News
Women & Infertility: Virginia Fertility Expert Addresses The Inconceivable
Published: Mar 06, 2005 - 09:58 AM
THE PRINCIPLES OF ANCIENT MEDICINE PROVES TO BOOST PREGNANCY ODDS-Acupuncture, an important element in the 4,000 year-old tradition of Chinese Medicine has been touted a miracle in curing ailments including allergies, headaches, acne, irritable bowel syndrome, arthritis, chronic fatigue syndrome and even quitting smoking.
Recently, there has been great speculation regarding acupuncture and infertility and its role in combination with in-vitro fertilization in helping women to get pregnant successfully. Dr. Fady Sharara incorporates acupuncture into his practice as an added incentive for women who are undergoing IVF treatment. ?Published studies do show pregnancy rates of women were higher when they had acupuncture treatments compared to those that did not,? says Dr. Sharara. In combination with IVF, acupuncture is thought to help make the uterus a better receiving place for the embryos or may improve blood flow to the uterus or ovaries.
PGD (Pre-Implantation Genetic Diagnosis) This landmark procedure tests embryos for abnormalities before they are placed in the womb. PGD is a technique that permits analysis of the genetics of an embryo prior to transferring embryos to a woman undergoing in vitro fertilization. As Dr. Sharara explains, ?its primary use is to permit the selection of chromosomally normal embryos along with testing for other common genetic abnormalities leading to diseases such as Down?s Syndrome, Edward?s Disease, Muscular Dystrophy and many others. PGD is very powerful and can be beneficial to any couple (husband and wife) willing to have IVF especially those in which the female is older or when either partner is at higher risk for causing the production of abnormal embryos.
HOW FAST IS YOUR BIOLOGICAL CLOCK TICKING?
Expert Reproductive Endocrinologist Uses Revolutionary Technique
In Predicting the Duration of a Woman?s Fertility-In contrast to healthy men whose sperm continuously divide and renew themselves well into later life, healthy women are born with all the eggs that they will ever have. Although a woman?s reproductive age may not correspond to her biological age, women are most fertile when they are younger (late teens and twenties) making getting pregnant more difficult by the mid-to-late thirties. According to Dr. Fady Sharara, board certified reproductive endocrinologist and Medical Director of the Virginia Center for Reproductive Medicine, ?Women who are worried about having babies later in life can find out just how fast their biological clock is ticking, how long they will be fertile and when they are likely to go through menopause by having a specialist measure their ?ovarian reserve.? The term "ovarian reserve" refers to a woman's current supply of eggs, and is closely associated with reproductive potential, therefore the biological clock. The greater the number of remaining eggs, the better the chance for conception. Conversely, low ovarian reserve greatly diminishes a patient's chances for conception. To date, the most specific and important test to measure ovarian reserve is the Transvaginal Ultrasound, which Dr. Sharara has been performing and published on in many leading fertility journals for the past seven years. The ultrasound is performed using a vaginal probe on the third day of the patient?s period. Both ovaries are examined, measured in three dimensions, and the small follicles (early egg sacs) in each ovary are then counted. According to Dr. Sharara, ?Women with small ovarian volumes and fewer than five follicles per ovary are much more likely to have an earlier menopause and have a much higher incidence of failed treatment cycles. In contrast, women whose ovaries are determined to be larger than average and have more than five follicles per ovary are likely to have a later menopause.?
NON-FERTILITY DRUGS USED TO TREAT INFERTILITY-Dr. Sharara has been giving infertile women a new choice of medical therapy, using non-fertility drugs to treat infertility which has proven time and again to be quite successful. ?For years the first line of drug treatment for infertility has been clomiphene citrate (also known as Clomid or Serophene) Yet, these days I see that more and more women are unresponsive to or have adverse effects from these drugs. Several drugs on the market today that have been approved by the FDA for other uses are proving to be highly successful in treating infertility.? Commonly called off-label indications, drugs including Letrozole, Thiazolidinedione and Lupron, have been approved for medical use in treating breast cancer, prostate cancer and diabetes, but are allowed to be used by a physician for anything he/she deems fit; in this case infertility.
MALE FERTILITY TESTING- Dr. Sharara is at the forefront of a small group of physicians who offer male patients this new test, which is actually able to screen a man for sperm DNA damage, and possible infertility. The test is painless, non-invasive, and cost efficient in the sense that it can screen men who might have very unhealthy or damaged sperm before their spouses go through infertility treatments that may have low chances of succeeding. It entails the man producing a semen sample just like for a semen analysis. A standard semen analysis is done on one part of the sample and the other portion is frozen and sent to the specialized lab that performs the assay. The percentage of damaged sperm is calculated and the sperm is determined to be good, fair or poor fertility potential. The test determines three key factors:
? What is the likelihood of the sperm contributing to the birth of a healthy baby?
