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Thursday, September 18, 2014

A Candid Story of One Woman’s Challenges with Fertility Treatment

There’s a single, unused syringe in the refrigerator at Valerie’s house. It serves as a reminder of the struggle she and her husband went through to get where they are today: happy parents of two-month old twins, a boy and a girl. The babies were born in June 2014.

“There were many layers to that struggle, different challenges at different times,” says Valerie, a resident of Philadelphia.

At 33 years old, Valerie, a surgical nurse at Penn Medicine, had never had so much as an abnormal period. Yet, doctors couldn’t decipher exactly what was causing her and her husband’s miscarriages and difficulties conceiving.

Valerie and Jason had gotten pregnant within two months of trying initially. But, then they miscarried. Over the next six months, they struggled to conceive again.

Diagnosing a Mystery

Their doctor was encouraged that they’d gotten pregnant naturally and said the couple had time to keep trying. Valerie was still two years shy of the pressure point in fertility—age 35 for women. Jason, also a nurse, was 38, and they wanted to be parents while they still had the energy to chase after a child.

“Initially, the challenge was not knowing. There was this lack of understanding, this mystery. We thought we should start investigating.” Valerie says.

Between 1 in 10 and 1 in 20 women has polycystic ovarian syndrome, or PCOS, according to the U.S. Office on Women’s Health. That means as many as five million women don’t produce an egg every month, which lessens their chance of conceiving.

Valerie didn’t fall under that diagnosis, though. She and Jason appeared healthy—no physical obstructions or fibroids. They had lab tests to check hormone levels. Those came back normal, too.

Except for one.

One of the tests showed that Valerie had a slightly elevated level of follicle stimulating hormone. This signaled that she may have poor quality or quantity of eggs. But nothing was certain.

“That was the first challenge.” Valerie says, “The insecurity, as a female, of feeling as though I was unable to get pregnant. I took it on my shoulders, even though it’s not an exact science, and there are many pieces to it.”

Learning the Language of Fertility

She and Jason were still in the beginnings of the process. They talked openly about it. Valerie worked to keep her ego in check and not take things personally. They focused on learning this new language —the terminology of fertility—and navigating this new system, even though they were both in the medical field.

“I can’t imagine not being a nurse and going through this,” Valerie says.

The couple decided to start on a method called intrauterine insemination, or IUI. In this process, doctors collect the husband’s sperm and wash it out to make it as potent as possible. They then monitor the wife’s cycle. When her ovaries release an egg, they insert the sperm and let nature take its course.

“Every step of the way has its own challenges. You look at your partner, you look at yourself, and you say, ‘What are you willing to do? How far are you willing to take this?’” Valerie says.

Despite multiple attempts over three months, the IUI wasn’t producing any results. In-vitro fertilization (IVF) was on the table. This process involves doctors fertilizing an egg outside of the body, and then inserting it into the woman’s uterus.

Constantly Questioning

Valerie hesitated at first. Financially, IVF is expensive, with no guarantee that it will work. The average cost per cycle in the U.S. is $12,400, according to the American Society of Reproductive Medicine.

“I thought I would never do IVF, that I would never go there. There’s this stereotype leading into it that people who do IVF are utterly baby crazy,” Valerie says. “It seemed like an extreme use of science. I didn’t know what to make of that.”

Yet, she was committed. A trained swimmer, Valerie knows that once you dive in, there’s no looking back. But doctors still couldn’t explain the couple’s fertility challenges, outside of that one slightly abnormal test.

“It’s probably a frustrating place to be as a clinician, to say you don’t know why,” Valerie says.

Physical Pains

In order to be within the Penn Medicine network, the couple switched doctors to Suleena Kansal Kalra, MD, MSCE. This enabled them to use financial aid that Penn reserves for employee fertility treatments. They sat with their new doctor and explained their recent decision—to try IVF.

“Her confidence made me nervous,” Valerie confesses. “I work with surgeons in an intensive care unit. I see confidence given to families all the time. They want to give people hope, but hope is a double-edged sword.”

Then the physical challenges began. Valerie started on a host of hormones for a month to prepare her body for IVF. A nurse explained the different medications Valerie would be administering to herself, some orally and some via needles.

“This part would be incredibly overwhelming as a non-nurse. I found it nerve-wracking as a nurse,” she says. “Who uses needles in everyday life if you’re a lawyer or an art teacher?”

Financial Stresses

The couple had to order five medications through the mail. Each one is so tailored to the individual taking them, that pharmacies and clinics don’t have the demand to keep them on-site. Here too, the financial challenges presented themselves. A single vial of medicine could cost thousands of dollars.

“I’m on the phone with some pharmacy or the insurance company saying, ‘Damn it. I’m trying to get pregnant.’ I felt like I was inventing the wheel to get things that I knew other people had gotten,” Valerie says.

“All the time, I’m thinking, ‘This is just because I want to be pregnant,’” she adds. “Emotionally, I was really high strung and hurt by this.” The struggle was making her question her resolve to get pregnant.

And financially, it wasn’t just about the price of the medications. Valerie had to miss work to wait for the deliveries, which could arrive anytime between 8 a.m. and 8 p.m. “And they would show up at 8:05 p.m.”

Every other day, she had to go back to the doctor for blood work and ultrasounds to monitor hormone levels and follicle growth.

“It was very stressful because I had to work with managers and get people to cover for me,” she says. “You’re handcuffed every single day for the length of your menstrual cycle. Don’t even think about going on a plane to your cousin’s wedding. This takes over. It’s all-invasive.”

Find out how the story ends in part two of Valerie’s fertility quest.

Thursday, September 11, 2014

Considering a Surrogate?

For some couples struggling with fertility, it’s simply not possible for the two partners to carry a pregnancy to term. But, keep in mind, it’s pregnancy that’s not possible. Parenthood—the ultimate goal—is still very much a possibility.

That’s where considering a surrogate or gestational carrier comes in:

Surrogate versus Gestational Carrier: What’s the Difference?

Surrogacy may be a good option if you are not able to produce enough healthy eggs or if you have a medical condition that will not allow you to carry a pregnancy to term.

With a surrogate, a woman will pair one of her eggs with your husband’s sperm and carry the child throughout the pregnancy, the US Office on Women’s Health explains.

The baby will be biologically related to your husband and the surrogate, but you can declare parentage before the baby is born or adopt the baby afterwards, depending on the laws in your state.

With a gestational carrier, your egg and your husband’s sperm are joined together to create an embryo. But another woman carries that embryo in her uterus and delivers the baby at birth. You and your husband are biologically related to the child. The gestational carrier is not.

The decision to go down this particular treatment path may not be easy for a number of reasons—biological, emotional, financial and legal. As with any fertility treatment option, it’s important to do your research and really take time to consider what is best for you and your partner.

Here are six questions to help guide the decision-making process for you, your partner and your medical team:

1. Do you want to go with a known surrogate or gestational carrier, such as a family member, or do you want to go with person to whom you have no personal ties?

There are pros and cons to both options. You and your partner will need to decide which of these options you feel most comfortable with.

If you decide to go with a stranger contracted through an agency, be sure to ask for references you can contact first, suggests the National Infertility Association.

Regardless of which one you choose, the American Society of Reproductive Medicine recommends that both the surrogate and the parents have separate representation by lawyers with experience in this area.

2. Do you want your surrogate or gestational carrier to undergo genetic testing? What if a test comes back abnormal?

If you go with an unknown surrogate or gestational carrier, you may want to make sure that her medical history does not include conditions that could be passed on and potentially threaten the baby’s health.

