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.
Patient Story- Kasi: Endometriosis, Infertility and the Path to Motherhood
As Endometriosis Awareness Month comes to a close, we wanted to share Kasi’s journey. It’s one of strength, resilience and hope. Kasi endured years of pain from endometriosis, multiple surgeries and several IVF cycles. Through every challenge, she never gave up on her dream of becoming a mother. Today she holds that dream in her arms- her beautiful son, Koah.
He has brown russet-colored eyes that are full of depth. They sparkle when he laughs and when he looks at me. He has his father’s hair and my jawline. His latte-colored skin comes straight from me. He is the light of my life and for many dark years, I wondered if he’d ever be here.
Years of Pain Without Answers
I had a plan for my life as many women do. The plan was to finish graduate school, get married, buy a house, and then start a family. My early twenties had their own hardships that centered around midterms and quarter-life crises. I also had unusually painful periods that most doctors dismissed with instructions to start taking ibuprofen a couple days before my period would start. But the pain would still leave me curled in a ball in the middle of my bed every few months. A doctor at the health services recommended taking birth control pills to help regulate my periods and reduce the pain. It worked for several years. When my husband and I turned 30 years old, we decided that we wanted to start our family. That required me to stop taking the birth control pills and to begin planning the next part of our lives. We planned on 2 or 3 children. We talked about the types of parents we would be, and we made plans around their impending arrival. But the arrival seemed stalled.
The pain was back. Sometimes it would be debilitating, and it would cause me to miss work. I was also having digestive issues that would cause chronic constipation and discomfort. I started a new job that could be stressful, so I thought it was all stress related. In the winter of 2012, the holidays were rough. After Christmas, I found myself in significant pain. I recently switched doctors and decided to see my new doctor to find out what was going on.
The Diagnosis That Changed Everything
Dr. Melissa Kwak was the first doctor who listened to me when I told her about all the pain I was having. She ordered an MRI that started me on my journey. The MRI found a fibroid the size of a grapefruit on my uterus. She sent me for further testing with Dr. Brett Cassidy and he recommended that I have surgery to have the fibroid removed in February 2013. I was 32 years old. I remember feeling so frustrated that my body could betray me in that way. I know the depth of the betrayal.
The surgery was meant to be laparoscopic. They explained that I would have tiny keyhole incisions made in my abdomen and another in my belly button so that the machine could excise the fibroid without them having to open me up with a lateral incision. They expected everything to go easily and after recovery, we could begin trying to have a baby again. When I woke up from anesthesia, I was in overwhelming pain. I began screaming and the nurses rushed to me. I heard one say, “We need to manage her pain!” I knew immediately that something went wrong. I kept asking over and over what happened, but no one answered me.
“You have endometriosis,” my doctor later explained to me. They had to abandon the laparoscopic surgery as soon as they could see what they were dealing with. They had to open me up laterally (like a c-section). I had adhesions all over and this was the reason for my extreme pain during menstruation. With endometriosis, endometrial tissue is found in other areas of the pelvis. When the body menstruates, the tissue in these other areas, outside the uterus, bleed as well. The body treats these areas as internal bleeding and rushes to heal it and create scar tissue around it. These are called adhesions. My doctor was able to save my reproductive system and remove the adhesions. He gave us the green light to begin trying to have a baby again. He explained that being on birth control was unknowingly treating the endometriosis. But to start our family, I could not take medication for the condition. The instructions were to get pregnant fast since there was no cure for endometriosis and the adhesions can return. We were optimistic, but another year passed without a baby.
IVF and the Emotional Toll of Infertility
We realized that it was time to talk to a fertility specialist to assist us. Dr. Cassidy recommended that we see Dr. Charles Miller in Naperville, IL to assist us. However, our insurance didn’t cover Dr. Miler. So, in 2014 we began working with another fertility clinic. The doctor with this center, decided quickly that IVF would be the best option. We were 33 years old, so the odds were in our favor.
