The American Society for Reproductive Medicine (ASRM), the global leader in reproductive medicine, has issued guidance for its members as we manage patients in the midst of the COVID-19 pandemic.  Many elements have contributed to the success of CARS over the years, in particular, our strict adherence to ASRM guidelines. Developed by an expert Task Force, of physicians, embryologists, and mental health professionals, the ASRM COVID – 19 guidelines, effective March 18, 2020, are as follows:

1. Suspension of initiation of new treatment cycles, including ovulation induction, intrauterine inseminations (IUIs), in vitro fertilization (IVF) including retrievals and frozen embryo transfers, as well as non-urgent gamete cryopreservation;
2. Strongly consider cancellation of all embryo transfers, whether fresh or frozen;
3. Continue to care for patients who are currently ‘in-cycle’ or who require urgent stimulation and cryopreservation;
4. Suspend elective surgeries and non-urgent diagnostic procedures;
5. Minimize in-person interactions and increase utilization of telehealth.

In addition, as a licensed ambulatory surgery center in Connecticut, we have to be mindful of recommendations set forth by the state’s Department of Health. Connecticut Department of Health [DPH] Guidelines:

• Currently the order to stop performing surgeries/procedures in outpatient surgical facilities is not addressed in the executive orders or Commissioner Orders.  There have been recommendations from the Centers for Medicare and Medicaid Services (CMS) to cease elective surgeries/procedures to stop the spread of COVID-19 and to conserve PPE.  So, the decision to cease performing procedures is a business decision for the individual facility;

• Family planning services (including IVF) were exempted in the governor’s order.
• DPH strongly recommends licensed Ambulatory Surgery Centers follow guidelines set forth by Center for Disease Control [CSC].

What CARS is Doing

CARS continues to be operational and is here for you. All clinical provider patient schedules have been transitioned to phone calls or video conferencing. Patients can call our main number to schedule appointments.

Each of our offices remains open with minimal staff to address urgent and emergent patient care needs such as confirmatory pregnancy scans, pain, bleeding, onco-fertility, etc. Our goal is to keep patients out of emergency rooms and the already strained regional hospital system.

All IUI and IVF services have been temporarily suspended. We continue to follow recommendations from ASRM, CT DPH and closely track regional COVID – 19 data. We hope to be able to resume treatments in at least some limited way by June 1.

The majority of our dedicated staff are working remotely from home but remain available to you throughout the day and weekends by calling our front desk. Although we remain open, all doors are locked so as to control health screening and admission into our offices. There are intercoms on front doors to call for entry. Upon entry, everyone is screened for social/health history and temperatures before being allowed into any clinical area. If you need to come to the office, we are asking that you do so alone. If a partner needs to drive, we are asking they wait in the car.

Through our partnership with Quest Diagnostics we continue to provide urgent and emergent blood draws in our Farmington location 9:30 am to 3 pm. 

Treatment Interrupted

We know it is extremely difficult to consider postponing fertility treatments. Most people have gone through tremendous loss and grief by the time they get to the place where they are doing an IUI or IVF cycle. In addition, navigating the cost and insurance coverage aspects is daunting. Many having come so far on their fertility journey are now dealt a huge unknown with the COVID-19 pandemic; wondering if they should proceed, or start, this medical treatment. It should be somewhat helpful to hear that there is no evidence that delaying treatment for a month or two will ultimately affect anyone’s ability to have a child, even those with concerns about advanced age and/or diminished ovarian reserve (low egg supply). The ASRM recommendations will be continuously reviewed and updated, as we know that many people do have concerns about waiting longer than two months. 

How Does Covid-19 Impact Fertility and Pregnancy?

Research is still ongoing in this area. There are no studies indicating that the virus has any impact on fertility. While Coronavirus fears have caused some people to seek out egg freezing, there is no known medical indication to seek out egg freezing as a preventive measure.

If you have tested positive for COVID-19, the Society for Assisted Reproductive Technology (SART) recommends avoiding getting pregnant for now and waiting until one fully recovers before attempting conception (either naturally or via assisted reproductive technology).