You also want to be sure that if your child does develop a medical condition that you and your partner are emotionally and financially prepared for it.

3. What type of relationship do you and your partner want to have with the surrogate or gestational carrier during the pregnancy and throughout the child’s life?

There are all kinds of horror stories out there about surrogates popping up and suing for parental rights or child support. Whether they are true or not, this is something that you and your partner should determine with your surrogate or gestational carrier and your respective legal teams beforehand.

During the pregnancy you may want updates and ultrasound pics from your surrogate or gestational carrier—but is she okay with that? If the surrogate or gestational carrier wants updates on the baby after birth, are you okay with that or would it disrupt your family bond?

4. If you choose a surrogate, how will you respond if the child eventually wants to know her biological identity?

First, this involves deciding if you’ll even tell the child how he was conceived. This is especially important if you do not plan to continue a personal relationship with the surrogate after the pregnancy.

After all, the surrogate is biologically related to the child. And the child may grow up wanting to know who his or her biological mother is.

5. How do you plan to tell others about taking this step toward building your family, if you want to tell them at all?

It could be awkward if you and your partner show up to the next family reunion with a baby. Be ready for the questions, the confusion and maybe even the judgement.

That’s why it’s important to decide who in your personal circle you’ll inform about this decision and how much information you’ll share. Because they will ask.

6. How much will the medical and legal costs come to?

As much as you may want to focus only on the emotional anticipation of becoming a parent, it’s important to spend time calculating the financial aspect of bringing your child into the world via surrogate or gestational carrier.

The ASRM suggests you agree upon the compensation for your surrogate or gestational carrier ahead of time.

Some of the costs to your and your partner may include:
  • A general fee for the surrogate or the gestational carrier
  • The agency fee if you choose one
  • Medical screenings for pre-existing conditions
  • Prenatal care after the surrogate or gestational carrier becomes pregnant and gives birth
  • Compensation for the surrogate or gestational carrier’s time off work, particularly for bed rest and recovery from delivery
  • Living expenses for the pregnancy, such as extra food, maternity clothes, travel to and from doctor’s appointments, prenatal vitamins, etc.
  • Legal costs for the surrogate or gestational carrier to have her own legal representation
All expected costs should be outlined in writing before any fertility procedures begin, advises the ASRM.

The process of choosing whether you want to go with a gestational carrier or surrogate can be difficult. Penn Medicine’s fertility experts can share additional questions to consider on your journey to parenthood.

Thursday, August 7, 2014

Recurrent Pregnancy Loss: How to Cope

For some women, the struggle with fertility happens after the pregnancy test comes back positive.

Imagine this: You’ve finally gotten past the loss of your pregnancy through miscarriage and now you’re pregnant again. You want to believe that this time is it—that you’ll really become a mom.

Then, you miscarry again.

When your doctor says you have recurring pregnancy loss, at first you feel devastated. But you soon discover that the emotional effects of this condition run the gamut from grief to fear.

Here’s what you need to know about recurrent pregnancy loss—what it is, what causes it, the emotional effects and how to cope.

What Is Recurrent Pregnancy Loss and What Causes It?

Recurrent pregnancy loss is a disease. It is not the same as infertility, says the American Society for Reproductive Medicine.

Infertility is an inability to get pregnant, whereas recurrent pregnancy loss means you can get pregnant but have had two or more miscarriages after the 10-week mark, the National Infertility Association explains.

If You've Experienced Recurrent Pregnancy Loss, You Probably Feel:


Couples who live with recurrent pregnancy loss may find themselves asking, “Why me?” At the root of this anger is likely disappointment. You saw this part of your life going one way, yet it’s going in a different direction. There is likely no reason why you are having challenges carrying your pregnancies to term while others don’t.


There’s a reason it’s called “loss” and not “failure.” You have in fact lost something, much like families who face grief when an infant or older child passes away. Avoid trying to talk yourself out of how you’re feeling or letting anyone else do it. It’s perfectly okay to let yourself go through the grieving process.


Feelings of guilt may stem from a sense that, as a woman, you are letting your spouse down. But it is important to remember that recurrent pregnancy loss is not something you’re choosing. And it’s likely not anything you’re doing to cause it.


But when you have just suffered from a miscarriage caused by recurrent pregnancy loss, it can be hard to stay encouraged that you’ll eventually carry to term. Feelings of helplessness are common.

You may feel as if you have no control over your body, and you’re waiting on some stroke of luck to make this happen for you. Remember that by seeking the right medical care, you are in fact taking control. It’s about being patient and open to your options.


How often do you find yourself asking “what if” and then filling in the rest of the question with the worst-case scenario. You may feel as if you will never be among that 65 percent who eventually become moms.

Fear that you will continue to face recurrent pregnancy loss over and over is understandable. But it is critical to your well being to not let this feeling become all-consuming. Otherwise, you risk being tempted to give up before you’re ready.

What are Some Coping Strategies for Dealing with Recurrent Pregnancy Loss?

Your best bet for dealing with the tumultuous emotions of consecutive miscarriages is to talk to someone. Open up to someone who will listen to you and encourage you.

Support groups

You may want to consider joining a support group if you are having a difficult time coping with the emotional effects of recurrent pregnancy loss. A support group can help you deal with feelings of loss, isolation and loneliness, says the National Infertility Association.

Support groups are especially beneficial if you feel as if you have no one to talk to about your experiences with recurrent pregnancy loss because no one you are close with has dealt with this condition.


Sometimes it helps just to have someone listen to your struggles without judging. If sharing in a group setting isn’t your thing, you could try individual or couples therapy. Look for a therapist who specializes in fertility related issues.

If you have recurrent pregnancy loss, you might consider seeing a fertility specialist for an evaluation. This is especially true if, in addition to miscarriages, you have a family history of repeated pregnancy loss or an autoimmune disorder. A fertility specialist can help you decide what the next step in fertility treatment should be.

Monday, July 14, 2014

In Vitro Fertilization: A Step-by-Step Process

When you think of common fertility treatments, in vitro fertilization (IVF), probably appears near the top of your list. There’s a reason for that.

IVF has been around for decades and today it accounts for a third of all fertility treatments worldwide, says the European Society for Human Reproduction and Embryology (ESHRE).

IVF is commonly used to treat:
  • Older women with fertility issues
  • Women with damaged or blocked fallopian tubes
  • Women with endometriosis
  • Male infertility caused by low sperm count or blockage
Source: NIH

You most likely already know the basic idea behind IVF: uniting egg and sperm outside the body in a culture. But there’s so much more to IVF that happens before and after that. Here’s a closer look at the IVF process in five steps.

1. Superovulation (Egg Production)

You’ll be given fertility drugs that will begin a process called stimulation—or superovulation, says the National Institutes of Health. In other words, the drugs—which contain Follicle Stimulating Hormone—will tell your body to produce more than just the normal one egg per month.

The more eggs you produce, the more chances you’ll have of a successful fertilization later on in the treatment.

You’ll receive transvaginal ultrasounds and blood tests on a regular basis during this step in the IVF process to check on your ovaries and monitor your hormone levels.

Source: National Institutes of Health and ESHRE

2. Egg Retrieval

A little more than a day before your eggs are scheduled to be retrieved from your body, you’ll receive a hormone injection that will help your eggs mature quickly.

Then, you’ll have a minor surgical procedure—called follicular aspiration—to remove the eggs. This is generally done as an outpatient surgery in your doctor’s office, according to the NIH.

