COVID-19 Vaccine and Pregnancy/ Breastfeeding

We have had many questions regarding the COVID vaccination and pregnancy.
 
Patients who are planning to conceive, who are currently pregnant, undergoing fertility treatment or who are lactating should be encouraged to receive the COVID-19 vaccination based on eligibility criteria. Since the vaccine is not a live virus, there is no reason to delay pregnancy attempts because of vaccination administration or to defer treatment until the second dose has been administered.
 
These recommendations, per the most recent update from The American Society for Reproductive Medicine (Update #11 – 12/16/2020) regarding the COVID-19 vaccination, are in line with those of the Advisory Committee for Immunization Practices (ACIP) of the U.S. Centers for Disease Prevention and Control (CDC), the American College of Obstetricians and Gynecologists (ACOG), and the Society for Maternal-Fetal Medicine (SMFM).
 

COVID-19 Update (April 2, 2020)

The ASRM recently confirmed their recommendations previously set forth in mid-March regarding fertility treatment during the COVID-19 outbreak.
 
We remain concerned that our fertility/surgery patients’ treatment have been detained by this worldwide pandemic.
 
Please stay in close contact with the office, as we will continue to monitor your health and provide updates.

COVID-19 and Fertility: Update

[PLEASE SEE OUR APRIL 2 UPDATE ON THIS]

These are the most recent recommendations from the American Society of Reproductive Medicine (ASRM).  I have spoken with a number of reproductive endocrinologists in the area as well as Lisa Ray, our embryology director.  I do realize that there are 9 cases in China where women diagnosed with coronavirus did have successful pregnancies. Unfortunately, the numbers are too small to ultimately know the risk to mother and baby with this novel coronavirus.

Therefore, based on ASRM’s recommendations, the discussion with my peers and my own concerns with potential risks in pregnancy (i.e. heightened risk to the mother of coronavirus due to pregnancy and the potential problems with diagnostic studies and treatment, if a pregnant woman has severe complications due to Coronavirus), at present, our team is proceeding as follows:

  • Patients on Clomiphene Citrate and gonadotropins should stop their cycle and not attempt pregnancy either via inseminations or timed intercourse. However, if the couple is inclined to proceed with cycle completion (inseminations and timed intercourse), they must sign a waiver stating that they understand the unknown risk to mother and baby in regards to the virus. Otherwise, the cycle will be cancelled. No new cycles with Clomiphene Citrate and gonadotropins will be initiated.
  • Women who are currently undergoing IVF stimulation can proceed with their cycle. We do recommend a freeze‐all with the caveat that fresh transfer can be considered if it is deemed that freezing of the embryos/eggs would be detrimental to successful pregnancy. Once again, a waiver must be signed stating that at present, the risk of subsequent transfer of coronavirus-infected embryos/eggs, although believed very low, is ultimately unknown to mother and baby. Furthermore, it must be understood that these cycles may be stopped at any time given further recommendations from the ASRM.
  • Because of the anticipated increase in the coronavirus, the ASRM has recommended that no new stimulations be started. However, as this is solely a recommendation, for the immediate future, we will continue to evaluate stimulation starts on an individual basis; again, with the recommendations as outlined above (i.e. freeze‐all of embryos/eggs, waiver must be signed, cycles may be stopped, etc.). Please contact our office regarding your individual cycle concerns.
  • In regards to patients who already have frozen embryos and wish to proceed to frozen embryo transfer and are currently on medication, once again, the risk of pregnancy in a patient who is positive for Coronavirus is unknown. Therefore, our recommendation is to not proceed at present. However, if a couple wishes to proceed, they need to be aware that we will support them in their decision, but will require them to sign a waiver. This decision could change at any time.

 

Thank you,

Charles E. Miller, MD FACOG

 

ASRM Issues New Guidance on Fertility Care During COVID-19 Pandemic: Calls for Suspension of Most Treatments

3/18/2020 The American Society for Reproductive Medicine (ASRM), the global leader in reproductive medicine, today issues new guidance for its members as they manage patients in the midst of the COVID-19 pandemic.  Developed by an expert Task Force, of physicians, embryologists, and mental health professionals, the new document recommends suspension of new, non-urgent treatments.