? What percentage of sperm has damage?
? Can the sperm sample be used for In-Vitro procedures or should the male partner be treated to improve the quality of the sperm?
CANCER TREATMENTS NO LONGER HAND DOWN A LIFE SENTENCE OF INFERTILITY
Options For Preserving Fertility In Women Undergoing Chemotherapy, Radiation or Surgery- There are more than 9 million cancer survivors alive in America today, and approximately 10% were diagnosed in their reproductive years. Survival being the number-one priority, patients are often given aggressive treatments including chemotherapy, radiation, hormone therapy and surgery, which are often times the causes of permanent infertility and premature ovarian failure. In addition, if a woman undergoes chemotherapy or radiation to the pelvic area during her reproductive years, she has between a 40-80% chance of losing her fertility. While several successful fertility preservation options are available, they are underutilized due to a general lack of awareness, education and financial resources. According to Dr. Sharara, ?There are many options available to cancer patients that their oncologists may not know much about, or may neglect to mention to them including egg and embryo freezing, ovarian tissue freezing and ovarian transposition.?
DELAYING CHILDBEARING
How Old Is Too Old?
According to an article published in the November 4th issue of the New England Journal of Medicine, the past decade has seen a remarkable shift in the demographics of childbearing in the United States. The number of first births per 1000 women 35 to 39 years of age increased by 36 percent between 1991 and 2001, and the rate among women 40 to 44 years of age increased by a remarkable 70 percent. Yet, how old is too old, and how realistic is it for a young woman today to expect to delay her childbearing into the later decades of her life? Dr. Fady Sharara, board certified reproductive endocrinologist and Medical Director of the Virginia Center for Reproductive Medicine, feels there is some denial among career women who lead an active and healthy life. ?Women tend to think that if they go to the gym, eat healthy, take vitamins and really take care of themselves properly, then they should be able to have a baby. Women need to separate general health and reproductive health and be aware that fertility DOES decrease with age no matter how well you take care of yourself.?
FERTILITY: A WEIGHTY ISSUE- If you are overweight (BMI over 25) and having trouble getting pregnant, try to lose weight. If you have irregular menstrual cycles (anovulation, or irregular ovulation) and you are overweight, weight loss might make your cycle regular - thereby making you more fertile. If you are obese (BMI of 30 or higher) and need IVF, you might have a significantly improved chance for success if you reduce your weight before going through the procedure. In a study published in 2001, Dr Sharara showed that the pregnancy rates with IVF are reduced by 50% in women with BMI > 25 compared with the normal weight women. These findings were recently confirmed in recent studies, which were presented at the ASRM meeting in October 2004.
INFERTILITY AND EATING DISORDERS- Infertility is a consequence of eating disorders that is not addressed as often as other consequences. What effect does an eating disorders have on infertility? Eating disorders can have people overweight, underweight and sometimes a normal weight. Body size has been related to several gynecological disorders. Higher risks of infertility have been found in both overweight and underweight women. To what extent being excessively under or overweight increases a woman?s risk for infertility is unknown. Women who are excessively underweight or overweight may be at increased risk of amenorrhea. Women need to have a certain amount of body fat in order to menstruate and conceive children.
Many anorexic girls and women either never get their period or their period stops due to extreme weight loss. The cessation of menstruation, (amenorrhea), can be permanent depending on how long a woman has been suffering from anorexia. But for most women menstruation will start up when they begin to gain weight. Roughly 80% of anorexic women who successfully treat their eating disorder will regain their ability to conceive. When a woman's percentage of body fat falls below a certain minimum her body doesn't produce the levels of hormones necessary to stimulate ovulation. Rapid weight loss and undernourishment leads a woman's body into a state of emergency and she will not menstruate if she is just barely surviving.
Fady I. Sharara, M.D, FACOG, is a Board Certified Reproductive Endocrinologist/Infertility specialist (since 1996), and a Board Certified Obsterician/Gynecologist (since 1994). He received his B.S in Chemistry in 1982, and his M.D in 1986 from the American University of Beirut. He was on the Dean's honor list during his premedical and medical studies. He then completed his residency in OB/GYN at George Washington University Hospital in Washington, DC in 1991, followed by a fellowship in Reproductive Endocrinology and Infertility from 1991 to 1994 at the prestigious National Institutes of Health in Bethesda, MD. He then moved to Chicago where he was an Assistant Professor at the University of Illinois and Michael Reese Fertility Center between 1994 and 1996. He then returned East to the University of Maryland where he was Assistant Professor and head of the IVF program from 1996 to 2000. He was promoted to Associate Professor before his departure from the University of Maryland. Dr Sharara then became the founder and Medical Director for the Virginia Center for Reproductive Medicine (VCRM), with offices in Reston, VA, and Hagerstown, MD. Dr Sharara has published more than 60 scientific papers and book chapters dealing with Infertility and Assisted Reproductive Technologies, and is a sought after speaker in his area of expertise, namely IVF and assisted reproduction. He is the recipient of numerous prestigious awards, and is on the speaker's bureau for multiple companies. Dr Sharara is also a reviewer for Fertility and Sterility and Human Reproduction, the two leading scientific journals in the area of Reproduction. Dr Sharara was recently named one of America's Who's Who in Medicine for 2002, 2003, and 2004.