During the procedure, your doctor will use an ultrasound to guide a thin needle into each of your ovaries through your vagina. The needle has a device attached to it that suctions the eggs out one at a time.

If this part sounds painful, don’t worry—you’ll probably be given medication beforehand so that you won’t feel any discomfort. You may experience some cramping afterward, but this usually disappears within a day, the NIH explains.

3. Sperm Collection

While your eggs are being removed, your partner is going to need to provide a sperm sample. The sperm are then put through a high-speed wash and spin cycle in order to find the healthiest ones.

4. Insemination and Fertilization

Now comes the part of IVF that everyone’s most familiar with—combining your partner’s healthiest sperm with your healthiest eggs. This stage is called insemination.

It usually takes a few hours for a sperm to fertilize an egg. Your doctor may also inject the sperm directly into the egg instead.

5. Embryo Culture and Transfer

Once your eggs have been collected, you’ll receive yet another medication. This one is meant to prep the lining of your uterus to receive the embryos that will be transferred back into you.

About three to five days after fertilization, your doctor will place the embryos in your uterus using a catheter. Like Step 3, this part of IVF is performed in your doctor’s office while you are awake.

Multiple embryos are transferred back into you in the hopes that at least one will implant itself in the lining of your uterus and begin to develop. Sometimes more than one embryo ends up implanting, which is why multiples are common in women who use IVF.

The IVF process basically replicates natural reproduction. The next step after the IVF process determines whether the procedure worked: the pregnancy test.

IVF is increasingly becoming one of the most common and successful procedures, helping couples become proud parents. If you think IVF is the next step in your fertility journey, check with one of Penn Medicine’s fertility experts.

Learn more about the IVF process from Director of Assisted Reproductive Technology (ART) and Andrology Laboratory, Matthew D. VerMilyea, PhD.

Tuesday, June 24, 2014

Fertility Specialist or OB/GYN: Which Is Right for You?

When you’re struggling with fertility issues, you might experience a bunch of different emotions, all at the same time:
  • Frustration that your efforts to get pregnant seem to be taking you on a fast train to nowhere;
  • Envy that your friends are decorating their nurseries, but you’re still waiting to see a plus sign on a home pregnancy test yet;
  • Maybe even embarrassment because you’ve finally come to a tough conclusion: It’s time to seek more specialized help.
But there’s one feeling you may need more of: Hope. And seeking medical help for fertility issues can provide you with a sense of hope.

At first, you may not know where to turn for treatment. Do you see your OB/GYN or would you be better off going to a fertility specialist? What’s the difference between them anyway?

Here are a few factors to consider, when deciding between a fertility specialist and an OB/GYN:

1. How Long You’ve Been Trying to Get Pregnant

A visit to an OB/GYN is generally the first stop in the fertility treatment journey.

Your gynecologist can perform a preliminary fertility evaluation, according to the American Society for Reproductive Medicine. A common problem for couples with fertility struggles is how to properly time intercourse with ovulation, says the National Infertility Association.

While an over-the-counter urine test—known as an ovulation predictor test—can sometimes do the trick, your OB/GYN can conduct an evaluation to see if there are other factors affecting your ability to get pregnant, the Association explains.

You should consider having a fertility evaluation if you:
  • Are under 35 years old and have been trying for at least one year
  • Are older than 35 years and have been trying for six months
Source: American College of Obstetricians and Gynecologists

If the evaluation points to an underlying fertility issue—such as pelvic inflammatory disease or uterine fibroids—it may be time to consider seeing a fertility specialist.

2. Your OB/GYN’s Training

Some obstetrician-gynecologists undergo extra training to better treat patients who are struggling with fertility difficulties.

If your doctor is board certified in reproductive endocrinology, then she’s had this extra training.

If she hasn’t, she may only be familiar with a few of the more common fertility treatments.

If that is the case, you might want to consider seeing a fertility specialist instead. This is especially true if other treatment methods have been unsuccessful for you.

A fertility specialist has completed three years of specialized training with an approved reproductive endocrinology fellowship program in addition to an OB/GYN residency.

Source: American Society for Reproductive Medicine

3. Your Medical History

If you have irregular or painful menstrual cycles, or you have a hard time tracking your ovulation, you may want to consider seeing a fertility specialist instead of an OB/GYN.

Other reasons to see a fertility specialist:
  • You’ve had more than one miscarriage
  • You or your partner had or have an STD
  • You or your partner are overweight or underweight
Source: National Infertility Association

4. Your Age

Women over 30 years old, who have a history of pelvic inflammatory disease or problems related to their menstrual cycles, should see a fertility specialist sooner than the recommended one year, according to the Association.

5. Your Partner’s Fertility

Another reason see a specialist, sooner rather than later, is if your partner has a low sperm count, according to the Association. If your partner’s semen analysis comes back abnormal, he might be referred to a urologist who has been trained to handle issues concerning male infertility, the American Society for Reproductive Medicine explains.

Have you or someone you know seen a fertility specialist? Was it more helpful than going to an OB/GYN?

Thursday, June 5, 2014

Four Ways To Handle Feelings of Failure When Dealing with Fertility Issues

Has this thought ever crossed your mind: What’s wrong with me?

Couples who are struggling with fertility issues are bound to struggle with feelings of failure at some point.
So what are you supposed to do when it seems like nothing ever goes right in your fertility journey? Here are four ways to handle feelings of failure when dealing with fertility issues:

1) See Failure for What It Really Is

As women, we’re told that our bodies are designed for pregnancy. But anyone who has faced fertility issues knows that design and function can be very different realities. That’s why it’s so important to re-frame the way you think about your struggles with fertility.

Failure isn't something you’ve done. It’s certainly not a character trait. It’s something that happens.

Internalizing fertility issues as a mark of personal failure implies that you’re the cause or that you’re
consciously doing something wrong.

That’s probably not the case. You are experiencing a challenging chapter in your life story. It’s temporary and that’s it. Recognizing this is an important first step in getting feelings of failure under control.

2) Don’t Let Your Emotions Take Over Your Body

You’re probably well aware that stress can wear you down physically and make you feel tired or sick. The same may be true of internalizing feelings of failure, according to an August 2012 Psychology Today article.

Negative thinking can cause your muscles to tense. Tension buildup leads to inflammation. And inflammation can lead to illness.

Practicing meditation and relaxation techniques are great ways to manage the physical and emotional effects of infertility stress, says the National Infertility Association. Eating well and staying active are good ideas as well.

A vacation or a visit to your favorite shoe store might help, too. Just a thought.

3) Recognize That Not All Setbacks Are Equal

Try to avoid all-or-nothing thinking, such as “Since this physician can’t help, no one can” or “If the treatment didn’t work this time, it won’t ever work.”

Viewing every setback as a complete loss can be detrimental to your well-being. Also, it leads to a false sense of defeat, when determination is probably the better approach.

Yes, sometimes it seems like everything is going wrong, but try putting negative experiences into perspective. Don’t give them more weight than they deserve.

In fact, re-framing minor setbacks as positive experiences can be one of the most effective coping strategies, says a July 2011 study published in Anxiety, Stress & Coping.

For example, if your doctor’s appointment gets pushed back, look at it as an opportunity to have some free time, not another stumbling block.

4) Remember—You Are So Much More than Your Fertility Issues

When getting pregnant is your top priority goal, it can be easy to lose sight of who you are, says the American Fertility Association (AFA).

But your goal to get pregnant is not your identity. Before this, you were an awesome swimmer, a great friend or a really good cook. And guess what—you still are.