Specifically, the recommendations include:

  • Suspension of initiation of new treatment cycles, including ovulation induction, intrauterine inseminations (IUIs), in vitro fertilization (IVF) including retrievals and frozen embryo transfers, as well as non-urgent gamete cryopreservation.
  • Strongly consider cancellation of all embryo transfers, whether fresh or frozen.
  • Continue to care for patients who are currently ‘in-cycle’ or who require urgent stimulation and cryopreservation.
  • Suspend elective surgeries and non-urgent diagnostic procedures.
  • Minimize in-person interactions and increase utilization of telehealth.

The above recommendations will be revisited periodically as the pandemic evolves, but no later than March 30, 2020, with the aim of resuming usual patient care as soon and as safely as possible.  ASRM has been closely monitoring developments around COVID-19 since its emergence. Data on its impact on pregnancy and reproduction remains limited. However, the task force used best available data, and the expertise and experience of the members to develop the recommendations. Until more is known about the virus, and while we remain in the midst of a public health emergency, it is best to avoid initiation of new treatment cycles for infertility patients. Similarly, non-medically urgent gamete preservation treatments, such as egg freezing, should be suspended for the time being as well. Clinics who have patients under treatment mid-cycle should ensure they have adequate staff to complete the patient’s treatment and should strongly encourage postponing, the embryo transfer.

Catherine Racowsky, President of ASRM, noted, “ASRM is striving, as we always do, to ensure our members have the very best information available as they care for their patients. We are all facing a great deal of uncertainty, but we do know our health care system is about to be stressed in a way it has never been stressed before. Only by working together medical professionals, patients, citizens of an inter-connected world, can we hope to meet this latest challenge.”

Ricardo Azziz, CEO of the ASRM stated, “This is not going to be easy for infertility patients and reproductive care practices. We know the sacrifices patients have to make under the best of circumstances, and we are loath to in add, in any way. to that burden. And it will not be easy for our members. The disruption to routines, the stress on staff members and the very real prospect of  economic hardship loom large for ASRM members all over the world.  But the fact is that given what we know, as well as what we don’t, suspending non-urgent fertility care is really the most prudent course of action at this time.”

Dr. Racowsky added, “We should recognize that the situation on the ground is fluid, and as such we will continue to revisit and review our recommendations at least every two weeks, to provide providers and their patients with the best information and support we possibly can.”

For almost a century, the American Society for Reproductive Medicine (ASRM) has been the global leader in multidisciplinary reproductive medicine research, ethical practice, and education. ASRM impacts reproductive care and science worldwide by creating funding opportunities for advancing reproduction research and discovery, by providing evidence-based education and public health information, and by advocating for reproductive health care professionals and the patients they serve. With members in more than 100 countries, the Society is headquartered in Washington, DC, with additional operations in Birmingham, AL. www.asrm.org


A Note About COVID-19 From Dr. Miller

Please see our 3/18/20 update about COVID-19 and fertility treatments. 

Dear All,

The health of our patients and their families is always on the forefront of our minds. In regards to the novel coronavirus, within the framework of the office, we are continuing to monitor and institute both local recommendations as well as those of the CDC. Our offices remain open during this time and schedules will proceed as planned for all appointments. If you are feeling ill, please contact your primary care physician and give us a call to reschedule your appointment.
 
Your willingness to allow us to assist you in achieving your dream of having a baby is truly an honor. We take this very seriously and will do everything in our capacity that we must do to make this as safe and successful of a journey as possible for you and your family.
 