PGD (Pre-Implantation Genetic Diagnosis) This landmark procedure tests embryos for abnormalities before they are placed in the womb. PGD is a technique that permits analysis of the genetics of an embryo prior to transferring embryos to a woman undergoing in vitro fertilization. As Dr. Sharara explains, ?its primary use is to permit the selection of chromosomally normal embryos along with testing for other common genetic abnormalities leading to diseases such as Down?s Syndrome, Edward?s Disease, Muscular Dystrophy and many others. PGD is very powerful and can be beneficial to any couple (husband and wife) willing to have IVF especially those in which the female is older or when either partner is at higher risk for causing the production of abnormal embryos.
HOW FAST IS YOUR BIOLOGICAL CLOCK TICKING?
Expert Reproductive Endocrinologist Uses Revolutionary Technique
In Predicting the Duration of a Woman?s Fertility-In contrast to healthy men whose sperm continuously divide and renew themselves well into later life, healthy women are born with all the eggs that they will ever have. Although a woman?s reproductive age may not correspond to her biological age, women are most fertile when they are younger (late teens and twenties) making getting pregnant more difficult by the mid-to-late thirties. According to Dr. Fady Sharara, board certified reproductive endocrinologist and Medical Director of the Virginia Center for Reproductive Medicine, ?Women who are worried about having babies later in life can find out just how fast their biological clock is ticking, how long they will be fertile and when they are likely to go through menopause by having a specialist measure their ?ovarian reserve.? The term "ovarian reserve" refers to a woman's current supply of eggs, and is closely associated with reproductive potential, therefore the biological clock. The greater the number of remaining eggs, the better the chance for conception. Conversely, low ovarian reserve greatly diminishes a patient's chances for conception. To date, the most specific and important test to measure ovarian reserve is the Transvaginal Ultrasound, which Dr. Sharara has been performing and published on in many leading fertility journals for the past seven years. The ultrasound is performed using a vaginal probe on the third day of the patient?s period. Both ovaries are examined, measured in three dimensions, and the small follicles (early egg sacs) in each ovary are then counted. According to Dr. Sharara, ?Women with small ovarian volumes and fewer than five follicles per ovary are much more likely to have an earlier menopause and have a much higher incidence of failed treatment cycles. In contrast, women whose ovaries are determined to be larger than average and have more than five follicles per ovary are likely to have a later menopause.?
NON-FERTILITY DRUGS USED TO TREAT INFERTILITY-Dr. Sharara has been giving infertile women a new choice of medical therapy, using non-fertility drugs to treat infertility which has proven time and again to be quite successful. ?For years the first line of drug treatment for infertility has been clomiphene citrate (also known as Clomid or Serophene) Yet, these days I see that more and more women are unresponsive to or have adverse effects from these drugs. Several drugs on the market today that have been approved by the FDA for other uses are proving to be highly successful in treating infertility.? Commonly called off-label indications, drugs including Letrozole, Thiazolidinedione and Lupron, have been approved for medical use in treating breast cancer, prostate cancer and diabetes, but are allowed to be used by a physician for anything he/she deems fit; in this case infertility.
MALE FERTILITY TESTING- Dr. Sharara is at the forefront of a small group of physicians who offer male patients this new test, which is actually able to screen a man for sperm DNA damage, and possible infertility. The test is painless, non-invasive, and cost efficient in the sense that it can screen men who might have very unhealthy or damaged sperm before their spouses go through infertility treatments that may have low chances of succeeding. It entails the man producing a semen sample just like for a semen analysis. A standard semen analysis is done on one part of the sample and the other portion is frozen and sent to the specialized lab that performs the assay. The percentage of damaged sperm is calculated and the sperm is determined to be good, fair or poor fertility potential. The test determines three key factors:
? What is the likelihood of the sperm contributing to the birth of a healthy baby?
? What percentage of sperm has damage?
? Can the sperm sample be used for In-Vitro procedures or should the male partner be treated to improve the quality of the sperm?
