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We truly have two #ttcsisters in our CORM family. Crystina B. and baby boy Brayden (left) and Mary B. and baby girl Wren (right) are both friends... and did their fertility treatment together both with Dr. Crochet (same delivering OB too). Their babies are about 4 weeks apart... Such a wonderful story for them to share with their sweet #miracles.
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Love. Hope. Strength. Inspiration.
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#MiracleBaby #IVF #DreamsDoComeTrue #NeverGiveUp #CenterOfReproductiveMedicine #onegoal #two lines #InfertilityTexas #IVF #DocsOfInstagram
We truly have two #ttcsisters  in our CORM family. Crystina B. and baby boy Brayden (left) and Mary B. and baby girl Wren (right) are both friends... and did their fertility treatment together both with Dr. Crochet (same delivering OB too). Their babies are about 4 weeks apart... Such a wonderful story for them to share with their sweet #miracles . . Love. Hope. Strength. Inspiration. . #MiracleBaby  #IVF  #DreamsDoComeTrue  #NeverGiveUp  #CenterOfReproductiveMedicine  #onegoal  #two  lines #InfertilityTexas  #IVF  #DocsOfInstagram 
Supplements ... what exactly are you taking?
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I have daily conversations with my patients and their partners about #dietarysupplements. They typically want me to verify that everything they are taking is “safe.”
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I’m completely honest with them - I have no clue if what they are taking is safe. Why? Because #supplements are considered “food” and therefore they are not monitored by the FDA for safety or effectiveness.
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This means what is in one supplement (even by the same company) may not be the same from one bottle to the next.
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A recent article published in JAMA Network proves this point. It found that unapproved pharmaceutical ingredients were identified in 776 supplements.
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The supplements that I discuss and worry about the most for my couples who are #ttc ➡️ preworkout muscle building supplements.
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This study found that 89% of this type of supplement had synthetic 💪steroids or steroid-like ingredients in them! WHAT? Can’t steroids cause #malefactorinfertility?!? YES!!!
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Take-home point: Supplements are not monitored by the FDA and for that reason they can have anything in them. If you are an #infertility patient make sure to discuss all your supplements and meds with your #fertilityspecialist. Even “harmless” pre-workout supplements may be adversely affecting your success rates.
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These posts are for educational purposes only.
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#infertilitysucks #infertilityawareness #infertilityjourney #fertilityawareness #fertility #ttccommunity #ttcsupport #fertilitydoctor #houstondoctors #docsofinsta #obgyn #medstudent #premed #somedoc #centerofreproductivemedicine #drperfetto
Supplements ... what exactly are you taking? . I have daily conversations with my patients and their partners about #dietarysupplements . They typically want me to verify that everything they are taking is “safe.” . I’m completely honest with them - I have no clue if what they are taking is safe. Why? Because #supplements  are considered “food” and therefore they are not monitored by the FDA for safety or effectiveness. . This means what is in one supplement (even by the same company) may not be the same from one bottle to the next. . A recent article published in JAMA Network proves this point. It found that unapproved pharmaceutical ingredients were identified in 776 supplements. . The supplements that I discuss and worry about the most for my couples who are #ttc  ➡️ preworkout muscle building supplements. . This study found that 89% of this type of supplement had synthetic 💪steroids or steroid-like ingredients in them! WHAT? Can’t steroids cause #malefactorinfertility ?!? YES!!! . Take-home point: Supplements are not monitored by the FDA and for that reason they can have anything in them. If you are an #infertility  patient make sure to discuss all your supplements and meds with your #fertilityspecialist . Even “harmless” pre-workout supplements may be adversely affecting your success rates. . . . These posts are for educational purposes only. . . . #infertilitysucks  #infertilityawareness  #infertilityjourney  #fertilityawareness  #fertility  #ttccommunity  #ttcsupport  #fertilitydoctor  #houstondoctors  #docsofinsta  #obgyn  #medstudent  #premed  #somedoc  #centerofreproductivemedicine  #drperfetto 
Go harder, climb smarter. 
@Regran_ed from @infertilitytexas -  #mondaymotivation... because who doesn’t wish that the weekend could last one more day?@!
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#longerweekendplease #ivf #infertility #ttcsisters #fertility #centerofreproductivemedicine #infertilitytexas #infertilitysucks #viewfromthetop#health #healthyliving #healthylifestyle #medicaldevices #vitamins #herbalsupplements #OnlineHealthHub #healthace - #regrann
Had so much fun at ASRM 2018! Great to see new research being presented by the next generation of REIs, great to hear from experts in our field and think about different perspectives, and great to reconnect with old friends! Until next time ☺️ #constantlearning #asrm2018 #ucla #infertilitytexas #centerofreproductivemedicine
We have the best patients EVER! 💕💙 Sometimes the two week waiting period after a transfer can be exhausting; it is like being on a rollercoaster of hope and fear. So we are sending lots of baby dust to Erika and Dennis.
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Thank you CORM!
Throughout our process, you all have been so kind, patient, and very helpful. We would like to thank each and every one of you at the #CenterOfReproductiveMedicine, Clear Lake. —Erika and Dennis
Sept. 27, 2018—Transfer Day
We have the best patients EVER! 💕💙 Sometimes the two week waiting period after a transfer can be exhausting; it is like being on a rollercoaster of hope and fear. So we are sending lots of baby dust to Erika and Dennis. . . . Thank you CORM! Throughout our process, you all have been so kind, patient, and very helpful. We would like to thank each and every one of you at the #CenterOfReproductiveMedicine , Clear Lake. —Erika and Dennis Sept. 27, 2018—Transfer Day
Last week, I outlined the differences between a biochemical pregnancy (BC) and a clinical #miscarriage (MC).
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We discussed that no matter the time of the loss, it is still painful and will leave the patient/couple devastated and raw. One of the more challenging issues for me as a #fertilityspecialist is discussing what to do after these recurrent losses- both CM and BC.
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The most important thing I can point out is that every #doctor, medical practice and society (ie. ASRM) has different outlooks on what to do after 2 or more losses.
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For #recurrentmiscarriage (specifically CM only)- ASRM has specific guidelines for uterine cavity evaluation, antiphospholipid antibody testing, hormone testing and parental karyotypes (I have discussed this in the past). They do not however, recommend this testing in those patients suffering from recurrent BC.
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Why is this? It really comes down to how common BC are, the high chance of recurrence BUT most importantly the even higher likelihood of a live birth without any testing or intervention.
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Meaning, based on chance alone:
1️⃣Chance of CM = about 15%
So, risk of 3 = (0.15^3) = <1% 
2️⃣ Chance of BC = about 60%
So, risk of 3 = (0.6^3) = 20%
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The above data does not negate the loss of a BC, nor should you feel like it does not count. It should be used to reassure those with a history of BC that the likelihood of a live birth is incredibly high.
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October is infant and pregnancy loss month. Although these babies are forever in our ❤️, the least we can do is use this month to honor them and discuss the losses we have suffered.
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These posts are for educational purposes only
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#infantandpregnancylossawareness #pregnancyloss #infertility #infertilitysucks #infertilityawareness #infertilitysupport #ttc #ttcaftermiscarriage #ttcafterloss #houstondoctors #infertilityblogger #obgyn #centerofreproductivemedicine #drperfetto
Last week, I outlined the differences between a biochemical pregnancy (BC) and a clinical #miscarriage  (MC). . We discussed that no matter the time of the loss, it is still painful and will leave the patient/couple devastated and raw. One of the more challenging issues for me as a #fertilityspecialist  is discussing what to do after these recurrent losses- both CM and BC. . The most important thing I can point out is that every #doctor , medical practice and society (ie. ASRM) has different outlooks on what to do after 2 or more losses. . For #recurrentmiscarriage  (specifically CM only)- ASRM has specific guidelines for uterine cavity evaluation, antiphospholipid antibody testing, hormone testing and parental karyotypes (I have discussed this in the past). They do not however, recommend this testing in those patients suffering from recurrent BC. . Why is this? It really comes down to how common BC are, the high chance of recurrence BUT most importantly the even higher likelihood of a live birth without any testing or intervention. . Meaning, based on chance alone: 1️⃣Chance of CM = about 15% So, risk of 3 = (0.15^3) = <1% 2️⃣ Chance of BC = about 60% So, risk of 3 = (0.6^3) = 20% . The above data does not negate the loss of a BC, nor should you feel like it does not count. It should be used to reassure those with a history of BC that the likelihood of a live birth is incredibly high. . October is infant and pregnancy loss month. Although these babies are forever in our ❤️, the least we can do is use this month to honor them and discuss the losses we have suffered. . . . These posts are for educational purposes only . . . #infantandpregnancylossawareness  #pregnancyloss  #infertility  #infertilitysucks  #infertilityawareness  #infertilitysupport  #ttc  #ttcaftermiscarriage  #ttcafterloss  #houstondoctors  #infertilityblogger  #obgyn  #centerofreproductivemedicine  #drperfetto 
I had such great intentions for a rockstar ⭐️ #feelgoodfriday post. But, sometimes things just do not work out as planned.
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Here I am, still in my office at 6pm- writing notes, reviewing labs and trying to catch up on patient tasks that I let build up all week long.
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To be down right honest, I had a poopy 💩 week. I had two patients with beautiful, euploid embryos and perfect transfers not get pregnant. I had two patients with beautiful pregnancies miscarry 😫. I had to cancel a transfer (in the OR) because I could not get into my patient’s uterus and I was not willing to decrease her chance of pregnancy to force the transfer.
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I know these are not #fertilityfeelgoodfriday moments, but they are a reality. Even when I want everything to go right, when I try my best and my patient does everything right, #infertilitysucks.
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Now for the feel good part ... My patients are amazing❤️. When I walked in slumped over about the negative pregnancy test, they told me “you are such an amazing #doctor. God bless you.” When I told my couple I cannot get into the uterus, you have blood on the catheter and if I push through on this transfer your pregnancy rates will decrease, they said “we trust you. You just tell us what you would do.”
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I appreciate my patients so much. I am honored to be their #fertilityspecialist and I feel so lucky to be involved in what may be one of the most difficult times of their lives.
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#infertility #infertilityawareness #infertilityjourney #infertilitysupport #infertilityblogger #houstondoctors #fertility #fertilityawareness #fertilityjourney #ivf #embryotransfer #ttc #ttccommunity #centerofreproductivemedicine #drperfetto
I had such great intentions for a rockstar ⭐️ #feelgoodfriday  post. But, sometimes things just do not work out as planned. . Here I am, still in my office at 6pm- writing notes, reviewing labs and trying to catch up on patient tasks that I let build up all week long. . To be down right honest, I had a poopy 💩 week. I had two patients with beautiful, euploid embryos and perfect transfers not get pregnant. I had two patients with beautiful pregnancies miscarry 😫. I had to cancel a transfer (in the OR) because I could not get into my patient’s uterus and I was not willing to decrease her chance of pregnancy to force the transfer. . I know these are not #fertilityfeelgoodfriday  moments, but they are a reality. Even when I want everything to go right, when I try my best and my patient does everything right, #infertilitysucks . . Now for the feel good part ... My patients are amazing❤️. When I walked in slumped over about the negative pregnancy test, they told me “you are such an amazing #doctor . God bless you.” When I told my couple I cannot get into the uterus, you have blood on the catheter and if I push through on this transfer your pregnancy rates will decrease, they said “we trust you. You just tell us what you would do.” . I appreciate my patients so much. I am honored to be their #fertilityspecialist  and I feel so lucky to be involved in what may be one of the most difficult times of their lives. . . . #infertility  #infertilityawareness  #infertilityjourney  #infertilitysupport  #infertilityblogger  #houstondoctors  #fertility  #fertilityawareness  #fertilityjourney  #ivf  #embryotransfer  #ttc  #ttccommunity  #centerofreproductivemedicine  #drperfetto 
Pregnancy loss at any stage can be devastating. To a patient or couple who finally sees a positive #hpt, it does not matter if the loss occurs later that day, a week from the positive or a month later.
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It is well known that #pregnancyloss is common- occurring in up to 50% of pregnancies (depending on your source and definition of loss). Today, I will specifically define the terms medical professionals use when discussing #earlypregnancy loss. .
Biochemical pregnancy- This type of pregnancy is diagnosed when a patient has a positive home pregnancy test or a low hCG level, but there is no ultrasound or pathology to confirm the pregnancy. Typically, these losses occur at <5.5weeks gestation, so about 1.5 weeks after a missed period.
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These losses are incredibly common, some report an occurrence of up to 60% in the general population. A lot of women may never know they were pregnant and may just think they are having a “late” cycle.
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Clinical miscarriage- This type of loss occurs slightly later in the pregnancy. It is considered a clinical loss because it has been identified on ultrasound or pathology. A clinical #miscarriage occurs in about 10-15% of pregnancies.
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The distinction between these pregnancies is more important for clinicians than patients. The patient is suffering a loss no matter what, but the #obgyn or #fertilityspecialist needs to identify the type of loss so that she can determine the appropriate investigation.
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I will talk more about that soon.
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These posts are for educational purposes only.
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#ttcaftermiscarriage #ttcafterloss #ttc #ttccommunity #ttcjourney #infertility #infertilitysucks #infertilityawareness #infertilityjourney #fertility #fertilityjourney #fertilityawareness #houstondoctors #infertilityblogger #centerofreproductivemedicine #drperfetto
Pregnancy loss at any stage can be devastating. To a patient or couple who finally sees a positive #hpt , it does not matter if the loss occurs later that day, a week from the positive or a month later. . It is well known that #pregnancyloss  is common- occurring in up to 50% of pregnancies (depending on your source and definition of loss). Today, I will specifically define the terms medical professionals use when discussing #earlypregnancy  loss. . Biochemical pregnancy- This type of pregnancy is diagnosed when a patient has a positive home pregnancy test or a low hCG level, but there is no ultrasound or pathology to confirm the pregnancy. Typically, these losses occur at <5.5weeks gestation, so about 1.5 weeks after a missed period. . These losses are incredibly common, some report an occurrence of up to 60% in the general population. A lot of women may never know they were pregnant and may just think they are having a “late” cycle. . Clinical miscarriage- This type of loss occurs slightly later in the pregnancy. It is considered a clinical loss because it has been identified on ultrasound or pathology. A clinical #miscarriage  occurs in about 10-15% of pregnancies. . The distinction between these pregnancies is more important for clinicians than patients. The patient is suffering a loss no matter what, but the #obgyn  or #fertilityspecialist  needs to identify the type of loss so that she can determine the appropriate investigation. . I will talk more about that soon. . . . These posts are for educational purposes only. . . . #ttcaftermiscarriage  #ttcafterloss  #ttc  #ttccommunity  #ttcjourney  #infertility  #infertilitysucks  #infertilityawareness  #infertilityjourney  #fertility  #fertilityjourney  #fertilityawareness  #houstondoctors  #infertilityblogger  #centerofreproductivemedicine  #drperfetto 
Let’s be honest - an #eggretrieval video is worth a thousand words.
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Today, after taking 10 days of #ivf stimulation medications, our patient underwent her #eggretrieval. She graciously allowed my staff to record and share today. Even our patients are rockstars ⭐️when it comes to #fertility education!
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This video clip shows her ovary with multiple stimulated follicles (black circles) present. As you watch the video you can see a thin needle inserted into one of the follicles. These follicles are filled with fluid and an egg 🥚. As we gently aspirate the fluid, the egg comes out with it.
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The fluid (with the egg) is then examined by my #embryologist (you can hear him call out “4” in the background) and as we go through the procedure he tells me how many eggs we have retrieved.
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Once we have completely aspirated all of the follicles, the procedure is considered complete. The anesthesiologist wakes up our patient and she typically recovers within a day.
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The eggs are then in the hands🖐 off to our amazing  embryologists. They inseminate the eggs with the partner (or donor) sperm. They follow the #embryos daily and update the patient on how they are progressing. Thank goodness for  our awesome #embryology team!
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These posts are for educational purposes only.
