Where Motherhood Can Be Possible

Dr. Louis R. Manara

Can DHEA Supplementation Improve IVF Outcomes In Patients With Normal Ovarian Function?

Dehydroepiandrosterone (DHEA) has been found to improve pregnancy rates in patients with diminished ovarian reserve.  However, the question of whether older patients with normal ovarian reserve will also benefit from DHEA supplementation, has not been addressed.  A recent study conducted at the University of Bari School of Medicine in Italy suggests that miscarriage rates are lower and IVF pregnancy rates are higher in patients treated with DHEA supplements before undergoing IVF treatment.

Highlights From March 2015 Combined European/American Reproductive Society Meeting

The American Society For Reproductive Medicine (ASRM) and the European Society of Human Reproduction and Embryology (ESHRE) held a combined meeting in New York City. Leaders from around the world in the field of Reproductive Medicine met to exchange ideas and debate controversial issues pertaining to infertility, and reproductive endocrine disorders.  In this blog post we provide a brief overview of some of the highlights of the symposium.

What Can We Learn From Measuring AMH (anti-mullerian hormone)?

AMH is a hormonal study that is commonly ordered early in the infertility evaluation to as part of the assessment of ovarian function.  More specifically the test provides some insight into the number and quality of eggs available.  When considered in the context of the ultrasound determined antral follicle count, cycle day 3 FSH (follicle stimulating hormone) and estradiol level, the AMH is a simple blood test that can contribute significantly to our understanding of a patient’s prospects for a live birth.  It is particularly helpful in assessing the affects of age on ovarian function.  One of the attractive features of this particular blood test is that it may be done at any time during the menstrual cycle as opposed to day 3 or 4, when the FSH and estradiol must be drawn.

Egg Freezing 2015 – An Update

Feb 28, 2015 — by manara99
Tags: Egg Freezing Aging And Fertility

Since the late 1990s we have been able to freeze human eggs successfully. It is imperative that we continue to add to our knowledge base concerning egg freezing and answer some of the difficult questions that are posed by our technical ability to provide this service.  This requires that we carefully monitor outcomes in those patients who have frozen eggs and have utilized these eggs to achieve pregnancy. Our understanding of egg freezing outcomes is somewhat limited at this time primarily because many women who have frozen their eggs have not yet used them.  Babies born after use of frozen eggs are not yet old enough to have been studied properly.


Embryo Selection – Some Thoughts

Selection of the best embryo for transfer has always been an important objective of IVF treatment.  The earliest attempts at selection relied heavily on cell number and detailed microscopic appearance of the embryo (morphology).  In this blog post we look at two commonly used methods of embryo selection, extended culture and pre-implantation genetic screening (PGS).

Smoking and Fertility

As reproductive specialists we are go to great lengths to couples prospects for a successful pregnancy.  It is important to recognize that lifestyle decisions may have a significant influence on a couples prospects for a successful pregnancy.  Among the many lifestyle considerations, smoking is high on the list of personal choices that profoundly influence reproductive function.  In this discussion, we consider the many ways that smoking adversely effects reproduction.

Clomid Better Than Letrozole for Unexplained Infertility!


A large recently published randomized study suggests that Clomid combined with intra-uterine insemination (IUI) results in improved live birth rates compared with letrozole/(IUI).  This study published in the October 2014 issue of Fertility and Sterility investigated outcomes for three different treatments for unexplained infertility and found significantly higher pregnancy and live birth rates in patients treated with gonadotropin (follicle stimulating hormone)/ IUI.  Relatively low multiple birth rates and an acceptable pregnancy rate make Clomid/IUI the favored initial treatment for unexplained infertility.

“Freeze All” – The Next Big Thing?

Jan 15, 2015 — by manara99
Tags: Improving Ivf Success Improving Fertility Potential

Several large infertility centers have recently suggested that freezing all embryos that develop in a stimulated cycle rather than placing them in the uterine cavity may improve the pregnancy rate achieved as a result of that egg retrievl. Some programs have found that freezing all embryos that develop to the blastocyst stage, and holding them for future transfer in an unstimulated cycle significantly improves pregnancy and live birth rates.  One of the advantages of freezing all of the embryos is that this allows for transfer of the best embryo(s) in a cycle that closely resembles the natural menstrual cycle. 

Unexplained Infertility – What the Semen Analysis Does Not Tell Us!

Dec 27, 2014 — by manara99
Tags: Improving Ivf Success Improving Fertility Potential

Infertility evaluations often fail to identify the precise cause of infertility.  While currently utilized standard infertility testing procedures may not find the precise explanation for the delay in conceiving, it is logical to assume that there is a defect in either the female or male leading to the delay in conception.  In this blog post we consider some of the shortcomings of the standard semen analysis. 

Intrauterine Insemination Explained

The objective of intrauterine insemination (IUI) is to introduce a quantity of sperm into the female partner’s uterus, and thereby facilitate fertilization.  For IUI, sperm are first washed and placed in a sterile medium.  The sperm are then concentrated in a small volume of medium and are injected into the uterus.

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Dr. Louis R. Manara


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