Where Motherhood Can Be Possible

Dr. Louis R. Manara

Fibroids and Infertility – New Information!

Mar 23, 2014 — by manara99
Tags: Fibroids And Infertility Ivf Success

It is generally agreed the while uterine fibroids are very common; they are usually not associated with infertility.  Size and location are the two main characteristics, which determine if fibroids may be implicated in infertility or increased risk of miscarriage.  These benign tumors have long been classified according to their location.  Fibroids located within the uterine cavity are referred as submucous fibroids.  If located within the uterine wall fibroids are classified as intramural, and when these tumors are positioned on the outer surface of the uterus, they are termed subserous.  

Should We Be Encouraging Preimplantation Genetic Screening (PGS)?

Mar 19, 2014 — by manara99
Tags: Ivf Success Improving Ivf Success Pgs

Selection of the best embryo for transfer is the goal of all IVF programs.  Preimplantation Genetic Screening, a technique that involves biopsy of an embryo and analysis of this cell(s) for specific disease or abnormality, holds the promise of identifying chromosomally normal embryos for transfer.  Although transferring only genetically normal embryos should theoretically lead to higher pregnancy rates, this has not been the case. In this article we will review PGS and provide some thoughts on the current clinical application of this technology.

DHEA – Improving Egg and Embryo Quality


An article in press at this time (“Role of dehydroepiandrosterone in improving oocyte and embryo quality in IVF cycles” by Zangmo, Singh, Kumar, Vanamail and Tiwari, in Reproductive BioMedicine Online) looked at the effects of dehydroepiandroterone (DHEA) in patients who had been shown to be poor responders in prior IVF treatment cycles.  This study looked at 50 patients before and after  four months of treatment with DHEA and noted an improvement in the number of oocytes retrieved, fertilization rates, and number of embryos in the DHEA treated group.

Frozen Embryo Transfer Success – Important New Information!

Many studies have shown that frozen embryo transfers result in a lower chance of pregnancy compared to fresh embryos.  However very few studies have looked at frozen embryo transfers in the context of the results of the preceding fresh embryo transfer (successful or not).  A recent study published in Reproductive BioMedicine Online  (Doherty, Martin, Kayisli, Sakkas, and Patrizio, Feb. 2014), looked at  outcomes of frozen embryo transfers in patients who had achieved pregnancy with the prior fresh embryo transfer and those who had not.

IVF – Sooner Rather Than Later?

In-vitro fertilization is the most effective treatment available to treat infertile couples.  Over the past three decades IVF technology has undergone numerous modifications and improvements.  It now represents the treatment of choice for infertility caused by severe tubal disease and severe male factor infertility.  The authors of a recently published article suggest that it is time to consider IVF the first treatment of choice for the majority of infertile couples, including those with unexplained infertility, women of advanced age (40 or older), and for patients with polycystic ovarian syndrome who fail to conceive with clomid therapy.

The Case For DHEA Supplementation In Patients With Diminished Ovarian Reserve!


Those of us who provide care to couples with diminished ovarian reserve related to advancing age are in a continuous search for treatments that improve pregnancy chances.  There is evidence that dehydroepiandrosterone (DHEA) improves egg and embryo quality and quantity, as well as prospects for successful pregnancy.  DHEA has also been demonstrated to decrease miscarriage rates. This review looks at DHEA supplementation and explores possible explanations for some of the observed benefits of DHEA supplementation.

Should We Be Monitoring Vitamin D Levels In Our Infertile Patients?

Feb 12, 2014 — by manara99
Tags: Improving Ivf Success Rates

A recent study suggests that IVF pregnancy rates are significantly higher when serum vitamin D levels are above 30 ng/ml compared with rates below 20 ng/ml.  The IVF pregnancy rate in patients with high vitamin D levels was 74% compared with 35% in patients with the lowest levels.

What is Ovarian Reserve and How Do We Evaluate It?

In the course of an infertility evaluation, we often come to the conclusion that there is an issue with egg quality and/or quantity, and describe the underlying problem as “diminished ovarian reserve”.   It is essential that multiple indicators of ovarian reserve be evaluated before arriving at this conclusion. Often, the choice of therapy is dictated by ovarian reserve status. Patient counseling regarding prospects for successful treatment should reflect the findings of ovarian reserve testing.  A discussion of ovarian reserve follows.

How Important Is The Age of an Egg Donor?

Jan 30, 2014 — by manara99
Tags: Ivf Success Improving Egg Donor Success

Choosing an egg donor is a difficult task for couples.  Many considerations such as race, ethnicity, height, weight, education, interests, and medical history enter into the decision making process.  However, choosing a donor to maximize success requires requires information and advice from the reproductive team.  Among factors influencing successful treatment, donor age is an important consideration.  A recently published abstract looks at the question of egg donor age and its influence on treatment success. The data from this study suggests that implantation is more likely to occur when the donor is 18-27 years of age compared with older donors.

Environmental and Physiologic Factors Influencing IVF Outcomes

Jan 21, 2014 — by manara99
Tags: Improving Ivf Success Improving Fertility Potential

Patients experiencing infertility often inquire about how they might improve their chances of successful pregnancy by modifying their diet, activity, or lifestyle.  This article is an attempt to provide some insight into these often asked questions.


Many factors affecting IVF success are completely out of the patient’s control such as age, genetics, egg quality, response to ovarian stimulation, and embryo implantation.  There are however some important factors that have a significant influence on the prospects for success that are under the couples control.  Stress, diet, weight, and lifestyle are all considered to be modifiable factors that may improve prospects for successful IVF.

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Dr. Louis R. Manara


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