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Trying to Conceive

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The staff at the Reproductive Science Center (RSC) understands that the decision to seek fertility treatment can be difficult. For a couple considering fertility treatment, it is important to ask the right questions about success rates, costs, medical services, and financial options. Also, consider your relationship with, and trust in, your physician.

Our advice to patients considering fertility clinics is to be certain they understand all aspects of their decision, and to make certain they receive understandable answers to any questions they may have. Understanding these issues before beginning treatment can save time, energy, frustration, and money. It may also increase your chances of achieving a successful pregnancy.

1. What factors should be considered when choosing a treatment program?

  • Success rates
  • Full range of procedures performed
  • Treatment flexibility and customization
  • IVF program stability over time, with an established “good track record”
  • Financial options, including insurance participation and financing
  • Staff accessibility and response

2. Is it possible to evaluate clinics objectively?

Interpreting statistics of fertility programs requires patience and care. Individual assisted reproductive technology (ART) programs do not use a standard format for reporting their success rates in advertisements and promotional literature, making comparison among clinics difficult. The Centers for Disease Control and Prevention (CDC) and the Society for Assisted Reproductive Technologies (SART) publish clinic-specific data on most of the ART programs in the U.S. Each clinic reports its annual outcome data to SART in a standardized format.

The SART report is comprehensive and provides valuable information about each clinic, including the number of cycles performed, pregnancy rates by age (with or without male factors), miscarriage rates, and average patient age.

You may be able to see trends or patterns that will help you understand the quality, stability, and experience of the programs you are considering, especially if evaluated over time. The SART reports are available online on a clinic-by-clinic basis.

We encourage you to visit the American Society for Reproductive Medicine (ASRM) for information on objective criteria.

3. How do I evaluate clinics based on current statistics?

While recent advances in fertility treatment are improving patients’ chances for success, it can also mean that the most recently published statistics available from CDC/SART may not reflect your actual odds. Ask the clinics you are considering for current statistics. Be sure to ask for documentation on the statistics, as well as for statistics for your age range and infertility diagnosis.

Since beginning an IVF program, RSC has published a comprehensive statistical analysis. of all ART cycles performed in its center and outcomes. We strongly encourage anyone considering advanced fertility treatments to obtain the same information from each clinic they are considering. View our most recent success rates.

4. How important are the statistics?

Couples with normal fertility have a 20-to-25-percent chance of conception each month if they have intercourse at the proper time of the cycle. Therefore a fertile couple has at least a 93 percent chance of achieving pregnancy within a year.

To help you understand how important success-rate statistics are, we’ll compare two theoretical clinics, Clinic A with a 30-percent delivery rate per cycle and Clinic B with a 12-percent delivery rate. From the chart below, you can see that the average couple undergoing IVF can expect:

  • Clinic A (30 percent delivery rate): a 65 percent chance of delivery after 3 cycles
  • Clinic B (12 percent delivery rate): a 31 percent chance of delivery after 3 cycles
Clinic A:
30 % Delivery
Rate		Clinic B:
12% Delivery
Rate
# of Couples# of Deliveries# of Couples# of Deliveries
Cycle 11003010012
Cycle 270218810
Cycle 34914789
Total
Deliveries		6531

You may also notice that you have nearly the same odds of success in one cycle at Clinic A as you have with three cycles at Clinic B. So, even if Clinic A’s fees are higher than Clinic B’s, you may save money with treatment at Clinic A.

5. How do I know that the fertility center I am considering offers a full range of services?

First, ask a lot of questions and listen carefully. Some centers specialize in one form of treatment, and all patients receive that form of treatment; unfortunately, other, more effective treatments may be overlooked. At RSC, we offer a full range of fertility treatments, and each patient undergoes a comprehensive assessment to ensure that all options are considered.

Secondly, we encourage patients to ask about all possible treatments, including surgery, intrauterine insemination (IUI), in vitro fertilization (IVF), egg donation, embryo freezing, and a full range of embryology services, including intracytoplasmic sperm injection (ICSI), embryo hatching, and preimplantation genetic testing (PGT).

6. Does it matter how long a program has been in existence? Isn’t newer better?

At RSC, we believe one of our strengths is our stability and longevity. Our physicians have been working together for almost 10 years, and we have worked with the same embryology laboratory director for over 20 years.