With regard to the health of your babies, at this point so far, the coronavirus does not seem to affect infants. A small case study in China showed nine infected mothers who have given birth to babies with no evidence of infection. Although the numbers are obviously small, this would appear to be good news.
According to a bulletin we received from the American Society of Reproductive Medicine (ASRM), patients with a high likelihood of having COVID-19 (including those showing symptoms, have had exposure within six feet of a confirmed COVID-19 patient and within 14 days of onset of symptoms, or who have a positive COVID-19 test result), and those who are planning to use oocyte donors, sperm donors, or gestational carriers, should strive to avoid pregnancy at this time. ASRM recommends that those particular individuals undergoing active infertility treatment consider freezing all oocytes or embryos and avoid an embryo transfer until they are disease-free. This does not apply when there is only a suspicion of COVID-19, because the symptoms are very similar to other more common forms of respiratory illness.
 
We have handouts in the reception area of both offices from the CDC and from the hospital, as well as information outlining basic protective measures.
 
If you have any questions regarding this information, please contact us.

How to Choose the Right Doctors for IVF Treatment

In vitro fertilization or IVF treatment can be a scary thought for couples who are having difficulty conceiving. It’s a complicated procedure that requires a combination of specialists from various medical backgrounds. Fertility clinics that offer IVF need to have the necessary medical specialists including specialists from gynecology, endocrinology, embryology, urology, psychology, and surgery. A clinic that does not have the right specialists present could prove to be unsafe and result in unsuccessful treatment.

The IVF Treatment Team and What They Do

Before you make any type of commitment, research various facilities, know your spending limits, and ask which fertility treatment tests you will need to have done beforehand. When researching good IVF center, you want to check to make sure treatments include care from the following specialists.

Geneticist. An examination by a geneticist to assess possible genetic disorders like thalassemia in patients that can be passed down do fetus. It also helps identify and prevent complications during pregnancy.

Reproductive Endocrinologist. The endocrinologist will monitor changes in hormones during the treatment cycle.

Reproductive Surgeon. A reproductive surgeon will be needed for surgical corrections such as obstructions in the fallopian tubes, endometriosis. and urinary tract disorders.

Urologist. A urologist will be needed in case there are obstructions in the male’s urinary tract.

Embryologist. An embryologist specializes in preserving viable embryos after fertilization. Their expertise is in freezing unused embryos and ensuring their safety and viability.

Immunologist. Should there be complications during implantation, and immunologist may be needed to handle immune-related issues.

Andrologist. Andrologists specialize in monitoring male hormones and sperm quality. The andrologist prepare sperm for the final fusion with the ova.

Gynecologist. The gynecologist treats any basic care related to the woman’s body.

Psychologist. Fertility treatments can be incredibly stressful on all parties involved. Patients often experience mental and emotional exhaustion throughout the IVF process.

These infertility doctors work in tandem to create ensure a successful pregnancy. All IVF doctors will hold a medical degree as well as an abundance of experience in their particular field. For a successful IVF treatment, providing care is a team effort among specialists. It’s imperative in order for patients to have an emotionally and physically rewarding treatment.

Because IVF is often a last resort for those seeking to have a child, an opportunity to take advantage of vulnerable patients by fake IVF doctors is rising. That’s why it’s important to make sure you research infertility doctors near me and research thoroughly.

A good IVF doctor will walk you through the entire process, have discussions and help you plan out the smallest details in order to increase your chances of a viable pregnancy. If you’re in Illinois, then you’ve likely heard about the amazing care IVF Center Chicago provides to patients. If you have any questions, do not hesitate to call or visit. Whether you choose us or another fertility clinic, make sure you check the success rates of facility. We can answer all your fertility and IVF questions so that you will be able to make the best decision for you and your family.


What Causes Infertility in Men and Women?

The mere word infertility can strike fear into men and women who are trying to conceive. Though infertility can affect both men and women, it’s often associated with women. Because women are the carriers of fetuses, may feel extra pressure to become pregnant when she and her partner are trying to conceive.

But their bodies may not be the cause of their inability to get pregnant. Men can also suffer from infertility issues. When seeking fertility treatment, it’s important to understand what infertility is before exploring options. The Advanced IVF Institute in Chicago seeks to help patients understand what could be causing their fertility issues.

What causes infertility?

According to The Mayo Clinic, “10% to 15% of couples in the U.S. are infertile.” There is no one cause behind infertility. And what causes infertility in women is not the same as what may cause infertility in men.

