Monday, October 31

Infertility specialists believe they might have an answer for women prone to having miscarriages - natural killer cells.

With no scientific evidence to back up their suspicions, they are willing - but extremely cautious - to treat women like a 31-year-old Johannesburg businesswoman who has been trying to have a baby for four and a half years, but has too many NK cells.

The woman, who wants to be known only as Chantal, said: "I've done pregnancy tests each month, but to see the stick with the one line on it, instead of two, can crush you," she said.

Dr Merwyn Jacobson, medical director of Vitalab centre for assisted conception in Johannesburg, said: "We're trying to find explanations for things we don't understand. We may be way out and have to eat humble pie, but that's our thinking as of now."

During early pregnancy there is a dramatic increase in the number of NK cells, which search for and destroy harmful cells in the body.
Based on research by controversial British infertility specialist Dr George Ndukwe, Jacobson and his colleagues Dr Lawrence Gobetz and Dr Stephen Volschenk think over-reactive NK cells in the uterus attach to the growing embryo and destroy it because the killer cells view it as an "invader".

My notes: I have been espousing this pathomechanism for years. Herbs help to mitigate activate natural killer cells in addition to IVIG or intralipid therapy. mike berkley, L.AC., FABORM

Thursday, October 27

Preserving Your Fertility - You're Invited


New York Fertility Services

Presents a free event

Stop The Clock

Preserving Your Fertility

Tuesday, November 15th, 2011

6:30pm – 8:00pm

16 E. 40th Street, 2nd Floor

New York, NY 10016

If you are single, in a relationship, or newly married and are wondering how long you can wait to start your family, this event is for you! Please join us for an evening of information about Age and Fertility. Dr. Joel Batzofin will address these topics:

 Infertility and Age – Where are you? How does one affect the other?

 Egg Freezing and Fertility Preservation – Can we “stop the clock”?

 Success Rates – What exactly do they mean?

 Egg Freezing Cycle Costs – Can I afford to do this? Can I afford NOT to?

Hors d’oeuvres will be served so bring your friends along to this informative event. We will have a drawing for a free Egg Freezing Cycle* to one lucky person who attends this event – you must be present to win. We will also offer a special “End of the Year” Egg Freezing Cycle Incentive for all who attend to help you preserve your fertility now so you can concentrate on living your life!

Reservations are a must.

RSVP to Teresa or call 212-679-2289.

ivf and cancer

Ovarian Malignancy Risk Seen Doubled 15 Years After IVF By: JENNIE SMITH, Family Practice News Digital Network.

Women who have undergone in vitro fertilization appear to have a twofold risk of ovarian malignancies later in life, compared with women with fertility problems who never used IVF.

However, the risk of invasive ovarian cancer was not significantly increased in IVF-treated women until 15 years after IVF treatment, the results of the study found.

Results from a large Dutch cohort study of 25,152 women using linked medical records to identify women who had been seen for infertility and/or treated with IVF from 1983 to 1995 showed that borderline ovarian tumors accounted for most of the increase in risk after a median 15 years of follow-up. Most of the women were in their late 40s at the study end point.

The investigators of the study, which was published Oct. 26 in Human Reproduction, compared the 19,146 IVF-treated women in the cohort with a control group of 6,006 women who had been seen for fertility problems but had not undergone IVF (although they may have received other forms of treatment, including drugs). The investigators also looked at rates of ovarian malignancies in the general population (Hum. Reprod. 2011 [doi:10.1093/humrep/der322]).

Having subfertile controls was important, the investigators said, because women with infertility have a different risk profile for ovarian malignancies than do women in the population at large. Causes of infertility in the study included fallopian tube disorders, subfertility of a male partner, cervical factor, and endometriosis.

The investigators, led by Flora E. van Leeuwen, Ph.D., of the Netherlands Cancer Institute in Amsterdam, noted that the findings of a risk increase for ovarian malignancies confirmed older findings from smaller cohort studies. Borderline tumors are considered to have a low malignancy potential, and not much is known about which will become invasive, but these tumors do require treatment.