According to the World Health Organization (WHO), pregnant women don’t appear to be at a greater risk for illness related to COVID-19 — and only 1% of pregnant women infected have experienced severe illness that required medical attention. However, the American College of Obstetricians and Gynecologists (ACOG) notes that very little is known about the effect of COVID-19 on pregnant women and infants. It is unclear if COVID-19 can cross the placenta. Because pregnant women are at greater risk of severe complications from similar respiratory infections, they are considered an at-risk population for COVID-19.  A study was conducted on nine pregnant women infected with COVID-19 in Wuhan, China. All women recovered from their illness and all nine had live births without any evidence of transmitting the virus to the baby. The virus was not detected in samples of cord blood, amniotic fluid, or throat swabs from the newborns, or breast milk. However, the COVID-19 infection was recently found in a newborn, so “vertical transmission” (meaning passage of the virus from mother to baby during the period immediately before and after birth) cannot be excluded at this point.

Support

Infertility treatment under the best of circumstances can be stressful. The conditions created by the COVID-19 pandemic certainly add to that stress. There are things you can do to help reduce that stress. CARS has an in-house, trained reproductive mental health provider who can consult with you on how to manage the stress and emotions surrounding this extremely difficult set of circumstances. Dr. Kim Crone is offering telehealth options to fertility patients and is available by calling our front desk.

The National Infertility Association (www.resolve.org) and RESOLVE of New England (www.resolvenewengland.org) have resources and various ways to get support. Both have an online support community, local support groups (now meeting virtually), webinars, and other content to help patients connect, get support, and stay informed. Also, we are continually adding patient support content to our Facebook page, https://www.facebook.com/uconnfertility/.

Together, we must stay focused on fighting the present viral threat. We can do this in numerous ways – by reassuring and educating you through telehealth, helping to “bend the curve”, by implementing social distancing mechanics for patients and staff, and ensuring both our own emotional and physical well-being, as well as that of our patients, staff, colleagues, and friends and family remains a priority. At CARS we are convinced we will come out of the current test stronger; as a community of women’s health professionals, as a nation, and as a global society. 

Be healthy. Be safe.

On Hold…Maintaining Hope During this Time of Uncertainty

Whether or not you’ve completed a cycle before or this was to be your first, hearing from the Center that your treatment is being put on hold due to the coronavirus outbreak is undoubtedly disappointing, and that’s probably an understatement.  In the meantime, you’re dealing with all of the anxiety the rest of the world is feeling about coronavirus, with the added concern about its unknown impact on fertility and pregnancy. It’s a lot to take.

The rational side of you probably understands that this decision was made in accordance with the recommendations from the American Society of Reproductive Medicine in an attempt to protect you and your potential pregnancy.  But the emotional side of you is devastated and grieving the hope of conceiving this spring. You have been living with uncertainty about conceiving already; the added uncertainty brought on by the coronavirus crisis might feel overwhelming. And the hormones aren’t helping either.   

You are probably experiencing lots of emotions right now: anger, sadness, frustration, disappointment, grief, anxiety, or all of the above.  These are all completely understandable and normal. No one can tell you differently. You are the one going through this and owning the emotional response you’re having is only fair to yourself.  But what’s not fair is to believe you have to continue feeling that way. These are very strong emotions, and they will fade. Own your negative emotions, then try to figure out ways to get past them.  They aren’t helping you feel better.    

Let’s talk about some strategies that might help you feel more in control of your emotions right now.  Here are some techniques aimed at coping with the negative emotions related to your treatment being put on hold and the crisis our country is in at present:  

Keeping Perspective: Although it’s very tempting to start catastrophizing, whether it be about coronavirus or your fertility treatment, this unhealthy thought pattern serves no purpose. It just pushes you further down the dark rabbit hole. Everyone is confronting challenges right now, and trying to remember those things in your life for which are grateful can keep you from falling into that hole. Whether it be your partner, your friends and family, your job, your home or the excellent blueberry muffin you had for breakfast, gratitude can go a long way in helping you keep perspective. So can remembering that others are dealing with worse and scarier situations at the moment.  And lastly, remember that this is a crisis, and crises are temporary. No one knows how long this will last, or when cycles at CARS will get back to normal, but rest assured they will get back to normal. Keeping in mind the temporary nature of this unpleasant situation can help you get through it and remain hopeful about what awaits on the other side! 

