PCOS Treatment Guidelines: Lifestyle, Medications and Fertility Options
This blog is the second part of Dr. Laurence Jacobs’ series on Polycystic Ovary Syndrome (PCOS). In part one, he discussed the signs, symptoms and diagnostic criteria for PCOS.
In this follow-up, Dr. Jacobs outlines the latest PCOS treatment guidelines, from lifestyle modifications and metabolic therapies to fertility medications and assisted reproductive technology (ART). PCOS is a complicated disease, understand your treatment options based on your fertility goals.
About PCOS
As discussed in part I, Polycystic ovary syndrome (PCOS) is characterized by a combination of excess hair growth, ovulatory dysfunction, and polycystic ovarian morphology on vaginal ultrasound, associated with insulin resistance. Latest treatment guidelines focus on lifestyle modifications, medications, and careful fertility care, including the role of newer agents such as GLP-1 receptor agonists.
Lifestyle Modification for Preconception Health
Lifestyle intervention, overlooked by many physicians for decades, remains the cornerstone of PCOS management. Weight management, improved nutrition, and physical activity are consistently associated with improved metabolic health, ovulation, and higher pregnancy rates. Even modest weight loss of 5–10% can often restore ovulation and/or improve pregnancy rates naturally, as well as with medication/IUI and IVF treatments. Programs that offer qualified medical nutrition therapy (MNT), regular exercise training, and behavioral modification via personalized provider telehealth have excellent outcomes for preconception health (WINFertility and OvumHealth).
Medical/Surgical Therapies for Weight and Metabolic Management
Metformin continues to be used as first-line pharmacologic therapy for metabolic abnormalities, such as impaired glucose tolerance and insulin resistance in women with PCOS. The supplement Myo-Inositol has also demonstrated significant benefit in dealing with insulin resistance.
GLP-1 receptor agonists (tirzepatide, semaglutide and related agents) are a major addition in the treatment options for weight loss. These medications significantly reduce body weight, and insulin resistance in PCOS patients. Current evidence also suggests improvements in menstrual cycle regularity and ovulation. They can be helpful as an adjunct to lifestyle changes for overweight/obese women but are most effective when used in conjunction with lifestyle improvements. Careful collaborative decision making is vital, as side effects (nausea, vomiting, pancreatitis, gallbladder disease, etc.), high costs with little insurance coverage and long-term safety remain an issue. Since pregnancy safety studies are lacking, contraception should always be utilized when GLP-1s are used in women planning pregnancy in the future and stopped when attempting conception.
Bariatric surgery may be considered for women with PCOS and severe obesity who meet criteria for surgical weight management. While not specific to PCOS, weight reduction from bariatric surgery may restore ovulation and improve metabolic health.
Laparoscopic ovarian drilling, another surgical option, has a very limited role in modern infertility practices, but in the past has helped some women by reducing ovarian testosterone and other male hormones (androgens). This option is rarely used today due to costs and potential damage to ovaries leading to adhesions.
Ovulation Induction and Infertility Management
Infertility is very common in PCOS, primarily due to anovulation and/or poor egg quality.
Letrozole has become the first-line medication therapy for ovulation induction in women with PCOS and anovulation, among most Reproductive Endocrine/Infertility specialists and many Ob/Gyns. Many well-controlled randomized studies have demonstrated higher ovulation, pregnancy, and live birth rates, as well as lower multiple birth rates with letrozole compared with clomiphene citrate.
Clomiphene citrate (Clomid) remains a popular option, particularly among Ob/Gyns. Combination therapy with clomiphene plus Metformin improves ovulation and live birth rates compared to clomiphene alone.
Metformin when used alone is less effective for ovulation induction but may be considered in combination with Letrozole and/or Gonadotropin medications (Menopur, Gonal F and Follistim), when doing ovarian stimulation for ovulation induction or IVF.
Gonadotropins are second-line therapy when oral ovulation induction fails. Careful monitoring is required to minimize the risk of ovarian hyperstimulation (OHSS) and multiple pregnancies. IVF is far more effective and safer regarding multiples.