Nearly half of the 61 malignancies detected in the IVF-treated women were borderline tumors, while in the general population of women under age 50 years, these normally account for 15%-30% of malignancies, Dr. van Leeuwen and her colleagues found. A high proportion – 63% – of the borderline tumors seen in the IVF-treated group were serous, while mucinous tumors are more frequent in the general population.

After the researchers adjusted for such potential confounding factors as age, parity, and causes of infertility, IVF-treated women saw a significantly elevated risk for borderline ovarian tumors, compared with subfertile controls (hazard ratio 4.23) and for all ovarian malignancies combined, compared with controls (HR 2.14).

Risk of invasive ovarian cancer was not seen as significantly increased in the IVF-treated women, compared with controls (HR 1.51). However, compared with the general population, the IVF-treated women’s risk of developing invasive ovarian cancer was higher 15 years after IVF treatment, with a standard incidence ratio of 3.54. No increased risk was reported for non-IVF controls, compared with the general population.

Dr. van Leeuwen and her colleagues noted that they did not find evidence that repeated cycles of IVF increased the risk of malignancies, as might be expected. However, they wrote, the powers of their analyses were reduced by missing data and small numbers of women in the subgroups. In the IVF group, 40% of women had one to two stimulated IVF cycles, 39% had three to four cycles, and 21% received five or more cycles.

The type of infertility treatments were as follows: clomiphene/hMG (human menopausal gonadotropins) or FSH (follicle stimulating hormone)/hMG stimulation protocols were used until 1988-1989, whereas stimulation with GnRH (gonadotropin-releasing hormone) agonists became common after 1990 (from 20% in 1986 to about 90% after 1990), the investigators said.

Dr. van Leeuwen and her colleagues cited the large cohort size and long follow-up period as strengths of their study, as well as linkages to population-based cancer and pathology registries, which enabled the investigators to also evaluate the occurrence of borderline ovarian tumors.

They noted as a weakness of their study the fact that their group of subfertile controls was relatively small and that 40% of controls had been prescribed clomiphene, meaning that they were not truly unexposed if the cause of the malignancies was drug related and not related to ovarian puncture. The study was based on IVF treatment protocols through 1995 only, they added.

Still, the researchers concluded that they had demonstrated sufficient risk for women and their physicians to consider when deciding whether to start or continue IVF treatment.

The study was funded by the Dutch Ministry of Health, the Health Research and Development Counsel, and the Netherlands Cancer Institute. J.L.H. Evers declared that he works in a department that has received unrestricted research grants from Merck and Ferring. Neither Dr. van Leeuwen nor any other of her colleagues declared any relevant financial disclosures.

Maybe acupuncture and herbal medicine should be tried first! (mike berkley's note)

Tuesday, October 25

Acupuncture: A Cure for Infertility?

Catherine Donaldson-Evans

At 36, Lucy Appert has suffered through two miscarriages, a stillbirth at 8 1/2 months and, because of a rare pregnancy-related liver dysfunction, intensive illness and surgery.

Yet after enduring five painful years of trying to have their own baby, Appert and her husband Edward finally saw their dream come true last month when their son Henry was born — premature, but healthy.

For all the fertility treatments, technologies and prenatal care available to women today, Appert credits the success of her pregnancy to an ancient Chinese secret.

"I recommend acupuncture (search) to everyone," Appert said. "It does work. I did everything possible for years to have a baby. I almost lost hope."

The millennias-old Asian medical practice — in which the acupuncturist places tiny needles in various pressure points, or "Qi" (Chee), in the body to improve circulation and reduce stress — has been around in the United States for years as an "alternative" treatment for numerous ailments.

But recently, acupuncture has been picking up steam as a possible remedy for female infertility, with a handful of American and European studies showing that it enhances the success rate of in vitro fertilization (IVF) (search).