Self-nurturance: Now more than ever, this is the time to take care of yourself, both physically and emotionally.  This is an opportunity to get as healthy as you possibly can so that you can be in a really good place for your next cycle.  This might include eating healthy meals, exercising regularly, and getting plenty of sleep. It might also include pampering yourself so that you can feel as good as possible during this difficult time.  Take some time to do something that is soul-nourishing for you. Some examples are: Learn a new skill or brush up on a foreign language. Read a book or magazine that you haven’t gotten to (I usually save Elin Hilderbrand for my summer beach reading, but I just ordered a few of her books for my coronavirus reading–we all need some happy endings right now!) Take a mindful walk, appreciating the outdoors, fresh air, and extra time you have.  Make a decadent dessert that you haven’t had time to make before. Learn to knit. Binge watch that show everyone has been bugging you to watch. Practice deep breathing, meditation or visual imagery (you can find some great videos on YouTube or on the fertility coping app–FertiCalm, which I recommend highly.) Anything that helps you feel better–you deserve to feel better!     

Social Connection:  Social distancing doesn’t mean social isolation.  If you have shared your fertility journey with others, reach out to them now for support and distraction.  If you have kept this journey private, possibly consider opening up to at least one trusted person in your life for support and as a sounding board.  It can be a huge relief to open up about what you’re going through. But be patient with people–no one can say the exact right thing all the time. They mean well and are trying.  If that’s all too much, and you still want to keep things completely private, still reach out to a friend or loved one for mutual support in this difficult time.  

Take a Break from Media Coverage: Right now, hearing about the details of the pandemic over and over again can essentially result in re-traumatization and can be exhausting.  Take breaks from watching the news and reading about the crisis. This includes social media–especially if you tend to be drawn to the more heartbreaking stories.  I know we are all yearning for some reassurance and confirmation that we are doing the right things to get through this. And it’s OK to watch some news coverage or check out a news source you trust.  But focus on getting facts, and if you find yourself feeling overwhelmed, stop! At least for some time, most of the statistics are going to get worse before they get better and none of us needs to hear bad news getting worse.  So be selective in what you are taking in and know your limits.     

In uncertain times, finding some aspect of your life that you can control can be beneficial.  These coping strategies can help give you a healthier sense of control and remain hopeful about the future.  Pick and choose which ones of these fit best for you. Your goal is to be healthy, energized and ready to go when it’s time to get back to CARS and get closer to your dream of growing your family.  

Take care of yourself and be well!  Feel free to call me at (860) 830-8862 to discuss some additional support options.

Kim Crone, PhD
Psychologist, Center for Advanced Reproductive Services

Covid-19 Updates

We are regularly updating our website with information relating to the Center and Covid-19. Please go to this page for the most up to date information.

Boost Your Fertility with this Essential Mineral

Do you crave chocolate in the second half of your cycle? Does stress have a toothbrush at your house? Are caffeine and sugar a fixed staple on your weekly meal plan and shopping list? If you answered yes to any of these, you likely are in need of magnesium. 

Magnesium is an essential mineral for your health and fertility.

​It’s responsible for 700-800 enzyme systems in your body. It supports chemical reactions in the body, helps you detoxify the fertility muggers through your liver, and is responsible for converting the food you eat into cellular energy. 

Magnesium is life-enhancing, but if you don’t have it becomes life-threatening. 

Most Americans – around 80% – are deficient in magnesium. Because the western diet is so focused on grains and processed foods, the majority of the magnesium that is in the grains is lost when foods are processed. Eating refined sugar also depletes magnesium. In the Women’s Health Study at Harvard, where 17,000 women were studied, women with a high carbohydrate diet were seen to be more infertile than those that ate fewer sugars. These high sugar diets are responsible for increased insulin resistance, which is often seen in women with PCOS. This can lead to an ovulatory dysfunction. Magnesium-rich diets help preserve insulin sensitivity and ovulatory function. 

Because magnesium is responsible for so many functions, there are numerous benefits to making sure you have enough magnesium in your diet. 

Magnesium supports stress and sleep.

When you are trying to conceive and not having success, I know how stressful it can be and your sleep may be affected too. Magnesium can be depleted in times of stress, so having enough magnesium will help you relieve stress because it’s a powerful relaxation mineral. It works by keeping your cortisol levels under control, so your insulin levels do not spike, which drops your blood sugar. Keeping your blood sugar stable is a key component of what I teach with my fertility clients. Steady blood sugar ensures steady energy going to your cells. When you take magnesium before bed, magnesium can also help you get a restful night’s sleep, which is THE most critical lifestyle component to optimal fertility.

Magnesium helps balance fertility hormones progesterone and estrogen.