Assisted Reproductive Technology (ART) and IVF
In vitro fertilization (IVF) is often reserved for women who fail less invasive ovulation induction therapies or who have additional infertility factors such as tubal disease or male factor infertility. In PCOS, IVF requires particular caution due to the high risk of OHSS. The newest guidelines emphasize the use of GnRH antagonist protocols (Ganirelix; Cetrotide) and individualized low dose stimulation strategies with Lupron triggers to minimize this OHSS risk. Pre-treatment with metformin may also reduce OHSS risk in women still undergoing IVF with GnRH agonist protocols. As noted above, Preconception care—including optimization of weight, hormones and metabolic status—is recommended prior to doing ART.
A Comprehensive Approach to PCOS Treatment
PCOS is a complex condition requiring an individualized, comprehensive approach. Preconception health with lifestyle modification remains first-line therapy. Medication therapy has improved. Metformin and Myo-Inositol supplements maintain their roles. GLP-1 receptor agonists, with proper counseling and informed consent, represent a new option for weight loss and metabolic improvement.
For infertility treatments, letrozole is clearly the first-line option for ovulation induction. Clomiphene, metformin (alone), and gonadotropins are occasionally used. IVF is very effective but requires careful strategies to minimize OHSS risk. Single frozen embryo transfers greatly reduce the risk of multiples. (1-2% identical, if embryo splits).
Expert Care for PCOS
Dr. Jacobs has helped women manage their PCOS for more than 40 years and was formerly the Director of the PCOS Center of Excellence. He understands firsthand how medications, supplements and lifestyle modifications can profoundly impact the health and fertility of PCOS patients.
If you think you may have PCOS or are struggling with symptoms, Dr. Jacobs and our team can help with the correct diagnosis and treatment options. Click here to schedule a consultation.
To understand more about PCOS, read part one of this blog discussing symptoms and diagnosis.
How Uterine Fibroids Can Affect Your Fertility
Did you know that 30% of all women have fibroids by the time they’re 30? While fibroids are incredibly common, for some women, they can be a cause of infertility, especially when their location affects the uterus. We asked Dr. Charles E. Miller to help us better understand how fibroids affect fertility and the recommended treatment options.
Why Fibroid Location Matters
The problem lies in where the fibroids are located. Fibroids in the uterine cavity or near the cavity are particularly concerning when it comes to fertility.
In the past, we always recommended surgery for women with fibroids in the cavity. But over the years, we’ve learned that fibroids near the cavity can be just as problematic.
Back in the 1990s, I conducted a study on women who were either miscarrying or unable to get pregnant and had fibroids within 4mm of the endometrial cavity. After surgery, 70% of them went on to have a successful delivery.
Treatment Options for Fibroids
Surgery remains the primary mode of treatment for fibroids that need to be removed. The approach depends on the size and location of the fibroid:
- If the fibroid is in the cavity or small and close to the cavity, we typically remove it using a procedure called hysteroscopy. This involves placing a small telescope into the uterus and removing the fibroid without any incisions.
- When the fibroid is firmly in the muscle wall or is larger, it needs to be removed laparoscopically. At our practice, we take great pride in performing these procedures minimally invasively.
Unfortunately, at other places, fibroids are sometimes removed via a mini laparotomy, a small but still open incision, similar to a C-section cut. My concern with this method is that it increases the risk of scar tissue, which can further impact fertility.
The Bottom Line
If you’re having trouble achieving a successful pregnancy and you have fibroids, don’t wait. Seek out a specialist with the expertise to evaluate and treat those fibroids properly.
I absolutely recommend a hysteroscopic or laparoscopic approach whenever possible. It’s effective, minimally invasive and gives women the best chance at a healthy pregnancy.
What to Expect at Your First Fertility Consultation with Dr. Jacobs
Starting your fertility journey can feel scary and intimidating, yet also hopeful. Knowing what to expect can help ease anxiety and make you feel more comfortable before beginning this process.
With more than 45 years of experience, Dr. Laurence Jacobs has guided thousands of families through their fertility consultations. Here’s what to expect when you schedule yours:
First Steps:
You and your partner (if applicable) should plan to attend the first consultation together; it usually lasts about an hour.