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#Repost @infertilitydrperfetto
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#ivfcycle #ivfjourney #ivfsuccess #ivfsupport #ivfcommunity #infertility #infertilityawareness #infertilitysupport #infertilityjourney #infertilitywarrior #infertilityblogger #houstondoctors #fertilityspecialist #fertilityjourney #centerofreproductivemedicine #drperfetto
Let’s be honest - an #eggretrieval  video is worth a thousand words. . Today, after taking 10 days of #ivf  stimulation medications, our patient underwent her #eggretrieval . She graciously allowed my staff to record and share today. Even our patients are rockstars ⭐️when it comes to #fertility  education! . This video clip shows her ovary with multiple stimulated follicles (black circles) present. As you watch the video you can see a thin needle inserted into one of the follicles. These follicles are filled with fluid and an egg 🥚. As we gently aspirate the fluid, the egg comes out with it. . The fluid (with the egg) is then examined by my #embryologist  (you can hear him call out “4” in the background) and as we go through the procedure he tells me how many eggs we have retrieved. . Once we have completely aspirated all of the follicles, the procedure is considered complete. The anesthesiologist wakes up our patient and she typically recovers within a day. . The eggs are then in the hands🖐 off to our amazing embryologists. They inseminate the eggs with the partner (or donor) sperm. They follow the #embryos  daily and update the patient on how they are progressing. Thank goodness for our awesome #embryology  team! . . . These posts are for educational purposes only. . #Repost  @infertilitydrperfetto . #ivfcycle  #ivfjourney  #ivfsuccess  #ivfsupport  #ivfcommunity  #infertility  #infertilityawareness  #infertilitysupport  #infertilityjourney  #infertilitywarrior  #infertilityblogger  #houstondoctors  #fertilityspecialist  #fertilityjourney  #centerofreproductivemedicine  #drperfetto 
Let’s be honest - an #eggretrieval video is worth a thousand words.
.
Today, after taking 10 days of #ivf stimulation medications, our patient underwent her #eggretrieval. She graciously allowed my staff to record and share today. Even our patients are rockstars ⭐️when it comes to #fertility education!
.
This video clip shows her ovary with multiple stimulated follicles (black circles) present. As you watch the video you can see a thin needle inserted into one of the follicles. These follicles are filled with fluid and an egg 🥚. As we gently aspirate the fluid, the egg comes out with it.
.
The fluid (with the egg) is then examined by my #embryologist (you can hear him call out “4” in the background) and as we go through the procedure he tells me how many eggs we have retrieved.
.
Once we have completely aspirated all of the follicles, the procedure is considered complete. The anesthesiologist wakes up our patient and she typically recovers within a day.
.
The eggs are then in the hands🖐 off to our amazing  embryologists. They inseminate the eggs with the partner (or donor) sperm. They follow the #embryos daily and update the patient on how they are progressing. Thank goodness for  our awesome #embryology team!
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These posts are for educational purposes only.
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.
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#ivfcycle #ivfjourney #ivfsuccess #ivfsupport #ivfcommunity #infertility #infertilityawareness #infertilitysupport #infertilityjourney #infertilitywarrior #infertilityblogger #houstondoctors #fertilityspecialist #fertilityjourney #centerofreproductivemedicine #drperfetto
Let’s be honest - an #eggretrieval  video is worth a thousand words. . Today, after taking 10 days of #ivf  stimulation medications, our patient underwent her #eggretrieval . She graciously allowed my staff to record and share today. Even our patients are rockstars ⭐️when it comes to #fertility  education! . This video clip shows her ovary with multiple stimulated follicles (black circles) present. As you watch the video you can see a thin needle inserted into one of the follicles. These follicles are filled with fluid and an egg 🥚. As we gently aspirate the fluid, the egg comes out with it. . The fluid (with the egg) is then examined by my #embryologist  (you can hear him call out “4” in the background) and as we go through the procedure he tells me how many eggs we have retrieved. . Once we have completely aspirated all of the follicles, the procedure is considered complete. The anesthesiologist wakes up our patient and she typically recovers within a day. . The eggs are then in the hands🖐 off to our amazing embryologists. They inseminate the eggs with the partner (or donor) sperm. They follow the #embryos  daily and update the patient on how they are progressing. Thank goodness for our awesome #embryology  team! . . . These posts are for educational purposes only. . . . #ivfcycle  #ivfjourney  #ivfsuccess  #ivfsupport  #ivfcommunity  #infertility  #infertilityawareness  #infertilitysupport  #infertilityjourney  #infertilitywarrior  #infertilityblogger  #houstondoctors  #fertilityspecialist  #fertilityjourney  #centerofreproductivemedicine  #drperfetto 
#Repost @infertilitydrperfetto (@get_repost)
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How do I decide the best treatment for a patient?
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This is a question I get all of the time and it is actually very easy for me to answer.
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I do not have a set protocol for anyone. I look at the whole couple/patient, the entire evaluation, the long term family planning goals and then we make a decision together.
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The most important factors?
1. Are the tubes open? We test this with the #hsg. If blocked then we must move to #ivf.
2. Is there adequate sperm for spontaneous conception? An #iuicycle? Or is it too low and we need to move to an #ivfcycle?
3. Is the female patient ovulating on her own? If not, then I can offer the most conservative option- oral medications to help with ovulation. If she is already ovulating on her own, then she can still be offered all treatment options, but her success rates are likely much lower.
4. What are the long term family planning goals? If the female is older (>37) and they/she wants more than 1-2 children then they/she may need to consider more aggressive treatment sooner.
5. There are numerous other things that I consider when helping guide a couple or single female to creating a family.
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As you can see there is no one size fits all. I view my job as one that helps educate and guide, not tell patients what they have to do.
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These posts are for educational purposes only.
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#infertility #infertilitysucks #infertilityhurts #fertility #fertilityjourney #fertilitytreatment #ttc #ttcsisters #ttcsupport #infertilityblogger #infertilityawareness #obgyn #houstondoctors #onegoaltwolines #centerofreproductivemedicine #drperfetto
#Repost  @infertilitydrperfetto (@get_repost) ・・・ How do I decide the best treatment for a patient? . This is a question I get all of the time and it is actually very easy for me to answer. . I do not have a set protocol for anyone. I look at the whole couple/patient, the entire evaluation, the long term family planning goals and then we make a decision together. . The most important factors? 1. Are the tubes open? We test this with the #hsg . If blocked then we must move to #ivf . 2. Is there adequate sperm for spontaneous conception? An #iuicycle ? Or is it too low and we need to move to an #ivfcycle ? 3. Is the female patient ovulating on her own? If not, then I can offer the most conservative option- oral medications to help with ovulation. If she is already ovulating on her own, then she can still be offered all treatment options, but her success rates are likely much lower. 4. What are the long term family planning goals? If the female is older (>37) and they/she wants more than 1-2 children then they/she may need to consider more aggressive treatment sooner. 5. There are numerous other things that I consider when helping guide a couple or single female to creating a family. . As you can see there is no one size fits all. I view my job as one that helps educate and guide, not tell patients what they have to do. . . . These posts are for educational purposes only. . . . #infertility  #infertilitysucks  #infertilityhurts  #fertility  #fertilityjourney  #fertilitytreatment  #ttc  #ttcsisters  #ttcsupport  #infertilityblogger  #infertilityawareness  #obgyn  #houstondoctors  #onegoaltwolines  #centerofreproductivemedicine  #drperfetto 
Great info if you are pregnant or planning on becoming pregnant. 🤰 🤱🏻 If you are a weight loss surgery patient that is pregnant or planning on becoming pregnant and need nutrition advice please make an appointment with Lin Lin (713) 493-7700 (Tlcsurgery dietitian.) #Repost @infertilitydrperfetto with @get_repost
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We have addressed the importance of being at a healthy weight while #ttc. Just as important is that once you are pregnant 🤰🏼, you need to gain the appropriate amount of weight to support and nourish your pregnancy.
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The CDC has published a easy to follow chart indicating the appropriate weight gain based on your pre-pregnancy BMI:
Underweight (BMI<18.5) ➡️ 28-40lbs
Normal weight (18.5-24.9) ➡️ 25-35lbs
Overweight (25-29.9) ➡️ 15-25lbs
Obese (>30) ➡️ 11-20lbs
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The weight gain is more for twins 👯. Swipe ⬅️to see the CDC charts for weight gain in Singleton and twin pregnancies.
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Weight gain is important because too little may lead to lower birth weight babies and poor feeding. Too much weight gain will increase the risk of cesarean section, gestational diabetes, gestational hypertension and large birth weight babies 👶🏻 (just to name a few).
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These posts are for educational purposes only.
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#ttcsisters #ttccommunity #ttcjourney #ttcsupport #ttcdiet #ttcwithpcos #pregnancy #pregnancyworkout #pregnancydiet #pregnancyfitness #pregnancyexercise #pregnancynutrition #pregnancyweight #infertility #fertility #fertilitydiet #fertilityawareness #infertilityblogger #houstondoctors #centerofreproductivemedicine #drperfetto #tlcsurgery #pregnacynutrition #healthypregnancy #pregnancyhealth #themoreyouknow
Great info if you are pregnant or planning on becoming pregnant. 🤰 🤱🏻 If you are a weight loss surgery patient that is pregnant or planning on becoming pregnant and need nutrition advice please make an appointment with Lin Lin (713) 493-7700 (Tlcsurgery dietitian.) #Repost  @infertilitydrperfetto with @get_repost ・・・ We have addressed the importance of being at a healthy weight while #ttc . Just as important is that once you are pregnant 🤰🏼, you need to gain the appropriate amount of weight to support and nourish your pregnancy. . The CDC has published a easy to follow chart indicating the appropriate weight gain based on your pre-pregnancy BMI: Underweight (BMI<18.5) ➡️ 28-40lbs Normal weight (18.5-24.9) ➡️ 25-35lbs Overweight (25-29.9) ➡️ 15-25lbs Obese (>30) ➡️ 11-20lbs . The weight gain is more for twins 👯. Swipe ⬅️to see the CDC charts for weight gain in Singleton and twin pregnancies. . Weight gain is important because too little may lead to lower birth weight babies and poor feeding. Too much weight gain will increase the risk of cesarean section, gestational diabetes, gestational hypertension and large birth weight babies 👶🏻 (just to name a few). . . . These posts are for educational purposes only. . . . #ttcsisters  #ttccommunity  #ttcjourney  #ttcsupport  #ttcdiet  #ttcwithpcos  #pregnancy  #pregnancyworkout  #pregnancydiet  #pregnancyfitness  #pregnancyexercise  #pregnancynutrition  #pregnancyweight  #infertility  #fertility  #fertilitydiet  #fertilityawareness  #infertilityblogger  #houstondoctors  #centerofreproductivemedicine  #drperfetto  #tlcsurgery  #pregnacynutrition  #healthypregnancy  #pregnancyhealth  #themoreyouknow 
We have addressed the importance of being at a healthy weight while #ttc. Just as important is that once you are pregnant 🤰🏼, you need to gain the appropriate amount of weight to support and nourish your pregnancy.
.
The CDC has published a easy to follow chart indicating the appropriate weight gain based on your pre-pregnancy BMI:
Underweight (BMI<18.5) ➡️ 28-40lbs
Normal weight (18.5-24.9) ➡️ 25-35lbs
Overweight (25-29.9) ➡️ 15-25lbs
Obese (>30) ➡️ 11-20lbs
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The weight gain is more for twins 👯. Swipe ⬅️to see the CDC charts for weight gain in Singleton and twin pregnancies.
.
Weight gain is important because too little may lead to lower birth weight babies and poor feeding. Too much weight gain will increase the risk of cesarean section, gestational diabetes, gestational hypertension and large birth weight babies 👶🏻 (just to name a few).
.
.
.
These posts are for educational purposes only.
.
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#ttcsisters #ttccommunity #ttcjourney #ttcsupport #ttcdiet #ttcwithpcos #pregnancy #pregnancyworkout #pregnancydiet #pregnancyfitness #pregnancyexercise #pregnancynutrition #pregnancyweight #infertility #fertility #fertilitydiet #fertilityawareness #infertilityblogger #houstondoctors #centerofreproductivemedicine #drperfetto
We have addressed the importance of being at a healthy weight while #ttc . Just as important is that once you are pregnant 🤰🏼, you need to gain the appropriate amount of weight to support and nourish your pregnancy. . The CDC has published a easy to follow chart indicating the appropriate weight gain based on your pre-pregnancy BMI: Underweight (BMI<18.5) ➡️ 28-40lbs Normal weight (18.5-24.9) ➡️ 25-35lbs Overweight (25-29.9) ➡️ 15-25lbs Obese (>30) ➡️ 11-20lbs . The weight gain is more for twins 👯. Swipe ⬅️to see the CDC charts for weight gain in Singleton and twin pregnancies. . Weight gain is important because too little may lead to lower birth weight babies and poor feeding. Too much weight gain will increase the risk of cesarean section, gestational diabetes, gestational hypertension and large birth weight babies 👶🏻 (just to name a few). . . . These posts are for educational purposes only. . . . #ttcsisters  #ttccommunity  #ttcjourney  #ttcsupport  #ttcdiet  #ttcwithpcos  #pregnancy  #pregnancyworkout  #pregnancydiet  #pregnancyfitness  #pregnancyexercise  #pregnancynutrition  #pregnancyweight  #infertility  #fertility  #fertilitydiet  #fertilityawareness  #infertilityblogger  #houstondoctors  #centerofreproductivemedicine  #drperfetto 
#Repost @infertilitydrperfetto with @get_repost
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Today I am all about positivity. I was so impressed by the responses I got about the #twnts movement yesterday I want to keep the positive momentum going.
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Today, and who knows - maybe every Friday going forward, I want our rockstar #infertility and #ttccommunity to take a moment to think about and share some positives.
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Maybe we can call it - #fertilityfeelgoodfriday 😁
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I’ll start:
1. My patient (who I fought with her insurance to get her #ivf covered after only 3 #iui cycles- which was a win on its own!) is pregnant with her ONLY embryo. 🎉 .
2. I saw 2 #recurrentmiscarriage patients today and when they left they both looked hopeful. Still heartbroken 💔, but hopeful about their future. The fact that I can offer even the smallest bit of hope is why I love this job.
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Alright, I would love some of you to join me... big or small - let’s celebrate the good stuff today.
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#infertilityawareness #infertilitysupport  #infertilityblogger #fertilityjourney #fertilityspecialist #fertilitysupport #fertilityawareness #ttcsisters #ttcafterloss #positivethinking #thinkpositive #onegoaltwolines #centerofreproductivemedicine #drperfetto
#Repost  @infertilitydrperfetto with @get_repost ・・・ Today I am all about positivity. I was so impressed by the responses I got about the #twnts  movement yesterday I want to keep the positive momentum going. . Today, and who knows - maybe every Friday going forward, I want our rockstar #infertility  and #ttccommunity  to take a moment to think about and share some positives. . Maybe we can call it - #fertilityfeelgoodfriday  😁 . I’ll start: 1. My patient (who I fought with her insurance to get her #ivf  covered after only 3 #iui  cycles- which was a win on its own!) is pregnant with her ONLY embryo. 🎉 . 2. I saw 2 #recurrentmiscarriage  patients today and when they left they both looked hopeful. Still heartbroken 💔, but hopeful about their future. The fact that I can offer even the smallest bit of hope is why I love this job. . Alright, I would love some of you to join me... big or small - let’s celebrate the good stuff today. . . . #infertilityawareness  #infertilitysupport  #infertilityblogger  #fertilityjourney  #fertilityspecialist  #fertilitysupport  #fertilityawareness  #ttcsisters  #ttcafterloss  #positivethinking  #thinkpositive  #onegoaltwolines  #centerofreproductivemedicine  #drperfetto 
Today I am all about positivity. I was so impressed by the responses I got about the #twnts movement yesterday I want to keep the positive momentum going.
.
Today, and who knows - maybe every Friday going forward, I want our rockstar #infertility and #ttccommunity to take a moment to think about and share some positives.
.
Maybe we can call it - #fertilityfeelgoodfriday 😁
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I’ll start:
1. My patient (who I fought with her insurance to get her #ivf covered after only 3 #iui cycles- which was a win on its own!) is pregnant with her ONLY embryo. 🎉 .
2. I saw 2 #recurrentmiscarriage patients today and when they left they both looked hopeful. Still heartbroken 💔, but hopeful about their future. The fact that I can offer even the smallest bit of hope is why I love this job.
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Alright, I would love some of you to join me... big or small - let’s celebrate the good stuff today.