At this clinic, we ran into more complications. They had trouble with egg retrieval. They sent me back to Dr. Cassidy for another laparoscopic surgery to remove more endometrial adhesions. We finally got 10 embryos but only 4 survived. They transferred 2 embryos in December 2014. We would have to wait 2 weeks to find out if the embryos took and if we were going to be parents. During that 2-week wait, my father-in-law passed away from heart disease and we were mourning. I look back on that period with a lot of pain. I often wonder if the grief and the negative emotions I felt made my body inhospitable for those little babies. We found out that the embryos didn’t take a couple days before the funeral, so we grieved my husband’s father, and the loss of the embryos. I fell into a mild depression after that. I admitted this to my doctor, and she suggested that I begin seeing a therapist. I was dealing with a lot of guilt and grief over my father-in-law passing. I felt like I was selfish in his last days because I was so focused on the embryo transfer, but I also felt that I was a terrible mother to those embryos because I did not provide a positive environment where they could grow.
Infertility can be a lonely thing. Even though I was surrounded by doctors and nurses and friends and family who encouraged me, I still felt alone. I felt profound shame and inadequacy. I didn’t think that I was worthy to be a mother and maybe somehow God had ordained it to be this way. I received confirmation of my own perceived condemnation when a second embryo transfer did not yield a pregnancy. I needed time off. For a year, I didn’t want to think about fertility or trying to have a baby. But during this time off, the endometriosis did not leave me. The pain became severe again and I knew that I’d need to address it and decide if we’d want to try to be parents again. Through this time, we switched to a new insurance. I went to see Dr. Cassidy to ask about another surgery for the endometriosis. He asked us again if we thought about Dr. Charles Miller. He said he was one of the leading specialists in the area for endometriosis and he could do the surgery. We investigated our insurance coverage, and we were happy to find that Dr. Miller was covered.
Finding the Right Specialist
When we first met with Dr. Charles Miller, it was on a Sunday. He was dressed in a beautiful suit. He looked outstanding. He immediately helped us feel at ease. He tailored the treatment plan to me and my unique circumstances. That was refreshing, because our last doctor wanted to use the same protocol with me that she used for every woman she treated, regardless of the diagnosis. We were 35 years old and desperate to make things work. The fertility world talks about age 35 as the gateway into geriatric pregnancy. The percentages of successful live births begin to go down at this point and risks of birth defects and other issues increase. We were anxious to get started. I had 4 or 5 surgeries, numerous egg retrievals and 3 embryo transfers with Dr. Miller. I remember, after a disappointing cycle, we sat in Dr. Miller’s office with him. He was quiet after explaining what happened and we were quiet. I remember asking him not to give up on me. I remember he took my hand and told me that he was willing to fight along with us for as long as we were willing to fight.
In January 2020, I needed another surgery for endometriosis. I was 39 years old and desperate to try again before I turned 40. We had one frozen embryo left from the previous cycle. The plan was to have the surgery, do a few more egg retrievals so we could transfer more than one embryo. The odds are always better when you have more than one embryo to transfer. By the summer of 2020 I went for tests, that showed that I wasn’t ovulating after the last surgery and there wasn’t much hope of getting more embryos. Dr. Miller talked to us about donor eggs, but my husband and I didn’t want to give up on the dream of having a child that was a little bit of both of us. So, we decided to transfer the one embryo we had. We decided we were done with the whole IVF process. We started looking into foster care and adoption. It took another 6 months to get insurance and all other circumstances to line up.
One Last Chance at Motherhood
In February 2021, a few months after I turned 40-years-old, I came into the office to transfer the last embryo we had frozen. We were in the thick of COVID protocols so my husband couldn’t come in with me. When the doctor came in, I tearfully told him about the amazing impact he had on my life. I told him that no matter the outcome, I was just so grateful that I had the opportunity to reach for my dream when so many other women didn’t even get the chance to try. We both cried and he told me that he had a great feeling about that transfer. I had a sense of peace after that last cycle. In the past I did acupuncture after the embryo transfers to increase the odds of the embryo taking. But this last time, we chose to go to my father’s house and pray. My husband, my father, and I joined hands and prayed the most beautiful prayer about gratitude and joy regardless of the outcome.
