Michael J. Tucker, Ph.D., Director of IVF and Embryology Laboratories at Shady Grove Fertility, Presented with the 2014 RESOLVE Hope Award for Advocacy

New York, NY – On Tuesday, November 18, 2014, RESOLVE: The National Infertility Association held the Night of Hope Gala in New York City. RESOLVE, an organization that supports and provides a voice for people diagnosed with infertility, established the Hope Awards to recognize professionals, companies, volunteers, and the media who have demonstrated outstanding leadership in the infertility field or have made a positive impact in the lives of people struggling with infertility. As a Visionary Partner with RESOLVE, Shady Grove Fertility is committed to upholding the standards of the Hope Awards and supporting their mission to increase awareness about infertility.

Night of Hope 2014In 2013, SGF’s Robert J. Stillman, M.D. was awarded with the Hope Award for Service. At this year’s event, Michael J. Tucker, Director of IVF and Embryology Laboratories at SGF, BSc Comb Hons, Ph.D., FIBiol, HCLD, was among those who were honored for their vital service to the infertility community. Dr. Tucker was recognized with the Hope Award for Advocacy to commemorate his many years of promoting infertility patient rights and access to care. Using his expertise as an embryologist, he has been able to inform and educate lawmakers in a number of states on legislation that has been integral to the infertility community.

Dr. Michael J. Tucker accepts the Hope Award for Advocacy.

Dr. Michael J. Tucker accepts the Hope Award for Advocacy.

“I have spent most of my life as an embryologist focused on the improvement of laboratory techniques, never imagining that I would be recognized for being an IVF patient advocate,” said Dr. Tucker. Working as a certified laboratory director in the field of clinical embryology for over 30 years, Dr. Tucker has received worldwide recognition for his pioneering work in the in vitro fertilization (IVF) technologies that have helped to revolutionize the treatment of infertility. In 1992, he helped to advance the intracytoplasmic sperm injection (ICSI) technique and was responsible for the first “ICSI babies” born in the United States, revolutionizing the treatment of male factor infertility. In 1997, he led the team that was successful in achieving the first-ever pregnancies and births using cryopreserved donor and immature eggs.

“RESOLVE is delighted to recognize Dr. Tucker for his commitment to the infertility community,” said Barbara Collura, RESOLVE’s President/CEO. “The Night of Hope is a special opportunity to come together and thank all those who work tirelessly to improve the lives of the 7.3 million women and men in the United States facing infertility.”

Mark Segal, Shady Grove Fertility CEO, and Alisyn Camerota, CNN anchor and RESOLVE board member, at the Night of Hope.

Mark Segal, Shady Grove Fertility CEO, and Alisyn Camerota, CNN anchor and RESOLVE board member, at the Night of Hope.

The 2014 Night of Hope recognized other leaders in the infertility community as well, including Lee Rubin Collins, J.D., a member of the Ethics Committee of the American Society for Reproductive Medicine (ASRM);  Rachel Gurevich, fertility expert for About.com; Susan Donaldson James, a retired ABC News reporter; Cindy Flynn, an applications report writer for Sutter Health; Angelica Nassar, a RESOLVE advocate; researchers at The Hastings Center and the Yale School of Medicine; and Our Misconception was recognized as the best blog to raise awareness about infertility and to shed light on what it’s like to live with infertility.

RESOLVE: The National Infertility Association was established in 1974 and remains the only nationwide non-profit organization established to promote reproductive health and to ensure equal access to all family building options for men and women experiencing infertility or other reproductive disorders. Through events like the Night of Hope, RESOLVE raises money to continue advocacy efforts for the infertility community.

If you have questions regarding infertility treatment or would like to schedule a new patient appointment, please call our New Patient Center at 877-971-7755 or click to schedule an appointment.

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Fox 5: Egg Freezing on the Rise

“Finding a work-life balance has more and more women turning to a different kind of banking.”  Watch the interview.