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#infertilityawareness #infertilitysupport  #infertilityblogger #fertilityjourney #fertilityspecialist #fertilitysupport #fertilityawareness #ttcsisters #ttcafterloss #positivethinking #thinkpositive #onegoaltwolines #centerofreproductivemedicine #drperfetto
Today I am all about positivity. I was so impressed by the responses I got about the #twnts  movement yesterday I want to keep the positive momentum going. . Today, and who knows - maybe every Friday going forward, I want our rockstar #infertility  and #ttccommunity  to take a moment to think about and share some positives. . Maybe we can call it - #fertilityfeelgoodfriday  😁 . I’ll start: 1. My patient (who I fought with her insurance to get her #ivf  covered after only 3 #iui  cycles- which was a win on its own!) is pregnant with her ONLY embryo. 🎉 . 2. I saw 2 #recurrentmiscarriage  patients today and when they left they both looked hopeful. Still heartbroken 💔, but hopeful about their future. The fact that I can offer even the smallest bit of hope is why I love this job. . Alright, I would love some of you to join me... big or small - let’s celebrate the good stuff today. . . . #infertilityawareness  #infertilitysupport  #infertilityblogger  #fertilityjourney  #fertilityspecialist  #fertilitysupport  #fertilityawareness  #ttcsisters  #ttcafterloss  #positivethinking  #thinkpositive  #onegoaltwolines  #centerofreproductivemedicine  #drperfetto 
Think before you speak. It is a phrase we hear from the time we are little. I like to think we are all pretty good about it most of the time, but for some reason when it comes to #infertility and #miscarriage people frequently bypass the “think before” part.
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I am guilty of this myself. As a #medstudent rotating through my #obgyn rotation, then as a resident on the floor and in the emergency room I always felt like I stumbled when it came to discussing #pregnancyloss.
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I do feel like my approach has improved immensely with experience, feedback and my own personal struggles. That being said, I still leave an ultrasound or consultation questioning if I said the right things.
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So, what do I say now?
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1. ALWAYS the first and most important thing - This is not your fault. You did not cause this, you cannot cause a loss.
2. I am sorry you are going through this, I wish you were not.
3. I am here if you need me- you can come for another visit, call or email - whatever you need.
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Of course, as the #doctor and #fertilityspecialist I still have to discuss next steps, which can sometimes be overwhelming for my patient. Sometimes, we talk that day, other times we talk when she feels up to it (I offer a return visit in a week).
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I am so appreciative of @thisisalicerose for reaching out to me to join the “Think what not to say” campaign. It is so important for us medical professionals, family members and friends to get the opportunity to discuss and learn from each other to help others during their time of need.
#twnts
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#infertilitysucks #infertilityawareness #ttc #ttcafterloss #ttccommunity #ttcsisters #fertility #fertilityjourney #fertilityawareness #premed #medicalstudent #medschool #centerofreproductivemedicine #drperfetto
Think before you speak. It is a phrase we hear from the time we are little. I like to think we are all pretty good about it most of the time, but for some reason when it comes to #infertility  and #miscarriage  people frequently bypass the “think before” part. . I am guilty of this myself. As a #medstudent  rotating through my #obgyn  rotation, then as a resident on the floor and in the emergency room I always felt like I stumbled when it came to discussing #pregnancyloss . . I do feel like my approach has improved immensely with experience, feedback and my own personal struggles. That being said, I still leave an ultrasound or consultation questioning if I said the right things. . So, what do I say now? . 1. ALWAYS the first and most important thing - This is not your fault. You did not cause this, you cannot cause a loss. 2. I am sorry you are going through this, I wish you were not. 3. I am here if you need me- you can come for another visit, call or email - whatever you need. . Of course, as the #doctor  and #fertilityspecialist  I still have to discuss next steps, which can sometimes be overwhelming for my patient. Sometimes, we talk that day, other times we talk when she feels up to it (I offer a return visit in a week). . I am so appreciative of @thisisalicerose for reaching out to me to join the “Think what not to say” campaign. It is so important for us medical professionals, family members and friends to get the opportunity to discuss and learn from each other to help others during their time of need. #twnts  . . . #infertilitysucks  #infertilityawareness  #ttc  #ttcafterloss  #ttccommunity  #ttcsisters  #fertility  #fertilityjourney  #fertilityawareness  #premed  #medicalstudent  #medschool  #centerofreproductivemedicine  #drperfetto 
The use of Metformin in Polycystic Ovarian Syndrome is a topic I have received a lot of questions about.
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💊What is #metformin?
It is an Insulin sensitizing medication - it lowers the glucose level by reducing absorption in the stomach/intestines, blocks liver production of glucose and increases glucose uptake in the cells.
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⏰When should it be used?
I recommend it in those patients with diabetes or pre-diabetes. I also offer it to any PCOS patient who requests it, especially those with laboratory proven insulin resistance (IR). There are A LOT of ways to test for IR, so the studies on Metformin in PCOS are very mixed - that’s why I feel comfortable prescribing it this way.
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⭐️How does it help women with #polycysticovariansyndrome?
1️⃣ Increases ovulation rate compared to placebo
2️⃣ Increases ovulation and pregnancy rate when paired with Clomid
3️⃣ Increases live birth rate when given for 3 months before starting an oral agent (Letrozole or Clomid)
4️⃣ Increases ovulation and pregnancy rates if added to Clomid in Clomid resistant patients
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Is there a benefit after you get pregnant?
5️⃣ There is insufficient data to show Metformin will reduce the risk of #miscarriage
6️⃣ In those women with diabetes, pre-diabetes or insulin resistance I do continue it until the patient sees her OB. This is to help with glucose control given the elevated risk of gestational diabetes in patients with PCOS.
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These posts are for educational purposes only.
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#infertility #infertilitysucks #infertilityblogger #infertilityawareness #fertility #fertilityjourney #fertilitysupport #fertilitytreatment #ttc #ttccommunity #ttcwithpcos #ttcwithinfertility #iui #ivf #onegoaltwolines #houstondoctors #obgyn #centerofreproductivemedicine #drperfetto
The use of Metformin in Polycystic Ovarian Syndrome is a topic I have received a lot of questions about. . 💊What is #metformin ? It is an Insulin sensitizing medication - it lowers the glucose level by reducing absorption in the stomach/intestines, blocks liver production of glucose and increases glucose uptake in the cells. . ⏰When should it be used? I recommend it in those patients with diabetes or pre-diabetes. I also offer it to any PCOS patient who requests it, especially those with laboratory proven insulin resistance (IR). There are A LOT of ways to test for IR, so the studies on Metformin in PCOS are very mixed - that’s why I feel comfortable prescribing it this way. . ⭐️How does it help women with #polycysticovariansyndrome ? 1️⃣ Increases ovulation rate compared to placebo 2️⃣ Increases ovulation and pregnancy rate when paired with Clomid 3️⃣ Increases live birth rate when given for 3 months before starting an oral agent (Letrozole or Clomid) 4️⃣ Increases ovulation and pregnancy rates if added to Clomid in Clomid resistant patients . Is there a benefit after you get pregnant? 5️⃣ There is insufficient data to show Metformin will reduce the risk of #miscarriage  6️⃣ In those women with diabetes, pre-diabetes or insulin resistance I do continue it until the patient sees her OB. This is to help with glucose control given the elevated risk of gestational diabetes in patients with PCOS. . . . These posts are for educational purposes only. . . . #infertility  #infertilitysucks  #infertilityblogger  #infertilityawareness  #fertility  #fertilityjourney  #fertilitysupport  #fertilitytreatment  #ttc  #ttccommunity  #ttcwithpcos  #ttcwithinfertility  #iui  #ivf  #onegoaltwolines  #houstondoctors  #obgyn  #centerofreproductivemedicine  #drperfetto 
I am so excited and honored to be featured by @westuniversitymoms today on their Meet a Mom Monday.
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One of the toughest things about medicine is that we are constantly uprooting ourselves and our families during #medicalschool, #residency, #fellowship and then when we finally settle down for our first “real” job as an #attending.
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My family and I feel so blessed that we landed in #houstontx and that my career at the #centerofreproductivemedicine has been so positive.
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Thank you #htx for making us feel so welcome. We are so happy to call this home!
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#Repost @westuniversitymoms with @get_repost
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Meet a Mom Monday! Meet Dr. Candice Perfetto, Fertility Specialist at Center of Reproductive Medicine @infertilitydrperfetto -read her inspirational interview in bio 🌟✨✨ -
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#houstonmom #houstondoctors #infertilitysupport
I am so excited and honored to be featured by @westuniversitymoms today on their Meet a Mom Monday. . One of the toughest things about medicine is that we are constantly uprooting ourselves and our families during #medicalschool , #residency , #fellowship  and then when we finally settle down for our first “real” job as an #attending . . My family and I feel so blessed that we landed in #houstontx  and that my career at the #centerofreproductivemedicine  has been so positive. . Thank you #htx  for making us feel so welcome. We are so happy to call this home! . . . #Repost  @westuniversitymoms with @get_repost ・・・ Meet a Mom Monday! Meet Dr. Candice Perfetto, Fertility Specialist at Center of Reproductive Medicine @infertilitydrperfetto -read her inspirational interview in bio 🌟✨✨ - - #houstonmom  #houstondoctors  #infertilitysupport 
Can patients with Polycystic Ovarian Syndrome conceive naturally?
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After my last couple of posts on #Letrozole and then Letrozole + Dexamethasone + Metformin I got a few questions asking if a person with #pcos can get pregnant spontaneously? Well, this is a loaded question... Sometimes yes, but frequently no.
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Truth: Any patient who ovulates (even if she ovulates on an irregular basis) can get pregnant. The challenge is that if you have no idea when you ovulate and do not have regular intercourse, the chance of pregnancy is lower.
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*** IMPORTANT: PCOS is NOT birth control! If you do not want to get pregnant use contraception ***
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Truth: If you want to increase your chance of pregnancy, an oral ovulation inducing medication like Letrozole will help (most of the time). If one does not ovulate the chance of pregnancy is virtually 0, if the ovulation medication stimulates follicle growth, we perform an ultrasound to confirm impending ovulation and then you time intercourse based on your monitoring your chance of pregnancy 🤰🏼 can increase up to 15-20%.
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PCOS can be so frustrating when you are first diagnosed. It can be overwhelming to hear about your long term health implications and the challenges you will likely face in #ttc. As a positive, once you get through the initial diagnosis and work up, #fertilitytreatment has a high chance of working.
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These posts are for educational purposes only.
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#polycysticovariansyndrome #pcosawareness #pcossupport #pcosawarenessmonth #infertility #infertilitysucks #infertilitytreatment #fertility #fertilityawareness #fertilitysupport #ttcwithpcos #ttccommunity #ttcsupport #obgyn #onegoaltwolines #centerofreproductivemedicine #drperfetto
Can patients with Polycystic Ovarian Syndrome conceive naturally? . After my last couple of posts on #Letrozole  and then Letrozole + Dexamethasone + Metformin I got a few questions asking if a person with #pcos  can get pregnant spontaneously? Well, this is a loaded question... Sometimes yes, but frequently no. . Truth: Any patient who ovulates (even if she ovulates on an irregular basis) can get pregnant. The challenge is that if you have no idea when you ovulate and do not have regular intercourse, the chance of pregnancy is lower. . *** IMPORTANT: PCOS is NOT birth control! If you do not want to get pregnant use contraception *** . Truth: If you want to increase your chance of pregnancy, an oral ovulation inducing medication like Letrozole will help (most of the time). If one does not ovulate the chance of pregnancy is virtually 0, if the ovulation medication stimulates follicle growth, we perform an ultrasound to confirm impending ovulation and then you time intercourse based on your monitoring your chance of pregnancy 🤰🏼 can increase up to 15-20%. . . . PCOS can be so frustrating when you are first diagnosed. It can be overwhelming to hear about your long term health implications and the challenges you will likely face in #ttc . As a positive, once you get through the initial diagnosis and work up, #fertilitytreatment  has a high chance of working. . . . These posts are for educational purposes only. . . . #polycysticovariansyndrome  #pcosawareness  #pcossupport  #pcosawarenessmonth  #infertility  #infertilitysucks  #infertilitytreatment  #fertility  #fertilityawareness  #fertilitysupport  #ttcwithpcos  #ttccommunity  #ttcsupport  #obgyn  #onegoaltwolines  #centerofreproductivemedicine  #drperfetto 
Look at these two... Grace and Isabelle! Thank you Lindsay for sending us these beautiful pictures of your miracle babies born December 2007. 
Love. Hope. Strength. Inspiration.
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#MiracleBaby #IVF #TTCSisters #DreamsDoComeTrue #NeverGiveUp #TTC #CenterOfReproductiveMedicine #InfertilityTexas
The life of a celebrity 📷 has got to be a mess of extreme highs and devastating lows. They experience the same challenges we all face, but theirs are blasted all over the internet and tv for everyone to critique.
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Today, I want to spend a few minutes appreciating the celebrities who have come out to discuss and raise awareness about - #infertility, #miscarriage, #gestationalcarrier and #eggfreezing.
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I’m going to start with my favorite celebrity #infertilitywarrior - @chrissyteigen. She has put #ivf and “things not to say to women” front and center. I applaud 👏her for starting and continuing the conversation. Plus her kids are freaking adorable!!
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This weekend, @vanderjames posted about miscarriage. If you have suffered the loss of a child, this is exactly what you want to hear from you partner, friends, doctor, etc. His post said it all - the loss is not your fault AND the pain you experience from it is insurmountable. Thank you for this, so frequently men do not discuss these feelings and it is so important that we recognize that the devastation of loss affects both partners.
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It would be amiss for me not to mention @kimkardashian in this list. She has been incredibly open about her struggles during pregnancy and her decision to use a #surrogate with her third child. Third party reproduction (GC and #eggdonor) is probably the most difficult reproductive decision a couple will have to make. In my opinion, it is a discussion I wish more celebrities would open up about.
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There are numerous other celebrities that have also discussed the decision to freeze their eggs (@oliviamunn and @kaitlynbristowe)- which I am excited to post more about soon!
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This is just a few of the celebrities who have openly shared about their #fertility struggles. There are actually dozens of others out there that have openly discussed this and I am so appreciative that they are opening up their challenges to the #infertilitycommunity.
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Do you have favorite celebrities that you follow?
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Just a quick note📝. I do not and have not treated any of these people. I am just admiring them today.
The life of a celebrity 📷 has got to be a mess of extreme highs and devastating lows. They experience the same challenges we all face, but theirs are blasted all over the internet and tv for everyone to critique. . Today, I want to spend a few minutes appreciating the celebrities who have come out to discuss and raise awareness about - #infertility , #miscarriage , #gestationalcarrier  and #eggfreezing . . I’m going to start with my favorite celebrity #infertilitywarrior  - @chrissyteigen. She has put #ivf  and “things not to say to women” front and center. I applaud 👏her for starting and continuing the conversation. Plus her kids are freaking adorable!! . This weekend, @vanderjames posted about miscarriage. If you have suffered the loss of a child, this is exactly what you want to hear from you partner, friends, doctor, etc. His post said it all - the loss is not your fault AND the pain you experience from it is insurmountable. Thank you for this, so frequently men do not discuss these feelings and it is so important that we recognize that the devastation of loss affects both partners. . It would be amiss for me not to mention @kimkardashian in this list. She has been incredibly open about her struggles during pregnancy and her decision to use a #surrogate  with her third child. Third party reproduction (GC and #eggdonor ) is probably the most difficult reproductive decision a couple will have to make. In my opinion, it is a discussion I wish more celebrities would open up about. . There are numerous other celebrities that have also discussed the decision to freeze their eggs (@oliviamunn and @kaitlynbristowe)- which I am excited to post more about soon! . This is just a few of the celebrities who have openly shared about their #fertility  struggles. There are actually dozens of others out there that have openly discussed this and I am so appreciative that they are opening up their challenges to the #infertilitycommunity . . Do you have favorite celebrities that you follow? . . . Just a quick note📝. I do not and have not treated any of these people. I am just admiring them today.
This little babe is a combination science and art.
SCIENCE 🔬= Letrozole + Metformin + Dexamethasone
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ART = Parental determination + Physician dedication + A lot of love ❤️
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This #pcospregnancy occurred after multiple treatment attempts and failures.