Infertility in Men

Male infertility affects roughly 7% of men and accounts for 40-50% of all infertility cases. Causes of male infertility include:

  • Abnormal sperm production or function
    Abnormal sperm production or function could be caused by undescended testicles, genetic deficiencies, health issues and disorders like diabetes, or infections such as chlamydia, gonorrhea, mumps or HIV. Having enlarged veins in the testes (varicocele) also can affect the quality of sperm.
  • Difficulty with the delivery of sperm
    There could be a number of factors that interfere with the delivery of sperm including, sexual problems like premature ejaculation. Some genetic diseases like cystic fibrosis could disrupt sperm delivery. Then, there are structural problems, like a blockage in one or both of the testicles. Damage or injury to the reproductive organs can also create difficult passage of sperm.
  • Overexposure to certain environmental factors
    Exposure or overexposure to harmful chemicals like pesticides, radiation, phthalates, lead, and dioxin can disrupt sperm production. Other chemicals and habitual actions that could disrupt sperm production include smoking cigarettes, marijuana, using anabolic steroids, taking medications that treat bacterial infections, high blood pressure and depression. Environmental disruptors like frequent exposure to saunas or hot tubs could also negatively impact sperm production.
  • Damage related to cancer and its treatment
    Chemotherapy and other chemical treatments for cancer can negatively impact sperm production.

Infertility in Women

Like men, infertility in women could be caused by one or even a combination of factors. Some factors that contribute to female infertility include:

  • Ovulation disorders
    Hormonal disorders that can greatly impair the release of eggs from the ovaries include Polycystic Ovary Syndrome or PCOS, Prolactinoma, Hyperthyroidism, or Hypothyroidism. Other issues that could affect the release of eggs include over-exercising, eating disorders, and tumors.
  • Uterine or cervical abnormalities
    Abnormalities in the uterus or cervix can cause infertility by blocking the fallopian tubes or stopping a fertilized egg from implantation in the uterus.

Fallopian tube damage or blockage

Damage to the fallopian tube is often caused by inflammation or salpingitis, usually from pelvic inflammatory disease from untreated sexually transmitted infections, endometriosis, or adhesions.

  • Endometriosis
    Endometriosis is when endometrial tissue grows outside of the uterus.

Early menopause or primary ovarian insufficiency

Early menopause occurs when the menstrual cycle ends, and the ovaries stop functioning. There are many variables that are associated with early menopause, including immune system disease, Turner Syndrome and other genetic disorders, and chemotherapy or radiation treatment.

  • Pelvic adhesions
    Pelvic adhesions are pockets of scar tissue that attach to organs, usually forming after pelvic infection, appendicitis, endometriosis or abdominal or pelvic surgery.
  • Cancer and cancer treatment
    Reproductive cancers often interfere with female fertility. The radiation and chemotherapy to treat those cancers may affect fertility as well.

If you and your partner are trying to conceive but haven’t been successful, contact Dr. Charles Miller & Associates. You can also google infertility doctors near me so that you can get the assistance you need.

 


fertility centers in Naperville

Can acupuncture help with infertility?

fertility centers in Naperville

There are many studies and anecdotes of individuals—men and women—who have overcome infertility from acupuncture. However, because both infertility and the body’s response to acupuncture can vary widely from person to person, it’s difficult to ascertain whether acupuncture will have a direct effect on someone’s fertility.

Acupuncture is an ancient Chinese medicine practice of using fine needles, placed in various acupressure points, to help relieve and open up energy channels, known as meridians, that are blocked in the body to restore its flow. Chinese medicine says that this blockage is sometimes the underlying cause of many chronic diseases and pain, including infertility. In modern medicine, acupuncture has played a complementary role to help elicit biochemical responses.

Visiting an acupuncturist is sometimes done over several weeks, once or twice a week. The patient lies on a table while the acupuncturist performs the procedure. It is designed to be a calming, meditative procedure, which fertility doctors will often say is important for treating infertility as well. Finding some calm during an otherwise emotional and stressful time period is crucial to someone’s well-being and fertility treatment.