“Do I believe in it? Absolutely,” said Dr. Paul C. Magarelli, an infertility doctor at the Reproductive Medicine & Fertility Center in Colorado Springs, Colo., and co-author of an ongoing study into the use of acupuncture with IVF with Dr. Diane K. Cridennda. Cridennda is a licensed acupuncturist with a master's degree in Oriental medicine from the International Institute of Chinese Medicine (search) who owns East Winds Acupuncture, also in Colorado Springs.

Magarelli said he joined the study at the urging of Cridennda, who had approached him about using acupuncture with IVF based on her knowledge of its history as an Eastern fertility treatment. A skeptic at first, Magarelli said he dismissed the idea for a while before signing on.

"I thought, this is rubbish — it can't be true," Magarelli said. "But no matter how I look at this data, I see an improvement. ... I'm pretty much a convert."

In general, studies seem to indicate that doing acupuncture about 30 minutes before and after in vitro fertilization can increase the chance that the embryo will be implanted successfully and reduce the chance of miscarriage.

There are also indications that the effectiveness of the IVF drugs and procedure may improve if acupuncture is done about once a week in the month or two leading up to the start of IVF and then continued regularly — once or twice a week — during the whole cycle.
And, as in Appert's case, there is anecdotal evidence that acupuncture can help with other fertility and pregnancy problems. Appert didn't need IVF to conceive, but she was told she probably couldn't carry a healthy baby to term because of her liver disorder.

But some doctors caution that there is no "magic pill" for fertility, pregnancy and IVF troubles — whether it's acupuncture or something else.

"The jury is still out on that," said Dr. Eric Surrey, president of the Society for Assisted Reproductive Technology (SART) (search), who has a practice at the Colorado Center for Reproductive Medicine. "I don't think we have good data to show that acupuncture before and after the embryo transfer is truly beneficial."
And they warn against making too much of claims that acupuncture can help with having babies.
"It's impossible to say at this point," said Dr. Robert Schenken, president of the American Society for Reproductive Medicine (ASRM) (search), who has a practice at the University of Texas Health Science Center. "In the absence of any controlled data, I don't think we can come to a firm conclusion."

Promising Research

Acupuncture seems to help some women because it improves circulation to the ovaries (search) — which makes for healthier eggs — and to the uterus (search), which increases the chances that the lining will be strong enough to hold those eggs to full-term.

"Acupuncture provides better circulation and better blood flow to the womb," said Dr. Raymond Chang, director of New York's Meridian Medical Group, who has been incorporating acupuncture into fertility treatments for the past decade. "It will give a better chance for the eggs to be nourished and therefore carried."

There's also the fact that acupuncture can be a stress-reliever during an emotional time.

"Trying to get pregnant is incredibly stressful," said Victoria Koos, the acupuncturist who treated Appert at Yin and Tonic Acupuncture in New York. "They're crossing their fingers. The longer they're trying to get pregnant, the worse it gets ... Part of [acupuncture's success] is simply relaxation. When the body is relaxed, all systems function better."

The Colorado study Magarelli and Cridennda presented at a conference this fall is one of a series the pair have done with acupuncture and in vitro.

That one looked at 114 patients who had a good chance of IVF being effective, some who did acupuncture and some who didn’t. It found, among other things, that there were fewer miscarriages, more pregnancies and a 7 percent higher birth rate among those who got acupuncture treatment over those who didn’t, according to Magarelli.

It piggybacked off other research the team did on 147 “poor responders” to IVF, which found that the pregnancy rate was 40 percent, with 11 percent more babies born, among those who did acupuncture with in vitro fertilization compared to those who didn’t.

In March, Magarelli and Cridennda released findings in Italy involving patients with an average prognosis for IVF success. Those yielded clear numbers that the pregnancy rate increased with acupuncture by 24 percent, according to Magarelli.

“What got us was that now we were seeing a firm trend toward getting more people pregnant,” he said.

The Colorado research seems to support some findings of two earlier studies, one in Germany by lead researcher Dr. Wolfgang E. Paulus — published in ASRM's “Fertility and Sterility” (search) in April 2002 — and one in Sweden by lead researcher Elisabet Stener-Victorin in the 1990s.