1. No response to #Letrozole
2. Over response to Clomid - #drperfetto cancelled the cycle!
3. Finally pregnant after a perfect concoction of Letrozole + Metformin + Dexamethasone
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Approximately 80% of patients with #PCOS will respond to and ovulate with oral ovulation induction medications (like Letrozole). If a patient does not develop a follicle with Letrozole (like this patient), then I consider other medication choices or I will pair it with other adjuvant medications to encourage a response.
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I typically will add Metformin and/or Dexamethasone to reduce resistance to Letrozole. Or my other option is to try oral Clomid, which may work better in some patients. I have also tried adding gonadotropin injections, but that has a high risk of multiple follicles, which can be risky for multiple pregnancies or cancellation.
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Although PCOS can seem like a horrible diagnosis, there are typically lots of options to help you conceive. And this little nugget is proof that sometimes you just need to find the right combination!
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#Repost @infertilitydrperfetto
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These posts are for educational purposes only.
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#pcosawareness #pcoswarrior #pcosjourney #pcosawarenessmonth #infertility #infertilitysucks #infertilityjourney #infertilityblogger #ttc #ttcwithpcos #ttcsisters #ttcsupport #houstondoctors #obgyn #centerofreproductivemedicine
This little babe is a combination science and art. SCIENCE 🔬= Letrozole + Metformin + Dexamethasone . ART = Parental determination + Physician dedication + A lot of love ❤️ . This #pcospregnancy  occurred after multiple treatment attempts and failures. 1. No response to #Letrozole  2. Over response to Clomid - #drperfetto  cancelled the cycle! 3. Finally pregnant after a perfect concoction of Letrozole + Metformin + Dexamethasone . Approximately 80% of patients with #PCOS  will respond to and ovulate with oral ovulation induction medications (like Letrozole). If a patient does not develop a follicle with Letrozole (like this patient), then I consider other medication choices or I will pair it with other adjuvant medications to encourage a response. . I typically will add Metformin and/or Dexamethasone to reduce resistance to Letrozole. Or my other option is to try oral Clomid, which may work better in some patients. I have also tried adding gonadotropin injections, but that has a high risk of multiple follicles, which can be risky for multiple pregnancies or cancellation. . Although PCOS can seem like a horrible diagnosis, there are typically lots of options to help you conceive. And this little nugget is proof that sometimes you just need to find the right combination! . #Repost  @infertilitydrperfetto . These posts are for educational purposes only. . . . #pcosawareness  #pcoswarrior  #pcosjourney  #pcosawarenessmonth  #infertility  #infertilitysucks  #infertilityjourney  #infertilityblogger  #ttc  #ttcwithpcos  #ttcsisters  #ttcsupport  #houstondoctors  #obgyn  #centerofreproductivemedicine 
This little babe is a combination science and art.
SCIENCE 🔬= Letrozole + Metformin + Dexamethasone
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ART = Parental determination + Physician dedication + A lot of love ❤️
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This #pcospregnancy occurred after multiple treatment attempts and failures.
1. No response to #Letrozole
2. Over response to Clomid - #drperfetto cancelled the cycle!
3. Finally pregnant after a perfect concoction of Letrozole + Metformin + Dexamethasone
.
Approximately 80% of patients with #PCOS will respond to and ovulate with oral ovulation induction medications (like Letrozole). If a patient does not develop a follicle with Letrozole (like this patient), then I consider other medication choices or I will pair it with other adjuvant medications to encourage a response.
.
I typically will add Metformin and/or Dexamethasone to reduce resistance to Letrozole. Or my other option is to try oral Clomid, which may work better in some patients. I have also tried adding gonadotropin injections, but that has a high risk of multiple follicles, which can be risky for multiple pregnancies or cancellation.
.
Although PCOS can seem like a horrible diagnosis, there are typically lots of options to help you conceive. And this little nugget is proof that sometimes you just need to find the right combination!
.
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These posts are for educational purposes only.
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#pcosawareness #pcoswarrior #pcosjourney #pcosawarenessmonth #infertility #infertilitysucks #infertilityjourney #infertilityblogger #ttc #ttcwithpcos #ttcsisters #ttcsupport #houstondoctors #obgyn #centerofreproductivemedicine
This little babe is a combination science and art. SCIENCE 🔬= Letrozole + Metformin + Dexamethasone . ART = Parental determination + Physician dedication + A lot of love ❤️ . This #pcospregnancy  occurred after multiple treatment attempts and failures. 1. No response to #Letrozole  2. Over response to Clomid - #drperfetto  cancelled the cycle! 3. Finally pregnant after a perfect concoction of Letrozole + Metformin + Dexamethasone . Approximately 80% of patients with #PCOS  will respond to and ovulate with oral ovulation induction medications (like Letrozole). If a patient does not develop a follicle with Letrozole (like this patient), then I consider other medication choices or I will pair it with other adjuvant medications to encourage a response. . I typically will add Metformin and/or Dexamethasone to reduce resistance to Letrozole. Or my other option is to try oral Clomid, which may work better in some patients. I have also tried adding gonadotropin injections, but that has a high risk of multiple follicles, which can be risky for multiple pregnancies or cancellation. . Although PCOS can seem like a horrible diagnosis, there are typically lots of options to help you conceive. And this little nugget is proof that sometimes you just need to find the right combination! . . . These posts are for educational purposes only. . . . #pcosawareness  #pcoswarrior  #pcosjourney  #pcosawarenessmonth  #infertility  #infertilitysucks  #infertilityjourney  #infertilityblogger  #ttc  #ttcwithpcos  #ttcsisters  #ttcsupport  #houstondoctors  #obgyn  #centerofreproductivemedicine 
There is nothing more controversial in medicine than diet and weight loss. Given, the majority of Americans (2 out of 3) are overweight or obese it is not surprising that one of the most frequent question I get as a #physician is: what diet is the best when #ttc?
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Let me start by pointing out that I truly champion a healthy lifestyle. I think a well-balanced diet with appropriate caloric restriction and moderate exercise is the only way to truly maintain weight loss. I was significantly heavier in #college and #medicalschool and I tried numerous diets (Atkins, big breakfast, etc). They were all just quick, short term fixes to see the number on the scale drop. Once I focused on caloric control and actually DECREASED my exercise habits, that is when I fell into a healthy weight category.
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Today, I will focus specifically on diets in polycystic ovarian syndome (PCOS). The data is consistent that ANY #weightloss in PCOS will improve cycle regularity, insulin resistance, abnormal lipid profiles and overall quality of life.
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Interestingly, there does seem to be some data supporting greater weight loss and even improved bloodwork in low-carbohydrate and fat-enriched diets. Enter, the interest in the #ketogenicdiet. After reviewing pubmed, I did find studies to support low carb diets (but most were not specifically <20gm of carbs a day) in women with PCOS. Almost every study showed improvement in PCOS signs, symptoms and hormone/endocrine profiles.
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So, how do these diets affect those patient with #leanpcos? There is even less data on thin PCOS patients compared to “traditional” PCOS patients. Would these women also benefit from a low-carbohydrate diet? Maybe. Do they benefit from a highly restrictive diet like that of the ketogenic diet?  Maybe, but it is very hard to maintain long term.
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My take: I still champion the benefits of a well-rounded healthy diet. There may be an even greater overall benefit for a low carb or diabetic diet in those with PCOS.
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Importantly- if pregnant you absolutely do not want to be on a low carbohydrate diet. It is not good for baby 👶🏻 brain to have constant exposure to ketones.
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These posts are for educational purposes only.
There is nothing more controversial in medicine than diet and weight loss. Given, the majority of Americans (2 out of 3) are overweight or obese it is not surprising that one of the most frequent question I get as a #physician  is: what diet is the best when #ttc ? . Let me start by pointing out that I truly champion a healthy lifestyle. I think a well-balanced diet with appropriate caloric restriction and moderate exercise is the only way to truly maintain weight loss. I was significantly heavier in #college  and #medicalschool  and I tried numerous diets (Atkins, big breakfast, etc). They were all just quick, short term fixes to see the number on the scale drop. Once I focused on caloric control and actually DECREASED my exercise habits, that is when I fell into a healthy weight category. . Today, I will focus specifically on diets in polycystic ovarian syndome (PCOS). The data is consistent that ANY #weightloss  in PCOS will improve cycle regularity, insulin resistance, abnormal lipid profiles and overall quality of life. . Interestingly, there does seem to be some data supporting greater weight loss and even improved bloodwork in low-carbohydrate and fat-enriched diets. Enter, the interest in the #ketogenicdiet . After reviewing pubmed, I did find studies to support low carb diets (but most were not specifically <20gm of carbs a day) in women with PCOS. Almost every study showed improvement in PCOS signs, symptoms and hormone/endocrine profiles. . So, how do these diets affect those patient with #leanpcos ? There is even less data on thin PCOS patients compared to “traditional” PCOS patients. Would these women also benefit from a low-carbohydrate diet? Maybe. Do they benefit from a highly restrictive diet like that of the ketogenic diet? Maybe, but it is very hard to maintain long term. . My take: I still champion the benefits of a well-rounded healthy diet. There may be an even greater overall benefit for a low carb or diabetic diet in those with PCOS. . Importantly- if pregnant you absolutely do not want to be on a low carbohydrate diet. It is not good for baby 👶🏻 brain to have constant exposure to ketones. . . . These posts are for educational purposes only.
There is truth in this statement. #Infertility is not something any of us wished for, but if we are to face it, we always try to look for the positive outcome (even if some days are harder than others) and how it will last forever.
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#ThursdayThoughts #MakingMiracles #InfertilitySucks #IVF #ivfsupport #ivfjourney #ivfcommunity #ivfsisters #ivfwarrior #infertility #infertilityjourney #infertilitysupport #infertilityawareness #ttc #ttcsupport #ttcsisters #ttcjourney #ttccommunity #hope #encouragement #inspiration #dontgiveup #hopeful #onedayatatime #oneday #onegoal #twolines #InfertilityTexas #centerofreproductivemedicine
There is truth in this statement. #Infertility  is not something any of us wished for, but if we are to face it, we always try to look for the positive outcome (even if some days are harder than others) and how it will last forever. . . . #ThursdayThoughts  #MakingMiracles  #InfertilitySucks  #IVF  #ivfsupport  #ivfjourney  #ivfcommunity  #ivfsisters  #ivfwarrior  #infertility  #infertilityjourney  #infertilitysupport  #infertilityawareness  #ttc  #ttcsupport  #ttcsisters  #ttcjourney  #ttccommunity  #hope  #encouragement  #inspiration  #dontgiveup  #hopeful  #onedayatatime  #oneday  #onegoal  #twolines  #InfertilityTexas  #centerofreproductivemedicine 
One of the toughest decisions for me, when I decided to subspecialize in Reproductive Endocrinology and Infertility, was “giving up” major surgical procedures.
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Choosing a career as a #fertilityspecialist meant that at least 75% of my time would be in the office setting seeing patients and the remaining time would be for operating. These cases would mostly include: #eggretrieval, #embryotransfer, #hysteroscopy for polyps, fibroids and septums and #laparoscopy for cysts or tubal disease. All are awesome procedures, but not quite as sexy as laparoscopic hysterectomies or a large #myomectomy.
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There are still #fertility specialists that perform difficult #endometriosis surgeries and myomectomies, but the numbers  are decreasing quickly. Hey, in my practice alone both of my partners perform #roboticsurgery, so I actually ask them to do most of these long cases for me. This is great for the patients because they are excellent surgeons and are focused on long-term fertility, which is super important when operating on a uterus or the ovaries. It is great for me because I believe #physicians should only operate when they are confident and maintain their skills- which I just could not do with only 4-5 myomectomies a year.
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When in medicine, just like in life, we have to make decisions on what is right for us. We have to be willing to “give up” certain things in order to gain extra time doing something else we love❤️.
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Lucky for me, I love small cases. I am super satisfied with a quick polypectomy or visualizing a beautiful cavity after a submucosal fibroid is removed. I would also rather be in the office seeing my patient for her first OB ultrasound or not feeling like I have to rush out of the room everyday to get to the OR. I really do not feel like I gave up anything, I just shifted with my priorities.
One of the toughest decisions for me, when I decided to subspecialize in Reproductive Endocrinology and Infertility, was “giving up” major surgical procedures. . Choosing a career as a #fertilityspecialist  meant that at least 75% of my time would be in the office setting seeing patients and the remaining time would be for operating. These cases would mostly include: #eggretrieval , #embryotransfer , #hysteroscopy  for polyps, fibroids and septums and #laparoscopy  for cysts or tubal disease. All are awesome procedures, but not quite as sexy as laparoscopic hysterectomies or a large #myomectomy . . There are still #fertility  specialists that perform difficult #endometriosis  surgeries and myomectomies, but the numbers are decreasing quickly. Hey, in my practice alone both of my partners perform #roboticsurgery , so I actually ask them to do most of these long cases for me. This is great for the patients because they are excellent surgeons and are focused on long-term fertility, which is super important when operating on a uterus or the ovaries. It is great for me because I believe #physicians  should only operate when they are confident and maintain their skills- which I just could not do with only 4-5 myomectomies a year. . When in medicine, just like in life, we have to make decisions on what is right for us. We have to be willing to “give up” certain things in order to gain extra time doing something else we love❤️. . Lucky for me, I love small cases. I am super satisfied with a quick polypectomy or visualizing a beautiful cavity after a submucosal fibroid is removed. I would also rather be in the office seeing my patient for her first OB ultrasound or not feeling like I have to rush out of the room everyday to get to the OR. I really do not feel like I gave up anything, I just shifted with my priorities.
Polycystic ovarian syndrome (PCOS) is incredibly common, affecting about 10% all of reproductive aged women. When I see patients with #pcos it is typically because they are TTC and they are not having a regular cycle (ie. not ovulating = not releasing an egg 🥚 = not pregnant). They come to me to find out if they have PCOS, discuss how to treat it and then #ttc.
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What is PCOS? To diagnosis it, I follow the Rotterdam Criteria. You need 2 out of 3 of the following:
1. Irregular or no cycles (Cycle length >35 days)
2. Evidence of high androgens (Either hair growth or elevated Testosterone in the blood)
3. High number of early follicles on ultrasound (>12 in one ovary). Most importantly I tell them that I consider PCOS a spectrum. Technically you need 2 out of 3 for the diagnosis, but some patients are more severe than others. .
Seventy-five percent of women with PCOS are overweight and/or obese, the others are considered “lean.” Most patients with PCOS (even those that have a normal BMI) have metabolic (insulin resistance and abnormal lipid profiles) and anthropometric abnormalities, although there are definitely differences between those with a normal BMI and those who have a BMI >25.
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The first line for treatment for all PCOS patient is lifestyle management (specifically weight loss if overweight or obese). The ideal diet 🥗composition has not been identified for PCOS (I will post specifically on this soon- ie. #ketogenic 🥩, diabetic, etc.), but it has been shown in numerous studies that any weight loss will return menstrual regularity, decrease insulin resistance and cholesterol, and improve overall quality of life.
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For those women with lean PCOS, weight loss may not be feasible. For these patients, they may see improvement with a change in diet composition and resistance exercise 🏃‍♀️.
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After lifestyle management, #metformin also may be beneficial. I prescribe it to those women with diabetes or pre-diabetes, but there is even some evidence that it may be useful in all patients with PCOS. It has been shown to return menses and improve response to oral ovulation induction meds (future post here🤓).
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These posts are for educational purposes only.
Polycystic ovarian syndrome (PCOS) is incredibly common, affecting about 10% all of reproductive aged women. When I see patients with #pcos  it is typically because they are TTC and they are not having a regular cycle (ie. not ovulating = not releasing an egg 🥚 = not pregnant). They come to me to find out if they have PCOS, discuss how to treat it and then #ttc . . What is PCOS? To diagnosis it, I follow the Rotterdam Criteria. You need 2 out of 3 of the following: 1. Irregular or no cycles (Cycle length >35 days) 2. Evidence of high androgens (Either hair growth or elevated Testosterone in the blood) 3. High number of early follicles on ultrasound (>12 in one ovary). Most importantly I tell them that I consider PCOS a spectrum. Technically you need 2 out of 3 for the diagnosis, but some patients are more severe than others. . Seventy-five percent of women with PCOS are overweight and/or obese, the others are considered “lean.” Most patients with PCOS (even those that have a normal BMI) have metabolic (insulin resistance and abnormal lipid profiles) and anthropometric abnormalities, although there are definitely differences between those with a normal BMI and those who have a BMI >25. . The first line for treatment for all PCOS patient is lifestyle management (specifically weight loss if overweight or obese). The ideal diet 🥗composition has not been identified for PCOS (I will post specifically on this soon- ie. #ketogenic  🥩, diabetic, etc.), but it has been shown in numerous studies that any weight loss will return menstrual regularity, decrease insulin resistance and cholesterol, and improve overall quality of life. . For those women with lean PCOS, weight loss may not be feasible. For these patients, they may see improvement with a change in diet composition and resistance exercise 🏃‍♀️. . After lifestyle management, #metformin  also may be beneficial. I prescribe it to those women with diabetes or pre-diabetes, but there is even some evidence that it may be useful in all patients with PCOS. It has been shown to return menses and improve response to oral ovulation induction meds (future post here🤓). . . These posts are for educational purposes only.
