LittleThings is the only digitally native media property that scales uplifting content while influencing women across generations.  Headquartered in New York City, LittleThings is the leading lifestyle destination for inspiring, uplifting, and engaging content.

LittleThings also happens to think that the “I Didn’t Know I was Pregnant” series is very entertaining.  How is it not entertaining?  A woman starts having horrible pains out of no where and the next thing she knows there is a baby coming out of her, when she didn’t know she was pregnant.  Now is it plausible?  That is a more interesting question.

When I was consulted about being on the show to help explain the medical side of things, I wasn’t sure how many women they would find who found themselves in this very predicament.  However, as time went on, the more women there were.  I did my best to help explain these unexplainable situations.  The longer I did the show, the crazier the stories became.

So, can it happen?  Can you not know your pregnant and find out only in labor?  The answer is yes.  HOWEVER, it is very unlikely and rare.  So did it really happen just as the women state in the videos?  Who knows.

What I do know is that even if only half of it is true, it still made for some crazy entertainment.

To view all of the  “I Didn’t Know I was Pregnant episodes” you can view my youtube channel.  Can you tell in which of the episodes I was pregnant?

Or check out “The Little Things” website and view lots of other little things to make you smile.

Check out my new article on MIND BODY GREEN to understand why it is important to go to the gynecologist every year.

MIND.BODY.GREEN

I was so excited when the editors at mindbodygreen.com were interested in having me come back on the site and write about the ZIKA virus and how it affects women who are trying to get pregnant.

If you don’t already know the mindbodygreen.com website is an amazing resource for information on wellness, tackling all sorts of issues related to both the mind and body and how we relate with the world.  The website is full of interesting, pertinent and useful facts on all sorts of topics ranging from skin care, to juicing to exercise, spirtuality and food.  They are committed to making sure we are up to date on important health topics that affect our well being.

Check out my article that is published about how ZIKA could affect you if you are trying to get pregnant on the MINDBODYGREEN website.

Check out my other article on their site, discussing pregnancy after 40.  And look our for more!!

GOOD MORNING AMERICA SEGMENT LINK

On Monday I was featured on Good Morning America to discuss Fertility Diagnostic Testing for women and men interested in understanding their current and potential fertility potential.  I think that having a sense of what is going on with your fertility is important to help women and men identify potential reproductive issues that may impact their current and future fertility.  Armed with this knowledge men and women can make better decisions for themselves about how they will face starting a family either now or later.

What didn’t get highlighted in the piece was the specific Fertility Diagnostic Testing Program at USC.

Here are some highlights from our website.

How does Fertility Diagnostic Testing work?

The Fertility Diagnostic Testing at USC is a flat fee of $150 per person that covers the costs of testing your fertility potential. For women that includes the three blood tests and the one ultrasound and for men that includes the semen analysis. Once your tests are completed, your results will be emailed to you within one week. A basic explanation of the results will be provided and a recommendation for consultation will be given if it is deemed advisable.  If you decide that you want further discussion of your results and future options, you will need to set up an consultation appointment with a physician and the fee is credited towards that consultation.

Fertility Diagnostic Testing for Women

Fertility for women declines with age. Both the quantity and quality of eggs declines as a woman gets older. Through a combination of three blood tests and an ultrasound of your ovaries we are able to determine your ovarian reserve, which reflects your age related fertility potential. None of these tests are 100% accurate. By doing multiple tests for ovarian reserve we are more likely to find out if there is an ovarian reserve issue, and that your fertility potential is diminished.

FSH

On day 2-3 of your period you will need to come to our office to have your blood drawn to assess your FSH level. FSH is the main hormone from the brain that tells the ovary to produce an egg. When a woman has less eggs, the amount of FSH that is secreted each month increases. An elevated FSH is predictive of low egg quantity, however because the monthly variability a normal result does not necessarily indicate normal egg quantity. An elevated FSH may indicate that your chances of getting pregnant are lower than expected for your age.