Of course, even those who believe in acupuncture concede that while the existing studies have yielded good information, there still isn't sufficient evidence, or a broad enough sample of patients tested, to call acupuncture a proven remedy.

"We are convinced, but scientifically you need proof — or so-called proof," Chang said. "There is a whole set of proof from lab experiments and animal studies to human studies, but it's very difficult to do human studies."

Schenken noted that even though there might be one set of data showing positive results, "it really needs to be corroborated, preferably with several different studies and different patient populations." For example, there can be bias when the entire study sample comes from the same clinic, or when patients know they're doing something different from usual.

Schenken said he doesn't get asked about acupuncture often, but when patients do, "we don't recommend it, but we do not discourage it."
Surrey takes a similar approach. In his opinion, the data "is not bad" on the theory that acupuncture can help when administered before IVF, but as far as acupuncture generally improving fertility or helping after the embryo transfer in IVF, "there really isn't a whole lot of data on that."

But at the very least, "there is absolutely nothing to show that it's harmful if it's done with a trained and appropriately skilled acupuncturist," he said. It's a notion that nearly everyone in the medical field — whether they believe in needles and Qi or not — seems to agree upon.

Some Eastern medicine-Western medicine rivalry may come into play with how to treat reproductive problems, but Chang said he sees more resistance with the use of Chinese herbs — which are ingested — than he does with acupuncture. Often, it's the in vitro specialists themselves who refer their patients to him for acupuncture after a couple of failed IVF attempts.

As for the couples trying to bring a child into the world — particularly through a complicated, invasive procedure like IVF— anything that helps the process along is welcome.

“IVF is so technical that patients feel like they’re being pushed and pulled … with acupuncture, they’re in a sense taking some control,” Magarelli said. "Acupuncture isn't a needle, it's an environment."

Added Koos: "They're on these incredibly strong drugs that make the poor women crazy. They're running around like Catwoman. This is to help them stay sane while they're going through the process."

The emotional cost of infertility comes with a hefty financial price tag as well — in vitro fertilization can cost anywhere from $10,000 to $20,000 a cycle and generally isn't covered by insurance; acupuncture ranges from about $30 to over $200 per treatment — Koos and Chang charge about $90 a pop — and certain health plans do cover at least a portion of it.

Meanwhile, researchers and experts in the field are excited at what they're seeing in the studies. Chang said he's currently working with NYU Medical Center on a trial that looks at IVF with and without acupuncture.
Appert, for her part, was at the end of her rope and felt she had nothing to lose. She started acupuncture with Koos about two months before she began trying to conceive — with needles in her toes and a couple of liver points — and continued with the treatments throughout the pregnancy.
"The first time I went, I was completely terrified. My husband went with me and held my hand," she said. "I could feel the muscles in my liver jump and an electric current going through my body. It was very strange but also felt right."

She said being monitored by both her obstetrician and Koos helped reassure her about what was going on during her high-risk pregnancy.

"She would tell me things about how I was doing physically and then I would go to the doctor and he would tell me the same thing," remembers Appert, who works as a professor.

When she got sick late in the pregnancy, both Koos and Appert's OB/GYN were able to detect when her liver went dangerously haywire and get her to the hospital for delivery six weeks early, before the problem harmed the fetus and caused another stillbirth.

Regardless of the skeptics, Appert said she's relieved that she was finally able to have a nearly full-term baby of her own. At 4 pounds, 6 ounces, Henry has been in intensive care but otherwise is doing "fine."

"It really was a miracle," the new mom gushed. "It's one of these weird things that Western medicine can't explain."

Thursday, October 20

Women with unexplained infertility are at heightened risk for having undiagnosed celiac disease

Women with unexplained infertility are at heightened risk for having undiagnosed celiac disease (CD), which may be a modifiable and treatable risk factor, research suggests.

To determine whether an increased prevalence of undiagnosed CD might exist among a population of infertile women, investigators conducted a prospective cohort study at a U.S. infertility clinic. Serologic screening uncovered CD in four of 188 subjects, translating to an overall prevalence in this population of 2.1%.