We recommend that anyone considering fertility treatment ask each clinic under consideration about stability and years of experience of the physicians and the embryology staff. Infertility treatment, particularly IVF, requires a great deal of timing, coordination and communication between doctors and embryologists. The longer teams have worked together, the more effective they are in assuring a well-executed treatment plan.

7. How much does treatment cost?

The costs for infertility treatments vary widely among clinics. The best way to assess your ultimate cost is to ask each clinic for a copy of its fee schedule. It is important to determine if there are any additional fees not included in the fee schedule such as hospital charges, drug costs, and testing.

At RSC, we recognize that cost is an important factor when selecting an ART program. Our financial options page provides information related to our refund and discount programs, as well as financing options.

In the San Francisco Bay Area, the costs for one cycle of IVF range from $14,000 to $19,000, plus medications.

The cost of medications is a significant portion of the total IVF expense, and can vary. RSC has developed a relationship with a pharmacy offering competitive prices and the convenience of shipping to your home. There is the added benefit of verifying your insurance coverage for medications.

8. Will my medical insurance cover infertility treatment?

Approximately one-half of insurers provide limited coverage for intrauterine insemination services. RSC participates in many local physician groups that represent the many commercial health plans in Northern California.

It is not highly likely that your insurance plan will provide coverage for in vitro fertilization, although some of the initial diagnostic examinations, and the medications, may be covered. In most cases, you will be covered for pregnancy resulting from fertility treatment. There are a few insurance plans that do cover IVF services.

Insurance companies usually have hundreds of plans to offer employers, each with different benefits. Contact your insurance provider and ask them what your insurance plan benefits are for infertility treatment. Our practice can investigate insurance benefits for you. We can also provide you with the necessary forms so that you may submit claims for reimbursement by your insurance company.

You may wish to consult ASRM’s website for information regarding state infertility insurance laws.

9. What other financial matters should I be considering?

When choosing an ART program, look for flexibility and evidence of programs designed in response to patients’ needs. The Reproductive Science Center has many financial options for patients, including a refund program, a discount program, and financing options that cover medication costs. See our financial options page for additional information, or contact one of our financial counselors at (925) 867-1800.

10. Who will be on my fertility treatment team, and how will I know how I am progressing?

Communication is a vital element in successful fertility treatment. The physicians at RSC are joined by a highly qualified team of nurse case managers, working collaboratively to coordinate your care. All of the physicians in our center may be involved in your care, along with IVF nurse case managers, operating room nurses, and embryologists.

At RSC, we have one of the most experienced teams around. Every IVF patient is assigned a nurse case manager, who will provide an overview of IVF, assist in communications, provide instructions, and make certain that any questions you may have are addressed.

We encourage individuals considering several clinics to ask about the availability of nurse case managers, and methods of care coordination and communication.

11. What other online resources are available for evaluating a fertility program?

The ASRM has a helpful publication “Selecting an ART Program” – a consumer’s guide to evaluating a fertility clinic, including a review of how success rate claims are calculated by providers.


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Polycystic ovary syndrome (PCOS) can make it difficult to get pregnant, but the right PCOS diet can help you manage the condition and conceive

If you have PCOS, polycystic ovary syndrome, and you’re visiting our website, chances are you already know that women with PCOS are at increased risk for infertility.

PCOS, the most common endocrine or hormonal condition in women, affects as many as 1 in 10 women of childbearing age. About 7 out of 10 women with the syndrome have fertility problems.

The good news – and there is good news – is that, unlike other fertility issues that you have little control over, you can manage your PCOS. Eating the right healthy foods can help alleviate PCOS symptoms and increase your chances of having a baby.

What is PCOS infertility?

PCOS can cause infertility by affecting your metabolism and throwing your hormones out of balance. This can lead to irregular periods and ovulation, ovarian cysts, and even weight gain – all of which can make it harder to conceive.

Polycystic ovary syndrome is the most common cause of ovulatory disorders. Ovulation issues in women with the condition can be traced to insulin resistance. Anywhere from 35-80% of women with PCOS have insulin resistance, which causes insulin levels to shoot up and affects ovulation.

Inflammation, which affects reproductive hormone production and ovulation, is another byproduct of PCOS. Inflammation is related to obesity, though it’s hard to figure out what comes first, obesity or inflammation. We do know that people with PCOS are more likely to be overweight or obese. Obesity is linked to inflammation, and inflammation can contribute to PCOS.

“Eating right will help you get healthier, control your PCOS, and boost your chances of having a baby. What better motivation could there be?”