If you remember that you are more than your fertility issues, you can prevent feelings of failure from taking over your entire perception of yourself.

Your fertility struggles must be kept separate from your sense of self, says the AFA. You’re still someone’s wife, daughter or best friend. Fertility issues don’t change that.

This may sound a bit self-helpish, but try drawing up a list of the different parts of your identity—your career, relationships, skills, hobbies and passions. Title the list “I am…” Ask your spouse or best friends to weigh in too. They may offer some of the defining characteristics that you overlook.

When you look at yourself and only see fertility issues, this list can remind you of one simple truth: This challenge does not define you. You do.

Read stories from couples struggling with fertility and find out the latest treatment options. 

Tuesday, May 20, 2014

What’s the Link Between Obesity and Infertility?

For couples struggling with fertility, there’s an unlikely tool that could help—the scale.

That’s right. Being overweight or obese can affect a couple’s ability to get pregnant.

In fact, obesity is the cause of fertility struggles in six percent of women who have never been pregnant before, says the American Society for Reproductive Medicine (ASRM).

Obesity affects infertility by changing the way a woman’s body stores sex hormones. Here’s how:
  1. Fat cells convert a male hormone known as androstenedione into a female hormone called estrone.
  2. Estrone affects the metabolism of the part of the brain that regulates ovarian and testicular function.
  3. This can impair reproductive function. 
And it’s not just the woman’s weight that affects fertility. Obese men are more likely to have low or nonexistent sperm counts, according to a March 2012 article in JAMA Internal Medicine. 

This happens for several reasons:
  1. Obesity can elevate body temperatures, especially around the scrotum. 
  2. It can also lead to hormonal imbalances. Obese men are more likely to have higher estrogen levels, combined with lower levels of sperm-producing hormones like inhibin b and androgen. 
  3. This can mess with sperm count, sperm concentration and the sperm’s ability to swim well, according to a March 2010 study in the journal Nature Reviews Urology. 

Making Fertility Issues Worse

Obesity and infertility can have a weird, circular relationship as well. It’s hard to tell which one caused the other. For example, stress—like the kind couples experience during a long fertility journey—can not only cause irregular periods, but some women “stress eat,” meaning they binge on junk food during times of stress. 

Then, there are health conditions like polycystic ovarian syndrome (PCOS), a hormonal disorder that can cause cysts on the ovaries. While the cause of PCOS is unknown, one side effect of PCOS is obesity. The National Infertility Association points out that obesity is common among PCOS patients, affecting 50 to 60 percent of women with this condition. The symptoms may be worse if a woman is obese.

Take Charge of Your Health

Sometimes addressing fertility challenges starts with getting to a healthy weight. Losing weight is a simple concept, but in practice, it’s not always easy. If changing your diet and exercising have not worked, you may want to talk to your doctor about bariatric surgery. It may be worth considering if you:
  • Are more than 100 pounds above your ideal weight
  • Have weight-related health issues, like high blood pressure or Type 2 diabetes 
  • Have tried weight loss programs, but nothing has worked 
  • Don’t have any current challenges with alcohol or drug abuse

Think about it. If obesity is the underlying cause of your fertility challenges, it’s best to address that before starting or continuing fertility treatments. Talk to your doctor about how your body weight may be affecting your fertility.

Friday, May 9, 2014

Trying to Conceive When Everyone Else Is Getting Pregnant

You’re sitting at your desk fiddling around on Facebook when a friend messages you via chat. She has big news: She’s pregnant.

On one hand, you’re happy for her and excited about this new phase in her life—and you want her to know that. But, on the other hand, your stomach drops. You can’t wait to be the one sharing the baby news. Until then, each birth announcement makes you want to either stand up and shout or break down and cry.

So how do you show your support while protecting your emotions? Here are five suggestions:

1. Predict announcements

Prepare yourself for pregnancy announcements before they happen. Get in the habit of predicting who you might hear from next.

● Which of your friends has recently gotten married?

● Has your sister been talking about starting a family?

● Have you noticed your former college roommate recently gave up wine and sushi?

Practice your response so you won’t be totally blindsided. If these friends and family members know you’re going through fertility treatments, you can also give them a heads up of what reaction to expect from you when they do share the news, such as “Hey sis, I know you are trying to get pregnant. If I act a little weird when it does happen, here’s why...”

2. Take social media breaks

Social media has turned into a giant, scrolling news feed—a strange mix of international stories, cat videos and friends’ updates. Often, those updates include baby announcements.

If you’re sick of seeing a new ultrasound photo pop up every other day, sign off. It doesn’t have to be forever, but taking a hiatus from Facebook, Twitter and Instagram can give you a chance to turn inward and focus on you.

Besides, the people closest to you will probably share these announcements with a phone call.

3. Vent somewhere

Did you (just barely) make it through your cousin’s baby shower? Now, your neighbors have told you their good news?

Online support groups like Resolve, part of the National Infertility Association, can be the perfect place for you to unleash some of your frustrations. And because they’re online, you’re still able to maintain your anonymity.

Tell the group what’s getting to you at the moment, and let them share their own experiences, reactions and coping mechanisms. You can learn from and help each other at the same time.

If some of the people in the group want to arrange for a meeting in person, don’t be afraid to join them. You also can confide in someone in your life who you know has struggled with fertility. She will likely have unique, honest insight to help you through.

Facebook has private groups that may fit your needs. Even if you’re not ready to open up about your situation, scroll through the feed to see if anyone is experiencing similar issues to yours.

4. Write it out

Writing in a journal can help you process your feelings without worrying about judgment from others. It’s a one-way conversation that can easily prompt self-realizations. At the same time, it can ease the weight of all those emotions you carry around with you.

You may have tried journaling at different points in your life to varying degrees of success. But this time, make a point of finding a system that works with you. Then, stick with it. A blank page or blank screen is one of the few spaces where you can pour out your raw feelings without wondering how it will be received.

Keep a Word or Google Drive doc opened on your computer at all times, so you can access it easily when the mood strikes you. You could also carry a small notebook in your purse and write down your thoughts whenever you find a free moment.

5. Take it to the mat

Whether you choose yoga, Pilates, weight lifting or jogging, exercise can help you work out some sources of frustration while at the same time bettering your health. Typically, your mood will feel better within five minutes of moderate exercise, according to the American Psychological Association.

Researchers also hypothesize that regular exercise can help the body adjust to anxious situations—which often include similar physiological reactions, such as sweating and increased heart rate.

So the next time someone tells you they’re pregnant, your body may know better than to go into fight-or-flight mode. You can extend the congratulations that your logical mind knows you want to give.

And remember that deep down inside, you know you’ll melt the second you meet that new baby.

Have you felt conflicted over friends’ pregnancy announcements while you’re trying to conceive?
How did you react?

Thursday, May 1, 2014

How Couples Struggling with Infertility Can Keep the Spark

There’s a reason diets are difficult. You have to switch from eating for pleasure to eating for a specific goal. That can make food unenjoyable. Cooking, a chore.

For couples struggling with fertility, sex and romance can feel the same way, only more intense.

Sex and romance can feel like an all-consuming, full-time job.

“At least it’s fun trying, right?”

Maybe not. Before, you and your partner probably had sex because you felt like it, because it was Saturday morning and raining.

But now, depending on where you are in the fertility process, you might need to have sex at very specific times to increase your chances of getting pregnant—whether you’re in the mood or not.

Here’s the reality: 

Sex on a schedule isn’t always that sexy.

