Should I do genetic testing?

There are a lot of factors to consider when deciding to conceive a child. Genetic testing can be a sensitive issue for some. It is important to talk openly with your doctor about any possible genetic risks and then consider your options.

Factors For Genetic Testing Consideration

A thorough health history can help decide if genetic testing should be considered. Factors include:

1. You and your spouses age
2. Ethnic background*
3. Family History
4. Medical History

*Common Genetic diseases related to your ethnicity include:

• Sickle cell anemia (most common in people of African heritage)
• Thalassemia (occurs most frequently in people of Italian, Greek, Middle Eastern, Asian and African ancestry)
• Tay-Sachs disease (most common among Ashkenazi Jews)
• Cystic fibrosis (most likely to occur if there’s a family history of cystic fibrosis — people with Caucasian background are more likely be affected than other ethnicity)
• Fragile X Syndrome
• Duchenne Muscular Dystrophy

If a thorough medical history suggests the possibility of a genetic disease, your doctor will probably recommend that you and your partner be screened to see if either (or both) of you carry a gene. The test can be done through blood testing.

Ultimately, the decision should be made by you and your partner. We recommend to speak to a genetic counselor (it is a free phone call) before scheduling the test so that all your questions/concerns are addressed. All genetic companies (such as Natera, Good Start Genetics, Recombine, etc) offer a free phone consult before doing the test, and if any of the screens come back positive for one of the common genetic diseases noted above. There’s no right answer, only the answer that’s right for you and your family.

If you are in the process of trying to conceive and are experiencing fertility issues, we welcome you to learn more about Virginia Center for Reproductive Health at: http://www.vcrmed.com/

Fertility Drugs and Medications to Treat Female Infertility

Fertility drugs are the primary treatment for women with ovulation issues. We know that the whole process can be very confusing with all the treatment options available. This is especially true for someone who is just beginning her fertility journey. To help you familiarize with various fertility medication options currently available in the marketplace, Virginia Center for Reproductive Medicine has compiled a list of the most common fertility drugs prescribed, how they work and how to use them.

1) Clomiphene Citrate

Common Brand Names: Clomid, Tamoxifen, Letrozole (Femara)

How it Works: these medications create an increase in the hormones that support growth and release of a mature egg.

How to Use: s taken by mouth for 5 days. Your fertility doctor will give you directions on how and when to take it. Be sure to follow the dosing schedule exactly for optimum results.

If these are successful, your fertility specialist may recommend injectable hormones to stimulate ovulation.

2) Menotropins

Common Brand Names: Menopur

How it Works: Menotropins provides the follicle stimulating hormone (FSH) and luteinizing hormone (LH) that help healthy ovaries make eggs. This medication is often combined with another hormone (hCG-human chorionic gonadotropin) to help you become pregnant by growing and releasing mature eggs.

How to Use: Menotropins is an injection. Your fertility clinic will train you on how to properly use this medication.

3) FSH preparations

Common Brand Names: Bravelle, Follistim, Gonal-F

How it Works: these medications provide the Follicle Stimulating Hormone (FSH) that stimulates the development and growth in ovaries. This medication is often combined with another hormone (hCG-human chorionic gonadotropin) to help you become pregnant by growing and releasing mature eggs. They are not recommended for women with primary ovarian failure.

How to Use: By an injection usually taken once a day. The medicine comes with Patient Information directions. Read over all the directions carefully

4) Human Chorionic Gonadotropin (hCG)

Common Brand Names: Pregnyl, Novarel, Ovidrel

How it Works: hCG is given after finishing Menotropins to cause the release of an egg.

How to Use it: hCG is an injection directly into a muscle by a health care professional. Occasionally this medication is taken at home

If you are in the process of familiarizing yourself with various fertility options before starting your fertility treatment journey, we welcome you to contact us at 703-437-7722 or visit or website at: http://www.vcrmed.com/

Surrogacy & Same Sex Couples

On June 26, 2015, the U.S. Supreme Court handed down a landmark decision in the case of Obergefell v. Hodges, recognizing that same-sex couples have equal marriage rights. All state laws banning same-sex marriage were overruled by the Court's decision.