How can my diet help with my PCOS?

While there is no known cure for this disease, research shows that with healthy eating habits, you can self-treat your PCOS and even improve your chances of getting pregnant.

A recent review of scientific articles examined the relationship between diet and fertility among women with polycystic ovary syndrome. Positive dietary changes improved fertility and alleviated hyperandrogenism, the presence of excessive male sex hormones like testosterone that often plague those with PCOS. Low-carb diets seemed to work even better to improve pregnancy rates and optimize ovulation, and surprisingly, focusing on higher-fat foods may be particularly useful in this setting.

The bottom line? Your diet can help control inflammation, blood sugar levels, hormone imbalances, and weight: all are PCOS symptoms that contribute to infertility. Losing a few pounds – just 5-10% of your body weight – can help restore ovulation.

So what’s the best PCOS diet?

The best PCOS diet is the same diet we’d recommend to anyone with heart disease, diabetes, or cancer. Eat foods that lessen inflammation and don’t spike your blood sugar. That means a whole-food, plant-based diet that is low in carbs.

Whole foods are natural foods, not foods cooked up in a factory, and include:

  • Colorful veggies and fruits, rich in antioxidants and nutrients
  • Healthy fats like avocados, nuts and seeds
  • Lean proteins like turkey, fish, chicken, and beans (try to eat some with every meal)
  • Complex carbohydrates such as whole grains, legumes and nuts
  • Fiber-rich foods like apples, broccoli, sweet potatoes, and berries (your gut helps regulate your hormones, and fiber from plants helps keep your gut healthy, combats insulin resistance, and helps you lose weight)

Whole foods fight insulin resistance and inflammation, contributors to infertility

First, let me dispel some myths about carbohydrates.

Not all carbs are created equal. Complex carbs, also known as “slow” carbs or low GI (glycemic index) carbs, release energy more slowly and will help stabilize your blood sugar instead of spiking it like simple carbs do.

Complex carbohydrates have high levels of a key nutrient that improves insulin sensitivity, decreases androgen levels (male hormones), and improves ovulatory function in people with PCOS.

Anti-inflammatory diets also have been proven to relieve symptoms of the condition. One study showed that people with PCOS who followed an anti-inflammatory diet for three months lost 7% of their body weight and showed significant improvements in cholesterol, blood pressure, and inflammatory markers.

Their reproductive health also improved: 63% of patients returned to having normal periods and 12% conceived while following the diet.

Another study focused on the DASH diet. It found that overweight patients with PCOS who ate less salt and focused on heart-healthy foods lost more abdominal fat and showed improved insulin resistance and inflammatory markers compared with patients who ate a standard diet.

What foods should I avoid in a PCOS diet?

Limit anything that will make your blood sugar skyrocket or cause inflammation, including:

  • Highly processed foods (lunch meats, candy, most packaged snack foods)
  • Sugar and high fructose corn syrup (that includes sugary drinks)
  • Simple or empty carbs like white bread or pasta that are stripped of fiber and nutrients.
  • Fried foods

Tips to make healthy eating easier

Cook your food. I know. Who’s got time for that? But trust me. It’s the best way to control what you’re eating and how much you’re eating.

Make it fun. No one likes to stare at a boneless chicken breast on their plate all the time. Find a new veggie or fruit to try. Change up the menu. The variety will give you a balance of nutrients and vitamins, too.

Experiment. Try a new recipe or better yet, toss some herbs and spices on your food. They’re great at fighting inflammation and making food tastier.

Watch the high-calorie beverages. Drinks like soda pop and a White Chocolate Mocha Frappuccino can sabotage your healthy diet. Water is always your best choice. Make sure you’re drinking enough water every day, and if you can’t stomach it plain, add fruit or cucumbers.

Pursue a PCOS diet one step at a time

Remember, you don’t have to make all these changes at once. To start, add one or two healthy options to each meal. Consistency is the key, and sustainability is the goal!

Eating right will help you get healthier, control your PCOS, and boost your chances of having a baby. What better motivation could there be?

Bon appétit!

Related Fertility Edge Podcast: What is PCOS?

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Dr. Mary Hinkley talks to Giddy about ovarian cyst warning signs

Giddy logo for news article on ovarian cysts | RSC of the SF Bay AreaOvarian cysts – fluid-filled sacs that can grow in or outside the ovaries – are a common condition among women that can cause a variety of symptoms, including abdominal bloating, discomfort and menstrual irregularities. In rare cases, ovarian cysts can make a person look pregnant, explains RSC’s Dr. Mary Hinckley in an interview with Giddy.