During the fertility treatment process, sex can become simply a means to a baby—if you let it. You or your partner might be so focused on getting pregnant and the next steps in the fertility treatment process that the rest of your relationship—including romance—takes a backseat.

And that can really strain your relationship.

Keep the Romance Alive During Fertility Treatments

Fertility treatments can be taxing, emotionally and physically. There are days you’ll feel sick, sad, grumpy or just plan unsexy. But remember: Sex isn’t the only way to connect.

Here are four ways to keep the flame from blowing out in your relationship during fertility treatments:

1. Talk About Other Stuff

You probably didn’t talk or stress about babies all day everyday before the fertility process. Perhaps when you first got together, you talked about the crazy people at your job, your next vacation or other things that make you interesting, complex people. Ideally, pick something that will get you both out of the baby conversation and back to seeing each other as complex people with other interests.

Because guess what? You still are those interesting, complex people. Check in with each other on the other aspects of life. And that shouldn’t be pushed aside just because having a baby has become a priority.

2. Remember the Beginning

Remember what connected you in the first place. Try to get back there. Maybe when you and your partner first got together, he made you dinner, and it blew your mind that he was such a great cook—or such a terrible one. What did you and your partner like to do before you started fertility treatments? What was something that made you feel close? What was something your partner did that attracted you in the beginning?

3. Relocate

Save the scheduled sex for a specific location that lends itself to doing what you have to do and getting it done—like an unoccupied guest room. Then, have another spot—like the bedroom—for the real-deal sex, when you’re both feeling romantic and aroused and just want to enjoy it.

This separation can remind both of you that there is a slice of your marriage that you will not allow to be taken over by the fertility process. It’s off limits, and it’s just for you two.

4. Show Your Love

Sometimes, there’s nothing sexier than a genuine compliment. Make an effort to give them and receive them with gusto. If your husband says, “You look really pretty today,” don’t come back with, “Ugh, I feel so gross.” Rub each other’s shoulders; leave each other love notes; plan fun dates. Then, remember to express appreciation for even the smallest romantic gesture.

The positive side is that you and your partner are a team, working toward something together. During the fertility process, make sure to keep your romantic spark a priority, too. Besides, it’s not like romance will get any easier when you become parents.

Wednesday, April 23, 2014

Pick Your Battles: How to Handle Insensitive Comments About Fertility

If you are working through fertility issues, you've probably learned that you can’t share your experience with everyone. No doubt, someone will say something that dismisses your feelings or outright offends you.

To be on the receiving end of those comments is tough—and it’s tempting to reply with an equally dismissive or rude comment. Many people simply don’t understand what it’s like to go through challenges trying to have a baby.

The key is to resist the urge to fire back. You don’t need added stress of trying to navigate insensitive comments.  Dealing with negativity gracefully—or not at all—can help you skip the fuming phase and get back to your day.

Here are five of the most common insensitive comments and positive suggestions for how to deal with them: 

1. "Maybe it's not meant to be."

This comment is painful on multiple levels. First of all, it assumes defeat, like you will never conceive. It also removes all of the power from your hands—at a time when you may already feel like you are not in control.

The first thing to remember is that the person who is saying this isn't thinking about the deeper implications. She probably has no idea what to say. And instead of just keeping quiet, people grasp at clich├ęs—not helpful. Some women have even heard this from their own doctors.

The best way to respond is not to. Just give her a blank stare, even if it means there’s an awkward pause while she’s waiting for you to say something. It’s amazing how weird silence can send the message that the comment was inappropriate. Then, make a note to yourself that you should avoid the topic with this person going forward.

2. "Fertility issues? I could just look at my husband and get pregnant."

This kind of “it’s easy for me” comment is annoying and belittling. How you respond depends on how close you are to the person.

If this is a random person you decided to vent to at the coffee shop, then feel free to just laugh, since she’s clearly trying to make a joke. If this is your grandmother, who’s so old she just says whatever she wants, let it slide—especially if she really did have 10 kids.

But if this is someone close to you, like a sister or best friend, you may want to address it more directly. Calmly explain that you’d rather her try to understand your experience, rather than compare it to her own.

3. "Whose fault is it?" or "What's wrong with you?"

Let’s assume that this person is genuinely asking about the cause of the fertility issues, not acting like you have a contagious virus. These are deeply personal—not to mention poorly phrased—questions, whether or not the person asking knows it.

If you even know the cause, you have to be cautious about what you share. Answering this question honestly may mean revealing more than you or your partner is comfortable with.

If you don’t want to go into detail, then say something like, “The reasons are personal, but we’re working through them.”

4. "How are you paying for all that?"

No one would ask how you managed to pay for a new car or your new home. And if you disclose too much about the out-of-pocket costs of fertility treatment, you may open yourself up to judgment, depending on who’s asking.

If it’s coming from someone else dealing with fertility issues, you may feel more comfortable sharing your advice. Or if it’s coming from someone who wants to make sure you’re okay financially, that may be fine too. Also, if it’s coming from someone to whom you owe money, you might want to explain.

But if it’s someone just being nosy or wondering if you've got a hidden stash, feel free to brush this comment off: “We’re handling the costs just fine.” Next subject.

5. "Why don't you just adopt? There are a lot of kids out there."

(Sigh.) The underlying social commentary here can be really hard to take.

While the person may be trying to offer a solution—or really thinks you never thought of adoption—this comment implies that something’s wrong with wanting to experience pregnancy and give birth to your own child. (Or that adopting an infant will somehow be easier.)

It also implies that you should give up trying to conceive. This might be the hardest comment to respond to because just about anything you say could continue the conversation.

If you choose to address this question, here’s the truth: You and your partner owe it to yourselves to try until you feel at peace about moving on to the next possibility. That may mean adoption. It may mean trying another fertility treatment.

The best way to address this comment but end the conversation is to be direct: “We know that adoption is an alternative, but we’re not ready to give up trying to conceive.”

Which insensitive comments are we missing?
Share how you've handled comments
about your fertility journey.

Tuesday, April 1, 2014

Parenthood After a Vasectomy?

That tattoo you thought was a great idea in college? Maybe not so much now. And that perm you shelled out big bucks for in 1985...probably wouldn't be a discussion with your hairstylist today.

It’s a fact of life – situations change, minds change, decisions change.

For men and couples who make a decision not to have any (or any more) children, they might decide to have a vasectomy. But what if their minds change? Or, in many cases, a relationship ends, a new one begins and all of the sudden you do want to have children?

“A vasectomy is one of the most common urologic procedures and should be considered a permanent form of contraception,” says Puneet Masson, MD, assistant professor of urology in surgery and director of Male Fertility at Penn Medicine. “That being said, approximately five percent of vasectomized men express the desire for future children and one to two percent may seek consultation regarding options for future fatherhood.”

Dr. Masson sees men who are interested in having a vasectomy. However, he advises that they should only have the procedure if they are 100 percent sure they do not want any more children. A man can also cryopreserve sperm if there is any concern that someday he may desire more children.

“Of course, we understand that life is dynamic and unpredictable and that some vasectomized men are highly interested in achieving a genetic pregnancy,” says Dr. Masson. “There are two options for these patients: vasectomy reversal, and sperm extraction. Both pathways are equally effective at achieving future children and the decision depends on the preferences of the patient/couple.”

Reversing a Vasectomy

First, it’s important to understand how sperm is made. Sperm are made in the testicle in extremely small tubules called seminiferous tubules. This process takes approximately 60 days. Afterwards, they are slowly transported to the epididymis and continue to mature over a period of two weeks. Following this, they are ready to be ejaculated and are stored in the section of the vas deferens immediately next to the epididymis and part of the epididymis itself.