Polycystic ovarian syndome (PCOS) is incredibly common. Patients with #pcos typically have irregular cycles - meaning their menstrual cycles occur less frequently than normal (intervals of >35 days) or they may not come at all.
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Having irregular cycles means that you may be ovulating at irregular intervals or you may not be ovulating at all. As you can guess, if you are not ovulating - you are not releasing an egg 🥚, then it will be incredibly hard to conceive.
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If a patient has PCOS and wants to #ttc we discuss her taking oral medications to help her ovulate. I typically prescribe Letrozole and then follow the patient with a mid-cycle ultrasound to see if she develops a follicle on the medication.
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If she does develop a follicle, we trigger her with a medication to stimulate ovulation and as long as there is not male factor infertility we can time intercourse based on her triggered ovulation.
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After that the couple deals with the dreaded #2ww to find out if she is pregnant🤰🏼. On a positive note, patients with PCOS that ovulate on oral medications have a high chance of conception. With about 50% conceiving within 3 cycles⭐️.
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Just so you know, most women with PCOS do ovulate with #letrozole (about 80%), but not everyone does. If a patient does not ovulate, I have a few options to try - I’ll post more on those soon.
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These posts are for educational purposes only.
Polycystic ovarian syndome (PCOS) is incredibly common. Patients with #pcos  typically have irregular cycles - meaning their menstrual cycles occur less frequently than normal (intervals of >35 days) or they may not come at all. . Having irregular cycles means that you may be ovulating at irregular intervals or you may not be ovulating at all. As you can guess, if you are not ovulating - you are not releasing an egg 🥚, then it will be incredibly hard to conceive. . If a patient has PCOS and wants to #ttc  we discuss her taking oral medications to help her ovulate. I typically prescribe Letrozole and then follow the patient with a mid-cycle ultrasound to see if she develops a follicle on the medication. . If she does develop a follicle, we trigger her with a medication to stimulate ovulation and as long as there is not male factor infertility we can time intercourse based on her triggered ovulation. . After that the couple deals with the dreaded #2ww  to find out if she is pregnant🤰🏼. On a positive note, patients with PCOS that ovulate on oral medications have a high chance of conception. With about 50% conceiving within 3 cycles⭐️. . Just so you know, most women with PCOS do ovulate with #letrozole  (about 80%), but not everyone does. If a patient does not ovulate, I have a few options to try - I’ll post more on those soon. . . . These posts are for educational purposes only.
Treatment of #endometriosis is different depending on the goals of the patient.
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In those patients who are #ttc (>90% of my patients), my approach is to optimize natural fertility and then identify the best options to improve the pregnancy rate. That may be through ovulation medications and #iui or #ivf.
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In those not TTC, the goals may be pain management and a better understanding of their disease. I try and focus on hormonal medications to try and improve the pain symptoms. I also consider surgery, but it’s typically after a patient fails medical management. I do not typically prescribe narcotics and instead I encourage patients to seek the advice of pain management specialists and other experts in the field.
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I am a big believer in the value of a multidisciplinary approach to this disease. After being on IG I have seen how pelvic floor therapy and nutrition can positively impact the patient suffering from endometriosis (when ttc and when not).
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Take home points:
⏸ Treatment of endometriosis is not the same for everyone and your #doctor should understand your short and long term goals before rushing to a treatment plan.
⏸ Endometriosis is a disease that benefits from a multidisciplinary approach. You will likely benefit from a number of practitioners, including: #gynecologist, #painmanagement specialist, #pelvicfloor specialist, #psychiatrist, #nutrionist, and a good #supportgroup.
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I am tagging a few of the IG accounts I have found helpful when learning more about “non-traditional” endometriosis treatment.
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Do you have others you think I should follow?!?
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#infertility #infertilitysucks #infertilityhurts #fertility #fertilitytreatment #fertilityjourney #fertilitydiet #ttcwithendo #endometriosisawareness #endometriosissurgery #obgyn #fertilityspecialist #womenshealth #womeninmedicine #centerofreproductivemedicine #drperfetto
Treatment of #endometriosis  is different depending on the goals of the patient. . In those patients who are #ttc  (>90% of my patients), my approach is to optimize natural fertility and then identify the best options to improve the pregnancy rate. That may be through ovulation medications and #iui  or #ivf . . In those not TTC, the goals may be pain management and a better understanding of their disease. I try and focus on hormonal medications to try and improve the pain symptoms. I also consider surgery, but it’s typically after a patient fails medical management. I do not typically prescribe narcotics and instead I encourage patients to seek the advice of pain management specialists and other experts in the field. . I am a big believer in the value of a multidisciplinary approach to this disease. After being on IG I have seen how pelvic floor therapy and nutrition can positively impact the patient suffering from endometriosis (when ttc and when not). . Take home points: ⏸ Treatment of endometriosis is not the same for everyone and your #doctor  should understand your short and long term goals before rushing to a treatment plan. ⏸ Endometriosis is a disease that benefits from a multidisciplinary approach. You will likely benefit from a number of practitioners, including: #gynecologist , #painmanagement  specialist, #pelvicfloor  specialist, #psychiatrist , #nutrionist , and a good #supportgroup . . I am tagging a few of the IG accounts I have found helpful when learning more about “non-traditional” endometriosis treatment. . Do you have others you think I should follow?!? . . . #infertility  #infertilitysucks  #infertilityhurts  #fertility  #fertilitytreatment  #fertilityjourney  #fertilitydiet  #ttcwithendo  #endometriosisawareness  #endometriosissurgery  #obgyn  #fertilityspecialist  #womenshealth  #womeninmedicine  #centerofreproductivemedicine  #drperfetto 
For the 4th consecutive year, the CDC reported an increase in cases of chlamydia, gonorrohea and syphilis.
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This is a big deal for the those seeking future #fertility because sexually transmitted infections are one of the most common causes of tubal factor #infertility.
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Tubal factor infertility (TFI) is identified as a cause of infertility 15-30% of the time. Tubal disease can occur from sexually transmitted infections (STI, most commonly chlamydia), pelvic inflammatory disease (PID- severe cases of STI), previous abdominal surgery and/or #endometriosis.
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In those patients exposed to an STI, there is a greater risk of TFI the longer it goes untreated, as well as with increasing severity of the infection. For example, the risk of TFI is about 10% after one, 25% after two or >50% after three episodes of PID.
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This is just one of many reasons why it is important to practice safe sex at every age!
#Repost @infertilitydrperfetto
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#infertilitysucks #infertilityawareness #infertilitysupport #infertilityblogger #fertilityjourney #fertilityawareness #ttc #ttcwithendo #miscarriage #ttccommunity #ttcsupport #obgyn #safesex #sexeducation #onegoaltwolines #centerofreproductivemedicine #drperfetto
For the 4th consecutive year, the CDC reported an increase in cases of chlamydia, gonorrohea and syphilis. . This is a big deal for the those seeking future #fertility  because sexually transmitted infections are one of the most common causes of tubal factor #infertility . . Tubal factor infertility (TFI) is identified as a cause of infertility 15-30% of the time. Tubal disease can occur from sexually transmitted infections (STI, most commonly chlamydia), pelvic inflammatory disease (PID- severe cases of STI), previous abdominal surgery and/or #endometriosis . . In those patients exposed to an STI, there is a greater risk of TFI the longer it goes untreated, as well as with increasing severity of the infection. For example, the risk of TFI is about 10% after one, 25% after two or >50% after three episodes of PID. . This is just one of many reasons why it is important to practice safe sex at every age! #Repost  @infertilitydrperfetto . . . #infertilitysucks  #infertilityawareness  #infertilitysupport  #infertilityblogger  #fertilityjourney  #fertilityawareness  #ttc  #ttcwithendo  #miscarriage  #ttccommunity  #ttcsupport  #obgyn  #safesex  #sexeducation  #onegoaltwolines  #centerofreproductivemedicine  #drperfetto 
Let’s talk about the media and #fertility. Both mainstream and social media are critical to general #fertilityawareness and education. Both can can be positive influencers, as well as negative stressors.
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In the last few months I have seen a number articles written in the @nytimes on the decreasing fertility rate in the US, utilization of fertility applications 📱 when #ttc, the unknowns about female fertility decline and most recently #eggfreezing.
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It is exciting and important that #womenshealth is all over the news. I applaud 👏 the authors for investigating these topics and reaching out to such educated sources (like @eggexpert, @valeriedlandis with @eggologyclub) to present a well rounded topic.
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Now, it is super important to note that not everything we read on the internet is correct, nor does it apply to everyone. Women and men are not one size fits all. This is especially true when it comes to #infertility. The exact same ovarian reserve test in two different patients may not lead to the same recommendation.
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Although media is key 🔑 in starting the education ball rolling, I highly recommend patients see a #fertilityspecialist to discuss his or her own unique history or concerns.
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Take home points:
➡️ Know the source of the information you are reading
➡️ Ask yourself if this information applies to you
➡️ If you have a question, ask an expert ➡️ If the information provided does not educate you or make you feel better about yourself - then take it with a grain of salt.
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#infertilityawareness #infertilitysucks #infertilityjourney #fertilityjourney #fertilitysupport #ttcsisters #miscarriage #obgyn #naturalfertility #ivf #iui #ivfpregnancy #onegoaltwolines #centerofreproductivemedicine #drperfetto
Let’s talk about the media and #fertility . Both mainstream and social media are critical to general #fertilityawareness  and education. Both can can be positive influencers, as well as negative stressors. . In the last few months I have seen a number articles written in the @nytimes on the decreasing fertility rate in the US, utilization of fertility applications 📱 when #ttc , the unknowns about female fertility decline and most recently #eggfreezing . . It is exciting and important that #womenshealth  is all over the news. I applaud 👏 the authors for investigating these topics and reaching out to such educated sources (like @eggexpert, @valeriedlandis with @eggologyclub) to present a well rounded topic. . Now, it is super important to note that not everything we read on the internet is correct, nor does it apply to everyone. Women and men are not one size fits all. This is especially true when it comes to #infertility . The exact same ovarian reserve test in two different patients may not lead to the same recommendation. . Although media is key 🔑 in starting the education ball rolling, I highly recommend patients see a #fertilityspecialist  to discuss his or her own unique history or concerns. . Take home points: ➡️ Know the source of the information you are reading ➡️ Ask yourself if this information applies to you ➡️ If you have a question, ask an expert ➡️ If the information provided does not educate you or make you feel better about yourself - then take it with a grain of salt. . . . #infertilityawareness  #infertilitysucks  #infertilityjourney  #fertilityjourney  #fertilitysupport  #ttcsisters  #miscarriage  #obgyn  #naturalfertility  #ivf  #iui  #ivfpregnancy  #onegoaltwolines  #centerofreproductivemedicine  #drperfetto 
For the 4th consecutive year, the CDC reported an increase in cases of chlamydia, gonorrohea and syphilis.
.
This is a big deal for the those seeking future #fertility because sexually transmitted infections are one of the most common causes of tubal factor #infertility.
.
Tubal factor infertility (TFI) is identified as a cause of infertility 15-30% of the time. Tubal disease can occur from sexually transmitted infections (STI, most commonly chlamydia), pelvic inflammatory disease (PID- severe cases of STI), previous abdominal surgery and/or #endometriosis.
.
In those patients exposed to an STI, there is a greater risk of TFI the longer it goes untreated, as well as with increasing severity of the infection. For example, the risk of TFI is about 10% after one, 25% after two or >50% after three episodes of PID.
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This is just one of many reasons why it is important to practice safe sex at every age!
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#infertilitysucks #infertilityawareness #infertilitysupport #infertilityblogger #fertilityjourney #fertilityawareness #ttc #ttcwithendo #miscarriage #ttccommunity #ttcsupport #obgyn #safesex #sexeducation #onegoaltwolines #centerofreproductivemedicine #drperfetto
For the 4th consecutive year, the CDC reported an increase in cases of chlamydia, gonorrohea and syphilis. . This is a big deal for the those seeking future #fertility  because sexually transmitted infections are one of the most common causes of tubal factor #infertility . . Tubal factor infertility (TFI) is identified as a cause of infertility 15-30% of the time. Tubal disease can occur from sexually transmitted infections (STI, most commonly chlamydia), pelvic inflammatory disease (PID- severe cases of STI), previous abdominal surgery and/or #endometriosis . . In those patients exposed to an STI, there is a greater risk of TFI the longer it goes untreated, as well as with increasing severity of the infection. For example, the risk of TFI is about 10% after one, 25% after two or >50% after three episodes of PID. . This is just one of many reasons why it is important to practice safe sex at every age! . . . #infertilitysucks  #infertilityawareness  #infertilitysupport  #infertilityblogger  #fertilityjourney  #fertilityawareness  #ttc  #ttcwithendo  #miscarriage  #ttccommunity  #ttcsupport  #obgyn  #safesex  #sexeducation  #onegoaltwolines  #centerofreproductivemedicine  #drperfetto 
Life is like a box of adorable anatomy-based cookies 🍪
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Trying to conceive a baby can quickly turn from all-fun to all-consuming. Although most couples (80%) do conceive spontaneously within a year of #ttc, many couples do not. I see patients who have been trying for a few months to trying for over a decade. No matter when a patient comes in, by the time they are seeing me they are usually overwhelmed, disheartened 💔and frustrated by the process.
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These adorable cookies, brought to us by one of our sweet patients, remind us and hopefully others that most of the time the end of the #fertilityjourney is sweet. This particular patient had more than her fair share of #iui, #ivf, mock cycles and #embryo transfers.
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She is not unique. A lot of patients go through a lot to get their baby👶🏻. Today, I am wishing everyone in the middle of this incredibly stressful journey a super sweet success story soon!
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#infertilitysucks #infertility #infertilityawareness #infertilitywarrior #infertilityblogger #fertility #fertilitytreatment #ttcjourney #ttcaftermiscarriage #miscarriage #embryotransfer #ivfcycle #houstondoctors #somedoc #onegoaltwolines #centerofreproductivemedicine #drperfetto
Life is like a box of adorable anatomy-based cookies 🍪 . Trying to conceive a baby can quickly turn from all-fun to all-consuming. Although most couples (80%) do conceive spontaneously within a year of #ttc , many couples do not. I see patients who have been trying for a few months to trying for over a decade. No matter when a patient comes in, by the time they are seeing me they are usually overwhelmed, disheartened 💔and frustrated by the process. . These adorable cookies, brought to us by one of our sweet patients, remind us and hopefully others that most of the time the end of the #fertilityjourney  is sweet. This particular patient had more than her fair share of #iui , #ivf , mock cycles and #embryo  transfers. . She is not unique. A lot of patients go through a lot to get their baby👶🏻. Today, I am wishing everyone in the middle of this incredibly stressful journey a super sweet success story soon! . . . #infertilitysucks  #infertility  #infertilityawareness  #infertilitywarrior  #infertilityblogger  #fertility  #fertilitytreatment  #ttcjourney  #ttcaftermiscarriage  #miscarriage  #embryotransfer  #ivfcycle  #houstondoctors  #somedoc  #onegoaltwolines  #centerofreproductivemedicine  #drperfetto 
Today on our Facebook page we posted a video from one of our patients, Kaitlin Miller. She is sharing about her experience with #infertility and the struggle and loss she experienced while growing her family. Thank you for sharing such a personal video and your journey... Be sure to watch. 
We love seeing your baby boys, so much love in these pics.
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FROM @Kaitlin Miller: Such a taboo subject no one wants to talk about. Something I haven’t talked about to anyone really other than my husband. Infertility and loss.