Same-sex spouses now have the same rights and benefits as legally married, opposite-sex couples, including tax relief, emergency medical decision-making power, access to domestic relations laws, spousal benefits (including workers' compensation), inheritance rights, and spousal testimonial privilege.

The Obergefell v. Hodges ruling also created hope for Same Sex parenting. In the Supreme Court's majority opinion, same-sex parenting was validated and even used as an example for marriage equality on the vitality of gay families. After declaring that a "basis for protecting the right to marry is that it safeguards children and families," Justice Anthony Kennedy explained that "same-sex couples provide loving and nurturing homes to their children, whether biological or adopted." Relying on Williams Institute research, he noted that "hundreds of thousands of children are presently being raised by same-sex couples." The majority affirmed a model of parenthood based on chosen, functional bonds rather than biology alone.

There are a four main ways that gay men and women can have children:

·      Adoption

·      Co-parenting arrangements (Between Lesbians & Male gay couples)

·      Donor Insemination (for Lesbians)

·      Surrogacy

·      We have also done many cases where one female partner is the egg donor and the other is the gestational carrier.

The Virginia Center for Reproductive Medicine has worked with dual gender partners with Egg Donor and Surrogacy treatments since 2004. Our practice has enjoyed the highest success rates in the DC metro area consistently for the past 9 years. We invite you to learn more about how our practice can assist you and your partner in building a family: http://www.vcrmed.com/other-services/gestational-surrogacy-in-reston-va-virginia/

Trying to Conceive (TTC) in your 30’s

A growing percentage of women are trying-to-conceive later in life. In the 1970’s, the average age on a new mother was around 24 or 25 and now the average age for getting pregnant is about 30.

Women are trying-to-conceive later in life because of a variety of factors like being career oriented, extending their education and just too busy to find “Mr. Perfect”.

Most couples will succeed in conceiving in their 30’s, though it most likely will take a bit more time and effort. Other couples may face some infertility hurdles and turn to fertility treatments for support. As we age, our fertility declines. This goes for women, and to a lesser extent, men! When a woman is TTC in her 30’s, the monthly chance of conception drops to less than 15%.

So what can be done to make TTC in your 30s more successful?

·      Staying fit and living a healthy lifestyle, avoid smoking or drinking excessively

·      Focus on a healthy diet and maintaining a proper weight

·      Once your are TTC, chart your fertility to discover when you ovulate during your cycle

A popular trend amongst successful, busy women is Egg Freezing. A woman’s fertility peak is in their early 20’s and begins to decline thereafter. If a woman uses her “younger” eggs, meaning eggs she froze in her 20’s or early 30s, her chances of pregnancy success are much higher.To learn more about Egg Freezing, we invite you to visit: http://www.vcrmed.com/other-services/egg-freezing-program/

Age does play a factor in fertility however each woman’s situation is different. To learn more about The Effects of Age on Fertility, we invite you to visit: http://www.vcrmed.com/fertility-reston-va/the-affects-of-age-on-fertility-virginia-center-for-reproductive-medicine-in-reston-va-virginia/

Questions to Ask During your Initial Infertility Consultation at a Fertility Clinic

When you have come to the decision that it is time to consult with a Fertility Center it important to know what to expect at your initial consultation. The doctors and staff at the Virginia Center for Reproductive Health in Reston, Virginia have put together some helpful hints for your Initial Infertility Consultation.