What We’ll Review:
- Medical records and history, menstrual cycle, past surgeries or complications
- Lifestyle factors and any medical issues (for you or your partner)
After that, we’ll outline the infertility workup to determine why pregnancy isn’t happening. This includes:
- Hormone blood tests
- Diagnostic ultrasounds
- X-rays
- Semen analysis
5 Key Fertility Factors We Evaluate (you may have more than one)
1. Male Factor
- Semen analysis
- Sperm function test, including strict morphology, to identify if there is any difficulty in being able to fertilize an egg
2️. Ovarian Reserve (Egg Supply)
- On cycle days 2-4, you will come into the office so we can check your hormone levels, including AMH, which helps assess your egg supply.
- We’ll also do an antral follicle count transvaginal ultrasound to measure how many egg sacs (follicles) are present. The sonographer will count the antral follicles on both ovaries, looking for them to be 2-10 mm in diameter. The more follicles the better!
3️. Ovulation Evaluation
- Ovulation predictor kits, which look for a rise in a hormone called LH that tells us when you’re about to ovulate
- Ultrasound to check egg sac (follicle) size
- Follow-up progesterone test about a week later to confirm ovulation and assess if you have produced enough progesterone to be able to build up the lining of the uterus to get it ready for a pregnancy
4️. Uterine and Tubal Factors
- HSG, an X-ray using contrast dye, to view the uterus and fallopian tubes or a saline sonogram to check for fibroids, adhesions or polyps
- We also flush the fallopian tubes (part of the HSG) to make sure the fluid goes through the tubes so we know if the tubes look healthy and are functioning properly.
5. Pelvic Factors
- Check for adhesions from endometriosis, pelvic inflammatory disease or past surgeries
- Assessment for fibroids that could impact fertility
Next Steps:
After your workup (typically completed in a few weeks), we’ll schedule a follow-up appointment to review results, discuss medications and consider options like IUI or IVF if necessary. We’ll also recommend lifestyle changes to help support your fertility.
Ready to schedule?
Call us at 630-428-2229 or fill out this request form to get started.
About Dr. Laurence Jacobs
Dr. Laurence Jacobs is a Mayo Clinic fellowship-trained Reproductive Endocrinologist with over 45 years of experience helping thousands of families build their dreams through personalized fertility care.
Board-certified in Obstetrics and Gynecology, Dr. Jacobs brings deep expertise in IVF, PCOS, male and female infertility and second opinions for complex cases. After decades in leadership and practice, he is proud to provide consultations at Charles E. Miller, MD & Associates | CCRM Fertility’s Naperville office. Known for his compassionate approach and trusted by both patients and peers, Dr. Jacobs has been recognized nationally as a Top Infertility Doctor and consistently honored for his patient-centered care.
Understanding Menopause: Real Talk About What’s Happening And What You Can Do
Menopause is a major life transition, but for many women, it can feel confusing, frustrating and even a little scary. That’s why Dr. Molly McKenna recently gave a presentation all about understanding what’s happening in your body and treatment options available.
Here’s a recap of what she shared.
What Is Menopause?
Menopause marks the permanent end of menstrual periods after the ovaries stop releasing eggs. It’s officially diagnosed after 12 months of no bleeding.
The average age for menopause is 51, but symptoms and changes can begin much earlier.
Definitions:
- Perimenopause: The transitional time leading up to menopause, where hormone levels begin to fluctuate.
- Menopause: The moment 12 months have passed without a period.
- Postmenopause: The time after menopause.
- Primary Ovarian Insufficiency: When menopause-like symptoms occur before age 40.
What to Expect: Common Symptoms
Menopause doesn’t affect everyone the same way, but hot flashes are the most common symptom. Dr. McKenna estimates 95% of her patients have them.
Other common symptoms include:
- Vaginal dryness or discomfort (reported by 10–40%)
- Sleep disturbances
- Mood changes like irritability, anxiety, or depression
- Changes in libido
These symptoms are not just "in your head," they are a real response to shifting hormones.
Do You Need Tests?
Sometimes, blood work can be supportive, but it’s important to remember that hormone levels fluctuate daily and this is merely a snapshot in time. One helpful marker is an elevated FSH (follicle-stimulating hormone), especially levels above 15–25 IU/L during the menopausal transition.
But diagnosis is primarily based on your symptoms and menstrual history.
Treatment Options: You Don’t Have to Live with the Symptoms
Let’s be clear: You do not have to tough out these symptoms. There are several options available, depending on your needs and health history.