During a vasectomy, the vas deferens is cut and each end of the vas is tied, clipped, and/or burned. Thus, the semen of a vasectomized man should not contain any sperm. During a vasectomy reversal, the vas deferens is reconnected so that the man’s ejaculate contains sperm.

A vasectomy reversal typically takes four to six hours and is done under general anesthesia. Afterwards, the patient is able to go home the same day. Following a healing period, the man is “allowed” to resume unprotected sexual relations. Due to swelling in the vas deferens, which occurs as a natural part of healing, it may take up to a year before sperm are visible in the ejaculate. If the more complicated connection is done (vas to epididymis), it may take up to 18 months.

“What all patients should understand is that there is no guarantee that a pregnancy will be conceived through natural means following a vasectomy reversal,” says Dr. Masson. “Though most studies report a ‘natural’ pregnancy rate between 50 and 70 percent, some couples may still choose to participate in assisted reproductive therapy following a vasectomy reversal and do in utero insemination (IUI) and/or in vitro fertilization (IVF).”

Retrieving Sperm

“A sperm extraction procedure is also an excellent option for vasectomized men who desire future children,” says Dr. Masson. A percutaneous epididymal sperm aspiration (PESA), testicular sperm aspiration (TESA), microsurgical epididymal sperm aspiration (MESA), and microsurgical testicular sperm extraction (microTESE) are procedures that directly extract sperm from either the epididymis or testicle. This can be done under local anesthesia, conscious sedation (aka “twilight anesthesia”), or general anesthesia, and can be completed in about an hour.

“What is important to understand is that all sperm extracted must be used in conjunction with IVF, where a woman undergoes an egg retrieval procedure and the sperm must be injected directly inside the egg,” Dr. Masson says. “After a few days, the developing embryo is placed into the woman’s uterus. Excess sperm that was not used for fertilization is usually cryopreserved and stored for future IVF cycles.”

All vasectomized men who are interested in future genetic children should be counseled on both options. A full female evaluation is also recommended, as this may aid couples in making an informed decision. Penn Fertility Care is committed to understanding a couple’s reproductive goals and preferences. Our team includes physicians, nurses, and financial counselors who can discuss all aspects of fatherhood after a vasectomy and individualize a plan for future family planning.

Tuesday, October 1, 2013

Nutrition and Pregnancy Event!

Penn Fertility Care
presents an informational seminar on
Nutrition and Pregnancy
October 9, 2013

Penn Fertility Care presents an informational seminar on Nutrition and Pregnancy

Join Samantha Butts, MD and Celeste Durnwald, MD for an informational seminar about the impact of nutrition on fertility and how the role of weight, diet, vitamins, and exercise during pregnancy plays a direct role in the health and well being of both mother and baby.

Date: October 9, 2013
Time: 6 to 7:30 pm
Place: Biomedical Research Building (BRB) Auditorium
421 Curie Boulevard
Philadelphia, PA 19104

Samantha Butts, MD
Assistant Professor of Obstetrics and Gynecology Dr. Butts
received a medical degree from Harvard University School of Medicine, and completed her residency in obstetrics and gynecology and a fellowship in reproductive endocrinology at the Hospital of the University of Pennsylvania. Her special interests include reproductive aging, nutrition, environmental exposures and reproductive outcomes, and neonatal/perinatal outcomes related to in vitro fertilization.

Celeste Durnwald, MD
Assistant Professor of Obstetrics and Gynecology
Dr. Durnwald received a medical degree
from Northeastern Ohio Universities College of Medicine. She completed a residency in obstetrics and gynecology at Summa Health System in Akron, Ohio and a fellowship in maternal fetal medicine at Case Western Reserve. Dr. Durnwald area of clinical focus is maternal fetal medicine and she specializes in the management of diabetes during pregnancy

Monday, July 1, 2013

Penn Medicine Welcomes Puneet Masson, MD

Puneet Massion, MD
Urology in Surgery and Obstetrics and Gynecology

Penn Medicine is pleased to welcome Puneet Masson, MD
to the Division of Urology and the Department of Obstetrics and Gynecology. Dr. Masson will serve as Director of the Male Fertility Program for Penn Fertility Care. Dr. Masson specializes in male-factor infertility, andrology, male sexual dysfunction, and general urology. He provides specialized care for men with fertility problems and performs microsurgical procedures for the treatment of male infertility and vasectomy reversals.

Monday, June 10, 2013

How do I become an egg donor?

Egg donation is an excellent, medically appropriate therapy to help women achieve pregnancy. Who is a Qualified Candidate?

Egg donors give a couple the opportunity to experience pregnancy, childbirth, and most importantly, the chance to build a family. Criteria to be an egg donor candidate include:
  • Healthy female
  • Normal ovarian reserve and no indication of impaired fertility
  • Between the ages of 21 and 30

Egg Donation
Before becoming an egg donor, a candidate receives a complete health evaluation by a fertility specialist. Penn Fertility Care’s team of specialists offer a full range of egg donation services all in one convenient location. Egg donors receive generous compensation.  Please note that donors will remain anonymous throughout the process.

How to Become an Egg Donor
A woman interested in becoming an egg donor candidate can make a confidential inquiry by visiting to complete a screening form, or contact Penn Fertility Care at 800.789.PENN or 215.615.4218.

Sunday, June 9, 2013

What do I do with Unwanted Hair?

Laser hair removal has become a common cosmetic procedure performed for women, as well as men, who have unwanted facial and body hair. Laser hair removal is commonly done on the upper lip, chin, ear lobe, shoulders, back, underarms, abdomen, buttocks, pubic area, bikini area, thighs, face, neck, chest, arms, legs, hands, and toes.

The process involves using a focused beam of light of a specific wavelength designed to selectively target the pigment in the hair follicle. When the laser beam is absorbed by the pigment (melanin) in the hair follicle heat is generated, and the ability of the follicle to produce a hair is disrupted. Because these lasers target pigment, traditionally, light skin and dark, coarse hair have been the ideal combination. Newer lasers are available for patients with skin of color. Its safety and effectiveness is highly dependent upon the skill and experience of the person operating the laser, along with the choice and availability of the appropriate laser equipment at the center, which is performing the procedure.

Tips for Healthful Dining

There are many ways to watch calories. Here are a few that may work for you.

  1. If you are going to dine at a restaurant or attending a party, have a healthful snack, such as a cup of light yogurt or a piece of fruit, before leaving home. If you are less hungry when you arrive at the restaurant/party, you are more likely to make careful choices. 
  2. Eat your calories, don't drink them. Choose low calorie beverages, such as sparkling water, diet soda, or sugar-free iced tea, rather than beer or mixed drinks with alcohol, which can have hundreds of calories per serving.
  3. If there is a buffet, look over the entire buffet table. Consider all of your choices before making your selection.
  4. Try the plate method of meal planning: half a plate of low calorie vegetables; one-fourth plate of lean protein foods (about the size of a deck of cards); and one-fourth plate of starchy foods (a cup--about the size of a woman's fist).
  5. Eat mindfully. Enjoy your food slowly; savor the aromas, flavors, and textures of special treats.
  6. If you are attending a party, rather than staying near the food, take a seat across the room and focus on the guests and the conversation.
  7. When you are the hostess, provide a selection of healthful choices for your guests: vegetables, fruits, and lean protein foods. When you are the guest, ask the hostess if you can bring a healthy dish to share with the other guests.