Such a taboo subject no one wants to talk about. 
Something I haven’t talked about to anyone really other than my husband. 
Infertility and loss.
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Love. Hope. Strength. Inspiration.
#miraclebaby #CenterOfReproductiveMedicine #InfertilityTexas 
#IVF #TTCSisters #DreamsDoComeTrue #NeverGiveUp #TTC
Today on our Facebook page we posted a video from one of our patients, Kaitlin Miller. She is sharing about her experience with #infertility  and the struggle and loss she experienced while growing her family. Thank you for sharing such a personal video and your journey... Be sure to watch. We love seeing your baby boys, so much love in these pics. . . . FROM @Kaitlin Miller: Such a taboo subject no one wants to talk about. Something I haven’t talked about to anyone really other than my husband. Infertility and loss. Such a taboo subject no one wants to talk about. Something I haven’t talked about to anyone really other than my husband. Infertility and loss. . Love. Hope. Strength. Inspiration. #miraclebaby  #CenterOfReproductiveMedicine  #InfertilityTexas  #IVF  #TTCSisters  #DreamsDoComeTrue  #NeverGiveUp  #TTC 
Today I graduated from the Center of Reproductive Medicine. It was bitter sweet! I spent the last year here almost every week, sometimes couple of times a week. Our journey didn’t start here but I am glad it ended here. It had its trials and tribulations, tears, heartache, uncertainty and pain. But it created friendships and taught me strength and to be more humble. I wouldn’t change a thing. Can’t wait to meet our sweet Jameson and to one day tell him his story and how hard we fought to make him 💙 Again I thank everyone for the support, prayers and love! 
#ivfbaby #ttcjourney #centerofreproductivemedicine #corm #retrievebelieveconceive #embryotransfer
Today I graduated from the Center of Reproductive Medicine. It was bitter sweet! I spent the last year here almost every week, sometimes couple of times a week. Our journey didn’t start here but I am glad it ended here. It had its trials and tribulations, tears, heartache, uncertainty and pain. But it created friendships and taught me strength and to be more humble. I wouldn’t change a thing. Can’t wait to meet our sweet Jameson and to one day tell him his story and how hard we fought to make him 💙 Again I thank everyone for the support, prayers and love! #ivfbaby  #ttcjourney  #centerofreproductivemedicine  #corm  #retrievebelieveconceive  #embryotransfer 
Male factor infertility.
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I require every male partner to have a #semenanalysis before we can start #fertilitytreatment. Why? Because approximately 30% of couples who are struggling to conceive have #malefactorinfertility.
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After I review the analysis I typically discuss what is abnormal and if there is anything we can do to improve the numbers.
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1. What is a normal semen analysis? Based on the WHO criteria we consider the following parameters “normal”:
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Volume 1.5-5.9ml
Count >15million/ml
Motility >50%
Morphology >4% (strict)
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It’s important to understand that men can still father a child 👶🏻 if outside of these ranges.
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2. What are frequent causes of low sperm parameters?
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Previous chemotherapy, previous surgery, certain medications (exogenous #testosterone 💪!!), excessive alcohol/drug use, excessive heat (hot tubs).
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I have seen men go from a normal SA to minimal or no sperm after: excessive hot tub use, taking workout supplements, having a high fever. Weird things can happen!
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If I have a concern about the analysis, I usually repeat it, I may draw labs and I frequently send to a qualified male #urologist👨‍⚕️ who specializes in reproductive medicine.
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These posts are for educational purposes only. #Repost @infertilitydrperfetto 
P.C.: @vitalveda
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#infertility #infertilitysucks #infertilityawareness #infertilityhurts #fertility #fertilityspecialist #fertilityjourney #fertilityjourney #ttc #ttccommunity #ttcsupport #infertilityblogger #houstondoctors #houstonblogger #menshealth #ivf #ivfjourney #ivfcycle #iui #onegoaltwolines #centerofreproductivemedicine #drperfetto #infertilitytexas #centerofreproductivemedicine
Male factor infertility. . I require every male partner to have a #semenanalysis  before we can start #fertilitytreatment . Why? Because approximately 30% of couples who are struggling to conceive have #malefactorinfertility . . After I review the analysis I typically discuss what is abnormal and if there is anything we can do to improve the numbers. . 1. What is a normal semen analysis? Based on the WHO criteria we consider the following parameters “normal”: . Volume 1.5-5.9ml Count >15million/ml Motility >50% Morphology >4% (strict) . It’s important to understand that men can still father a child 👶🏻 if outside of these ranges. . 2. What are frequent causes of low sperm parameters? . Previous chemotherapy, previous surgery, certain medications (exogenous #testosterone  💪!!), excessive alcohol/drug use, excessive heat (hot tubs). . I have seen men go from a normal SA to minimal or no sperm after: excessive hot tub use, taking workout supplements, having a high fever. Weird things can happen! . If I have a concern about the analysis, I usually repeat it, I may draw labs and I frequently send to a qualified male #urologist 👨‍⚕️ who specializes in reproductive medicine. . . . These posts are for educational purposes only. #Repost  @infertilitydrperfetto P.C.: @vitalveda . . . #infertility  #infertilitysucks  #infertilityawareness  #infertilityhurts  #fertility  #fertilityspecialist  #fertilityjourney  #fertilityjourney  #ttc  #ttccommunity  #ttcsupport  #infertilityblogger  #houstondoctors  #houstonblogger  #menshealth  #ivf  #ivfjourney  #ivfcycle  #iui  #onegoaltwolines  #centerofreproductivemedicine  #drperfetto  #infertilitytexas  #centerofreproductivemedicine 
Male factor infertility.
.
I require every male partner to have a #semenanalysis before we can start #fertilitytreatment. Why? Because approximately 30% of couples who are struggling to conceive have #malefactorinfertility.
.
After I review the analysis I typically discuss what is abnormal and if there is anything we can do to improve the numbers.
.
1. What is a normal semen analysis? Based on the WHO criteria we consider the following parameters “normal”:
.
Volume 1.5-5.9ml
Count >15million/ml
Motility >50%
Morphology >4% (strict)
.
It’s important to understand that men can still father a child 👶🏻 if outside of these ranges.
.
2. What are frequent causes of low sperm parameters?
.
Previous chemotherapy, previous surgery, certain medications (exogenous #testosterone 💪!!), excessive alcohol/drug use, excessive heat (hot tubs).
.
I have seen men go from a normal SA to minimal or no sperm after: excessive hot tub use, taking workout supplements, having a high fever. Weird things can happen!
.
If I have a concern about the analysis, I usually repeat it, I may draw labs and I frequently send to a qualified male #urologist👨‍⚕️ who specializes in reproductive medicine.
.
.
.
These posts are for educational purposes only.
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.
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#infertility #infertilitysucks #infertilityawareness #infertilityhurts #fertility #fertilityspecialist #fertilityjourney #fertilityjourney #ttc #ttccommunity #ttcsupport #infertilityblogger #houstondoctors #houstonblogger #menshealth #ivf #ivfjourney #ivfcycle #iui #onegoaltwolines #centerofreproductivemedicine #drperfetto
Male factor infertility. . I require every male partner to have a #semenanalysis  before we can start #fertilitytreatment . Why? Because approximately 30% of couples who are struggling to conceive have #malefactorinfertility . . After I review the analysis I typically discuss what is abnormal and if there is anything we can do to improve the numbers. . 1. What is a normal semen analysis? Based on the WHO criteria we consider the following parameters “normal”: . Volume 1.5-5.9ml Count >15million/ml Motility >50% Morphology >4% (strict) . It’s important to understand that men can still father a child 👶🏻 if outside of these ranges. . 2. What are frequent causes of low sperm parameters? . Previous chemotherapy, previous surgery, certain medications (exogenous #testosterone  💪!!), excessive alcohol/drug use, excessive heat (hot tubs). . I have seen men go from a normal SA to minimal or no sperm after: excessive hot tub use, taking workout supplements, having a high fever. Weird things can happen! . If I have a concern about the analysis, I usually repeat it, I may draw labs and I frequently send to a qualified male #urologist 👨‍⚕️ who specializes in reproductive medicine. . . . These posts are for educational purposes only. . . . #infertility  #infertilitysucks  #infertilityawareness  #infertilityhurts  #fertility  #fertilityspecialist  #fertilityjourney  #fertilityjourney  #ttc  #ttccommunity  #ttcsupport  #infertilityblogger  #houstondoctors  #houstonblogger  #menshealth  #ivf  #ivfjourney  #ivfcycle  #iui  #onegoaltwolines  #centerofreproductivemedicine  #drperfetto 
National rainbow 🌈 baby day
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Today we remember the babies that have blessed us after suffering a #pregnancyloss.
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There is nothing more challenging in #fertility than trying to relax and enjoy a pregnancy when you have lost others before. Every cramp, spot of blood or milestone is a bitter memory of the past.
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Patients who have lost babies always tell me they just need to get past week X and then they will feel better. I listen to them and then gently suggest that probably is not true, they will likely be worried about this baby until the day he or she is born. And then they will continue to worry after the birth, but for other reasons.
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This anxiety is completely normal. You have lost something so important to you in the past, it is appropriate to fear it may happen again. My most important advice is to understand that you did not cause the last loss and you cannot cause another one, so try and believe me and try to enjoy every small milestone you reach in this pregnancy.
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I am so grateful 💛we have a day to celebrate these babies. They are often the child that helps a patient start to heal her heart. They will never take the place of the baby lost, but they often help make the family feel whole.
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#NationalRainbowBabyDay #rainbowbabyday #rainbowbaby #pregnancyafterloss #miscarriage #miscarriageawareness #miscarriagesupport #ttcaftermiscarriage #ttc #ttcsisters #infertility #infertilitysucks #infertilityhurts #infertilityblogger #houstonblogger #houstondoctors #centerofreproductivemedicine #drperfetto
National rainbow 🌈 baby day . Today we remember the babies that have blessed us after suffering a #pregnancyloss . . There is nothing more challenging in #fertility  than trying to relax and enjoy a pregnancy when you have lost others before. Every cramp, spot of blood or milestone is a bitter memory of the past. . Patients who have lost babies always tell me they just need to get past week X and then they will feel better. I listen to them and then gently suggest that probably is not true, they will likely be worried about this baby until the day he or she is born. And then they will continue to worry after the birth, but for other reasons. . This anxiety is completely normal. You have lost something so important to you in the past, it is appropriate to fear it may happen again. My most important advice is to understand that you did not cause the last loss and you cannot cause another one, so try and believe me and try to enjoy every small milestone you reach in this pregnancy. . I am so grateful 💛we have a day to celebrate these babies. They are often the child that helps a patient start to heal her heart. They will never take the place of the baby lost, but they often help make the family feel whole. . . . #NationalRainbowBabyDay  #rainbowbabyday  #rainbowbaby  #pregnancyafterloss  #miscarriage  #miscarriageawareness  #miscarriagesupport  #ttcaftermiscarriage  #ttc  #ttcsisters  #infertility  #infertilitysucks  #infertilityhurts  #infertilityblogger  #houstonblogger  #houstondoctors  #centerofreproductivemedicine  #drperfetto 
What a wonderful surprise 2 week visit from baby Everett and moms Amanda and Chelsey. These pictures are giving us all the feels on this Monday.
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Love. Hope. Strength. Inspiration.
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#miraclebaby #CenterOfReproductiveMedicine #InfertilityTexas #IVF #TTCSisters #DreamsDoComeTrue #NeverGiveUp #TTC #loveislove
Struggling with infertility is like dealing with the five stages of grief.
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One of my former patients recently posted on this and I cannot agree with her more. When struggling to conceive it is common to deny, bargain, get angry, cry and then accept.
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In a typical day, I may visit with patients in every stage of the grieving process. What is interesting about grief is that we all do not grieve in the same order, nor do we experience each stage similarly.
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In one day, I may see two different patients suffering with 5 years of #infertility - One may be angry about her diagnosis and the other may be accepting it and planing to move in another direction.
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Grief is so often associated with the loss of a loved one. What is unique to those suffering from infertility, is that they are grieving the loss of their future, their future children and the dreams they had for those children.
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Much like how we experience the stages of grief, we all work through it differently. I encourage my patients to speak with family, friends and counselors who specialize in infertility, journal, go on walks and make sure to take time for themselves.
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I would love to hear any suggestions you may have to help get you through this challenging time.
Struggling with infertility is like dealing with the five stages of grief. . One of my former patients recently posted on this and I cannot agree with her more. When struggling to conceive it is common to deny, bargain, get angry, cry and then accept. . In a typical day, I may visit with patients in every stage of the grieving process. What is interesting about grief is that we all do not grieve in the same order, nor do we experience each stage similarly. . In one day, I may see two different patients suffering with 5 years of #infertility  - One may be angry about her diagnosis and the other may be accepting it and planing to move in another direction. . Grief is so often associated with the loss of a loved one. What is unique to those suffering from infertility, is that they are grieving the loss of their future, their future children and the dreams they had for those children. . Much like how we experience the stages of grief, we all work through it differently. I encourage my patients to speak with family, friends and counselors who specialize in infertility, journal, go on walks and make sure to take time for themselves. . I would love to hear any suggestions you may have to help get you through this challenging time.
How do I decide the best treatment for a patient?
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This is a question I get all of the time and it is actually very easy for me to answer.
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I do not have a set protocol for anyone. I look at the whole couple/patient, the entire evaluation, the long term family planning goals and then we make a decision together.
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The most important factors?
1. Are the tubes open? We test this with the #hsg. If blocked then we must move to #ivf.
2. Is there adequate sperm for spontaneous conception? An #iuicycle? Or is it too low and we need to move to an #ivfcycle?
3. Is the female patient ovulating on her own? If not, then I can offer the most conservative option- oral medications to help with ovulation. If she is already ovulating on her own, then she can still be offered all treatment options, but her success rates are likely much lower.
4. What are the long term family planning goals? If the female is older (>37) and they/she wants more than 1-2 children then they/she may need to consider more aggressive treatment sooner.
5. There are numerous other things that I consider when helping guide a couple or single female to creating a family.
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As you can see there is no one size fits all. I view my job as one that helps educate and guide, not tell patients what they have to do.
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These posts are for educational purposes only.
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#infertility #infertilitysucks #infertilityhurts #fertility #fertilityjourney #fertilitytreatment #ttc #ttcsisters #ttcsupport #infertilityblogger #infertilityawareness #obgyn #houstondoctors #onegoaltwolines #centerofreproductivemedicine #drperfetto
How do I decide the best treatment for a patient? . This is a question I get all of the time and it is actually very easy for me to answer. . I do not have a set protocol for anyone. I look at the whole couple/patient, the entire evaluation, the long term family planning goals and then we make a decision together. . The most important factors? 1. Are the tubes open? We test this with the #hsg . If blocked then we must move to #ivf . 2. Is there adequate sperm for spontaneous conception? An #iuicycle ? Or is it too low and we need to move to an #ivfcycle ? 3. Is the female patient ovulating on her own? If not, then I can offer the most conservative option- oral medications to help with ovulation. If she is already ovulating on her own, then she can still be offered all treatment options, but her success rates are likely much lower. 4. What are the long term family planning goals? If the female is older (>37) and they/she wants more than 1-2 children then they/she may need to consider more aggressive treatment sooner. 5. There are numerous other things that I consider when helping guide a couple or single female to creating a family. . As you can see there is no one size fits all. I view my job as one that helps educate and guide, not tell patients what they have to do. . . . These posts are for educational purposes only. . . . #infertility  #infertilitysucks  #infertilityhurts  #fertility  #fertilityjourney  #fertilitytreatment  #ttc  #ttcsisters  #ttcsupport  #infertilityblogger  #infertilityawareness  #obgyn  #houstondoctors  #onegoaltwolines  #centerofreproductivemedicine  #drperfetto 
Come one, come all! 
Step right up and join us for the 
2018 BABY REUNION!
WHEN: Saturday, September 22, 2018
TIME: 12:00pm-2:00pm
WHERE: Clear Lake Park
Landlot Pavilion
5002 E. Nasa Pkwy.
Seabrook, TX 77586
RSVP: (281) 332-0073 thamil@infertilitytexas.com
Petting Zoo, Balloon Artist, Face Painting, BBQ, Popcorn, and Snow Cones… You won’t want to miss it!