1. Lifestyle Changes
Healthy habits, like regular exercise, sleep hygiene and balanced nutrition, can help support your body during this time.
2. Non-Hormonal Medications
- SSRIs/SNRIs like Venlafaxine (Effexor) and Paroxetine (Paxil) can significantly reduce hot flashes (up to 62% improvement).
- Gabapentin, although off-label, has shown up to 45% symptom reduction in clinical trials.
- Fezolinetant (Veozah) is a newer, non-hormonal option.
3. Herbal and Natural Remedies
Some women report symptom relief from:
- Black Cohosh
- Evening primrose oil
- Ginseng
- Soy products
- Vitamin E
However, keep in mind the evidence for effectiveness is mixed.
4. Hormonal Therapy
Hormone therapy is still the most effective treatment for hot flashes, vaginal dryness, and bone loss prevention. Options include:
- Estrogen (oral, patch, gel, vaginal)
- Progesterone (needed if you still have a uterus)
Dr. McKenna emphasizes:
- Use the lowest effective dose for the shortest necessary time.
- Risks (like breast cancer) typically don’t increase until after 5+ years of use.
- Vaginal estrogen is a low-risk, localized option with no systemic absorption and it is safe for nearly everyone! This is one of Dr. McKenna’s favorite options.
Key Takeaways from the North American Menopause Society
- Hormone therapy is safe and effective for most women under 60 and within 10 years of menopause.
- Transdermal estrogen (patch or gel) may lower the risk of blood clots and stroke.
- Hormone therapy can be continued after age 65 if symptoms persist and benefits outweigh risks.
- Be cautious with compounded bioidentical hormones as they are not regulated by the FDA and may vary in dose or quality.
Menopause doesn’t need to feel overwhelming or isolating. Whether you’re in perimenopause, postmenopause or somewhere in between, you deserve real answers and personalized care.
Dr. McKenna and our team are here to support you every step of the way with compassionate care, up-to-date treatments and no judgment.
Have questions or symptoms you’re struggling with? Schedule a consultation with our team. You’re not alone and you don’t have to figure this out by yourself.
How Endometriosis Affects Fertility: Causes, Symptoms, Diagnosis and Treatment
We spoke with Dr. Laurence Jacobs, a reproductive endocrinologist with over 30 years of experience, to explore how endometriosis impacts fertility and how to recognize the signs of this often misunderstood condition.
How Does Endometriosis Affect Fertility?
Endometriosis can make it much more difficult to get pregnant. In fact, 20-50% of all infertile women have endometriosis, making it a prevalent issue in reproductive health.
One of the main ways endometriosis affects fertility is through scar tissue formation. When endometrial tissue grows outside the uterus, it can create scar tissue, adhesions and inflammation around the ovaries and fallopian tubes. This can often distort the normal anatomy of the pelvis, making it harder for the fallopian tubes to move over to the ovary and pick up the egg during ovulation.
Endometriosis can also interfere with ovulation. Endometriomas, which are cysts formed by endometriosis growing deep within the ovaries, can disrupt ovulation by affecting both the development and/or release of eggs. Additionally, some research suggests endometriosis can negatively affect the egg quality due to the inflammatory environment it creates within the pelvis.
Another concern is embryo implantation. The inflammation caused by the endometriosis can make it more difficult for the embryo to successfully implant within the uterine endometrial lining, leading to infertility or recurrent pregnancy loss.
The severity of endometriosis plays a significant role in its impact on fertility.
- Stages 3 or 4 (more advanced endometriosis) involve severe adhesions and endometriomas, which can have a major impact.
- Stages 1 or 2 (milder cases) may only involve small implants of endometriosis, which can still affect fertility but to a lesser degree.
The stage, severity and location of lesions and implants all play a significant role in how endometriosis affects fertility.
How Can You Tell If You Have Endometriosis?
The most common symptoms of endometriosis include:
- Pelvic pain
- Moderate to severe menstrual cramps
- Pain during sexual intercourse
Although some women with endometriosis have no symptoms at all. A pelvic exam can sometimes reveal signs of endometriosis, such as hard nodules at the bottom of the pelvis.
