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:
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!
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.
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.
Newly Released 2020/2021 ASRM/AUA Guidelines for Male Infertility Suggest Greater Role in Evaluation and Treatment of the Male
By Stanton Honig, MD
The American Urological Association (AUA) and the American Society of Reproductive Medicine (ASRM) have combined to release new Guidelines for the evaluation and treatment of male infertility. This updates the guidelines that were last reviewed about eight years ago and gives a much more detailed approach to men who have fertility problems. In this update, we will review some of the important new concepts and why it is important for men to be evaluated.
One of the new guidelines stresses the importance of doctors to review the health risks associated with infertile men with abnormal sperm production. This has been known for years and includes the concept that men with these abnormalities may have some underlying medical conditions such as testicular cancer, genetic abnormalities such as Klinefelter’s syndrome, tumors of the pituitary gland, etc that may be responsible for their low sperm production. This is important because as one of the guidelines says “men with one or more abnormal semen markers should be evaluated by a male reproductive expert with a complete history and physical exam.” In the era of telehealth, discussion is important but physical exam can identify specific abnormalities like a testis mass.
There is also growing evidence that men who have abnormal semen parameters may have a slightly higher mortality rate or “chance of dying earlier.” This is based on preliminary data in one study, is certainly concerning. More studies are necessary to confirm whether this is true or not.
One of the other important new guidelines involves advising couples that “men who are older are at increased risk of adverse health outcomes for their offspring.” This has been noted previously with older women but now there is evidence that this is true for paternal age as well. There is a higher incidence of schizophrenia, autism and chondrodysplasia (genetically caused bony and cartilage disorders). While there is no clear definition for advanced paternal age, this risk starts to increase over the age 40 and increases further above the age of 50.
One of the important new guidelines stresses the importance that doctors discuss risk factors such as lifestyle, medication usage and environmental exposures associated with male infertility. However, the guidelines stress that the current data on the majority of these risk factors is limited. It is clear to most reproductive urologists that a “healthy lifestyle will most likely result in healthier sperm.” So eating healthy, not smoking, not drinking excessively, not using marijuana excessively and generally living a healthy lifestyle is going to portend a better outcome in terms of getting your partner pregnant.
The benefits of supplements such as antioxidants and vitamins in the treatment of male infertility are highlighted in the new guidelines as well. At the present time, existing data is inadequate to provide specific recommendations for men regarding dietary supplements. Supplements that have thought to be valuable for men include vitamin C, vitamin E, carnitine, and Coenzyme Q.
One of the most important guidelines addresses the use of testosterone in men of reproductive years.
Testosterone use will shut off sperm production and is NOT indicated in the treatment of male factor infertility. In patients with low testosterone, these patients may be treated with “off label” use medications such as clomiphene citrate or “clomid,” (a selective estrogen receptor modulator) or human chorionic gonadotropin (hCG) or with a combination of these medicines. These medications will increase testosterone but will not have a negative effect on sperm production.
One of the other new guidelines addresses the use of FSH analogues (Follicle-Stimulating Hormone) with the aim of improving sperm count, pregnancy rate and live birth rates in men with unexplained infertility male infertility. Although these studies are old, there is data to show a benefit to men. Unfortunately, these medications can be expensive and may not covered by insurance plans.
Men who have a clinical or palpable varicocele should be repaired with the hopes of improving abnormal sperm parameters. In this patient population, with normal female partners, a significant # of men will see an improvement in semen quality. In patients who have non-palpable varicoceles detected only by imaging, these should not be repaired as they do not typically result in improvement in semen quality. Seeing a reproductive urologist can be helpful to tell the difference.
In men who have azoospermia as a result of an obstruction, there are two options to achieve a pregnancy. These patients should be counseled regarding the possibility of surgical reconstruction, surgical sperm retrieval and IVF (in vitro fertilization) or a combination. The most common cases are a result of a prior vasectomy or blockages in the epididymis. In the patients who choose surgical sperm retrieval, this can either be performed timed with the ivf cycle or performed prior to an egg retrieval and frozen. The new Guidelines identify that success rates are equivalent.
In patients who have no sperm in ejaculate as a result of low sperm production (non-obstructive azoospermia), a procedure called a microsurgical testicular sperm extraction or “microTESE” should be performed to give the best results in finding sperm. 50% of the time, sperm can be found in these cases and if found, then can be combined with oocytes in vitro to achieve a pregnancy.
It is important for patients and their partners to understand the new guidelines developed by the American Urological Association and the American Society of Reproductive Medicine. Much of this is based on scientific data but it also includes the expert opinions of many reproductive urologists and has been “peer reviewed’ by multiple physicians and scientists from around the country.
Dr. Honig works closely with The Center for Advanced Reproductive Services and is a Clinical Professor of Surgery in the Division of Urology at UConn Health. He is also the Director of Men’s Health and a full time faculty member at Yale University Department of Urology and President Elect of the Society of Male Reproduction and Urology. Dr. Honig sees patients in New Haven, the Shoreline and in Farmington. He can be reached at 203-785-2815 or 860-679-4100.
The Center for Advanced Reproductive Services (The Center) has been named a Nursing Center of Excellence by the Nurses’ Professional Group of the American Society for Reproductive Medicine (ASRM). In addition, the Center also earned the Center of Excellence in Laboratory Learning (CELL) classification: the first in the country to have earned this designation. These elite certifications assure patients that the Center’s registered nurses and nurse practitioners are highly experienced in reproductive endocrinology nursing, and that the embryologists in the laboratory have completed the most advanced continuing medical education.
