The Laurence A. Jacobs M.D. Blog

Polycystic ovarian syndrome (PCOS) can have many variable and subtle symptoms. Unfortunately, some doctors may overlook the diagnosis in young women who are not trying to get pregnant, particularly if the young woman is simply interested in regulating her periods with medications, such as Provera or birth control pills. 

While PCOS has several potential implications for fertility and is the most common form of female-related infertility caused by the absence of ovulation, the condition may also lead to numerous serious general health problems. PCOS Awareness is an important first step. My practice is now offering a screening program called PCOS Awareness. 

When you embark on any medical journey, you will find there are many physicians who excel in their technical knowledge and skill. But what makes a truly great physician? In my opinion, it is compassion — a skill that is not found in medical journals or taught in medical school.

Folic acid is a synthetic form of vitamin B that has many functions and benefits to the human body. The main function of folic acid is to make and maintain cells, which are the building blocks of life. Folic acid helps the cells to rapidly divide and grow; thus producing healthy new red blood cells that carry oxygen throughout the body. Folic acid is also responsible for making other components that are essential building blocks of life such as DNA, RNA and amino acids.

Polycystic ovary syndrome (PCOS) occurs when a hormone change causes problems with ovulation, the release of an egg from a woman’s ovary. PCOS is a major cause of infertility. The name of the syndrome, however, focuses on the ovarian cysts that may be present with PCOS. Now, experts want to change the name of this complex disease, as the presence of cysts on the ovaries is no longer the definitive factor in the diagnosis.

It is readily apparent that increasing numbers of women are using antidepressant drugs, mostly selective serotonin reuptake inhibitors (SSRIs) and selective serotonin norepinephrine reuptake inhibitors (SNRIs).  SSRIs are used to treat anxiety, depression and certain personality disorders. The most common brand names include Prozac, Zoloft, Lexapro, Paxil and Celexa. A significant percentage of reproductive age women (including infertility patients) are taking these medications before and during pregnancy. 

Yes, the holidays are a joyous time, but the stretch from Thanksgiving to New Year's actually encourages two things that can wreak havoc on your fertility or fertility treatment. What are they? Stress and overeating.

Let's look at the first: stress. The shopping, the decorating, the parties, the family events — even if it's fun, it can be stressful. The relationship between stress and fertility treatment is confusing. Some studies, including a recent meta-analysis, have found that there is no significant relationship between stress and the outcome with in vitro fertilization (IVF). However, other studies have found that stress relief programs can improve IVF pregnancy rates.

In my practice, I have noticed that patients who are in optimal health and are best able to manage the stresses of life and infertility have better success with treatment because they are able to persist during a difficult journey.
 

Egg freezing, or oocyte vitrification, has recently had its "experimental" label lifted by the American Society for Reproductive Medicine (ASRM). The ASRM report found that advances in egg-freezing techniques now produce rates of pregnancy and healthy babies comparable to those seen with in vitro fertilization (IVF) using fresh eggs. ASRM did not go so far as to recommend egg freezing in order for a woman to slow down her biological clock if she just isn't ready to have children.

A new retrospective review of studies on endometrial biopsy — also known as “womb scratching” — suggests that women who undergo this procedure prior to in vitro fertilization (IVF) are twice as likely to become pregnant. The study by British researchers — “Local endometrial injury and IVF outcome: a systematic review and meta-analysis” — was published in the journal Reproductive Medicine Online.
 
The study authors wrote: “Our review found that when endometrial surface injury was performed before an IVF treatment cycle, there was a significant improvement in the outcome of that treatment cycle."
 
In my practice, I have used the endometrial biopsy “scratching” technique for women who have good embryo quality, but have failed IVF.
 
 

Gender selection — choosing the sex of your baby — is a a topic that inspires much discussion centered around moral concerns, ethical concerns and religion. But in my experience, parents who want to choose the sex of their baby are doing it for medical reasons (to avoid passing on a sex-linked genetic disease) or for family balancing (for example, they have two boys and want that little girl to complete their family).
 
In addition, there are many couples who are already undergoing  and having genetic testing on the embryos to check for chromosomal abnormalities. These tests make it very simple to go ahead and select the embryo of the desired sex to transfer to the woman’s uterus when the time comes.



 

Recently I have had several questions via Facebook and Twitter about progesterone — whether it is safe and whether certain side effects can be attributed to it.

 Progesterone is a naturally occurring hormone in the body that is involved in a woman's menstrual cycle and supports pregnancy. In women, the hormone is produced in the ovaries, the adrenal glands and in the placenta during pregnancy, and it is stored in the fat tissue.
 
In women trying to conceive, progesterone supplements may be used to regulate periods in women who have stopped menstruating. If a woman is undergoing ovulation induction or  in vitro fertilization (IVF), progesterone supplements are also used.