Ultrasound is another useful tool for identifying endometriosis. Endometriosis growing very deep inside the ovaries, can form a cyst called an endometrioma and these cysts can be seen on ultrasound. However, most smaller implants of endometriosis cannot be seen on ultrasound. Ultrasound can only detect advanced stage 3 or 4 endometriosis, while smaller implants and adhesions seen in Stage 1 or 2 may not be visible.
How Is Endometriosis Diagnosed?
Symptoms and signs of endometriosis and even ultrasounds can make one suspicious of endometriosis, but the only way to definitively diagnose the condition is through laparoscopy. A laparoscopy is a minimally invasive procedure that allows a surgeon to look inside the pelvis using a laparoscope, which is a thin, telescopic rod with a video camera on the end. Not only can laparoscopy surgery confirm endometriosis, but the procedure can treat it as well.
Why does surgical expertise matter?
Because advanced endometriosis (Stage 3 or 4) often involves severe adhesions affecting the ovaries, intestines, bladder and ureter, it is highly recommended that the laparoscopy be performed by a skilled reproductive surgeon rather than a general gynecologist.
- A skilled reproductive surgeon can both diagnose and remove endometriosis in one procedure.
- You don’t want to undergo surgery just for diagnosis, only to need a second procedure for treatment.
- A less experienced surgeon may leave some endometriosis behind or be unable to treat complex adhesions.
New Advances in Endometriosis Testing
In the last seven years, innovative diagnostic measures have been developed to help determine if a woman with no symptoms or ultrasound evidence might have endometriosis. It also helps physicians decide who would be a good candidate to undergo laparoscopy.
Back in the 1980s and 1990s, it was standard procedure that everyone with infertility undergo laparoscopy, but now we try to be much more selective. The ReceptivaDX test, an endometrial biopsy performed in the office, checking or sampling the uterine lining, measures a protein called BCL6, a marker usually associated with endometrial uterine inflammation and potentially silent endometriosis.
An abnormal biopsy result usually means there is endometriosis or inflammation in the pelvis. This biopsy can be very helpful for women who have no symptoms, evidence of endometriosis on ultrasound or unexplained fertility.
Seeking Expert Care
If you think you might have endometriosis, it is imperative to seek out an experienced reproductive surgeon specialized in treating advanced endometriosis. In my opinion, Dr. Charles Miller, Dr. Kirsten Sasaki, and Dr. Molly McKenna are among the best reproductive surgeons for endometriosis treatment in the Midwest. Their expertise ensures that patients receive the highest level of care for both diagnosis and treatment, improving their chances of achieving a successful pregnancy.
Request a consultation or call 630-428-2229 to schedule.
May 10 is Dr. Miller Day!
Did you know May 10th is Dr. Miller Day? Neither did we, until our patient, Jamie, shared that she created this special day to remember her fertility journey, the support she received from her “village” and of course the doctor who helped her become a mom!
Jamie writes:
Our fertility journey started as most do, with a lot of hope and a lot of disappointing negative pregnancy tests. During my initial testing, I found out I had 2 fibroids and one was very large. Although I kept asking about the large one, I was told by 3 different doctors that they weren’t an issue and was encouraged to start IUI or IVF.
Although reluctant, we started planning on how and when to move forward. Through that process, we started applying for grants. While looking at the grant application, I started reading into how it would be scored. In the fine print, I noticed certain types of fibroids would disqualify us from the grant, and that is because they can make IVF less successful. This made me, once again, question my fibroid. I told my husband that I wanted to find an expert opinion to rule out the fibroid causing my fertility issues before beginning any treatment. I started to research fibroid experts, and one name kept coming up again and again in my search, Dr. Charles Miller.
In April 2022, during my consultation with Dr. Miller, I expected to hear, once again, that the fibroid was “fine.” Dr. Miller recommended surgery, and on May 10th, 2022 he successfully removed both fibroids. We spent the next few months healing, trying to enjoy life, appreciating what we have, and planning our next steps to bring home a baby of our own.
In August 2022, I returned to Dr. Miller’s office, and he told me that things healed well and we could start trying again. During that same month, I was on pins and needles hoping to hear that we got the IVF cycle grant. However, less than three weeks after my follow-up visit with Dr. Miller, our jaws dropped when we got our positive pregnancy test! It was clear that the fibroid was what had been causing my infertility, and if we hadn’t done our research and sought out Dr. Miller’s expertise, we would have spent thousands on IVF without any success.