Magnesium controls follicle-stimulating hormone, or FSH, because estrogen-dependent on magnesium status, and FSH is the hormone that stimulates the ovaries. Low magnesium can also signal to low progesterone levels, which can lead to a short luteal phase and increased miscarriage risk. Finally, for those of you that struggle with PMS, magnesium should become your friend. Magnesium levels fall before your period, so ensuring enough magnesium helps you produce serotonin and feel good. 

Magnesium also helps decrease inflammation. 

If you are trying to conceive with IVF, this means that having a diet rich in magnesium can improve your chances of a successful embryo transfer. This is because you are lowering your overall inflammation and increasing the chances of implantation. 

Magnesium is anti-aging. 

Fertility is often about turning back the clock, and magnesium can help with this. When your body is deficient, it ages at an accelerated rate. Many of you may be taking CoQ10 to support your cellular health, including egg cells and sperm cells. And while CoQ10 supports egg quality, it is responsible for only one (of eight) of the steps related to converting food into energy. On the other hand, magnesium is necessary for six of the eight steps where carbohydrates, fats, and proteins are converted to energy. In other words, for improved sperm and egg quality, continue taking the CoQ10, but also supplement with magnesium.

Magnesium supports your male partner’s fertility.​

In many instances, what’s good for the goose is good for the gander, and magnesium is responsible for enzymatic functions in your partner’s body as well.  Male factor infertility has also been associated with men have lower magnesium levels, so be sure to share your magnesium foods and supplements with your partner.

What are the best magnesium-rich foods?

Typically foods rich in dietary fiber like green leafy vegetables, legumes, nuts, seeds, and whole grains, are good sources. Additionally, seaweed and low sugar, dark chocolate are as well, but I would hold off on too much chocolate. While craving chocolate in the second half of your cycle is common, the better solution would be to supplement with magnesium.

There are a couple of ways to supplement with magnesium. 

One way is to take a powdered form or ionic form of magnesium. Natural Calm and ReMag are two brands that I recommend. Natural Calm may have a laxative effect on some people, so sip it throughout the day instead of taking it all at once and start on a lower dose (based on the label recommendations). Another effective and calming way to absorb this mineral is to take an Epsom salt bath (or foot soak), which is a great way to receive magnesium transdermally or through your skin. Simply, add a cup of Epsom salt to your warm bath, and step into the tub for a dose of relaxation and self-care. 

I believe your fertility is a function of your whole health, and sufficient magnesium is a necessary mineral for you as well as your future child.

Ami Chokshi is the Center’s Integrative and Functional Nutrition Health Coach. As a former IVF patient and RESOLVE Group Support Leader, Ami guides fertility patients towards optimal wellness and helps them navigate their fertility journey. Through lifestyle and behavioral adjustments, she provides patients with education and support to achieve their health-related goals. She also partners with your provider to help implement their recommendations for your health and treatment plan.

To contact Ami for a complimentary consultation or register to receive her fertility lifestyle tips, please click here to go to her webpage.

Make Dreams Come True While Pursuing Your Own

Become An Egg Donor

Did you know that February is not only Valentine’s Month – but also National Donor Month? This is a great time to raise awareness and explain how someone like you could possibly help make dreams come true by becoming an egg donor. In fact, just one donor can help multiple couples achieve their dream of having a child.

The Egg Donor Program at The Center for Advanced Reproductive Services assisted in conceiving the first child born from a donor egg in New England in 1987. Since then, we’ve helped many women conceive with donated eggs and our program continues to grow. The gift egg donors provide is truly the answer to many couples’ dreams and we are reaching out to healthy women between the ages of 21 and 32 to help identify more potential donors.

The Process of Becoming A Donor

Candidates interested in becoming an egg donor go through a careful screening process that helps us determine if you are medically and genetically appropriate and emotionally prepared for donation. All information is kept completely confidential. Insurance coverage is provided, and there is no cost to potential donors for any tests or consultations.

Here’s a look at the process to become an egg donor:

Compensation 

To complete an egg donation cycle, donors commit time, energy and emotion. Donors who complete the cycle will be compensated $8,000 for their time and inconveniences. Following the experience of egg donation, most donors feel a great deal of satisfaction from this act of giving.  

To Learn More

If you think you would like to be an egg donor at The Center, please call our Coordinator at (860) 321.7082 EXT 8014 or visit www.donoreggct.com.

The ART of Radical Self Care

“Creating a habit of radical self-care enables you to be more in control of your thoughts and emotions and builds resilience during fertility challenges.” Check out this guest blog from the Center’s Health Coach, Ami Chokshi, in Circle & Bloom.