Estradiol

When you come to our office on day 2-3 of your period from one single blood draw we will also be able to assess your estradiol level. The estradiol level is used primarily to ascertain if the FSH value can be correctly interpreted. If the estradiol is elevated then it may mean that your ovaries have an advanced egg that month, which can also be a sign of ovarian aging. The elevated estradiol level will artificially decrease the FSH value, therefore the FSH is “falsely low” that month.

AMH

From the one single blood draw, we will also evaluate your AMH level. AMH is a hormone that is made in the follicles, the fluid filled sacs that contain your eggs. A high AMH is reflective of good egg quantity and a low AMH is found in women with lower egg numbers. Like FSH, AMH is reflective of your chances for success conception.

Ovarian Ultrasound

At your visit, a vaginal ultrasound will be performed that will evaluate your uterus and ovaries. The ultrasound of the uterus will evaluate the overall shape of the uterus and look for abnormalities that could impact your ability to carry a pregnancy. The ovaries will be examined for abnormalities and to count the number of follicles, in what we call your “antral follicle count”. A low follicle count is consistent with decreased fertility potential as it is indicative a lower quantity of eggs.

Fertility Diagnostic Testing for Men

Semen Analysis

The male partner is responsible solely or partially for infertility in 40% of couples. A semen analysis is a simple test to evaluate for male fertility potential. After abstaining for several days, a specimen is collected to test for number, motility and shape of sperm.

Take charge of your future fertility by having Fertility Diagnostic Testing done today!

I was thrilled to find out that the editors at mindbodygreen.com wanted to publish my article on getting pregnant over the age of 40.  I had already starting focusing on this subject because of recent media coverage of celebrity pregnancies, and I thought it was important to disseminate ACCURATE information about what your options are for pregnancy when women are older.   I have written extensively about the subject previously as you can see in my previous post on Janet Jackson’s pregnancy announcement.  The article on mindbodygreen.com is a concise version of some of my longer blogs on this subject and speaks to the heart of the issue.

The mindbodygreen.com website is an amazing resource for information on wellness, tackling all sorts of issues related to both the mind and body and how we relate with the world.  Their all encompassing approach to living your best life speaks to my view of the world and how I want to live MY best life.  The website is full of interesting, pertinent and useful facts on all sorts of topics ranging from skin care, to juicing to exercise, spirtuality and food.  It’s all interconnected, so embrace it.

Check out my article that is published about pregnancy after 40 published on the MINDBODYGREEN website.  And spend some time on the site, perusing what they have to offer.  You won’t be disappointed.  It is a gem!!

“I’m A Fertility Doctor. Here’s What I Tell My Patients About Getting Pregnant After 40”

Janet Jackson Is Expecting

Options for women over 40 trying to have babies

Due to the recent announcement that at 49 years old, Janet Jackson is pregnant, I have been flooded with questions about how women who are older can get pregnant.  Although it is common knowledge that it is harder to get pregnant as a woman gets older, a fact that has been emphasized recently due to the explosion in knowledge about egg freezing, many women still don’t have a great grasp on when it is just too late to get pregnant.  The advent of assisted reproductive technologies has changed the landscape of reproduction for older women, but has also led to confusion on when having a baby is no longer possible, and what limitations IVF can overcome.

How does our reproductive function age?

A woman is born with all the eggs she is ever going to have.  As she gets older the quantity and quality of eggs decrease.  When the number of eggs is miniscule then a woman enters menopause.  However there is a period of several years before menopause, when a woman still has eggs and is still ovulating but can no longer get pregnant.  Why is that?  The answer is simple, the quality of eggs is poor.  Eggs are cells just like any other cell in the body, and thus they age as a woman gets older.  I like to think of them like cars.  The first year you have a car it works great, but leave that car in your driveway for 15 years, even if you don’t drive it, by the time you start it up again something is going to breakdown.  Eggs go through the same aging process with time.  The biggest issue is that eggs go through the most important stages of their development, not when they are brand new eggs right after a woman is born, but during each month as the egg is ovulating and being fertilized by the sperm.  So for a woman who is 35, her egg is also 35 when it goes through those critical developmental stages.  For a woman is 45, her egg is also 45, and thus more likely to have a mechanical error during those crucial stages that lead to either errors in the amount of genetic material or other errors leading to failed implantation.  Therefore, for women over the age of 40, it is harder to get pregnant because it is just less likely that the egg will develop normally and lead to a healthy baby.