On April 17, 2023 our miracle baby girl, Fontana, was delivered via c-section. We cannot thank Dr. Miller enough for taking his time to listen to our concerns, truly evaluating the fibroid and its impact, and for his flawless surgery. Without Dr. Miller, we wouldn’t have had a first birthday to celebrate last month.
This Friday we will celebrate our second Dr. Miller Day. This year we took the time to reflect and appreciate those who were a part of our village by writing cards to family, friends, and those strangers who supported us during our darkest days of infertility. Each person is represented by a house, and when we put them all together, it was empowering to see just how many people helped us along the way. No two infertility journeys are the same, but for those still in the trenches, trust your gut and advocate for yourself.
Patient Story- SJ
SJ has been a patient of ours since 2012. After years of trying at another clinic, she underwent surgery with Dr. Miller, and then made the difficult decision to use donor eggs. In 2013, SJ and her husband welcomed twins! However, their family was not complete, and they welcomed another son last year! SJ understands the complexities of using donor eggs but hopes her journey brings awareness and inspiration to others in similar situations.
If you would like to learn more about our donor egg program, please contact Lindsey Bartscher (lbartscher at drcharlesmiller.com). Special thanks to SJ and her husband for sharing their inspiring story.
Our journey to build our family was a long one, but we are happy to say we are on the "other side" of infertility thanks to Dr. Miller and his wonderful staff!
We started trying to conceive in May 2009 when I was 29 years old. Both of our parents had conceived easily, and we were both healthy, so we didn't expect to have any problems. Unfortunately, after a year of negative cycles, we started seeing a fertility doctor in June 2010. Despite all our tests looking normal, we did four IUIs that all failed. When we finally got to the point of doing IVF, we just expected it would work. Our first IVF cycle, I got pregnant and for the first time ever saw two pink lines! Even though my hcg numbers were low, I thought just the fact that I'd finally seen a positive pregnancy test meant things might work out. We lost the pregnancy around 5.5 weeks and quickly moved into a frozen embryo transfer (FET). That cycle failed, and we did two more IVF retrieval cycles and fresh transfers that both failed. After our third failed IVF cycle, my original fertility doctor suggested that we may need to use donor eggs. I was not ready to move forward with donor eggs then, so we tried one more IVF cycle with our original doctor. When that cycle failed, our doctor suggested not only donor eggs but donor sperm. We asked our doctor if he would be willing to perform further testing and a laparoscopy to test for endometriosis, since my sister had recently been diagnosed with it. When he refused, we decided it was time to switch clinics.
I had a friend who was able to get pregnant after a procedure Dr. Miller performed, so based on her recommendation and a lot of research, we decided Dr. Miller's office was the right place for us to continue our journey. Dr. Miller was completely on the same page as us and understood that before we did donor eggs or donor sperm or another IVF, we wanted to be 100% sure we had tested for any potential issues like endometriosis or immune issues that could affect implantation of an embryo. Our motto was "no regrets," so we wanted to make sure we had no regrets about our decisions on this fertility journey. Dr. Miller performed a laparoscopy after finding mild endometriosis, and he discovered I had homozygous MTHFR, both issues he thought could affect IVF success. We tried one more IUI cycle and one IVF cycle with Dr. Miller. After our first IVF cycle with Dr. Miller, he told me I had "soft" eggs and recommended donor eggs. He said he did not think we needed donor sperm, but he showed us the statistics on donor eggs and explained how such a cycle would work. Dr. Miller's Donor Egg IVF Coordinator also gave us a lot of information on donor egg agencies and counselors.
After taking a few months to regroup and make sure we were ready, we decided to move forward with donor eggs in August 2012. Dr. Miller also added Lovenox and Medrol to my cycle due to my MTHFR and repeated IVF failures. We found an amazing donor egg agency (Graceful Conceptions) and moved forward with a fresh donor egg cycle in December 2012. The difference between our donor egg cycle and my egg cycles was night and day! We had so many more embryos to work with that we did with my cycles, and they were all top quality! We transferred two embryos on December 18th and were able to freeze five more high graded embryos. And right before Christmas I got two beautiful pink lines on a pregnancy test! It was the BEST Christmas gift we could ever imagine! We found out two weeks later that we were expecting not only one but TWO babies!