“People can look pregnant with cysts because the cyst fills the same place that a growing pregnancy would fill. They stretch out the abdominal muscles and skin and generally fall to the midline as they enlarge, rather than staying on one side of the pelvis,” Hinckley said.

While they usually go away on their own, symptoms can linger and even interfere with fertility. The article goes on to highlight the potential physical signs associated with ovarian cysts and when to seek out a doctor, especially if one is trying to conceive.

Get Giddy’s article

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Dr. Michael Homer talks to Giddy about hazards to male sperm count from prolonged cycling

Giddy logo for news article on sperm count and cycling | RSC of the SF Bay AreaPedaling for miles & miles is good for a man’s cardio health but possibly bad for his fertility and chances of becoming a father down the road. Dr. Homer gives Giddy, the largest online platform for sexual health, his viewpoint and advice for male cyclists concerned about their fertility.

“I think for bicycling in general, too much of a good thing applies,” said Dr. Homer, a reproductive endocrinologist and expert in infertility at the Reproductive Science Center of the San Francisco Bay Area.

Some studies show a link between cycling and erectile dysfunction, sperm count and sperm viability, and numbness in the genitals. Other studies found no links to cycling and male infertility.

“We don’t have a definitive answer (to whether cycling can cause infertility issues), but we have biological plausibility,” Dr. Homer said. “We know that some men who bike report genital numbness. But in recreational bicyclists, weekend warriors and mountain bikers who stand up (occasionally while they ride), there’s no evidence to suggest that’s a problem.”

He adds, “If you aim to stand 20 percent of the time while cycling, that’s associated with lower odds of numbness, which is a decent marker for possibly causing issues with sperm.”

To maximize comfort and minimize risk, ride a bike that’s the right size and is fitted specifically for you. Dr. Homer also recommends standing up while pedaling.

 

Get Giddy’s article

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A shameful lesson for Black History Month of faltering medical ethics, forsaking the Hippocratic oath, and promoting medical racism through the Tuskegee Syphilis Study.

In light of Black History Month, I want to share some thoughts about how medicine is different and better because of the contribution of Black Americans. It also allows me to reflect on what can be done to improve medicine as a profession to serve more people and allow them to thrive at their best.

I think if you ask almost any doctor what Tuskegee means to them, you will find them cast their eyes downward in shame. Why? Because we have been taught about the Tuskegee Syphilis Study and learned principles of medical ethics using this as a case study of what not to do.

Tuskegee Syphilis Study on African Americans offered as free medical treatment

Tuskegee is a town in Macon County, Alabama that was originally inhabited by the Creek Indians. Then it became known for its cotton plantations. From 1932-1972 the United States Public Health Service funded a study on the natural course of untreated syphilis.

At the time the study began, it was not known that antibiotics could cure syphilis, but it was known that mental illness and death could result from untreated syphilis. By promising research subjects free medical treatment, they enrolled approximately 400 Black men who had syphilis and compared them with similar men who did not.

Withholding penicillin known to be effective against syphilis – for decades

Initially, they were given heavy metal treatment, which was standard, but by the 1940s (within eight years) it was known that syphilis was better treated with penicillin. However, the men were not offered penicillin or even told that the spinal taps that were done to study the course of the disease were not therapeutic.

“I am hopeful that we as doctors and researchers will never fall to such a depth of character in our quest for knowledge again.”

Every 4-6 years starting in 1936, results were published for medical review, and yet the study was not stopped until 1972 when the results were made public through the national press and there was a national outcry about the inhumane treatment these men received. In 1974 the HEW (Department of Health, Education, and Welfare) stopped the study and subsequently passed the National Research Act that set up the Institutional Review Board (IRB), requiring that any study involving humans be reviewed for its ethical standards.

No informed consent, and “do no harm” from the Hippocratic oath goes out the window

The tragedy of this study is that there was no informed consent to participate and the health and welfare of the patients were not considered. Patients were marginalized and taken advantage of to further research.

The precious Hippocratic oath to “do no harm” was blatantly disregarded when a better treatment became available that could have been used to stop the course of the disease. Countless men, their sexual partners, their families, and their communities suffered because of this. It also “laid a foundation of distrust”(1) of the medical community.