• To prepare your body for a successful pregnancy, VCRM recommends the following, even before meeting with your Fertility Specialist for the first time:

1)   Quit smoking
2) Eat a balanced diet
3) Take a pre-natal vitamin daily
4) Exercise and be active daily
5) Eliminate or reduce stress in your daily life

• Once you have an appointment confirmed with a Fertility Center, you will receive a Patient Registration packet. There will be a variety of forms to fill out, these are usually required to be sent back to the office BEFORE your consultation

• Your consultation usually will be between one to two hours.  You will meet your doctor and review your medical history and discuss your family’s goals. Depending on your history, age and interest, your doctor will order a variety of diagnostic tests to evaluate you and your partner. Most fertility centers also have a genetic and financial counselor to meet with, depending on your needs

• Be sure to provide your doctor with your full and accurate fertility history, bring any records you may have from previous fertility centers or gynecological surgery

• Know your schedule. If you have a vacation planned, work commitments or other events that cannot be rescheduled, share these plans with your doctor so diagnostic testing and treatment can be scheduled accordingly

• Compile a list of questions. Brainstorming the questions, concerns and topics you want to discuss is helpful. You will receive a lot of information during the consultation, take notes!

Just as there are many factors that can cause infertility, there also are many factors that can affect your chances for successful treatment including your age, your personal diagnosis, duration of infertility, and the number of previous unsuccessful treatment attempts. In addition, chances for your success will be influenced greatly by the specialists involved with your care and continued attention to details. It is important to find a fertility center that can best assist at making your dreams a reality.

You can read more about finding the best fit Fertility Center for you by visiting: http://vcrmed.blogspot.com/2015/04/how-to-choose-fertility-center.html

To learn more about VCRM, you can visit:http://www.vcrmed.com/

Ovarian Reserve & Egg Quality: What can I do to improve them?

 Age is not the only factor that determines ovarian and egg health. Many factors can impact the health of a woman’s ovaries and eggs including environmental factors, hormones and stress, just to name a few! There are habits and factors you can focus on to increase the health of your eggs. 

Oxygen flowing to the ovaries is important for good egg health. To increase blood flow to the ovaries consider:

• Drinking at least 8, 8oz glasses of water everyday. Dehydration can cause your blood to become thick and decrease circulation in the body

• Exercise. Stay moving, run, dance, play a sport. Exercise increases blood flow and helps oxygenate the blood. However, avoid intense workouts and running 

• Get a massage. A common therapy for increasing blood flow to the reproductive system is by massaging your uterus and ovaries. Massages and acupuncture may help bring fresh, oxygenated blood to the ovaries and removes old stagnant blood. You can have a massage therapist perform an abdomen massage or find an acupuncturist who specializes in fertility

• Some supplements (such as CoQ10 and DHEA) may be helpful to egg quality. Please discuss this with your doctor before taking any of these

• Eat Healthy  

What you are eating can also impact the health of your ovaries and eggs in good or bad ways. 

Foods known to make a positive impact on Egg Health Include:

Broccoli            Berries            Dark Leafy veggies            Halibut

Salmon            Pumpkin Seeds            Sesame seeds            Ginger

Foods known to make a negative impact on Egg Health include:

Caffeine            Alcohol            Sugar                        Soda                        Processed foods           

Trans Fat            GMO Foods

Check out our useful app that will educate you on how simple dieting can help with fertility: http://theinfertilitydiet.com/

Life is overwhelming and women are constantly multi-tasking a variety of roles and responsibilities. To improve you egg health, reducing the stress in your life needs to be a priority. You need time for YOU! (and deserve it) Consider some of the following ideas:

·      Go for a walk

·      Take a warm bath

·      Read a good book

·      Craft or learn a new skill

·      Meditate

Supporting egg health is important for every woman who is trying to conceive. These simple habits can support and protect your egg health.

Egg Donation: Earn $8,000 while helping make a couples dream come true

Are you interested in becoming an Egg Donor? Its women like you that help make the dream of having a family a reality for those struggling with infertility.

Healthy women aged 21-31 may qualify to be a donor for our anonymous egg donor program.

To help us determine your eligibility for the program, please complete the confidential questionnaire by visiting: http://www.vcrmed.com/donate-eggs/

*Please note, women must have medical insurance to qualify as an egg donor

Once accepted into the donor program you may donate a maximum of six times. Upon completion of a cycle, you will be compensated $8,000 for your time, effort and commitment.

Your donation would be a precious gift to infertile couples whose only chance of conceiving is through the generosity of women like you!