When is it too late?

A woman’s fertility starts to decline after the age of 30, with more significant changes after the age of 35.  However, the most dramatic decline occurs after the age of 37, and continues until the age of 45 when the likelihood of pregnancy is exceedingly rare.  This is hard concept for women to grasp, as they don’t feel old when they are 40, so it seems hard to believe that their eggs are so bad that pregnancy is unlikely and that the chance of conceiving is maybe only 1 in 5.  After the age of 40, not only does the chance of pregnancy decline precipitously each year, but the chance of miscarriage also rises significantly each year.  Even with the use of IVF, by the time a woman is 45 her chance of conceiving with one embryo is 1-2%, and her chance of miscarriage exceeds 50%.

Why can’t IVF overcome age?

IVF is not a total cure for infertility.  IVF can make more eggs be ovulated in one month and optimize fertilization, however IVF can not reverse the aging process.  We can’t make a 45 year old egg act like a 30 year old egg.  A 45 year old egg is a 45 year old egg, no matter if the woman is trying to conceive on her own or going through IVF.  With IVF we can cheat time, by making multiple eggs ovulate when they are younger, instead of letting one egg ovulate each month, and as each month the woman is getting older and older and the eggs are getting older and older.  That is helpful, but it doesn’t make the eggs younger.  One of the biggest constraints with IVF is that the number of eggs that can grow in response to the stimulation medication will decrease as a woman ages because the number of eggs that are available decreases with age.  So in a woman is 45, when you really need lots of eggs to compensate for their poor quality due to age, that is also the time when she doesn’t have a lot of eggs, so no matter what we do we can only get a few eggs to grow.  At some point, the ovary gets to a point when it just stops responding to medication and despite large amounts of drugs the ovary will make only one egg, so the benefit of the stimulation portion of IVF no longer exists.

What are options when your own eggs aren’t working?

The amazing thing about the female body is that although egg quality declines with age, the ability of the uterus to carry a pregnancy does not.  A woman can carry a pregnancy well into her late 40’s without any issue.  Over the age of 50 there does seem to be a rise in complications during pregnancy, with an increase in high blood pressure and diabetes in pregnancy, and an increased risk of preterm delivery and cesarean section.  Many fertility clinics have cut offs of age 50 or 53, at which point they  require patients to use a surrogate to carry the pregnancy.  So if the eggs aren’t working but the uterus is, what are the options?  In these situations, women can conceive and carry a pregnancy in one of two ways, they can use an egg from an egg donor or if they froze their eggs when they were younger they can use those.  Pregnancy rates are predicated on the age of the egg, so if the egg is young the pregnancy rates are good, no matter the age of the uterus.  This is why women who are menopausal can get pregnant.  They aren’t using their own eggs at the age of 50, they are using their own eggs from when they were younger or they are using someone else’s eggs who is in their 20’s.

Being Proactive

If you are 40 or older and want to get pregnant, it is best for you to have a fertility evaluation right away to assess the chance of conception.  Unlike women who are 30 who can try to conceive for a year without needing a fertility assessment, for women over 40, the clock is ticking and it is best to understand how the ovaries are doing right away.  The information gained in a fertility assessment can best serve to help with family planning by determining how long to try on your own right away, or identify those women that proceed with fertility treatments immediately.  Time is limited so you want to make the best use of it.  Understanding your fertility potential by having a consultation with a fertility specialist will arm you with the knowledge that helps you make educated decisions about your reproductive life and potential to have a baby.

Last week at the annual Pacific Coast Reproductive Society (PCRS) Meeting, I was asked by one of the genetics companies we work with to give a talk at one of their dinner events. Given my experience with social media, they wanted me to talk about how physicians can better use social media to provide greater awareness of fertility issues and facilitate communication with our infertile patients. I figured a fun way to address the topic would be to discuss “The 10 Most Common Mistakes Made with Social Media” (from a perspective of someone in the health care industry). I think I succeeded as the audience, full of doctors and industry representatives, seemed to have a blast.