The Call That Changed Everything
On the morning of my blood test after the 2-week-wait, I felt hopeful and peaceful. I knew this was going to be my last time going through the process and maybe knowing this gave me peace that day. Normally, the results of the pregnancy tests came to us on a portal app on my cell phone. I thought that I wouldn’t hear anything until the afternoon. During my morning break from work, I decided to lay down and take a nap. Before I could fall asleep, my phone started ringing and it was Dr. Miller’s office. They never called before on pregnancy test day, so my heart was in my throat when I answered the phone. The nurses in the office had me on speaker phone. The phlebotomist, the ultrasound tech, and two of the nurses were gathered around the phone. They asked me if I was sitting down. When I told them I was, one of the girls screamed, “You’re pregnant!” I immediately fell on my knees. I cried on the phone with them for what felt like an hour. I could hear a few ladies crying with me and I heard them yelling “Congratulations!’ I couldn’t even speak. It was 10 years of waiting. 10 years of crying. 10 years of wondering what I had done wrong, 10 years of disappointments. The emotion that flowed through my body in that moment was pure joy.
A Dream Come True
My pregnancy went forward without any complications. We were blessed because I was healthy, and the baby was healthy. I gave birth to a beautiful baby boy named Koah. I am certain that I just gazed at him for hours. I still love to look at him. We had waited so long for him, and he had waited for us as a frozen embryo. He was the very last to be transferred, but he was destined to make it into our arms. Koah is our only child, but our hearts remain open and excited about this beautiful life we will have with our son. I knew from the moment that my pregnancy was confirmed that I would share this story. I knew that I wanted to encourage other women who feel isolated while going through this journey. I persevered and I was able to experience the miracle of feeling a life growing inside me. I can watch him grow as a walking and breathing testament to my own strength and endurance. The journey taught me to feel worthy regardless of the outcome and I am looking forward to helping other women feel empowered and strong.
-Kasi
Patient Story- Chloe- Asherman's Syndrome
Today we are featuring Chloe’s patient journey with intrauterine adhesions. According to Dr. Miller, these adhesions are one of the hardest things to deal with in infertility. Chloe sought Dr. Miller’s help after a pregnancy loss and being diagnosed with Asherman’s syndrome, a condition where adhesions form inside the uterus. Dr. Miller performed surgery to remove the adhesions and Chloe participated in a clinical trial aimed to prevent the return of these adhesions. The surgery was successful and Chloe recently welcomed her daughter, Charlotte. We are so happy to have played a part in helping Chloe become a mother.
Check out Chloe’s story:
In September 2021 we found out that we were pregnant with our first baby and we were over the moon. Fast forward to January 2022 and we lost our little boy when I was 23 weeks pregnant. We were distraught and didn’t know what to do. On top of losing our baby I was then diagnosed with Asherman's Syndrome. According to the Cleveland Clinic, Asherman’s syndrome is an acquired condition where scar tissue (adhesions) form inside your uterus. The scar tissue can build up, decreasing the amount of open space inside your uterus. Women with Asherman’s syndrome may experience light or no periods, pelvic pain or infertility.
We weren’t very educated on this syndrome at the time, but later on found out that it would be difficult to get pregnant with Asherman's syndrome. I was told that I would need a hysteroscopy to get rid of these adhesions. A hysteroscopy is a procedure in which a surgeon inserts a thin, lighted telescope to see inside the uterus. Adhesions can be removed at this time.