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#babyreunion #infertilitytexas 
#centerofreproductivemedicine #circus #circusparty #family #familyfun #familyfunday #2018
Come one, come all! Step right up and join us for the 2018 BABY REUNION! WHEN: Saturday, September 22, 2018 TIME: 12:00pm-2:00pm WHERE: Clear Lake Park Landlot Pavilion 5002 E. Nasa Pkwy. Seabrook, TX 77586 RSVP: (281) 332-0073 thamil@infertilitytexas.com Petting Zoo, Balloon Artist, Face Painting, BBQ, Popcorn, and Snow Cones… You won’t want to miss it! . . . #babyreunion  #infertilitytexas  #centerofreproductivemedicine  #circus  #circusparty  #family  #familyfun  #familyfunday  #2018 
You probably cannot tell, but I have serious Operating Room Face on right now.
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I take my role as a #surgeon very seriously. My patients and their families trust me with their health, bodies and lives and I will do my absolute best for them.
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First, I always prepare for the case. I review the patients history (present complaints, surgical history, allergies, current medications) and I always do a complete evaluation before rushing to the #operatingroom. Some diagnoses need an ultrasound, hysterosonogram, MRI, hysterosalpingogram, etc. I never want any surprises in the middle of a #surgery. Now don’t get me wrong, there are always surprises, but some you can be better prepared for than others.
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Second, I do not perform surgeries that are beyond my skill set. This is something I learned once I entered #privatepractice. As an #obgyn resident I would perform every surgery offered- hysterectomy, myomectomy, urethral slings, stage 4 cancer, etc. and it was excellent training. I felt like I could do anything in the OR, and I could because someone far more skilled than me was also there and could fix my mistake if I made one (now I was never a cowboy so that was rare).
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Third, BE NICE in the OR. There is absolutely no reason not to be.  The admin staff, OR circulators, #surgicalassistant, surgical #nurses, nurses anesthetists, anesthesiologists all want the case to go successful and being rude or nasty will not help you in any way. Remember you will be working with these people for a long time, they deserve as much respect as you do.
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Now, back to the OR; time to take out a hydrosalpinx, transect a septum and resect a few polyps!
You probably cannot tell, but I have serious Operating Room Face on right now. . I take my role as a #surgeon  very seriously. My patients and their families trust me with their health, bodies and lives and I will do my absolute best for them. . First, I always prepare for the case. I review the patients history (present complaints, surgical history, allergies, current medications) and I always do a complete evaluation before rushing to the #operatingroom . Some diagnoses need an ultrasound, hysterosonogram, MRI, hysterosalpingogram, etc. I never want any surprises in the middle of a #surgery . Now don’t get me wrong, there are always surprises, but some you can be better prepared for than others. . Second, I do not perform surgeries that are beyond my skill set. This is something I learned once I entered #privatepractice . As an #obgyn  resident I would perform every surgery offered- hysterectomy, myomectomy, urethral slings, stage 4 cancer, etc. and it was excellent training. I felt like I could do anything in the OR, and I could because someone far more skilled than me was also there and could fix my mistake if I made one (now I was never a cowboy so that was rare). . Third, BE NICE in the OR. There is absolutely no reason not to be. The admin staff, OR circulators, #surgicalassistant , surgical #nurses , nurses anesthetists, anesthesiologists all want the case to go successful and being rude or nasty will not help you in any way. Remember you will be working with these people for a long time, they deserve as much respect as you do. . . . Now, back to the OR; time to take out a hydrosalpinx, transect a septum and resect a few polyps!
Fresh vs. Frozen? We are not talking veggies or pizza ... We are talking embryos.
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An #embryotransfer can be performed one of two ways.
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Fresh —> It is part of the #ivfcycle. After the retrieval the patient starts progesterone to prepare the lining for implantation. At my practice this is almost always a day 5 (blastocyst stage) transfer. Day 3 transfers used to be common, but now most #ivf centers prefer a day 5 transfer - they have higher success rates.
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Frozen —> It is typically performed after the IVF cycle. The patient has a menses and we can plan the transfer the next month (or months/years later). The patient typically starts estrogen and once the lining thickens we add progesterone to prepare the uterus for the transfer.
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Personally, we perform far more frozen transfers than fresh transfers. The reasons for that?
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1. More and more of our patients are opting for PGT-A testing of their embryos. That means the embryos must be frozen after the biopsy while we wait for the embryo results.
2. Patients with high ovarian response (lots of eggs and high estradiol levels) are at risk of ovarian hyperstimulation and it is better not to get pregnant in that situation.
3. There is data to support that frozen embryo transfers are better for the baby. They tend to stay in the uterus a little longer and have a slightly higher live birth rate.
4. A lot of clinics have higher success rates with frozen transfers. This is for many different reasons (some of which are patient related), so frequently the decision for a #frozenembryotransfer may be patient or practice preference.
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Every situation, patient and clinic are different. You definitely want to speak with your own #fertilityspecialist about your options.
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Oh, for pizza 🍕 and veggies 🌽- Always fresh!
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These posts are for educational 📓purposes only.
Fresh vs. Frozen? We are not talking veggies or pizza ... We are talking embryos. . An #embryotransfer  can be performed one of two ways. . Fresh —> It is part of the #ivfcycle . After the retrieval the patient starts progesterone to prepare the lining for implantation. At my practice this is almost always a day 5 (blastocyst stage) transfer. Day 3 transfers used to be common, but now most #ivf  centers prefer a day 5 transfer - they have higher success rates. . Frozen —> It is typically performed after the IVF cycle. The patient has a menses and we can plan the transfer the next month (or months/years later). The patient typically starts estrogen and once the lining thickens we add progesterone to prepare the uterus for the transfer. . Personally, we perform far more frozen transfers than fresh transfers. The reasons for that? . 1. More and more of our patients are opting for PGT-A testing of their embryos. That means the embryos must be frozen after the biopsy while we wait for the embryo results. 2. Patients with high ovarian response (lots of eggs and high estradiol levels) are at risk of ovarian hyperstimulation and it is better not to get pregnant in that situation. 3. There is data to support that frozen embryo transfers are better for the baby. They tend to stay in the uterus a little longer and have a slightly higher live birth rate. 4. A lot of clinics have higher success rates with frozen transfers. This is for many different reasons (some of which are patient related), so frequently the decision for a #frozenembryotransfer  may be patient or practice preference. . Every situation, patient and clinic are different. You definitely want to speak with your own #fertilityspecialist  about your options. . . Oh, for pizza 🍕 and veggies 🌽- Always fresh! . . . These posts are for educational 📓purposes only.
Endometrial receptivity array.
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I have received quite a few DMs and questions about Endometrial receptivity array (ERA) testing. So, let’s look into it:
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1. What is it? ERA is a biopsy of the endometrium that is performed at the time of a “typical” #embryotransfer. Meaning you prepare the uterus for a transfer, but instead of placing an embryo in the cavity your #fertilityspecialist performs an endometrial biopsy to obtain tissue lining. That tissue is then sent to an outside company to look for specific genes that are expressed when the uterus is typically receptive to an embryo implanting.
2. What is it looking for? The ERA is assessing if the time an embryo is being put back into the uterus is the correct time for that patient. Meaning, we know there is a specific “window of implantation” for every woman, we used to think it was the same for everyone, but we have found it is actually not universal. So, this test is designed to find the right time to perform an embryo transfer for an individual. Ie. #personalizedmedicine 
3. Is there data to support this testing? Yes, there is a little data (on a fairly small number of patients) out there to support using this test in women with a history of recurrent implantation failure (RIF). RIF = failure to have implantation of 3 or more high quality embryos. This being said- doing this test does NOT mean your implantation rate sky-rockets. They have found patients without RIF are “not receptive” 12% of the time, whereas it is 25% in those with RIF. Those with RIF that then had an appropriately timed transfer had a 50% pregnancy rate (Again, NOT 100%).
4. When do I perform an ERA? I think the test has value for patients who have RIF of 3 untested (no PGT-A) embryos, failure to implant 1-2 euploid embryos or in those older women who have only 1 euploid embryo and have a low chance of having another successful IVF cycle.
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I hope this helps! I think ERA has promise, but also has limitations. It is likely a piece of the very important #fertility puzzle.
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These posts are for educational 📓purposes only.
Endometrial receptivity array. . I have received quite a few DMs and questions about Endometrial receptivity array (ERA) testing. So, let’s look into it: . 1. What is it? ERA is a biopsy of the endometrium that is performed at the time of a “typical” #embryotransfer . Meaning you prepare the uterus for a transfer, but instead of placing an embryo in the cavity your #fertilityspecialist  performs an endometrial biopsy to obtain tissue lining. That tissue is then sent to an outside company to look for specific genes that are expressed when the uterus is typically receptive to an embryo implanting. 2. What is it looking for? The ERA is assessing if the time an embryo is being put back into the uterus is the correct time for that patient. Meaning, we know there is a specific “window of implantation” for every woman, we used to think it was the same for everyone, but we have found it is actually not universal. So, this test is designed to find the right time to perform an embryo transfer for an individual. Ie. #personalizedmedicine  3. Is there data to support this testing? Yes, there is a little data (on a fairly small number of patients) out there to support using this test in women with a history of recurrent implantation failure (RIF). RIF = failure to have implantation of 3 or more high quality embryos. This being said- doing this test does NOT mean your implantation rate sky-rockets. They have found patients without RIF are “not receptive” 12% of the time, whereas it is 25% in those with RIF. Those with RIF that then had an appropriately timed transfer had a 50% pregnancy rate (Again, NOT 100%). 4. When do I perform an ERA? I think the test has value for patients who have RIF of 3 untested (no PGT-A) embryos, failure to implant 1-2 euploid embryos or in those older women who have only 1 euploid embryo and have a low chance of having another successful IVF cycle. . I hope this helps! I think ERA has promise, but also has limitations. It is likely a piece of the very important #fertility  puzzle. . . . These posts are for educational 📓purposes only.
#mondaymotivation... because who doesn’t wish that the weekend could last one more day?@!
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#longerweekendplease #ivf #infertility #ttcsisters #fertility #centerofreproductivemedicine #infertilitytexas #infertilitysucks #viewfromthetop
Good times with #coworkers and #friends that have become #family. A night filled with so much fun @TopGolf!
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There are friends, there is family, and then there are friends that become family.
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#workfamily #oneteam #bettertogether #OurFamilyHelpsMakeFamilies #employeeappreciation #employeeperks #coworkers #team #squad #squadgoals #greattimeswithgreatpeople #topgolfwebster #CenterOfReproductiveMedicine
Good times with #coworkers and #friends that have become #family. A night filled with so much fun @TopGolf!
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There are friends, there is family, and then there are friends that become family.
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#workfamily #oneteam #bettertogether #OurFamilyHelpsMakeFamilies #employeeappreciation #employeeperks #coworkers #team #squad #squadgoals #greattimeswithgreatpeople #topgolfwebster #CenterOfReproductiveMedicine #InfertilityTexas
So this happened today in our #Houston office... @infertilitydrperfetto was able to share the exciting news with our patient and her husband that they are one of three $10K #IVFGiveaway WINNERS!
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#centerofreproductivemedicine #ivf #infertility #fertility #ttc #ttcsisters #miraclemakers #tearsofjoy
#Congratulations to the three lucky winners of our 2018 Summer IVF Giveaway!!! ♥️♥️♥️
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Each winner was randomly selected to receive $10,000 in reimbursement for IVF services from the #CenterofReproductiveMedicine.

Thank you to everyone who participated and helped make this contest a success.
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#IVFGiveaway #InfertilityTexas #ttc #MakingMiraclesHappen
Preimplantation genetic testing (PGT) is additional testing that can be added to an #ivfcycle.
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There are two different types of PGT:
1. Aneuploidy (PGT-A, also referred to as PGS)- this is the most common type and what I will focus on in this post. It tests each embryo to determine if it has the correct number of chromosomes. It can also identify gender.
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2. Monogenic/Single gene disorder (PGT-M, also referred to as PGD)- tests for a specific disease that the two parents carry and are at risk of passing on to their children.
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Once the decision has been made to proceed with #ivf, I discuss the option of adding PGT-A of the #embryos (also commonly referred to as an #embryo biopsy).
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Once the embryo develops into a blastocyst (day 5 or 6) it is biopsied in the #embryology lab. The #embryologist removes 5-6 cells off of the blastocyst (specifically the trophectoderm- the cells that are destined to become the placenta) and sends those cells to an outside lab for PGT-A analysis.
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The outside lab then identifies which embryos have the “normal” number of chromosomes- either 46,XX (girl) or 46,XY (boy) karyotype vs. those with an “abnormal” number of chromosomes.
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Those embryos with a gain or loss of certain chromosomes will most frequently lead to no pregnancy, miscarriage or a child with developmental delay. So this testing helps couples identify which embryo to transfer to improve the odds of a healthy live birth.
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This testing is not for everyone. At this time around 50-60% of my patients add PGT-A to their IVF cycles, but it is not required. In some patients it is more valuable than in others. I encourage anyone interested to discuss this option with their #fertilityspecialist.
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#Repost @infertilitydrperfetto
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These posts is for educational 📓purposes only.
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#ivfjourney #ivfsuccess #ivfcommunity #infertility #infertilitysucks #infertilityhurts #infertilityblogger #ttc #ttcsupport #ttccommunity #fertility #fertilityjourney #fertilityawareness #fertilitytreatment #obgyn #doctorsoffice #houstondoctors #somedoc #centerofreproductivemedicine #drperfetto
Preimplantation genetic testing (PGT) is additional testing that can be added to an #ivfcycle . . There are two different types of PGT: 1. Aneuploidy (PGT-A, also referred to as PGS)- this is the most common type and what I will focus on in this post. It tests each embryo to determine if it has the correct number of chromosomes. It can also identify gender. . 2. Monogenic/Single gene disorder (PGT-M, also referred to as PGD)- tests for a specific disease that the two parents carry and are at risk of passing on to their children. . Once the decision has been made to proceed with #ivf , I discuss the option of adding PGT-A of the #embryos  (also commonly referred to as an #embryo  biopsy). . Once the embryo develops into a blastocyst (day 5 or 6) it is biopsied in the #embryology  lab. The #embryologist  removes 5-6 cells off of the blastocyst (specifically the trophectoderm- the cells that are destined to become the placenta) and sends those cells to an outside lab for PGT-A analysis. . The outside lab then identifies which embryos have the “normal” number of chromosomes- either 46,XX (girl) or 46,XY (boy) karyotype vs. those with an “abnormal” number of chromosomes. . Those embryos with a gain or loss of certain chromosomes will most frequently lead to no pregnancy, miscarriage or a child with developmental delay. So this testing helps couples identify which embryo to transfer to improve the odds of a healthy live birth. . This testing is not for everyone. At this time around 50-60% of my patients add PGT-A to their IVF cycles, but it is not required. In some patients it is more valuable than in others. I encourage anyone interested to discuss this option with their #fertilityspecialist . . #Repost  @infertilitydrperfetto . . . These posts is for educational 📓purposes only. . . . #ivfjourney  #ivfsuccess  #ivfcommunity  #infertility  #infertilitysucks  #infertilityhurts  #infertilityblogger  #ttc  #ttcsupport  #ttccommunity  #fertility  #fertilityjourney  #fertilityawareness  #fertilitytreatment  #obgyn  #doctorsoffice  #houstondoctors  #somedoc  #centerofreproductivemedicine  #drperfetto 
Preimplantation genetic testing (PGT) is additional testing that can be added to an #ivfcycle.
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There are two different types of PGT:
1. Aneuploidy (PGT-A, also referred to as PGS)- this is the most common type and what I will focus on in this post. It tests each embryo to determine if it has the correct number of chromosomes. It can also identify gender.
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2. Monogenic/Single gene disorder (PGT-M, also referred to as PGD)- tests for a specific disease that the two parents carry and are at risk of passing on to their children.
.
Once the decision has been made to proceed with #ivf, I discuss the option of adding PGT-A of the #embryos (also commonly referred to as an #embryo biopsy).
.
Once the embryo develops into a blastocyst (day 5 or 6) it is biopsied in the #embryology lab. The #embryologist removes 5-6 cells off of the blastocyst (specifically the trophectoderm- the cells that are destined to become the placenta) and sends those cells to an outside lab for PGT-A analysis.