Our twins were born healthy in 2013, and we kept our frozen embryos for several years. Eventually, in 2022, we decided to try and expand our family. We knew it might take a few tries, but we got lucky and had success on our second frozen embryo transfer in May 2022.
We know some people are not comfortable with donor eggs, but Dr. Miller made us feel so comfortable about it, and he reminded me that with donor eggs I would still be carrying my children. We know our three beautiful children would never have been possible without donor eggs or Dr. Miller. We are forever grateful we decided to switch clinics back in 2012, and we are thankful Dr. Miller was so straightforward about donor eggs being our best chance of having a baby and building our family. We explained to our kids that donor eggs are just part of their story and something that makes them special, and they will always know how much they were wanted and loved! We hope our story gives other couples hope, especially when faced with failed IVF cycles. "Success" looks different for everyone, but we are blessed and grateful that our donor, Dr. Miller and science have made our family possible!
-SJ
Patient Story- Charlinda
As we wrap up Endometriosis Awareness Month, it’s only fitting that we share a patient story with you. Charlinda had endured years of pain and surgeries because of her endometriosis and wondered if she would ever be able to have a child. In 2017, she was referred to Dr. Miller. He performed surgery and three short months later, Charlinda conceived her son, Preston. Today is Preston’s 6th birthday! Charlinda shares her journey so that others won’t let a diagnosis like endometriosis discourage them from motherhood. Read Charlinda’s inspiring story below.
I remember how what first looked like a super sad day actually became a blessing in disguise. Sitting nervously in my OBGYN office, hearing her tell me she could no longer see me, felt like a huge break up. She was the only doctor I trusted since moving to Illinois. Due to the numerous endometriosis surgeries she performed on me and the fact that I wanted to become a mom one day, she felt there was another doctor who could better help me. With tears in my eyes, I reluctantly took the number of Dr. Charles Miller.
At the time, I was in my late 30s and not feeling particularly optimistic about meeting a new doctor and his staff for the first time. However, my OBGYN said Dr. Miller was the best in the area and I trusted her judgment. I walked into the waiting room and saw anxious couples and beautiful baby pics posted on the walls. At that moment I told myself my child will be on that wall one day. I finally met Dr. Miller who just returned from vacation, fully tanned and full of life. He listened intently as I explained my health journey and how I knew IVF financially wasn’t an option. It’s been some years but I do remember him saying this was not a problem and that he would get me as close as he could as though I would be an IVF patient. Per his recommendations, I exercised more and ate a healthier diet in preparation of my surgery to remove the endometriosis. I can honestly say after all of my other surgeries this one was the easiest recovery I ever experienced. I followed his plan to a tee and I conceived three months later. Now my son just turned 6 years old.
I know everyone’s journey is different but I share my story so others won’t allow a diagnosis that “may” increase infertility discourage you. Once realizing I was determined to defy the odds, I kept reminding myself what my parents constantly told me, fear and faith cannot live in the same house. I was so proud to announce to Dr. Miller I had a successful pregnancy. Once he knew I conceived, it was onto the next patient. This just goes to show his dedication to his craft. This is so important because I didn’t need him to hold my hand but to get me healthy enough for a fighting chance to conceive naturally. I was glad to get him quickly back to make other women moms. Words can’t express the gratitude our family has towards Dr. Miller and his entire staff!! Thank you.
Ovarian Pexy- A Simple Procedure to Help Improve Egg Retrieval Outcomes
We posted a video of Dr. Miller discussing a recent surgical procedure he performed called an Ovarian Pexy that helps improve egg retrieval outcomes. We figured this was a procedure many were unfamiliar with, so we asked Dr. Miller for more information. Get ready to understand how this simple procedure can make a big difference on your road to becoming a parent.
Q: What is an Ovarian Pexy?
Dr. Miller: A laparoscopic procedure to move the ovaries closer into the pelvis so that the follicles can be more easily identifiable.
Q: How do you know if you are a good candidate for Ovarian Pexy?