Overcoming Valentine’s Day Challenges When Infertile

Many holidays we celebrate are focused on families—and for those struggling with fertility—on the babies they don’t yet have. While Valentine’s Day is really focused more on couples, still, it can bring its own kind of stress.

While some couples can consciously reconnect with their partners and indulge in the many standard Valentine’s Day romantic options, others can feel burdened and become more anxious by the added expectations society places on this “lovers’ holiday”. 

Those without fertility challenges will never understand how disruptive fertility treatments necessarily are to the romance in a relationship. What used to be private and intimate has suddenly been thrown into the light, exposed, and placed under the literal microscope. While most prospective parents don’t think twice about sacrificing some privacy in the quest for a baby, fertility treatment can temporarily impact their love life.

Fortunately, continued advancements in assisted reproductive technologies and higher success rates for IVF can mean shorter infertility journeys for many patients. But if realizing that baby dream is taking a bit longer than expected, the daily grind of testing and treatments, semen collecting and/or timed intercourse can make it hard to keep the passion in lovemaking. 

When all a couple wants is takeout pizza in sweatpants and midnight baby feedings, a Valentine’s Day focused on chocolate hearts, satin sheets, flowers, and champagne fall far short of what the heart needs. And those who are single—by choice or by circumstance—and are unable to have a baby of their own also suffer on Valentine’s Day. In fact, having neither a partner nor a baby on Valentine’s Day can be extra painful for those who wish for both.

Infertility is hard on even the strongest relationships. There will be bad days and not-as-bad days. But if the time comes where are you or your partner feel you can benefit from professional counseling, the Center offers support that can help ease the tougher times. HealthCircle, our holistic approach to fertility care, can help you enhance your fertility treatment plan with programs that are meaningful, relevant and personal, including supportive counseling. We offer many individual and group solutions that can help overcome fertility obstacles, provide relief from emotional stress, and support and guide you on making the best decisions for treatment. 

The most important thing to remember–you truly are not alone.

 

Elective Single Embryo Transfer

By Claudio Benadiva, MD, HCLD

You are probably familiar with the issues of multiple births resulting from fertility treatments. Some of the health and ethical problems have been a focus of the news since the birth of octuplets to a California woman in 2009. IVF procedures are not perfect and come with risk, so it became standard practice to transfer more than one embryo to improve success rates. Transferring multiple embryos can result in multiple births, which carry a number of risks, including prematurity, low birth weight, learning disabilities and developmental problems for the infants, and preeclampsia, gestational diabetes, and cesarean section for the mothers. And of course, this also increases the costs for delivery and subsequent hospital stay. Some estimates for the 2009 octuplets placed the hospital costs alone between $1.5 and $3 million.

But years worth of advancements and better clinical management, along with guidelines from the American Society for Reproductive Medicine, have greatly improved the results for elective single embryo transfers (eSET). Here at the Center, the majority of our births are singleton deliveries, resulting in healthier moms and healthier babies. In fact, our most recently published data from the Society for Advanced Reproductive Services from 2016 shows that 81% of our IVF births were singleton births. 

Today, with better techniques for growing and selecting the best quality embryos, transferring one embryo instead of two or more is a viable option for many women, depending on their age and other fertility-related issues.  Women/couples who don’t want to risk multiple pregnancies or who have a preexisting medical condition for which a multiple pregnancy would not be safe should consider single-embryo transfer, and we advise you to consult with us to see if it makes sense for you.

Our Center’s goal is to achieve the highest live birth from single embryo transfers and to continue to improve outcomes for all IVF patients.

Congrats to Dr. Nulsen, Dr. Benadiva and Dr. Grow

Congratulations to Dr. John Nulsen, Dr. Claudio Benadiva and Dr. Daniel Grow as having been named by their peers to the 2019-2020 Best Doctors in America®List. Approximately 4 percent of U.S. doctors are named to the list, according to Best Doctors, Inc.

“The physicians included in the Best Doctors in America database provide the most advanced medical expertise and knowledge to patients with serious conditions – often saving lives in the process by finding the right diagnosis and right treatment,” according to Best Doctors, Inc.

To be selected for the list, physicians must be nominated and then voted on by existing members of the Best Doctors in America List.

As one of the largest fertility programs in the country, we are proud to have played a role in the births of over 13,000 babies.