Where Motherhood Can Be Possible

Dr. Louis R. Manara

PCOS Management – An Update

Our understanding of polycystic ovarian syndrome (PCOS), the most common endocrine disorder of women, has improved dramatically in recent years.  Its association with metabolic abnormalities has been well established and new treatment approaches are being studied and often implemented.  This review will look at recent developments in the management of PCOS and attempt to clarify contemporary management of the syndrome in the context of the available scientific information.


More Evidence That Genetic Abnormalities Explain Age Related Infertility!

Mounting evidence suggests that the significant reduction in infertility treatment success as women age is mostly related to increased production of genetically abnormal (aneuploid) embryos with advancing years.  A recent multicenter study in which embryos were studied with PGD (preimplantation genetic diagnosis), demonstrated that the percentage of genetically abnormal embryos produced by women less than 35 years of age was 31.7%, while the percentage of genetically abnormal embryos produced by women 41-42 years of age was 76.3%.  However, when genetically normal embryos were available, the implantation rate was not significantly different across all age groups.


Letrozole For Ovulation Induction – Better Than Clomid?

Letrozole is one of a class of drugs termed aromatase inhibitors, which work by inhibiting the production of the enzyme responsible for the synthesis of estrogen.  With low blood levels of estrogen, the hypothalamus and pituitary are released from their negative feedback mechanism and will increase their production of pituitary hormones, which control ovulation. While not yet FDA approved, letrozole seems to have some distinct advantages and applications making it an attractive first or second line treatment option for certain categories of infertility.  Treatment with letrozole seems to result in improved pregnancy rates and reduced multiple birth rates compared to clomid treatment.


Do Uterine Fibroids Cause Infertility?

 

Uterine fibroids are present in approximately 30-50% of reproductive aged women, and are often identified through ultrasound in the course of the infertility evaluation.  It is well established that fibroids located within the uterine cavity (sub-mucous fibroids) can cause infertility, but there is uncertainty concerning whether fibroids located within the walls (intramural) of the uterus or just beneath the outer surface of the uterus (sub-serosal fibroids) cause infertility.  Proximity of the fibroid to the uterine lining and size of the fibroid are two important factors in determining whether a fibroid is responsible for infertility, but it is not always completely clear that the fibroid(s) in question is the cause of infertility and needs to be removed.


Voorhees, New Jersey

Dr. Louis R. Manara

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