Dr. Miller: The procedure would be performed on someone whose ovaries are out of position. A woman can be born with her ovaries misplaced, making IVF difficult. Additionally, another potential cause is adhesive disease – whether from infection, endometriosis or prior surgery, the ovaries are simply pulled away from the pelvis.
However, keep in mind that you don’t know whether or not there is room for improvement until you look at the anatomy. If I cannot see the ovary, I will not take the patient to stimulation. Generally, we have indications that the ovary is not in the right place and see this while the patient is undergoing transvaginal ultrasound or when I perform a saline infused sonogram. At that point, I recommend surgery. Pexy of the ovaries is ultimately a game time decision at the time of surgery, when the anatomy can be seen.
Q: Why does this procedure improve your chances for a more successful egg retrieval?
Dr. Miller: It gets the ovaries to a place where they can be easily visualized via ultrasound and thus, makes egg retrieval easier.
Q: What is the recovery time and how soon can you do an egg retrieval after the procedure?
Dr. Miller: The recovery time is 5-7 days at home and the patient can start preparing for an egg retrieval with her next cycle.
Q: How common is an Ovarian Pexy?
Dr. Miller: Since most reproductive endocrinologists do not perform surgery, this procedure is not routinely performed. Instead, patients settle for a lesser amount of eggs. Oftentimes, Dr. Miller sees patients who have gone through cycles with other physicians and have not had eggs retrieved on one side because of the ovary position. After the ovarian pexy procedure, patients can go from not being able to retrieve eggs to having a comparable number of eggs retrieved from either ovary.
Interested in scheduling a consultation with Dr. Miller? Call 630-428-2229 to set up an appointment or request a consultation online.
IVF Superstitions Uncovered: From McDonald’s French Fries to Pineapples and More
You’ve been there, late night scrolling through Instagram or TikTok and filing away any and all tricks that hold the key to a successful embryo transfer. We decided to take a closer look at some of these IVF superstitions and better understand their origins.
McDonald’s French Fries
One popular superstition among IVF patients is consuming McDonald’s French Fries on the way home from the embryo transfer. The origin of this myth is unclear, but it is believed that the high salt content in the fries may help the body to absorb any excess fluids, potentially fending off ovarian hyperstimulation syndrome (OHSS). However, it should be noted that there is no scientific evidence to support this belief.
Pineapple
Eating one ring of pineapple, including the core, daily for five days starting on the day of the embryo transfer is another common IVF superstition. Because pineapple contains bromelain, a mix of enzymes that may break down scar tissue and decrease inflammation, patients were eating pineapple on an empty stomach the day of their embryo transfer. But again, there is no scientific research that supports this will improve implantation.
Pomegranate Juice
Drinking pomegranate juice before and after the embryo transfer is another IVF superstition. Pomegranate juice is known to contain antioxidants and vitamins, and it is thought to thicken the uterine lining, which could aid with implantation. Additionally, the antioxidants may improve egg quality prior to the transfer. Despite these potential benefits, there’s no scientific evidence to back up this practice.
Water
Drinking more than 64 ounces of water in the days after the embryo transfer is another common recommendation. It is believed that staying well-hydrated can support blood flow to the uterus, which in turn can aid in implantation.
Warm Feet/Cozy Socks
Many people believe that keeping your feet warm during the transfer is beneficial. The reasoning is that if your body is sending blood flow to your extremities to keep your feet warm, it may redirect blood flow away from the uterus and embryo. However, like all the other superstitions, the scientific support for this is lacking.
Dr. Charles Miller Weighs in on IVF Superstitions
Dr. Miller, a renowned fertility expert, acknowledges the existence of these superstitions. He notes, “While all of these IVF myths have some sort of scientific support, at the end of the day, none of them have been studied and certainly, none have been shown to be effective.”
He adds humorously, “Nonetheless, I’m waiting for the day that one of our patients walks into the office eating the McDonald‘s Infertility Happy Meal consisting of fries, pineapple core and pomegranate juice. I guess it’s healthier than chicken nuggets and a Coke!”
In conclusion, while these IVF superstitions may seem to have a scientific basis, there is no evidence to suggest that any of them actually influence the outcomes of IVF treatment and they should not replace the medical advice from your fertility care team. Remember, success in IVF is primarily determined by medical factors and a tailored treatment plan.