These men contributed to our understanding of a disease, but more importantly, contributed to our understanding of how not to run a research study and how to make sure that doctors and researchers are protecting and looking out for the best interest of their patients.

I am hopeful that we as doctors and researchers will never fall to such a depth of character in our quest for knowledge again. I owe it to my patients and to future generations to practice medicine truthfully and openly – explaining what we know and what we don’t know, and making available the best medical treatment.

The Tuskegee Study can change the way Americans view illness

I will close with a quote from James H. Jones, a historian and specialist in bioethical issues who wrote “Bad Blood: The Tuskegee Syphilis Experiment.”(2)

“As a symbol of racism and medical malfeasance, the Tuskegee Study may never move the nation to action, but it can change the way Americans view illness. Hidden within the anger and anguish of those who decry the experiment is a plea for government authorities and medical officials to hear the fears of people whose faith has been damaged, to deal with their concerns directly, and to acknowledge the link between public health and community trust. Government Authorities and medical officials must strive to cleanse medicine of social infection by eliminating any type of racial or moral stereotypes of people or their illnesses. They must seek to build a health system that will make adequate health care available to all Americans. Anything less will leave some groups at risk, as it did the subjects of the Tuskegee Study.” (p. 241)

(1) The Tuskegee Syphilis Study and Its Implications for the 21st Century
(2) Jones, J. H. (1993). “Bad Blood: The Tuskegee Syphilis Experiment”, New York: The Free Press (1993)

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Is it 16/8 or 5/2, or should it be every other day? Is intermittent fasting really better than low-carb or keto?

Forty percent of the American population is obese, and this translates into a lot of women trying to get pregnant who are not at their ideal in terms of physical health. They are often struggling to figure out the best way to lose weight while keeping their body healthy enough to conceive. Intermittent fasting is a possible solution.

Fortunately, or unfortunately, math always tells the truth. Reducing caloric intake while increasing expenditure is the only real way to lose weight and keep it off.

For many people, subtle changes in what they eat as well as increasing exercise will help them move steadily toward their desired weight without causing undue stress on their body. By cutting down on simple carbohydrates, including the simple sugars in sweets and desserts, the body can better utilize proteins and vegetables with some healthy fats to get all of the nutrients it needs – without the extra calories or the detrimental effects of glucose and insulin.

Intermittent fasting could be the not-a-diet plan for those TTC (trying to conceive)

However, following a diet plan requires an enormous amount of willpower to maintain over the long haul, and this has proven to be impossible for most. But intermittent fasting introduces a novel idea: shorten the number of hours that people are allowed to eat, then let them eat what they want. This is not a diet at all!

“Most subjects lost 8-9 pounds in three months. Their systolic blood pressure decreased by 7 mmHg.”

Time-restricted eating is often suggested in a 16/8 ratio: 16 hours is for the fast (allowing water and calorie-free beverages) and 8 hours is the time during which they may eat (a regular, healthy selection of foods). Most people will eat from 10 a.m. to 6 p.m. Some time-restricted eating plans alternate days where there is a relative fast with a subsequent day being greater than average intake. Another variation requires that patients have two nonconsecutive days per week of only 500 calories a day.

The exciting thing is that intermittent fasting works! A study by Dr. Krista Varady over 12 weeks showed that the eight-hour, time-restricted feeding produced mild caloric restriction (300 calories) and weight loss, without calorie counting. It also reduces blood pressure.

Weight loss, improved health, and a lifestyle change you’ll stick to that can help you get pregnant

Most subjects lost 8-9 pounds in three months. Their systolic blood pressure decreased by 7 mmHg. However, there was no significant difference in fat mass, diastolic blood pressure, LDL cholesterol, HDL cholesterol, triglycerides, fasting glucose, and fasting insulin. By shortening the window even more to only 6 hours of eating, 500 calories a day on average were restricted and there were improvements in metabolic disease risk including less insulin resistance and less oxidative stress.

Most importantly, patients opted to stay on this “diet” even when the study was closed as they felt that intermittent fasting was easy to maintain. While it may be a slower process of weight loss, the benefit is that patients, men, and women, will be able to stick to it longer, maintaining their ideal body weight.

So if you’re noticing that the scale has gone a bit higher recently and you’re hoping to trim down to give yourself the best chance of pregnancy, intermittent fasting can be a reasonable approach while you are attempting to conceive.

Get off to a good start by calculating your  macros and daily supplementation details:

Intermittent Fasting Calculator

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