Laboratory CELL Designation
The CELL designation is for laboratories that have a minimum of 50% of their embryologists complete and pass the ASRM airLearning Embryology Certificate. Currently The Center is the only fertility practice out of about 450 to achieve this distinction.
“Our embryologists are more than lab technicians–they are true scientists. The ASRM airLearning Embryology Certificate course was very comprehensive and allowed our embryology team to more deeply explore and understand the science behind what we do every day. This kind of knowledge is power: scientific power we can translate into great clinical outcomes for our patients,” stated Alison Bartolucci, PhD, HCLD, Laboratory Director. “We are very proud of the enthusiasm and commitment the entire embryology team brought to achieving this goal. The threshold was 50% and, in the end, we achieved almost 90% of the IVF lab team earning their CELL certificates.”
Nursing Center of Excellence Designation
A fertility center may achieve the Nursing Center of Excellence designation if at least 50 percent of the practice’s registered nurses and/or nurse practitioners are experienced in reproductive endocrinology nursing and have completed additional training through ASRM. Of the approximately 450 fertility practices in the U.S., there are only 57 fertility programs with this designation.
“Our nurses play a key role in providing compassionate, comprehensive care. Their pursuit of continuing education demonstrates a deep commitment to their patients, the Center, and the field of reproductive medicine nursing,” said Maureen Rescildo, Director, Clinical Operations. “Achieving this designation took an incredible amount of energy and time: time that probably would have not been available if not for our shut down during the COVID crisis. This is truly an example of making lemonade out of lemons. The Center is extremely proud to have received this recognition.”
These acknowledgements recognize the Center as an organization committed to advanced continuing education for our expert and dedicated staff and positions the Center among the nation’s most learned family building programs.
The Center is currently experiencing phone issues at all its offices. We have contacted Windstream and they are working on the problem. If you have an urgent need please call our service directly at 860-280-3321 and they will get your message to us.
Also, due to a traffic accident this afternoon we have lost all power in our Branford office. We are closing the office for the afternoon and re-assigning staff to other CARS locations.
Thank you for your support and patience.
Join us for a special conversation, in partnership between the New Haven Pride Center and the Center for Advanced Reproductive Services, on one of the hottest topics in the LGBTQ+ community – Parenting! Join us as parents, community members, and health experts talk about family building options from surrogacy to pregnancy.
Thursday, June 17th at 6 PM. LIVE on the Center’s Facebook page, or on the New Haven Pride Center’s Facebook page or youtube channel.
Updated June 3, 2021
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 has remained stable with COVID-19 cases and hospitalizations, we are writing to tell you about fertility treatments at CARS at this time.
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 June 3, 2021:
- We are currently at 100% of normal volumes for IUI & IVF and 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. Those who are not vaccinated are on a weekly COVID 19 testing schedules.
Next Steps [effective Monday, June 7, 2021]
- All CARS facilities will continue to require ALL patients and partners, children, guests, etc to always wear masks.
- All patient consults will continue to be remote via TEAMS.
- 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.
- Virtual waiting room, texting to enter. Patients can come right in. Please arrive as close to your scheduled time as possible to control patient traffic thru the offices.
- Patient screening tables
- A modified screening will occur at each clinical entrance:
- Do you have any cold or flu symptoms?
- Have you traveled internationally?
- A modified screening will occur at each clinical entrance:
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.
- Partners and other family members are welcomed for all visits so long as masked at all time.
- Children are allowed in building so long as masked.
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.
- 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 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.
- 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.
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.
CARS will begin to see all satellite patients for basic monitoring [bloodwork and monitoring ultrasounds]. As always CARS will not perform pregnancy testing or ultrasounds on satellite patients.
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.
Have a great summer and thank you for your continued support.
Paul Verrastro, CEO
Update May 3, 2021
Effective Wednesday, May 19 the governor is lifting all COVID 19 business restrictions in CT. Since late March there has been no travel ban.
In recognition of this, and in an abundance of caution, attached find our revised COVID 19 Mitigation and Travel Policy. Please take the time to read it. Below are highlights. These changes will be effective as of Monday, May 24, 2021.
Please let us know if you have any questions.
The following COVID mitigation practices will continue until further notice:
Virtual waiting room program [patients wait in cars and are texted in}
- Virtual New Patient visits.
- SA produced at home [unless > hour away]
- Front door screening and temps
- Scheduled appointments only. No walk-in scans or bloods
- Virtual follow up visits.
- No children
- Continue weekly testing for unvaccinated staff.
However, the following restrictions will be LIFTED:
- Prohibition on partners. Allow partners [or another family member] in for all live visits. However, PACU is still off limits to partners per anesthesia. No children under any circumstances.
- Start allowing satellite patients in IF patient was a past patient of CARS.
All of the guidelines outlined in this document are subject to change based upon new local, state and federal recommendations.
COVID-19 vaccination program
- CARS employees are strongly encouraged to obtain the COVID-19 mRNA vaccine. At this time, it is not a requirement. However, those employees who have not received the vaccine may be asked to undergo serial COVID-19 testing at the cost of CARS.
Addendum to CARS COVID-19 Management and Mitigation:
Travel to States listed on CT Travel Advisory List
Mandatory travel restrictions have been lifted in the state of CT, as of March 19, 2021. However, travel advisories remain in effect from both the state and the CDC. With that in mind, while CARS has modified its travel policy for both staff and patients, restrictions will remain in place in order to maintain the safety of the practice.
For all employees and patients:
Any domestic or international travel will require COVID-19 testing within 3 days of return and prior to entry into CARS.
This policy does not apply to travel to any state that borders CT including MA, NY and RI. No testing is required after travel to these states.
This policy applies to all employees and patients regardless of vaccination status.