Interest in egg freezing has been on the rise for the past few years, but in the last month, it has exploded due to the announcement by Facebook and Apple that they would provide egg freezing benefits for their employees. To meet this rising demand for information and education, Shady Grove Fertility recently held its inaugural Egg Freezing Conference. In conjunction with the conference, Sarah Simmons of Fox 5 Health Watch interviewed Joseph Doyle, M.D. of Shady Grove Fertility’s Rockville office. Sarah asked Dr. Doyle several questions about egg freezing, many of which were similar to questions that arose at the conference. The below Q&A session provides an in-depth look at questions patients have begun to ask about egg freezing:

What is the actual egg freezing process? 

When a woman begins the egg freezing process, her physician will first put her on birth control pills to create a baseline for follicle (or undeveloped eggs) development. Following this step, the patient will begin taking injectible medications for approximately 12 days. These medications essentially help stimulate the follicles that would otherwise naturally die off. During this time the patient has several ‘monitoring’ appointments at a Shady Grove Fertility location to monitor follicle growth and development.

When an appropriate number of ovarian follicles have responded and are determined to contain mature eggs, a final trigger injection will be given to help with the final maturation and release of the eggs for retrieval.  36 hours after the trigger injection, the patient would go to a local Shady Grove Fertility lab (Rockville, MD, Towson, MD and Harrisburg, PA) for the egg retrieval. The egg retrieval is painless as it is done transvaginally and while the patient is under twilight sedation (a light anesthesia). Because it is a minor surgical procedure, you will need a ride home on the day of the retrieval and it is advised to rest the day. Many women are able to return to work the next day.  You will receive a call the day after your egg retrieval to let you know the number of mature eggs that were able to be frozen. Medial contribution provided by Shruit Malik, M.D.

What is a thaw/thaw rate?

Thaw refers to the initial step in the use of frozen eggs when it is time to fertilize them to form embryos.  Though it is a carefully performed process when it comes to frozen eggs, it can simplistically be thought of like thawing something that has been frozen in the freezer.  Frozen eggs are warmed to body temperature, at which point they can be combined with sperm, resulting in the production of an embryo.  Thaw data represents how successful a fertility center is at using frozen eggs for fertilization and pregnancy. This is valuable information when selecting a center; if they do not have thaw data, they would not be a good candidate for your elective egg freezing procedure. -Medical contribution provided by Joseph Doyle, M.D.

How and where are the frozen eggs stored? Are there preventative measures in place for the stored eggs in the event of a natural disaster, power failure, etc.?

After undergoing the vitrification or flash-freeze process, both eggs and embryos are stored in liquid nitrogen tanks in the liquid phase.  The tanks are stored in our labs which are secured in an alarmed area that is monitored remotely; 24 hours a day and every day of the year. The tanks are measured and topped off weekly as part of our quality control.  While the tanks only require liquid nitrogen and therefore no electricity, the monitoring system does require electricity, so our lab is on a backup generator in case of a power failure.

If there is a warning for a major tornado near any of our three labs (D.C., Baltimore and Philadelphia), we can move the tanks to one of our other labs. For something more serious and unprecedented, we could drive inland to one of our affiliate practices like FCI in Chicago.

Are the procedures any different for same-sex couples?

The procedure for a same-sex female couple is the same procedure as it would be for heterosexual couples. The only difference is in how the eggs can be used in the future; the couple may opt to return and have the other partner carry the pregnancy, (the woman who did not have the egg freezing cycle).

Can I switch between financial programs Assure20 and Assure30?

Assure20 and Assure30 are the only financial programs for egg freezing offered at any center in the nation. If a patient chooses to enroll in one of these guarantee programs – Assure20 or Assure30, they are essentially locked in to that program. However if a patient chooses the single cycle, they are able to move forward in the multi-cycle discount program for subsequent cycles.

What happens to my eggs if I ultimately do not need to use them?

Patients that opt not to use their eggs in the future can elect to: Donate their eggs to research, discard them, or potentially donate them to another patient.