Roasted Veggies


4 to 6 small zucchini, cut into ¾ inch chunks
1 large or 2 small (3/4 pound total) sweet onion(s), cut into ¾ inch chunks
2 large yellow and/or orange bell pepper, stemmed, seeded, and cut into ¾ inch pieces
3 tablespoons olive oil
¼ teaspoon kosher salt
Freshly ground black pepper
Six 5- or 6- inch sprigs fresh rosemary or 2 Tbsp dried rosemary

Preheat the oven to 375
degrees. Have a large roasting pan ready for use. Combine the zucchini, onions and bell pepper pieces in the pan. Add 2
tablespoons of the oil; season with salt and pepper to taste, then toss to coat them. Add the remaining tbsp. of oil as
needed. Place the sprigs of rosemary on the vegetables then continue to roast foranother 20-25 minutes,
or until vegetables are tender and lightly browned. Discard the rosemary sprigs and any loose rosemary
leaves. Transfer to a large bowl, serve warm or at room temperature.
Recipe serves 6

Low Fat Chicken Caesar Salad


1 Large head of Romaine Lettuce, torn
2 cups chopped,cooked, skinless chicken-breast
1 cup fat-free or low fat croutons
¼ cup freshly grated parmesan cheese


1/3 cup plain non-fat yogurt, drained (or fat-2 free mayonnaise)
2 tsbp fresh lemon juice
1 tsp olive oil
1 tsp white wine vinegar
1 tsp anchovy paste (optional)
1 tsp Worcestershire sauce
1 garlic clove,crushed


Arrange torn Romaine lettuce in a big serving bowl. Top with chicken, croutons and sprinkle with cheese.
Whisk dressing ingredients together and drizzle over salad. Gently toss until combined. Add freshlyground black pepper to taste. Serves 4

Per Serving: Calories 188,
Calories from Fat 39, Total Fat
4.5g (Sat 1.5 g), Cholesterol
54mg, Sodium 328 mg,
Carbohydrates 11.3g, Fiber
2.3g, Protein 25.9g

Saturday, June 8, 2013

Depression in women with PCOS

Depression is a common mood disorder with significant impact on daily life. Approximately 5% of the general population is dealing with depression at any given time. Women are twice as likely to suffer from depression as men, although men are less likely to get help. Depression may be related to experiencing a major life event such as a loved one’s death, or not situational and may recur over the course of an individual’s life.Major depressive disorder causes many symptoms that result in an inability to function in daily life in contrast with feeling “sad,” or “down in the dumps.” People experiencing major depression cannot simply “lift themselves out of it,” and usually require psychotherapy and/ or medication to feel better.

Depression and Women

As many as one in four women will suffer from depression throughout their lifetime,and often will experience it during the childbearing years, during pregnancy and within the first year after delivery.Deborah Kim, MD, a Psychiatrist at Penn Center for Women’s Behavioral Wellness and Assistant Professor of Psychiatry in the Perelman School of Medicine states, “If a woman is experiencing prolonged sadness guilty feelings, hopelessness or low self esteem,she may be suffering from depression or an anxiety disorder.”

Depression and PCOS

Depression, anxiety and eating disorders often occur in women with PCOS. A 2005 research study of 206 women conducted by Anuja Dokras, MD, PhD and Elizabeth Hollinrake, MD found that 35% of women with PCOS had depression. The study found that women with PCOS are more likely to develop depression or depressive symptoms. Dr. Dokras noted that depression in PCOS patients is significantly associated with both high body mass index (BMI) and insulin resistance. This may have some correlation with the psychological and metabolic effects of obesity. Women with PCOS often have abnormal levels male
hormones such as testosterone but there is no clear evidence to link these to depressive symptoms.

Another possible contributing factor to depression is that women with PCOS often struggle with the physical symptoms of the disorder such as weight gain, acne, increased facial hair and hair loss. These symptoms can often lead to feelings of frustration, lack of control over one’s appearance and isolation. Whatever the cause, both Drs Kim and Dokras believe that PCOS women should be treated with a holistic approach. Women with depression and anxiety disorders show improvement when treated with psychiatric medications and to some extent, with a healthy diet and exercise program, nutritional supplements and stress management. Weight loss also helps reduce insulin resistance.

Women with PCOS should be screened regularly for depression and anxiety. According to Dr. Dokras, "Between 50 and 70 percent of women who are treated for depression recover completely, so this is an important target population that we should be both screening and treating." If you are experiencing some of the physical signs of depression (depressed mood, loss of motivation, insomnia, overeating, sleeping
too much and not eating) and feel that you are very overwhelmed with PCOS, you may benefit from seeing a therapist with experience in reproductive issues, infertility or women’s health.

The Penn Center for Women's Behavioral Wellness is a collaboration between the Departments of Psychiatry and Obstetrics/Gynecology in the Perelman School of Medicine at the University of Pennsylvania. The center provides clinical consultation and treatment, as well as opportunities to participate in research focusing on conditions related to women’s behavioral health across the lifespan.

Friday, June 7, 2013

When is it Time to See a Fertility Specialist?

Many women wonder what the right amount of time is to wait before seeing a fertility specialist.

At a glance, follow these general guidelines to determine when the time is right:

• Women under age 35 unable to conceive after a year of unprotected intercourse.
• Women age 35 and over and unable to conceive after  six months of unprotected intercourse.
• Women who have lost two or more pregnancies to miscarriage.
• Women with a history of irregular ovulation/menstrual cycles.
• Men with a low sperm count, poor motility (movement), or poor morphology (structure).
• Men, women or both who have health conditions affecting reproduction or when other infertility treatments  have not been successful.

One in seven couples experience infertility, but today there are more options to conceive than ever before, and Penn Fertility Care is ready to help you get started. 

Fitness Tips during the Summer

From Kristen Dowell, Fitness Instructor and Personal Trainer

The long days and warm weather is a welcome change for those of you who rely on walking as your main source of exercise. You can  safely navigate the streets without fear of slipping on ice, and without  the extra prep time needed to arm yourself with the endless layers of clothing, and of course, tissues! Walking is an easily accessible (and free!) form of exercise, and it can be an effective tool for increasing your level of fitness. However, at some  point during your walking career you are bound to hit a plateau when you no longer see the results you once enjoyed. When this happens, there are 3 categories of adjustments you  can make to your routine, each one of them having the ability to rev up your results:

1. Adjust the frequency. This one is a no-brainer. If you typically walk twice a week,
add a third session. To prevent boredom, research other routes. Visit local parks outside of your neighborhood, if you’re used to walking at a track, switch things up and try the town.

2. Adjust the duration. If your legs have been traveling the same
distance walk after walk they are begging for change! Sneak in an extra 10 minutes each day,
or challenge yourself once a week and double your mileage.

3. Adjust the intensity. This is the category in which you can get the most
creative. If you don’t have the extra time in your week to tackle #1 or #2 above,
then you must work smarter during the time you have.

Here are a few ways to spice up the jaunts:

  • Grab a stopwatch and prepare to break up your walk into timed sections:Let’s say you typically walk for 30 minutes. This time walk at your normal pace for 40 seconds,and then speed up your pace for 20 seconds. Repeat this over the course of the entire trip.
  • Get inclined! Adjust your route so that the same 30 minutes contains more hills than usual.
  • If you’re feeling brave, center the entire session at the base of one large hill or staircase.
  • Count how many times you can go up and down the hill in those 30 minutes. Try the same route in a month to see if you have improved.
  •      Play! When was the last time you skipped down the street? If it’s been a few decades, you’re missing out! This activity might be best done at a walking/jogging track or park where uneven sidewalks aren’t a safety hazard. Substitute your regular gait with measured bouts of skipping, galloping, side shuffles or backward walking. These fun substitutions will wake your muscles from their boredom and burn more calories in the same amount of time.