Although this rate was not significantly higher than the expected 1.3%, undiagnosed CD was significantly more prevalent in the subset of 51 women presenting with unexplained infertility: Three (5.9%) of these women had previously undiagnosed CD (J Reprod Med. 2011;56:199-203).

All four women found to have CD underwent nutrition counseling to help them change over to a gluten-free diet. All four became pregnant within a year of diagnosis.

"Diagnosing CD in an infertile woman would be particularly beneficial if the low-cost (and low-risk) therapy of pursuing a gluten-free diet could improve chances for conception," study researcher, Janet Choi, MD, said in a statement.
From the October 2011 Issue of Clinical Advisor

Women with PCOS or anovulation demonstrate higher live birth rates than women with tubal infertility

Women with polycystic ovary syndrome appear to have more success across the reproductive lifespan than women with tubal infertility, new data suggest.

“Women with PCOS have an increased number of antral follicles in the ovary and higher anti-Mullerian hormone levels,” researchers at the University of Pennsylvania in Philadelphia wrote.

To determine if this plays a role in reproduction, the researchers collected information on 44,286 women who underwent in vitro fertilization (IVF) and were listed in the 2004 to 2006 Society for Assisted Reproductive Technologies database. They then compared outcomes of women with PCOS with those of women with tubal infertility after completion of IVF.

Results revealed that women of all ages with PCOS had a considerably higher live birth rate than women with tubal infertility. An adjusted model also indicated that the RR for live birth in women with PCOS vs. those with tubal infertility after IVF was 1.12 at age 35 years, 1.22 at age 40 years and 1.34 at age 45 years (P<.001), the researchers said.

“Women with PCOS or anovulation demonstrate higher live birth rates than women with tubal infertility across the reproductive lifespan,” the researchers wrote. “This novel finding becomes more robust in later reproductive life and suggests a lengthening of the fertility window.”

Tuesday, October 18

Acupuncture increased success rate of 37.3 percent

A randomized placebo-controlled study of 309 women concludes that electro-acupuncture “significantly improved the clinical outcome of ET (embryo transfer).”1 IVF (in vitro fertilization) live birth rates jumped from 21.2 percent for women who did not use acupuncture to a 42 percent success rate for women who received acupuncture twice. The women received acupuncture 24 hours before the IVF procedure and 30 minutes after IVF. In another control group, women who only received acupuncture once, 30 minutes after IVF, had an increased success rate of 37.3 percent.

IVF is a treatment for infertility. This involves controlling a woman’s ovulatory process with medications, removing the ova (eggs) from the body, fertilizing the ova with sperm outside of the human body and then implanting the fertilized ova (zygote) into the uterus. Acupuncture for the treatment of infertility has received a great deal of press because singers Mariah Carey and Celine Dion used acupuncture with success. Mariah Carey used acupuncture to balance her body after a miscarriage in 2008. Carey said she did not use IVF but used acupuncture for stress relief and hormone therapy to boost her fertility. Celine Dion used acupuncture to achieve success with her 6th attempt at IVF. Both singers gave birth to healthy twins.


Fertility and Sterility. Volume 96, Issue 4, October 2011, Pages 912-916. Increase of success rate for women undergoing embryo transfer by transcutaneous electrical acupoint stimulation: a prospective randomized placebo-controlled study. Rong Zhang Ph.D., Xiao-Jun Feng B.S., Qun Guan B.S., Wei Cui M.S., Ying Zheng M.S., Wei Sun B.S., Ji-Sheng Han M.D.

Research Centers:

Neuroscience Research Institute and Department of Neurobiology, Peking University Health Science Center, Key Laboratory of Neuroscience, The Ministry of Education and the Ministry of Public Health, Beijing, People's Republic of China.

Reproductive medical center, The second hospital affiliated to Shandong University of traditional Chinese medicine, Jinan, People's Republic of China.