If you would like to learn more about the Egg Freezing Program at Shady Grove Fertility and whether it’s the best option for you, call 1-877-411-9292 or schedule an appointment today by filling out this brief form.

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Optimizing Fertility Treatment with Clomid

ClomidMany couples having trouble conceiving are frequently prescribed clomiphene citrate, more commonly referred to as Clomid. Often times, this low-tech treatment option is the first line of therapy for women, especially those who experience irregular or absent menstrual cycles. Prescribed by an OB/GYN or reproductive endocrinologist, Clomid is an affordable oral medication that is used to induce ovulation.

The chance of success with Clomid treatment depends upon a woman’s age and the cause of infertility. In a young woman who does not ovulate regularly, she has a 15–20% chance of conceiving each month on Clomid. Understanding how to optimize each treatment cycle can help couples achieve success with Clomid treatment.

What is Clomid?

Clomid is an anti-estrogen medication that works by blocking the estrogen receptors in the hypothalamus. As a result, follicle-stimulating hormone (FSH) production by the pituitary gland increases, resulting in the development of one or more follicles inside the ovaries. About a week after the last dose of Clomid, ovulation will occur when a surge of luteinizing hormone from the pituitary gland stimulates the developing egg inside the follicle(s) to mature and release.

How much does Clomid cost? Clomid is an affordable medication commonly covered by insurance providers that only costs a few dollars. If insurance isn’t an option when paying out of pocket, Clomid can cost between $25 to $50 per cycle.

Where can a Clomid prescription be filled? Clomid prescribed by your physician can easily be obtained by most local pharmacies, whether they specialize in fertility medications or not.

What are the common side effects? Though it is generally well tolerated, Clomid can lead to cervical mucus changes and thinning of the uterine lining that can negatively impact success rates. As a result, approximately 80% of women taking Clomid will successfully ovulate, but fewer than 50% of patients will conceive. Another risk to consider is the increased chance of multiples – which is around 10% – as compared to the natural rate of twinning, which is between 1-2%.

Tips for Optimizing Fertility Treatment with Clomid

 Get a basic infertility work-up

While ovulation is an important part of conception, it isn’t more important than the quality of the male partner’s sperm or the ability for the sperm to access an ovulated egg in the fallopian tubes. For this reason, a full fertility evaluation looking at the sperm quality through a semen analysis and confirming that the tubes are open with an HSG, should be completed prior to starting any treatment, including Clomid. Why spend time on a treatment that may not work due to other unforeseen factors?

Add Monitoring to the Cycle

While the American Congress of Obstetricians and Gynecologists’ guidelines for Clomid treatment do not require monitoring during a Clomid cycle, valuable time-saving information can be gained by adding an ultrasound and hormone monitoring after the last dose of medication.

Monitoring appointments consist of an ultrasound and bloodwork. The ultrasound, completed intravaginally, allows the physician to visualize the thickness of the uterine lining and the ovaries, more specifically the number of follicles within them. The bloodwork shows the trend of pre to post-stimulation hormone levels; increased levels of estrogen indicate follicular development.

These two measures of the progress of the cycles tells physicians about three important events during stimulation.

Follicle1. Did it work? This seems like a no-brainer, but the first thing a physician learns from monitoring the progress of the cycle is if a follicle was recruited and developed. Finding the correct dosage that results in the development of a single follicle in the beginning is a bit of guess and check. Some women will respond to a 25 mg dose, while others can require up to 150 mg before follicular development starts to occur. Starting with a conservative dose until the physician knows how a patient will respond is the best approach, as overstimulation can result in the development of more than one follicle and, as a result, an increased risk of multiples. In an unmonitored cycle, the physician would base the response to medication solely on if the cycle resulted in a pregnancy and then adjust the dosage accordingly.

So what if it doesn’t work? Lack of response indicates to the physician a higher dosage of medication is needed. This higher dose can start the same day since the patient is still in the follicular phase of her cycle. The ability to know that the dosage was ineffective early in the treatment cycle saves the patient nearly an entire month.