There are many acupuncture practices in Chicago and near fertility centers in Naperville, Illinois, as well, who can offer the method to individuals experiencing infertility. Contact your Chicago fertility specialist to see if there are any acupuncturists they may recommend to help you through your infertility and during your fertility treatments. Make sure that the practices do not interfere with your fertility treatments as well. In some cases, insurance may even cover your acupuncture treatments as well.


pregnant women in hospital

Handling Infertility and Depression

pregnant women in hospital

Living with depression presents a major challenge to daily life. Living with depression while dealing with infertility can be incredibly overwhelming. Luckily, treatment is available to help you handle issues of infertility and depression so that you can plan for your family in a healthy way.

According to the World Health Organization, 300 million people around the world are living with depression. Of that 300 million, 16.2 million adults in the United States have had a major depressive episode within the last year. Additionally, 1 in 8 couples have trouble conceiving or sustaining pregnancy.

Both infertility and depression used to be topics people were too ashamed to discuss. Now, people are more willing to discuss depression and infertility issues openly. The Gynecologic Surgery Institute can provide the information you need to help you stay healthy, mentally and physically, during fertility treatments.

For many couples, a diagnosis of infertility and the subsequent treatment can bring on chronic stress and may eventually lead to depression or increasing existing feelings of depression. Research has even shown that women experiencing infertility is comparable to the stress and emotional pain of women facing chronic pain, cancer, and HIV/AIDS.

Depression is more likely to surface in people facing infertility who have a history of depression or does not have a support system to help them through the stress of infertility treatment.

Depression is not the same as just being sad

Sadness and depression are not one in the same. Since we associate depression with persistent sadness, its primary symptom, many people do not know how to tell the difference. Too often, people do not seek help for depression because they think they are just sad.

Sadness is a natural emotion triggered by hurtful, disappointing, or other challenging events in our lives. When we have adjusted to the circumstances or gotten over the event, the disappointment, the sadness dissipates.

Depression, on the other hand, is abnormal sadness—a mental illness or mood disorder, that affects how we think, perceive, and behave. When someone is depressed, they are sad about everything. Most depressive episodes do not need an event to trigger sadness.

Psychology Today says to be diagnosed with depression, someone must have at least five of the following symptoms continuously:

  • A depressed or irritable mood most of the time.
  • A loss or decrease of pleasure or interest in most activities, including ones that had been interesting or pleasurable previously.
  • Significant changes in weight or appetite.
  • Disturbances in falling asleep or sleeping too much.
  • Feeling slowed down in your movements or restless most days.
  • Feeling tired, sluggish, and having low energy most days.
  • Having feelings of worthless or excessive guilt most days.
  • Experiencing problems with thinking, focus, concentration, creativity and the ability to make decisions most days.
  • Having thoughts of dying or suicide.

While there is mixed evidence as to whether depression causes infertility, there may be links between depression and infertility due to hormonal imbalances and certain medications used to treat depression and/or other mood disorders. Visit your local IVF specialist in Chicago to help you understand how hormonal imbalances can affect fertility treatment.
One study found that male partners with active major depression and not using antidepressants were less likely to achieve conception. But with women with major depression, not using antidepressants, the likelihood of pregnancy increased slightly. Also, non-SSRI antidepressants were associated with increased risk of miscarriage in the first trimester.
If you begin to experience symptoms of depression during infertility treatments, talk to your fertility specialist in Chicago.


infertility specialist

5 Questions to Ask Your Doctor About Infertility

Getting pregnant is a challenge for many couples trying to conceive. While there’s around a 25 to 30 percent chance per cycle that a woman will get pregnant in her 20s or 30s, that percentage decreases with age. Seeking professional help about infertility can be a stressful experience. However, if you and your partner are struggling with conception your seeing a fertility specialist can give you the best advice for your individual needs.

What’s the first line of treatment for infertility?
After your doctor diagnoses you with infertility or low chances of fertility, the first line of treatment for infertility is usually medication. Specific medications are engineered to increase the likelihood of pregnancy.