The steps for egg donation are listed below:

Step One

Complete the initial application. This form assists our Donor Team in determining if you qualify for our Egg Donor Program.

Step Two

If you qualify for the program, you will be sent an email with the next steps and a link to complete a comprehensive online application.

Step Three

Once the comprehensive application is approved and you are accepted into our anonymous egg donor program, your initial consultation will be scheduled with our nurse coordinator. During this visit, the donation process will be discussed in detail. In order to complete the medical portion of the donor application process, a variety of medical tests will also be scheduled at this time for a later date. These medical tests must be performed at specific points throughout your menstrual cycle and for that reason, may require more than one visit. After all testing is completed, reviewed and approved by the VCRM physician, you will be formally matched with a recipient and the donation cycle will be scheduled. All costs for your medical care will be covered by the recipient.

Step Four

Once the egg donation cycle begins, you will be put on birth control pills followed by injectable medications for up to 13 days to stimulate production of multiple eggs in your ovaries. At the same time, the recipient’s uterus is being prepared to receive the resulting embryos. Once the eggs have matured, you will be scheduled for your retrieval. You will be given IV sedation and your eggs will be retrieved via transvaginal ultrasound with a needle guide.

Step Five

Once the eggs have been retrieved, your portion of the egg donation process is complete. In our laboratory, the donor eggs will be mixed with sperm to fertilize. Three to six days following egg retrieval, the developing embryos will be transferred to the recipient’s uterus. A pregnancy test will be performed on the recipient in 11 days. The anonymous egg donation process, from initial application to egg retrieval, may take up to three months to complete. The initial screening tests can be arranged to accommodate your schedule. Blood work will be taken and ultrasounds will be performed to check your hormone levels and visualize the number and size of your egg follicles. These monitoring visits are extremely important; not only do they ensure your safety throughout the process, but they also provide essential information that will help us maximize the success of the cycle.

You can contact us with any questions by calling 703-437-7722

Uterine Lining measurements for conceiving

A prepared uterine lining (Endometrium) is critical for successful implantation after embryo transfer. A commonly used guideline for assessing the endometrium is to measure its thickness. Endometrial thickness is often abbreviated as EMT.

During the stimulation phase of IVF, EMT usually increases in response to estrogen released by the ovaries. It is generally accepted that it is a “thick” lining that will be receptive for the embryo(s) after transfer.  The most commonly used cut off for defining a thin endometrium is less than or equal to 7 mm. Some studies have suggested that a thin lining is associated with low IVF pregnancy rates whereas others were not able to confirm this thesis. Despite this, EMT is now routinely measured using transvaginal ultrasound during in vitro fertilization (IVF).

Poor endometrial lining most commonly occurs in women with a history of unexplained recurrent IVF failures or early recurrent miscarriages and is usually attributable to the following factors:

• Endometritis: Chronic infection of the endometrial cells.
• Fibroids of the uterine wall (non-cancerous muscle tumors of the uterus).
• Scar tissue of the endometrium (called Asherman’s syndrome), caused by prior D&Cs or other uterine manipulations

Endometrial thickness cannot predict the outcome of an IVF cycle. The impact of endometrial patterns on IVF pregnancy rates has been investigated with conflicting results.

You can learn more by visiting: http://www.vcrmed.com/ivf-reston-va/

Schedule an appointment with Dr. Sharara (one of the leading IVF specialists in the US) to discuss your situation and how we can assist you in IVF success.

A 411 on Fertility Abbreviations

Are you new to the “Trying to Conceive” club? Don’t worry, you are not alone. In fact there are forums, support groups and blogs for just about ANY topic you may want to research or involve yourself with. What you may not realize is, there are abbreviations for almost EVERYTHING. We’re talking medical stuff here; can you really spell “Intrauterine Insemination” off the top of your head? Obviously it’s easier to shorten it up as IUI. The Virginia Center of Reproductive Medicine has compiled a list of the most frequently used menstrual, fertility and reproductive health abbreviations and acronyms to help you along during your TTC journey. We hope you find it helpful!