CANCER TREATMENTS NO LONGER HAND DOWN A LIFE SENTENCE OF INFERTILITY
Options For Preserving Fertility In Women Undergoing Chemotherapy, Radiation or Surgery- There are more than 9 million cancer survivors alive in America today, and approximately 10% were diagnosed in their reproductive years. Survival being the number-one priority, patients are often given aggressive treatments including chemotherapy, radiation, hormone therapy and surgery, which are often times the causes of permanent infertility and premature ovarian failure. In addition, if a woman undergoes chemotherapy or radiation to the pelvic area during her reproductive years, she has between a 40-80% chance of losing her fertility. While several successful fertility preservation options are available, they are underutilized due to a general lack of awareness, education and financial resources. According to Dr. Sharara, ?There are many options available to cancer patients that their oncologists may not know much about, or may neglect to mention to them including egg and embryo freezing, ovarian tissue freezing and ovarian transposition.?
DELAYING CHILDBEARING
How Old Is Too Old?
According to an article published in the November 4th issue of the New England Journal of Medicine, the past decade has seen a remarkable shift in the demographics of childbearing in the United States. The number of first births per 1000 women 35 to 39 years of age increased by 36 percent between 1991 and 2001, and the rate among women 40 to 44 years of age increased by a remarkable 70 percent. Yet, how old is too old, and how realistic is it for a young woman today to expect to delay her childbearing into the later decades of her life? Dr. Fady Sharara, board certified reproductive endocrinologist and Medical Director of the Virginia Center for Reproductive Medicine, feels there is some denial among career women who lead an active and healthy life. ?Women tend to think that if they go to the gym, eat healthy, take vitamins and really take care of themselves properly, then they should be able to have a baby. Women need to separate general health and reproductive health and be aware that fertility DOES decrease with age no matter how well you take care of yourself.?
FERTILITY: A WEIGHTY ISSUE- If you are overweight (BMI over 25) and having trouble getting pregnant, try to lose weight. If you have irregular menstrual cycles (anovulation, or irregular ovulation) and you are overweight, weight loss might make your cycle regular - thereby making you more fertile. If you are obese (BMI of 30 or higher) and need IVF, you might have a significantly improved chance for success if you reduce your weight before going through the procedure. In a study published in 2001, Dr Sharara showed that the pregnancy rates with IVF are reduced by 50% in women with BMI > 25 compared with the normal weight women. These findings were recently confirmed in recent studies, which were presented at the ASRM meeting in October 2004.
INFERTILITY AND EATING DISORDERS- Infertility is a consequence of eating disorders that is not addressed as often as other consequences. What effect does an eating disorders have on infertility? Eating disorders can have people overweight, underweight and sometimes a normal weight. Body size has been related to several gynecological disorders. Higher risks of infertility have been found in both overweight and underweight women. To what extent being excessively under or overweight increases a woman?s risk for infertility is unknown. Women who are excessively underweight or overweight may be at increased risk of amenorrhea. Women need to have a certain amount of body fat in order to menstruate and conceive children.
Many anorexic girls and women either never get their period or their period stops due to extreme weight loss. The cessation of menstruation, (amenorrhea), can be permanent depending on how long a woman has been suffering from anorexia. But for most women menstruation will start up when they begin to gain weight. Roughly 80% of anorexic women who successfully treat their eating disorder will regain their ability to conceive. When a woman's percentage of body fat falls below a certain minimum her body doesn't produce the levels of hormones necessary to stimulate ovulation. Rapid weight loss and undernourishment leads a woman's body into a state of emergency and she will not menstruate if she is just barely surviving.
Fady I. Sharara, M.D, FACOG, is a Board Certified Reproductive Endocrinologist/Infertility specialist (since 1996), and a Board Certified Obsterician/Gynecologist (since 1994). He received his B.S in Chemistry in 1982, and his M.D in 1986 from the American University of Beirut. He was on the Dean's honor list during his premedical and medical studies. He then completed his residency in OB/GYN at George Washington University Hospital in Washington, DC in 1991, followed by a fellowship in Reproductive Endocrinology and Infertility from 1991 to 1994 at the prestigious National Institutes of Health in Bethesda, MD. He then moved to Chicago where he was an Assistant Professor at the University of Illinois and Michael Reese Fertility Center between 1994 and 1996. He then returned East to the University of Maryland where he was Assistant Professor and head of the IVF program from 1996 to 2000. He was promoted to Associate Professor before his departure from the University of Maryland. Dr Sharara then became the founder and Medical Director for the Virginia Center for Reproductive Medicine (VCRM), with offices in Reston, VA, and Hagerstown, MD. Dr Sharara has published more than 60 scientific papers and book chapters dealing with Infertility and Assisted Reproductive Technologies, and is a sought after speaker in his area of expertise, namely IVF and assisted reproduction. He is the recipient of numerous prestigious awards, and is on the speaker's bureau for multiple companies. Dr Sharara is also a reviewer for Fertility and Sterility and Human Reproduction, the two leading scientific journals in the area of Reproduction. Dr Sharara was recently named one of America's Who's Who in Medicine for 2002, 2003, and 2004.