How does my lifestyle affect my fertility?
While fertility chances can weaken with age, your health conditions can help improve or lower your chances for conception. Illnesses that affect the thyroid can affect women’s fertility. Cancer, poor nutrition, and infections can affect the reproductive chances of both men and women, just as smoking, drinking alcohol and come medications. Being in good health condition prior to conception ideally helps increase chances of pregnancy.

Will surgery be involved in infertility treatment?
If your infertility involves issues with your reproductive organs, your doctor may opt to perform female fertility surgery. Surgery could be used to fix blocked or fallopian tubes so that an egg can be released and fertilized successfully.

What are the risks involved with infertility treatments?
Some fertility medications may have side effects. Fertility surgery, like most surgeries, can run the risk of infection. Fallopian surgery can increase the risk for ectopic pregnancy, a serious condition where the fertilized egg and later fetus grows outside of the uterus.

What are my chances of success with fertility treatment?
Some estimates put infertility treatment between an 85 to 90 percent success rate. Of course, it depends on the type of treatment and other variables like the patient’s health and age. For example, doctors could estimate that Intrauterine insemination or IUI (artificial insemination) could have a 20 percent chance for success while an embryo donation could have a 50 percent chance for success. Your doctor will be sure to give you a better idea of your chances of success with different treatments based on your individual needs.

Beginning your journey into fertility treatment can be overwhelming, feel complicated, and scary. Before selecting a fertility clinic, make sure you research fertility specialist near me to research infertility specialists in your area. A well-established fertility clinic will usually be more than accommodating and welcome questions about their specialists and discuss any concerns you may have. Your doctor will be able to provide options and offer you realistic advice. The right fertility specialist should be able to provide easy-to-understand information so that you are well prepared to make the best, informed decisions about growing your family.


infertility book

Books and Movies That Tackle Fertility Issues

When you’re experiencing infertility, it may seem as if nobody understands what you’re going through. And while friends and even family may be very sympathetic and supportive, it can sometimes feel very lonely.

It’s incredibly important to build a strong support network around you of family and friends, even if they don’t quite understand it. At the same time, you can also find support groups in Chicago of similar women experiencing infertility. Given the size of this town, it’s not uncommon to meet other women who may be seeing a fertility specialist in Chicago or the suburbs (like at an IVF clinic in Naperville, for example) and receiving fertility treatments, possibly even at the same fertility clinic.

Infertility and undergoing fertility treatments can be exhausting, which is why finding entertainment is another good way to make yourself feel better. This list of books and movies are a great way to escape your own infertility briefly, and also relate well to the characters who may be experiencing the same thing as you.

Fiction novels about infertility

Where I Lost Her – by T. Greenwood. A New York power couple’s marriage is left fraught after years of failed infertility treatments and failed adoption, and the wife begins to find ways to mend her broken heart through the search for a lost girl in Vermont.

The Snow Child – by Eowyn Ivey. A childless older couple in Alaska happen upon a girl in the woods, seemingly made from snow, and changes their lives.

Then Came You – by Jennifer Weiner. Four separate women, two who donate eggs, one experiencing infertility who receives the eggs, and a fourth who is a stepdaughter, are thrown together in a scenario that examines what being a mother is about.

Movies about infertility

Private Life, starring Paul Giamatti and Kathryn Hahn. A stark, poignant look at what infertility means to a middle-aged couple.

What to Expect when you’re Expecting, starring Anna Kendrick, Elizabeth Banks and Jennifer Lopez. Women experience different types of fertility struggles: miscarriage, difficulty, adoption.

Maybe Baby, starring Hugh Laurie and Joely Richardson. A perfect London couple’s perfect marriage erupts when infertility enters the picture and display to what extent normally rational people would do to have a baby.

One More Shot, documentary by Maya Grobel Moskin and Noah Moskin. This film follows the husband-and-wife documentary team as they face the challenges in overcoming their infertility.

Vegas Baby, documentary by Amanda Micheli. She follows several aspiring parents with fertility problems who enter a contest from a Las Vegas doctor. The winner gets a free round of IVF treatment.