New Study Finds Sperm Quality Decreases as Males Age

Colorado Researchers Confirm Men, like Women, have a Ticking Biological Clock that Impacts Fertility

DENVER, Oct. 17, 2011 /PRNewswire via COMTEX/ -- A new study conducted by the Colorado Center for Reproductive Medicine (CCRM) in conjunction with the National Foundation for Fertility Research (NFFR) concludes that sperm from middle-aged and older male mice is less likely to lead to a successful pregnancy. The study, the first-of-its-kind, found that sperm quality began to decrease in males at mid-life, 12 months and older (equivalent to forty and older for human males).

"This is not a study observing male factor infertility. Rather, this is a study about once fertile males becoming infertile because of age," said Mandy Katz-Jaffe, PhD, Scientific Director of NFFR. "We were able to document when sperm from older males begins to suffer quality problems, and to understand the impact of older sperm on reproductive outcome."

This is the first longitudinal study following males over a lifetime to directly correlate sperm aging with reproductive success. Ten young male mice with proven fertility were mated every month during their lifetimes as they naturally aged with fertile young females. "This study is unique because we were able to remove infertility related to the female aging from the equation and focus solely on the male," said Katz-Jaffe. "This is something that is impossible to accomplish with human studies."

This study found that when proven fertile male mice reached mid-life (12 months = forties):

Eggs were less likely to be fertilized by aged sperm.

Embryos were less likely to develop in vitro.

Embryos were less likely to implant in the uterus.

Natural conceptions were far fewer. Only 50 percent achieved pregnancy naturally at 12 months (forties) and 10 percent naturally at 15 months (fifties).

Assisted reproductive technologies (ART) improved the chance of clinical pregnancy.

The few successful natural conceptions with aged sperm resulted in significantly smaller fetuses and placental weight.

"There is much focus in society on the 'maternal biological clock.' This study shows us that we also need to be concerned about the 'paternal clock,'" said William Schoolcraft, M.D., Founder and Medical Director of CCRM. "Men in their thirties should consider freezing sperm if they plan to wait to have children. Men in their forties and fifties should consult a reproductive endocrinologist if their partner is unable to conceive after six months of active trying."

About the Colorado Center for Reproductive Medicine

Founded in 1987 by Dr. William Schoolcraft, the Colorado Center for Reproductive Medicine is one of the nation's leading infertility treatment centers, providing a wide spectrum of infertility treatments ranging from basic infertility care to advanced in vitro fertilization (IVF) technology. Today, joined by Drs. Eric Surrey, Debra Minjarez and Robert Gustofson, Dr. Schoolcraft and his staff achieve some of the highest pregnancy rates in the country. CCRM has been ranked "The #1 Fertility Center in the U.S., with the Greatest Chance of Success" by For more information, visit .

About the National Foundation for Fertility Research

The National Foundation for Fertility Research is 501 (c) (3) non-profit collaborative of internationally known researchers dedicated to advancing the field of reproductive medicine. The mission of NFFR is to ensure that all who seek fertility treatment have that joyous moment when they hold their baby for the very first time. Under the direction of Dr. Mandy Katz-Jaffe and her team of senior scientists and embryologists, NFFR research studies will continue to bring hope and new opportunities to couples seeking fertility treatment. For more information, visit .

SOURCE Colorado Center for Reproductive Medicine (CCRM)

Copyright (C) 2011 PR Newswire. All rights reserved

Friday, October 14

Embryo Grading

I never understood the presumed science behind embryo grading. In fact the 'science of embryo grading' may be an oxymoron. Embryo grading is theoretical but not scientific. It is my experience that embryo grading gives patients fall hopes and also lowers hopes of patients inappropriately.  There have been many 4 cell embryos transferred on day two back in the 1980's in the U.S., which resulted in live births. There are many 6 cell embryos with up to 25% fragmentation which yield live births. There are countless grade A blastocysts which do not yeild a pregnancy or do, but with resultant miscarriage.  Yes, if an embryo has > 45 or 50% fragmentation it can be safely assumed that won't result in a pregnancy or live birth. But without such an extreme presentation, it is really not possible to predict an outcome.