2. Is the lining thick enough for implantation? The second factor that monitoring can tell a physician is how the lining responded to the Clomid. Some patients using Clomid will suffer from a thinning of the uterine lining, making for a less than optimal environment for embryo implantation. Should this occur, physicians can help to supplement the thickening of the lining with an estrogen suppository. In some cases a follicle will develop, but pregnancy may not have occurred because the lining was too thin – a factor that the physician wouldn’t be aware of without a monitoring cycle.

3. Was there an over-response to medication? Unmonitored cycles can result in an increased chance of multiples, which is risky for both mother and babies. Multiples can occur when several follicles are developed and ovulated in a single cycle. Monitoring can tell the physician when an unsafe number of follicles have been developed, allowing them to advise the patient to abstain from intercourse to avoid the increased risk of a higher order pregnancy.

Add a Trigger Shot

While under the care of a reproductive endocrinologist, the stimulation phase of a Clomid cycle in most cases ends with a trigger shot. The trigger shot provides the final maturation signal to the developing follicle and sets ovulation in motion. One of the biggest benefits to a trigger shot is the increased ability to correctly time intercourse at home or insemination in the office. The majority of patients will be instructed to administer their trigger injection between 6 and 10 p.m. Two days later, the IUI – if that is your planned method of insemination – will be scheduled at one of our 18 full service locations. Intercourse on the night of the trigger shot is encouraged so that sperm is present in the reproductive track at the time of ovulation. Those patients using timed intercourse will be instructed to also have intercourse the day of the trigger shot and then again two days later.

Consider an Intrauterine Insemination

Clomid treatment helps with the first part of the equation, developing an egg and inducing ovulation. The other part of the equation centers around getting the egg and sperm to meet. With Clomid treatment, there are two common methods used to facilitate this introduction, with the most familiar to patients being timed intercourse. Some couples, especially those still at their OB/GYN, will start with this option, using ovulation predictor kits to help determine the right time for intercourse.

The second option is an intrauterine insemination (IUI), which is usually done while under the care of a fertility doctor. During an IUI, a concentrated specimen of sperm is placed in the uterus. The procedure is completed in the office and does not require sedation. An IUI may be needed if conception has not occurred due to mild sperm abnormalities or for unexplained reasons.

Use a Fertility-Friendly Lubricant

Another side effect associated with Clomid is vaginal dryness that can make intercourse uncomfortable. Choosing a fertility-friendly lubricant such as pre-seed can help alleviate dryness and not negatively impact sperm. It is not, however, suggested to use many of the other over the counter personal lubricants as they can have a negative effect on the sperm.

Talk to your Provider about trying Femara

Femara (generic name Letrozole) is another oral medication that can be used to induce follicular development. Femara works by suppressing estrogen levels, causing the brain and pituitary gland to increase the output of follicle-stimulating hormone (FSH). The chances of pregnancy with Femara have been found to be the same as with Clomid, between 15-20% depending on diagnosis and the female partner’s age.

One of the major benefits of using Femara is the decrease of detrimental side effects, such as thinning of the endometrial lining and the risk of multiples. Femara supports more unifollicular development, allowing a single follicle to emerge as the dominate follicle that is ultimately ovulated. Since often times only one follicle develops, the chance of multiples is lower. While Femara is relatively new in the fertility realm, it has been shown to be helpful for women with ovulatory disorders like polycystic ovary syndrome (PCOS).

For women beginning fertility treatment, it’s important for them to know that Shady Grove Fertility uses a stepped approach to care, starting with the least invasive treatment options to start.  Fifty percent of treatment programs at SGF are low-tech options such as timed intercourse or IUI, giving patients the same chance of conception that the fertile population has on a monthly basis (15-20%).

If you have questions regarding infertility treatment or would like to schedule a new patient appointment, please call our New Patient Center at 877-971-7755 or click to schedule an appointment.

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