I knew that I wanted to make sure I had the best doctor performing this procedure since my ability to have kids depended on it. I learned about Dr. Miller from my husband's cousin, who is a nurse in Park Ridge. At the end of 2022 I scheduled an appointment. Dr. Miller ended up performing the hysteroscopy and lysis of adhesions in March 2023. I took part in a clinical trial to get rid of my adhesions. The trial looked at the effect of a soft gel-like material, called Juveena™ Hydrogel, inserted into the uterus after the removal of adhesions to reduce the formation of adhesions again.
After my procedure the nurse told me that my adhesions were some of the worst she had ever seen. However, they felt like they had gotten all of them. I had a follow up a few months later where I was told everything looked good and I was ready to try for another baby.
In November 2023 I found out that I was pregnant again. My husband and I were very excited, but also nervous after everything we had previously gone through. Dr. Miller and his team were great from the moment I told them that I was pregnant. They got me in for a visit right away and started monitoring me until they felt I was in the safe zone.
In June we welcomed a sweet little girl named Charlotte into the world. We are so in love with our baby and so thankful to Dr. Miller and his team. If it wasn’t for him I truly don’t believe we would have Charlotte. I know if I have any issues in the future Dr. Miller would be the first person I would reach out to.
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.
The Advanced IVF Institute Joins the CCRM Fertility Network of Clinics
Big news for our practice- the best just got better! We are pleased to announce we are now a part of the CCRM Fertility network of clinics. CCRM Fertility is a global pioneer in fertility treatment, research and science and specializes in the most advanced fertility treatments, with deep expertise in IVF, fertility testing, egg freezing, preimplantation genetic testing, third party reproduction and egg donation, achieving some of the highest Iive birth success rates in the U.S.
Dr. Miller and our dedicated and innovative team can’t wait to join forces with CCRM Fertility to provide exceptional care to our patients and give them the best opportunity for success.
Rest assured, Dr. Miller will remain as Practice Director and you will continue to receive the outstanding and personalized care you expect of us; however, now your access to top-tier medical resources has expanded to become even more innovative, efficient and accessible.
Dr. Miller had this to say: “It is an honor to join the prestigious CCRM Fertility network. Together, we are committed to our patients through innovative thought, procedures and technologies. I look forward to caring for existing patients and welcoming new patients through our doors as they face fertility and gynecologic challenges.”
We are excited to join with CCRM Fertility to bring joy to even more families! Check out the official press release below.
CCRM Fertility Broadens North American Footprint By Adding The Advanced IVF Institute to its Network
CHICAGO, Aug. 2, 2023 /PRNewswire/ -- CCRM Fertility, a global pioneer in fertility treatment, research and science, has added The Advanced IVF Institute, to its rapidly expanding fertility treatment and family-building network. Dr. Charles Miller leads two Chicago-area locations and provides cutting-edge fertility treatments, including in vitro fertilization (IVF), fertility preservation and reproductive surgery.
For more than 35 years, CCRM Fertility has helped transform lives through exceptional fertility care. CCRM Fertility's diverse, highly regarded team of physicians, research scientists, embryologists and professional staff are dedicated to helping patients achieve their dream of having a baby today, or in the future, achieving some of the highest Iive-birth success rates in the U.S. CCRM Fertility's expansive network currently serves 16 major metropolitan areas with 37 locations across the U.S. and Canada. Now, Chicagoans can have the benefit of the CCRM expertise in their own backyard.
"We are excited to welcome Dr. Miller and his team to our network, as they spearhead one of Chicago's leading IVF and surgery clinics and are recognized nationally and globally," said CCRM Fertility CEO Bob LaGalia. "Dr. Miller is an innovator in reproductive surgery and has a passion for learning new procedures, techniques and instrumentation that can positively impact patient outcomes. Dr. Miller and his experienced team will be an invaluable asset to CCRM as we collaborate to make assisted reproductive technologies more efficient and accessible for our patients."