My dinner presentation at PCRS 2016

One of my favorite entertaining pictures from the talk was this one. Clearly a surgeon should never operate while drinking and smoking, much less post on facebook about it.

On a More Serious Note

Social media can be a wonderful tool to educate patients and potential patients about their own health. With accurate knowledge, patients will be better informed to make better health care decisions for themselves and their partners.

I have noticed that there is a lot of misinformation pertaining to infertility, fertility treatments and pregnancy loss that is circulated on social media and the web.

One of the best online sources for accurate information about issues related to reproduction, women’s health and infertility is the American Society for Reproductive Medicine’s (ASRM) patient site called, ReproductiveFacts.org.

http://www.reproductivefacts.org/

This website is full of accurate, detailed and easy to understand information about infertility, fertility preservation, fertility diagnostic testing and egg donation as well as many other topics. On the website, they have links to current headlines trending in the reproductive field as well as links to ASRM news and research. You can find information through educational videos and fact sheets on almost every topic imaginable including, age and fertility, adoption, egg freezing and In Vitro Fertilization.

Health care professionals have a responsibility to guide their patients as to where they can best seek additional information if they want it, as they often do. I am happy that women and men suffering from infertility have a resource like the ASRM’s The ReproductiveFacts website to provide a trusted source of information on things related to fertility.

On the 24^th of February I was thrilled to be a part of CureTalks, an online radio program with a mission to heal the world through information, discussion and sharing of knowledge.

It was an amazing experience to share my knowledge about miscarriage with a larger audience. Miscarriages occur in approximately 15-20% of all pregnancies, so they are more common than people think.  People are unaware of how often miscarriages occur, because often times it is something that a woman keeps private and doesn’t share with even with her closest friends.

In my practice I see a lot of both fertile and infertile women who have suffered from a miscarriage or multiple miscarriages.   In my consultations with these women I find that they focus on three things they want me to answer for them.

1. Why did this happen
2. Can we treat it
3. What is the chance that this will happen again.

Listen in to the CureTalk for more information.

If you are trying to conceive, you may have heard some of the recent press coverage concerning the Zika virus which has been possibly linked to a certain neurological birth defect in babies known as microcephaly (an abnormally small head and brain).

Couples who are trying to get pregnant need to exercise caution in order to minimize the risk of infection.

Most importantly, Do Not Travel to Areas Where Zika is Present

This applies to both males and females as there has been evidence that Zika is sexually transmissible from men to women. According to the latest information provided by the CDC, the Zika virus can be active in semen for up to two weeks after infection, although it is possible that it persist past that time period.   It is unknown if the Zika virus can be sexually transmitted from a woman to a man.

The virus remains in the blood of the infected person for only about a week to ten days.  You should abstain from sexual activity during the transmissible period, or at the very least, use condoms during any form of sexual activity.  Researchers believe that if a baby is conceived after the virus is cleared from the blood, the baby is not at risk for birth defects.

There are no concrete recommendations for couples who are attempting to conceive.  However, it is safe to assume that if a man is infected that the virus will be present in the semen for at least two weeks if not longer.  We also have no data to suggest that performing intrauterine inseminations (IUI) can prevent the spread of Zika.  Therefore, the safest course of action is to stop attempting to conceive for a couple of months after symptoms appear, by either abstaining from sexual contact or using a condom.

There are tests to detect Zika virus, but they are not commercially available.  The tests can be used to establish the diagnosis of infection in the blood.  Although they can also be used to detect the Zika virus in the semen, we have a limited understanding of how to interpret the results of the tests, so testing of semen is not recommended. Testing of the Zika virus is solely used to establish infection, not to determine the risk of sexual transmission. The American College of Obstetrics and Gynecology (ACOG) recommends that if a pregnant patient becomes clinically ill within 2 weeks of travelling to affected country then testing should be performed, but testing is not recommended if symptoms do not occur within 2 weeks of travel.