AF: Aunt Flo — menstruation/period
BBC: BabyCenter
BBT: basal body temperature
BC: Birth control or before children
BCPS: birth control pills
BFN: big fat negative (after taking a pregnancy test)
BFP: big fat positive (after taking a pregnancy test)
BM breast milk, or bowel movement
CD: cycle day
CF: cervical fluid
CM: cervical mucus
CS or C/S: cesarean section
DPO: days past ovulation
EBF: extended breastfeeding, exclusively breastfeeding
EBM: expressed breast milk
EDD: estimated due date, or expected date of delivery
EWCM: egg white cervical mucus
FF: formula feeding
HPT: home pregnancy test
IC: incompetent cervix
IUI: intrauterine insemination
IVF: in vitro fertilization
L&D: labor and delivery
LP: luteal phase
MC or M/C: miscarriage
O: ovulation
O’d: ovulated
OPK: ovulation predictor kit
PG: pregnant or pregnancy
PPD: postpartum depression
RE: reproductive endocrinologist
SD: sperm donor
TTC: trying to conceive
US or U/S: ultrasound
VBAC: vaginal birth after cesarean section

VCRM would be delighted to assist you in your dream of becoming a parent. Please visit our website to learn more about us: http://www.vcrmed.com/about-us/why-us/

What to expect after an embryo transfer

The IVF treatment cycle consists of several parts. In this article, we will be focusing on what to expect after an Embryo Transfer and the activities you can engage in.

Five days following the Egg Retrieval the patient will have the Embryo Transfer (ET). The procedure only takes approximately 15 minutes; afterwards, a patient will remain in a horizontal position for about 15 minutes. She will then be discharged to leave.

Directly after the Embryo Transfer patients should go directly home or to your hotel and take it easy for 24 hours. This does not mean staying in bed. You can do all your regular activities but avoid strenuous exercise or carrying heavy objects.

You may have some watery discharge. This is from the vaginal wash and not the embryos “coming out”.

The day after your transfer, you may resume light normal activities.It is important to stay on all your medications. These medications support the uterine lining and help maintain a pregnancy. These are usually estrogen & progesterone through pill, injection, or vaginal suppository.

We advise our patients to avoid travel for 24 hours so that they are near their doctor in case any complications, such as bleeding, arise.

If you are ready to learn how VCRM and Dr. Sharara can help your dream of having a baby, then please complete the Request A Consultation form or call us at 703.437.7722.

Trying to conceive with Uterine Fibroids

Uterine fibroids are very common benign, smooth muscle cell tumors that affect 25% to 40% of reproductive-age women. Multiple studies have found there is an association between fibroids and infertility, especially when fibroids are large, in the uterine cavity, or compress the cavity. There are several explanations as to why uterine fibroids may reduce fertility:

*Fibroids change the position of the cervix (the vaginal opening to the womb) and may affect the number of sperm that can travel through the cervix
*Changes in the shape of the uterus can interfere with sperm movement
*Blockage of the fallopian tubes by the fibroids
*Affecting the blood flow to the uterine cavity where the embryo would implant.
*Changes in the uterine muscle may prevent movement of the sperm or the embryo

Dr. Sharara at the Virginia Center for Reproductive Medicine can help determine if fibroids might be hampering your ability to conceive. Treatment options vary depending upon the age of the patient, the severity of the symptoms and the size of the tumor(s).

To Schedule a Consultation, please visit http://www.vcrmed.com/ or call 703-437-7722.

FAQ about IUI-Intrauterine Insemination

Virginia Center for Reproductive Medicine prides itself on providing each patient with the utmost personal care and attention. We are happy to answer any questions you may have about fertility treatments and the procedures involved. Below, we have composed a list of most frequently asked questions about the Intrauterine Insemination (IUI) process and associated responses.

Who should consider IUI?

Patients suffering with low sperm count, decreased sperm mobility, unexplained fertility, hostile cervical condition or ejaculation dysfunction can all benefit from an IUI procedure.

How is IUI done?