As an internationally renowned expert in minimally invasive gynecologic surgery and in the treatment of infertility, Dr. Miller founded The Advanced IVF Institute in 2008. He is a graduate of the Honors Program in Medical Education from Northwestern University and completed his residency in obstetrics and gynecology at the University of Texas Southwestern Medical School, Parkland Memorial Hospital. Dr. Miller then earned his fellowship in reproductive endocrinology and infertility at the Hospital of the University of Pennsylvania.
Dr. Miller is a past president (2008) of the AAGL (formerly the American Association of Gynecologic Laparoscopists), the largest association of laparoscopic and hysteroscopic surgeons dedicated to the research and advancement of minimally invasive gynecologic procedures. Dr. Miller is also a past president (2011-2013) of the ISGE (International Society for Gynecologic Endoscopy).
In 2022, Dr. Miller received the AAGL esteemed distinction of Honorary Chair for his exemplary service to the AAGL and the outstanding contributions he has made in the field of reproductive medicine and minimally invasive gynecologic surgery.
Dr. Miller is the Director of Minimally Invasive Gynecologic Surgery and since 2010, Director of the Fellowship in Minimally Invasive Gynecologic Surgery Program at Advocate Lutheran General Hospital. He is the current president of the Foundation of the AAGL. He is also a faculty member of the Clinical Fellowship in Reproductive Medicine and Immunology, Rosalind Franklin University of Medicine and Science. Dr. Miller's ongoing dedication to developing young minimally invasive gynecologic surgeons earned him the AAGL's honorable John F. Steege, MD, Mentorship Award in 2018.
"It is an honor to join the prestigious CCRM Fertility network. Together, we are committed to our patients through innovative thought, procedures, and technologies," said Dr. Miller, who will continue to serve as Practice Director. "I look forward to caring for existing patients and welcoming new patients through our doors as they face fertility and gynecologic challenges."
About CCRM Fertility
CCRM Fertility is a global pioneer in fertility treatment, research and science. Founded by Dr. William Schoolcraft more than 35 years ago, CCRM Fertility specializes in the most advanced fertility treatments, with deep expertise in IVF, fertility testing, egg freezing, preimplantation genetic testing, third party reproduction and egg donation. CCRM Fertility leverages its own data and a dedicated team of in-house reproductive endocrinologists, embryologists and geneticists to deliver industry-leading outcomes. CCRM Fertility is a proud strategic partner of Unified Women's Healthcare, which is accelerating meaningful change in women's healthcare by building healthy, innovative and mission-driven businesses to meet the comprehensive needs of women across the entirety of their health journey. For more information, visit www.ccrmivf.com.
IVF Patient Journey- Karen
“I took time to educate myself about the IVF process. I started following some fertility accounts on Instagram and realized how big this community is. It’s the worst club to be a part of, but it has the best members!”
Today we are excited to introduce a new type of patient story to you. We will be sharing Karen’s journey and her efforts to become a mother. Karen had no reason to suspect she would have trouble conceiving until she tried for almost a year with no success. Now she is preparing to go through IVF and is ready to share the good, bad and the emotional with you. It is important to remember that each patient case is unique and Dr. Miller personalizes each treatment plan based on the patient’s age, medical history and test results. Here is Karen’s story:
My name is Karen and I am 38 years old, I have been married to my husband for four years and we live in Lombard with our sweet 5-year-old boxer mix, Cali. When my husband and I started trying for a family in 2021 and it wasn’t happening as quickly as I thought, I got worried. We both live a very healthy lifestyle, have clean bills of health and never thought we would have any issues trying to conceive. I had a ton of girlfriends that got pregnant very quickly, but then I also had several that went through IVF or were currently going through it. I didn’t know much about IVF because I tried not to let my mind think that would ever be an option for us. But then reality started to hit me. After eight months of no success, we decided that we needed to look into the IVF process and find a doctor.