If you are concerned you have symptoms of the Zika virus you should speak to a healthcare provider, especially if you are pregnant.  Our knowledge of Zika is constantly evolving.  If you want the most up to date information about the Zika virus or to find out where the Zika virus is prevalent please check out the CDC website http://www.cdc.gov/zika/index.html.

New UPDATE 4/12/2016

American Society for Reproductive Medicine Issues Guidance Document on Zika Virus

Washington DC – The American Society for Reproductive Medicine (ASRM) today issued a new document “Guidance for Providers Caring for Women and Men of Reproductive Age with Possible Zika Virus Exposure.”  The report is intended to help physicians and other health care providers who are treating and counseling patients concerned about Zika’s impact on reproduction.

Among the key points of the report:

• Women who have Zika disease symptoms should wait at least 8 weeks after symptoms appear, and men should wait 6 months, before attempting reproduction.
• Men and women with possible exposure to, but not showing symptoms of, Zika should also wait 8 weeks. (this includes travel to countries where Zika is prevalent)
  
• These same timelines should be used for sexually intimate couples using their own gametes in fertility treatments.
• For donated reproductive tissue, FDA guidance should be followed. Currently, FDA rules a potential donor ineligible for 6 months following being diagnosed with, or having had a high probability of exposure to, the virus.
• Testing for Zika virus is complicated, not universally available and routine serologic testing is not currently recommended.
• In areas of active Zika virus transmission, the use of contraceptive methods to prevent unintended pregnancy is essential.
• Physicians should counsel and educate their patients on Zika and update their informed consent procedures to reflect that counseling.

Bottom Line:  You need to talk with your physician if you have traveled to a ZIKA country or have plans to travel to a ZIKA country.

Altered Sex Ratio after IVF.  Is it real?

You may have heard that after IVF you are more likely to have a boy.  There is some truth to that.  During an IVF cycle, the embryos are cultured for a few days in the laboratory before they are transferred back into the woman’s uterus.  The day of transfer is not set in stone, and you can put the embryos back any time between the 2^nd and 5^th day without comprising pregnancy rates.  Extending the duration of culture allows the embryos to progress to the “blastocyst stage” which typically occurs on day 5.  There are some advantages for some patients to wait to day 5 before the transfer; however the embryo must remain in culture media longer.

Research has shown that if you wait for the embryo to reach the blastocyst stage before transfer, instead of performing the transfer at day 3, that sex ratio of the embryos is altered so that there are a higher percentage of male babies.  Animal data has shown the increase in altered sex ratio in multiple species. The thought was that in animal models, male embryos develop faster, and therefore look better on day 5 and are more likely to be chosen by the embryologists for the transfer.

In humans, research has shown a slight trend to an altered sex ratio if embryos are kept in culture media longer, with approximately 55-57% of pregnancies being male with day 5 transfers compared to closer to 50-51% males with day 3 transfers.

We have long known that extended culture can alter certain genetic modifications of the DNA that routinely occur during that time period.  Some of these abnormal genetic modifications can lead to rare diseases called imprinting disorders.

A new study just published in Proceedings of the National Academy of Sciences (PNAS), demonstrates that genetic modifications due to extended culture, may be the cause of the altered sex ratio (not the speed at which the embryos develop).

The researchers elegantly showed the following

1. The presence of alterations in the genetic modifications of mice embryos that led to abnormal development in female embryos (which ultimately leads to the altered sex ratio).
2. By correcting these alterations they were able to rescue the female embryos, and restore a balanced sex ratio.
3. By altering a supplement in the culture media they were also able to rescue the female embryos and restore a balanced sex ratio.

This study is important because it makes us rethink our hypothesis of why the altered sex ratio is occurring and provides a potential solution to fix it.  In addition, these findings show that the extended culture environment truly impacts embryo gene expression and ultimately embryo development.

More research needs to be done to corroborate these exciting findings and confirm them in human studies.

Until then, don’t count on getting a boy just by going through IVF, the altered sex ratio, if truly there, is very slight.  So it is still pretty close to flipping a coin as to whether you will have a girl or a boy.