I would rather the 'line' that reproductive endocrinologists offer their patients be "we have transferred 3 embryos successfully into your uterus. In 2 weeks we will know if you are pregnant. Let's keep our fingers crossed and hope for the best."  This way the patient has no expectation other than the fact that she will or will not become pregnant.  This is an issue of 'patient management' and one, which in my opinion, should be adhered to.

It is possible to determine a poor embryo. For example a 3 cell embryo with 40% fragmentation probably won't yeild a pregnancy or a live birth. However, it is impossible to determine a good quality embryo if by good quality it means that a reasonable expectation of pregnancy can be expected.  The underpinnings of what makes a good embryo good have yet to be parsed out scientifically.  This is equivalent to an acupuncturist feeling a pulse and telling the patient that they are pregnant. The acuracy of this endeavor is rarely experienced. However, a very experience acupuncturist probably can tell by pulse palpation whether a patient is pregnant before a reproductive endocrinologist can prognosticate the outcome of an IFV ET based upon visual inspection of an embryo.

The take-home message is this: do not be excited when you have an IVF-ET and your doctor raves about the beauty of your embryos just transferred, nor be dismayed when you are told that they are a grade C. You must clear your mind of expectation and 'be' and wait. It is very difficult to go through the day without an expected outcome. Expected outcomes are derived from your output which typically yeilds a result. This is an example of 'control' which we all thrive on and feel so lost without.  In the case of IVF-ET your output nor that of your doctor has any prognostic value. You must 'be' and wait and have no expectation. You can hope; and that's it.

This is also the case of the endometrium. Your doctor will tell you that you have a "beautiful 10 millimeter lining." You are 30 years old and so is your husband. His sperm is healthy, you are hormonally within-normal-limts and both you and your husband are anatomically normal. You have tried to conceive for two years with intercourse, you have done 4 intrauterine inseminations and two invitro-fertilization-embryo-transfers and you have never gotten pregnant. There is a good possibility that your endometrium is defective and can only be properly diagnosed via an endometrial biopsy.  Remember the things needed for a successful pregnancy and a live-birth are good egg, good sperm, good lining, anatomic normalcy and absence of pathology which can mitigate conception. Pathology which can mitigate conception is often under-diagnosed.  A perfect example of this is endometriosis. The mean-time to diagnosis for endometriosis in 10.3 years. Imagine this: a couple is idiopathic meaning that there is no known casue for their inability to conceive. After multiple attemps via assisted-reproductive-technology-interventions the reproductive endocrinologist states "it's time for you to consider using a donor egg" You are devastated, but you MUST HAVE THAT BABY! So you proceed and the transfer is negative. Then, after six years of trying, a doctor recommends a diagnostic laparoscopy to rule out endometriosis and you are found to have stage four endometriosis which is why, all along, you have not been able to conceive. But now you're forty-years old. So even though the endometriosis has been resceted, you have 40 year old eggs and your chances of conceiving with your own eggs are about 8-10%.  You were robbed of your opportunity to conceive becasue of the ultra-conservitism, ignorance or ego of your doctor.  I am not suggesting that at the drop of a hat a diagnostic laparscopy should be scheduled. What I am suggesting is that many reproductive endocrinologists (just as is the case with acupuncturists and every other type of health-care-provider) are too conservative and think-out-of-the-box when it's too late.

I had a doctor tell me recently that mild endometriosis doesn't interfere with conception. This is not true; it does. "Endometriosis is likely the most the common cause of endometrial receptivity defects, especially in cases of minimal or mild disease for which mechanical reasons do not explain the loss of fertility." This is from the September, 2011 issue of Fertility & Sterility, Vol 96, No 3, page 524.  When I brought this to the attention of the doctor, he replied with "Fertility & Sterility is a lousy journal." It is not. In fact, most American reproductive endocrinologists read it and respect it.

It is very difficult to find a good doctor in any field.  I know most of them, especially in New York City. If you would like guidance in finding one with an open mind, an agressive outlook and that has you in mind rather than protecting his or her ego I wouuld be happy to offer it to you.

Mike Berkley, L.Ac., FABORM