I found Dr. Miller by doing some research on local doctors online through RE doctor websites. My friends who went through IVF all had different stories and different outcomes, with doctors all over the suburbs. My main concern was finding a clinic that didn’t make me feel like just a number. I wanted a doctor that had years of experience, would take the time to understand what we were going through and not push us through the consultation process. I also wanted to make sure there was a supportive nursing team that would be there for us during our journey. After our first meeting with Dr. Miller, I said to my husband, “Wow, this man is going to help get us our baby, I like him!”
After all the bloodwork, baseline ultrasound, HSN and semen analysis, we found out that my husband and I are both factors. Obviously my age was a huge factor and my husband had abnormal morphology, which made Dr. Miller suggest that we should go straight to IVF with ICSI (a method that involves injecting sperm directly into an egg to induce fertilization and pregnancy).
Actually hearing those words brought me to tears after we got off the call. I couldn’t believe we were going to have to go through this. A ton of questions went through my mind of why can’t I just be like everyone else, why can’t this be easy for us? I took time to educate myself about the IVF process. I started following some fertility accounts on Instagram and realized how big this community is. It’s the worst club to be a part of, but it has the best members! Finding girls that are currently going through the exact same process is a blessing. They totally know what you are going through and they feel your pains, the struggles and the wins.
Fast forward to October of 2022, and we were ready for our first round for egg retrieval. I started stims and was on a very basic protocol- menopur, follistim, ganirelix and double trigger shot. Once I got that big box of meds delivered, I was a little overwhelmed. Organizing, setting up my area where I was going to do the shots and going through the consultation with Nurse Patty, gave me the confidence that I was ready to take on the shots. I watched a ton of videos online of girls that were going through stims on Instagram to hype me up.
I had talked about the shots with my husband and showed him videos to get him ready for what I was going to be doing. I asked him (even though I knew I was going to be giving myself the shots) if he wanted to give me the shots and he said he would do them if I didn’t think I could. I let him know that he was off the hook with the stim shots, but that he would have to step up to give me the PIO shots once we got to that point in our journey.
To be honest, the shots were not that bad. Mixing and getting the shots prepped is the most hassle. I usually put on some music to sing along to as I am doing the shots to take my mind off what is going on!
I did ten days of shots and had my egg retrieval on November 3. I got six eggs! It was one more than I thought I was going to get. Results came the next day, that four matured and two fertilized with ICSI. Then we waited six more days to hear how those two did. On day 6, we received a message that only one made it to blast and a biopsy was being sent off for PGT-A testing.
We went through another long two week wait. I received the result that our only embryo was low mosaic- trisomy 1. It was heartbreaking to hear that our only embryo from our first egg retrieval had these results. We didn’t really understand what this meant, so we scheduled a follow up call with Igenomix with a genetic counselor to review the results. I am so glad we did, because after finding out what low mosaic really meant, we decided that we indeed were going to keep this embryo frozen. There might be some hope with this little embaby. After processing all this news, we knew that we had to get right back into another egg retrieval. When we first started this process, we were prepared with the possibility that we were going to have to do multiple egg retrievals based off of my test results.
At the end of November, we had our follow up consultation with Dr. Miller to review what happened and get his thoughts. He told us that this next round was going to be different and we are going to switch up the protocol now that we know what worked and what didn’t work. He gave us so much hope during that call, making sure to remind us that we are going to get our baby! Since I knew we would be starting the process again sometime in January, my husband and I just took the time to enjoy the holidays and not focus on IVF. It was a nice distraction.
Heading into round 2, I am excited and nervous. I am looking forward to seeing the end results with this retrieval since we are switching up my protocol. Even though I have been through this process once and I know what to expect, I have a feeling this path will be different and that’s ok. The main thing is that I have my support group to cheer me on, sending me positive vibes and prayers. Here we go round 2!
Stay tuned to follow Karen’s journey as she prepares for her second egg retrieval . She is excited to share her story with you and shed some light into the IVF process.