Even with the implementation of the above changes, you will eventually hit another plateau.
Never fear! Refer back to the above list and make another tweak to the frequency,
duration, or intensity.

No matter your strategy, be sure to include a warm up period in the beginning of the walk.
Here you travel at a slower pace and allow the muscles to prep for the workout ahead.
And whatever you do, be sure to allow time at the end to adequately stretch the lower body.
Lengthening the muscles after they’ve been working will help prevent soreness, and the
increased flexibility will make your next walk that much more enjoyable!

Happy Exercising!

Kristin Dowell

Monday, June 3, 2013

We are interested in IVF and the gestational carrier program, but have many questions. Can you help?

Piero asks: Hi we are an Italian couple, I'm 45 and my wife is 39. We already have a 9-year-old daughter and we wish to have one more child, but due to asherman syndrome (endometrium adhesions that partially close the uterus cavity) my wife cannot carry the baby. We have good gametes from several test results and so we want to use our eggs and sperm, excluding any donors. We are interested in IVF and the gestational carrier program. Is there list of fees and costs? What is included and what is not (for ex. medicines, ultrasound, etc)? Our interest, obviously, is to keep down costs, still looking at quality of services and success rate, is there any chance? How many oocytes do you normally obtain with stimulation and how many embryos with IVF? Also, how many embryos do you transfer to the carrier per time? Waiting for your answer, ciao.

Samantha M. Pfeifer, MD responds: Success of IVF is dependent on the age of the woman. The number of eggs obtained depends on the woman's age and her ovarian reserve. We like to have more than 5 follicles present after stimulation to go through the egg retrieval process. The average 39 year old woman will get approximately 5-10 eggs, unless there is a decreased ovarian reserve. Our program follows the American Society for Reproductive Medicine Guidelines for the number of embryos to transfer - on average 2-4 in this age group depending on fertility/reproductive history, quality of embryos, and stage of embryos (example: day 3 or 5 after retrieval).

Financial costs vary depending on your insurance coverage. Some insurances cover diagnostic services, ultrasound and blood work, while others may cover diagnostic services and procedures. The same applies for medications. Some insurance benefits cover medications and others do not. The cost is determined by the medication and the dose that is prescribed. At Penn Fertility Care we have financial counselors that will meet with you to review your insurance benefits and answer any questions related to your financial concerns.

If you would like to schedule an appointment with a Penn Fertility Care specialist, please contact 1-800-789-PENN (7366) or request an appointment online.

Sunday, May 26, 2013

Creating a Modern Family through Third-Party Reproduction

Fertility treatments have evolved considerably throughout the last 40 years. These advances are evident in the development of third-party reproduction options.

“Third-party reproduction, also called assisted reproduction, is a process where a person provides eggs, sperm or embryos to another person so that they may become pregnant,” says Anuja Dokras, MD, PhD, medical director of Penn Fertility Care’s in vitro fertilization program. “Another scenario includes surrogacy, where a woman provides her uterus to carry another woman’s baby to term. In vitro fertilization (IVF) is the most common treatment used to initiate this third-party pregnancy and involves implanting an embryo into a woman’s womb.”

“The third party’s assistance is limited to the reproductive process and does not involve raising the child,” explains Dokras. “This may not be a traditional method to have a baby, but these services have helped to build families around the world.”

When to Consider Third-Party Reproduction - Learn more...

Thursday, August 30, 2012

Herb Dip with Raw Veggies

Makes six servings. Each with: 70 calories, 2 grams fat,
225mg sodium, 11 grams carbohydrate
1/2 cup plain nonfat yogurt
1/3 cup reduced fat mayonnaise
2 tsp dried dill weed
1 tbsp lemon juice
1 tsp dijon mustard
1 tsp honey
1/2 tsp garlic powder
6 cups raw carrots, bell peppers,
broccoli or cauliflower florets,
celery, cherry tomatoes, etc.

Whisk together all ingredients except veggies. Chill several hours to blend

PCOS Summer 2010 Newsletter recipe

Thursday, August 23, 2012

Fitness for Life

Fitting fitness into your life will reward you in many ways. Weight loss, increased energy,strength and endurance and a decrease in risk for diabetes, hypertension and heart disease are just a few of the great benefits of taking the time to  EXERCISE. There are 3 parts to every complete exercise program:
  • Cardiovascular training
  • Resistance training and 
  • Flexibility exercises. 
It is recommended that cardiovascular training be done for 30 minutes most daysof the week. Walking is
one of the easiest ways to get regular cardiovascular exercise. Just dress in layers and head out of the door!
Start with 15 minutes and work your way up to 30 minutes. Maintain a pace that allows you to complete
the time, and use the Talk Test to determine your intensity. If you can sing asong then you will need
to work harder. If you cannot hold a conversation, then decrease your intensity.

  • Resistance training may be done 2-3 times per week and exercises should cover all of the major muscle groups. Shallow squats over a chair, push ups on a kitchen counter, and some abdominal exercises on the floor or a plyo-ball will get you started and can be done in just a few minutes. 
  • Flexibility exercises may be done daily and will help increase range of motion and decrease joint pain. Hold each stretch for 30 seconds or more. Put it all together by heading out for a walk, run through 1-2 sets of 10-15 repetitions of each resistance exercise then reward yourself with some relaxing stretching at the end. Getting started can be tough but with a little knowledge and patience you will be successful! 
Set realistic expectations and create a plan to keep progressing at an appropriate pace. Start slowly and work your way up to longer workouts with increased intensity. You’ll feel better first and the results will soon follow.  Enlist the help of a personal trainer or find a friend to partner up with and before you know it you will find yourself in the new habit of exercising regularly!

Vicki Amon is a degreed and nationally certified personal trainer with over 15 years of experience. She is the owner of Fit 4 You, Inc. Personal Training and strives to help her clients feel comfortable with their own individualized workouts while achieving great results!


Wednesday, April 11, 2012

How can you get pregnant with low FSH?

Mary asks:How can you get pregnant with low FSH?

Penn Medicine responds:
We suspect you mean FSH (follicle stimulating hormone). Each person is different. To advise you properly, we would have to review your health history to get a complete picture of what is going on — i.e. other hormone values, weight loss, etc.

If you would like to have an evaluation, we would be happy to help. To schedule a consultation, please call 1-800-789-PENN (7366) or request an appointment online.

Monday, March 5, 2012

Treating Infertility Resulting from PCOS

Polycystic ovary syndrome, or PCOS, can be a cause of infertility, but there are treatments available to help women with PCOS become pregnant. PCOS occurs when the follicle, a small sac in the ovaries filled with eggs, doesn’t mature correctly and release an egg each month during ovulation. Irregular ovulation is a common cause of fertility issues.

Anuja Dokras, MD, PhD, director of the Penn Polycystic Ovary Syndrome Center, talks with about treatment options for women with PCOS who are trying to become pregnant, including:
  • Medication management
  • Minimally invasive surgery
  • Weight management

Read the full article on treating PCOS.

Learn more about The Penn Polycystic Ovary Syndrome Center or request an appointment by calling 800-789-PENN (7366).