IUI with washed semen is a technique that places prepared sperm directly into the uterus using a catheter. IUI bypasses the vagina and cervix where many sperm are otherwise lost, thus the number of motile sperm available to fertilize an egg is increased.

When should the IUI procedure occur?

An IUI procedure is performed around the time of ovulation.

Does the procedure hurt?

Most women consider IUI to be fairly painless, similar to having a pap smear. There can be some minimal cramping afterwards, but often what is felt is ovulation-related rather than from the IUI.

Can sperm fall out?

Once sperm is injected into the uterus it doesn’t fall out. Occasionally there is wetness after the IUI procedure but this is related to the catheter loosening the cervical mucus.

How long after IUI should implantation occur?

Implantation generally takes place 7 days days after ovulation/your IUI procedure.

How soon can I take a pregnancy test?

It is highly recommend that the patient wait two weeks before taking a pregnancy test to prevent a false positive due to hormones and injectibles.

What is the success rate for IUI?

Success rates will vary with the couple’s original diagnosis and the number of cycles of IUI.  The pregnancy rate per cycle of insemination is 15-20%.  The pregnancy rate may be as high as 30-50% in couples undergoing three cycles of IUI. 

The use of fertility medication, such as Clomid, Tamoxifen, or injectable Gonadotropins, increases the chance of pregnancy. The pregnancy rate using Clomid/Tamoxifen is about 15-%, and that of injectables/IUI is about 20-25%, but these rates are age-dependent and are significantly lower in women > 35. The multiple pregnancy rate is about 5% with Clomid or Tamoxifen (mostly twins), but increases to about 20-25% with injectable gonadotropins (some may be higher-order multiples, i.e triplets or more).

How many IUIs should I try before moving on to IVF?

It depends on what you can afford and what medication you are taking. If a couple doesn't have success after four ovulatory cycles on injectables with well-timed IUI, it would be time to consider IVF.

If you are considering IUI or other fertility treatments, we invite you to Contact Us

The patients at VCRMED are taken care of by a single physician who knows everything about their specific case. We believe this care results in faster success. We would love to assist you in making your dreams come true.

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Fertility Clinic: How to choose the right one

It is estimated that there are almost 500 Fertility Clinics throughout the United States. So when a woman or couple begins to explore Infertility Therapy, there are a lot of options to consider. There are a variety of Fertility Clinics to choose from:

·      Sole Practitioner

·      Small Practices

·      Large, Full Service Practices

·      Networks

·      University and Hospital Clinics

The sole practitioner or smaller practices offer a more personable experience, with more direct access to your doctor than larger practices or universities.  Full service practices usually have the laboratory and other resources on site, which is convenient for women however communication is usually done through nurses and staff. In fact, you may even have the uncomfortable experience of seeing a different doctor each time you have an appointment.

IVF, IUI, or any Infertility Therapy is a costly investment. Each clinic’s’ cost will vary, and it is important to ask exactly what is included for the service. While cost is an important consideration, don’t let it be the determining factor.

When selecting a Fertility Clinic, it is important to review their success rates. It is suggested to compare multiple clinics fertility reports and choose a center that has above average success rates. Choosing a fertility center with higher success rates may help woman and couples achieve positive results quicker and at a lower cost.

The Virginia Center for Reproductive Medicine (VCRM) is a unique Fertility Clinic because it offers its patients the best of both worlds - a boutique and personalized setting as well as a highly successful onsite laboratory. At VCRM, patients are guided through their evaluation and treatment by the same physician who is initimately familiar with their specific situation. This allows the practice to create a highly custom treatment plan for each patient and the results speak for themselves.

In 2013, VCRM had 76% better live birth results (delivery of an actual baby) than the National Average! VCRM has also been rated very highly in the Washington DC area by the Washingtonian magazine. Additionally, an independent data aggregation website ranked VCRM #2 in the United Stats for its results in patients between 35-37 yrs of age.

We invite you to learn more about us and what makes our Fertility Center unique by visiting: http://www.vcrmed.com/about-us/why-us/