.
The outside lab then identifies which embryos have the “normal” number of chromosomes- either 46,XX (girl) or 46,XY (boy) karyotype vs. those with an “abnormal” number of chromosomes.
.
Those embryos with a gain or loss of certain chromosomes will most frequently lead to no pregnancy, miscarriage or a child with developmental delay. So this testing helps couples identify which embryo to transfer to improve the odds of a healthy live birth.
.
This testing is not for everyone. At this time around 50-60% of my patients add PGT-A to their IVF cycles, but it is not required. In some patients it is more valuable than in others. I encourage anyone interested to discuss this option with their #fertilityspecialist.
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These posts is for educational 📓purposes only.
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#ivfjourney #ivfsuccess #ivfcommunity #infertility #infertilitysucks #infertilityhurts #infertilityblogger #ttc #ttcsupport #ttccommunity #fertility #fertilityjourney #fertilityawareness #fertilitytreatment #obgyn #doctorsoffice #houstondoctors #somedoc #centerofreproductivemedicine #drperfetto
Preimplantation genetic testing (PGT) is additional testing that can be added to an #ivfcycle . . There are two different types of PGT: 1. Aneuploidy (PGT-A, also referred to as PGS)- this is the most common type and what I will focus on in this post. It tests each embryo to determine if it has the correct number of chromosomes. It can also identify gender. . 2. Monogenic/Single gene disorder (PGT-M, also referred to as PGD)- tests for a specific disease that the two parents carry and are at risk of passing on to their children. . Once the decision has been made to proceed with #ivf , I discuss the option of adding PGT-A of the #embryos  (also commonly referred to as an #embryo  biopsy). . Once the embryo develops into a blastocyst (day 5 or 6) it is biopsied in the #embryology  lab. The #embryologist  removes 5-6 cells off of the blastocyst (specifically the trophectoderm- the cells that are destined to become the placenta) and sends those cells to an outside lab for PGT-A analysis. . The outside lab then identifies which embryos have the “normal” number of chromosomes- either 46,XX (girl) or 46,XY (boy) karyotype vs. those with an “abnormal” number of chromosomes. . Those embryos with a gain or loss of certain chromosomes will most frequently lead to no pregnancy, miscarriage or a child with developmental delay. So this testing helps couples identify which embryo to transfer to improve the odds of a healthy live birth. . This testing is not for everyone. At this time around 50-60% of my patients add PGT-A to their IVF cycles, but it is not required. In some patients it is more valuable than in others. I encourage anyone interested to discuss this option with their #fertilityspecialist . . . . These posts is for educational 📓purposes only. . . . #ivfjourney  #ivfsuccess  #ivfcommunity  #infertility  #infertilitysucks  #infertilityhurts  #infertilityblogger  #ttc  #ttcsupport  #ttccommunity  #fertility  #fertilityjourney  #fertilityawareness  #fertilitytreatment  #obgyn  #doctorsoffice  #houstondoctors  #somedoc  #centerofreproductivemedicine  #drperfetto 
#MiracleMonday of the week... We love hearing these beautiful stories from our patients.
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These are my CORM Miracles Landon and Leo they were born on 2-12-16.  They are now about to be 2 and a half.  After 11 years of infertility struggles due to PCOS I was sent to CORM through a friend who’s daughter worked at CORM, Marilyn Bean.  I was told Dr. Schnell was the best.  After reading the mission statement of the practice I was sold.  I made an appointment and begin treatments immediately.  The best route for me was IVF I was 34 years old when we began that November.  We implant our first embryo on December 23rd, 2014 which resulted in pregnancy, but I miscarried at almost 6 weeks.  We were heart broken but had many frozen embryos left so we tried again in April implanting 2 and it didn’t work.  I was emotionally drained but I decided to give it a 3rd try we implanted 2 frozen embryos this time in June.  I didn’t know how to think or feel.  I tried to not get my hopes up and get excited, but after my 2WW, I got the call your pregnant.  Not only did I get 2 lines,  I was pregnant with twins.  Both embryos had stuck.  We were beyond excited and the pregnancy was almost perfect.  I delivered 2 perfect and healthy boys at 35.2 weeks just a little over a year since our CORM journey had begun.  They have brought so much joy to our lives.  I am forever grateful to Dr. Schnell and her wonderful staff for helping make our dreams come true.  One goal. Two lines.
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#ivf #ivfwarriors #ivfjourney #centerofreproductivemedicine #infertilitytexas #infertility #ttc #ttcsisters
#MiracleMonday  of the week... We love hearing these beautiful stories from our patients. . These are my CORM Miracles Landon and Leo they were born on 2-12-16. They are now about to be 2 and a half. After 11 years of infertility struggles due to PCOS I was sent to CORM through a friend who’s daughter worked at CORM, Marilyn Bean. I was told Dr. Schnell was the best. After reading the mission statement of the practice I was sold. I made an appointment and begin treatments immediately. The best route for me was IVF I was 34 years old when we began that November. We implant our first embryo on December 23rd, 2014 which resulted in pregnancy, but I miscarried at almost 6 weeks. We were heart broken but had many frozen embryos left so we tried again in April implanting 2 and it didn’t work. I was emotionally drained but I decided to give it a 3rd try we implanted 2 frozen embryos this time in June. I didn’t know how to think or feel. I tried to not get my hopes up and get excited, but after my 2WW, I got the call your pregnant. Not only did I get 2 lines, I was pregnant with twins. Both embryos had stuck. We were beyond excited and the pregnancy was almost perfect. I delivered 2 perfect and healthy boys at 35.2 weeks just a little over a year since our CORM journey had begun. They have brought so much joy to our lives. I am forever grateful to Dr. Schnell and her wonderful staff for helping make our dreams come true. One goal. Two lines. . #ivf  #ivfwarriors  #ivfjourney  #centerofreproductivemedicine  #infertilitytexas  #infertility  #ttc  #ttcsisters 
Sometimes you just need to have fun. Let your hair down, grab a cocktail and swing a golf club as hard as you can.
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Love that I got to do this tonight with my amazing staff! So thankful that be part of the Center of Reproductive Medicine!❤️
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#topgolf #centerofreproductivemedicine #workhardplayhard #ilovemyjob #ttccommunity #infertility #infertilitytexas #houstondoctors #houstonblogger #drperfetto
Sometimes you need to phone a friend. Today was that day for me...
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For the past few weeks I have been struggling. After months of positive pregnancy tests, beautiful ultrasounds with squirmy babies and first trimester graduations I have hit a wall. This wall is made of bricks and it is leaving me bruised.
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In the last 3 weeks I have had more negative pregnancy tests, pregnancies of unknown location and miscarriages than I had all year. I doubt it will surprise anyone when I tell you that a negative pregnancy test sticks with me for weeks. I think about everything I did, what I could have changed, I hound my #embryologist about the transfer  and then I stew over the loss.
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I know this is incredibly unhealthy. I know that I cannot have a 100% live birth rate (even though I sure do try).
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So today, after I diagnosed my patient with her third pregnancy loss and I was just about to lose it I called my #fertilityspecialist bestie Amelia.
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This girl is my go-to girl; she is smart, funny, (attractive😉) and she tells me how it is. I needed her today and she stepped up to remind me that I cannot get everyone pregnant every time. We try our best, we are kick a** doctors and that is not something we should forget. Our patients appreciate how hard we try, but they know we do not have complete control over life.
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So, I’m going to pick myself up and remember her smarty pants words. I will continue to try my best, do my best for my patients and be grateful for the supportive friends and family I have like her.
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#ivf #ivfcycle #ivfsupport #fertility #fertilityawareness #fertilityjourney #infertility #infertilitysucks #infertilityhurts #infertilitysisters #ttc #ttcaftermiscarriage #miscarriage #miscarriageawareness #recurrentmiscarriage #ttcsupport #ttccommunity #infertilityblogger #obgyn #medstudent #medschool #premed #houstondoctors #somedoc #centerofreproductivemedicine #drperfetto
Sometimes you need to phone a friend. Today was that day for me... . For the past few weeks I have been struggling. After months of positive pregnancy tests, beautiful ultrasounds with squirmy babies and first trimester graduations I have hit a wall. This wall is made of bricks and it is leaving me bruised. . In the last 3 weeks I have had more negative pregnancy tests, pregnancies of unknown location and miscarriages than I had all year. I doubt it will surprise anyone when I tell you that a negative pregnancy test sticks with me for weeks. I think about everything I did, what I could have changed, I hound my #embryologist  about the transfer and then I stew over the loss. . I know this is incredibly unhealthy. I know that I cannot have a 100% live birth rate (even though I sure do try). . So today, after I diagnosed my patient with her third pregnancy loss and I was just about to lose it I called my #fertilityspecialist  bestie Amelia. . This girl is my go-to girl; she is smart, funny, (attractive😉) and she tells me how it is. I needed her today and she stepped up to remind me that I cannot get everyone pregnant every time. We try our best, we are kick a** doctors and that is not something we should forget. Our patients appreciate how hard we try, but they know we do not have complete control over life. . So, I’m going to pick myself up and remember her smarty pants words. I will continue to try my best, do my best for my patients and be grateful for the supportive friends and family I have like her. . . . #ivf  #ivfcycle  #ivfsupport  #fertility  #fertilityawareness  #fertilityjourney  #infertility  #infertilitysucks  #infertilityhurts  #infertilitysisters  #ttc  #ttcaftermiscarriage  #miscarriage  #miscarriageawareness  #recurrentmiscarriage  #ttcsupport  #ttccommunity  #infertilityblogger  #obgyn  #medstudent  #medschool  #premed  #houstondoctors  #somedoc  #centerofreproductivemedicine  #drperfetto 
Today the first baby born from In Vitro Fertilization turns 40 years old.
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Since the first birth from #ivf in 1978, it is estimated that 8 million people have been born through this technology. In the United States, 1-2% of all babies born each year are conceived with the help of #invitro.
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I feel so blessed to be a part of this celebration today. I absolutely love what I do, how IVF has helped build so many beautiful families and how much this field grows every year!
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A special thank you to my amazing staff in the Houston Medical Center, the entire #centerofreproductivemedicine family and most definitely our amazing #embryologists who make IVF possible everyday.
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Happy birthday Louise Brown!🎂
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#happybirthdaylouisebrown  #happy40thbirthdaylouisebrown #ivfis40 #ivfsuccess #ivfcycle #ivfsupport #ivfcommunity #ivfpregnancy #ivfjourney #infertility #infertilitysisters #infertilityhurts #fertility #fertilityjourney #fertilityspecialist #fertilityawareness #fertilitytreatment #infertilityblogger #houstondoctors #somedoc #onegoaltwolines #drperfetto
Today the first baby born from In Vitro Fertilization turns 40 years old. . Since the first birth from #ivf  in 1978, it is estimated that 8 million people have been born through this technology. In the United States, 1-2% of all babies born each year are conceived with the help of #invitro . . I feel so blessed to be a part of this celebration today. I absolutely love what I do, how IVF has helped build so many beautiful families and how much this field grows every year! . A special thank you to my amazing staff in the Houston Medical Center, the entire #centerofreproductivemedicine  family and most definitely our amazing #embryologists  who make IVF possible everyday. . . . Happy birthday Louise Brown!🎂 . . . #happybirthdaylouisebrown  #happy40thbirthdaylouisebrown  #ivfis40  #ivfsuccess  #ivfcycle  #ivfsupport  #ivfcommunity  #ivfpregnancy  #ivfjourney  #infertility  #infertilitysisters  #infertilityhurts  #fertility  #fertilityjourney  #fertilityspecialist  #fertilityawareness  #fertilitytreatment  #infertilityblogger  #houstondoctors  #somedoc  #onegoaltwolines  #drperfetto 
6 days ago I posted about an #eggretrieval. It is only fitting that today - day 5 for an embryo retrieved last Thursday - is the day I post about #embryotransfer.
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Once you get through the #ivf prep cycle, IVF stim cycle, egg retrieval and daily updates from the #embryology lab about your embryos, the actual embryo transfer is easy.
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I will start by pointing out that on day 5 (#blastocyst stage) the embryos will undergo either:
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1. Embryo transfer of one #embryo and cryopreservation of remaining #embryos
2. Cryopreservation of all embryos (common if a #fertilityspecialist is concerned about ovarian hyperstimulation)
3. Embryo biopsy for genetic testing of the embryos, followed by cryopreservation
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I will post today specifically on the embryo transfer. Future posts will look at genetic testing, ovarian hyperstimulation, and frozen embryo transfers.
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For a fresh embryo transfer the patient will take estrogen and progesterone (as directed) after the retrieval. The day of the embryo transfer she will arrive at the clinic with a full bladder. She will know how full her bladder needs to be because I perform a practice transfer in the IVF prep stage to be sure the process will be easy.
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Just like the retrieval, she will walk back to the #operatingroom and once there she will be positioned on the operating room table. Our embryologist will confirm your identity and we will sign consents for the transfer.
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We will administer Valium to help relax the patient and her uterus. My super-star MA will perform an abdominal ultrasound to confirm the bladder is full and the position of the uterus. A full bladder is essential because water in the bladder helps us to visualize the uterus on ultrasound. This helps me guide the embryo (in a catheter) through the cervix and then into the uterus with minimal trauma to the uterine lining and embryo.
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After the transfer we have you relax for 30 minutes. You can then empty your bladder and head home. We encourage our patients to take off 2-3 days to relax at home- home rest, not bed rest!
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Two weeks later we check an hCG level and will let you know if your little #embaby stuck!
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These posts are for educational purposes only.
6 days ago I posted about an #eggretrieval . It is only fitting that today - day 5 for an embryo retrieved last Thursday - is the day I post about #embryotransfer . . Once you get through the #ivf  prep cycle, IVF stim cycle, egg retrieval and daily updates from the #embryology  lab about your embryos, the actual embryo transfer is easy. . I will start by pointing out that on day 5 (#blastocyst  stage) the embryos will undergo either: . 1. Embryo transfer of one #embryo  and cryopreservation of remaining #embryos  2. Cryopreservation of all embryos (common if a #fertilityspecialist  is concerned about ovarian hyperstimulation) 3. Embryo biopsy for genetic testing of the embryos, followed by cryopreservation . I will post today specifically on the embryo transfer. Future posts will look at genetic testing, ovarian hyperstimulation, and frozen embryo transfers. . For a fresh embryo transfer the patient will take estrogen and progesterone (as directed) after the retrieval. The day of the embryo transfer she will arrive at the clinic with a full bladder. She will know how full her bladder needs to be because I perform a practice transfer in the IVF prep stage to be sure the process will be easy. . Just like the retrieval, she will walk back to the #operatingroom  and once there she will be positioned on the operating room table. Our embryologist will confirm your identity and we will sign consents for the transfer. . We will administer Valium to help relax the patient and her uterus. My super-star MA will perform an abdominal ultrasound to confirm the bladder is full and the position of the uterus. A full bladder is essential because water in the bladder helps us to visualize the uterus on ultrasound. This helps me guide the embryo (in a catheter) through the cervix and then into the uterus with minimal trauma to the uterine lining and embryo. . After the transfer we have you relax for 30 minutes. You can then empty your bladder and head home. We encourage our patients to take off 2-3 days to relax at home- home rest, not bed rest! . Two weeks later we check an hCG level and will let you know if your little #embaby  stuck! . . . These posts are for educational purposes only.
11 seconds. During a medical visit, the clinician interrupts a patient after a median of 11 seconds.
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A recent article, published in the Journal of General Internal Medicine, found that medical practitioners seldom elicited the patients agenda (only 36% of the time). They also found that in visits where the agenda was addressed, the clinician interrupted the patient within 11 seconds (range 7-22 seconds). It was worse in specialty clinics compared to primary care.
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This is disheartening. In medicine communication is paramount to diagnosis and a strong patient-physician relationship. If the #physician and patients do not speak, listen and communicate efficiently with each other neither will feel satisfied at the conclusion of the visit.
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This article reminds me how lucky I am that I chose to specialize in #fertility and reproductive medicine. I remember being a resident in #obgyn - struggling to get through a full clinic, rushing to a delivery and then trying to remember and document everything from the day. Time was the enemy and I definitely did not feel I had the same relationship with my patients that I do now.
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I love that a typical day in my office allows me 60 minutes for new patients- which I definitely wait more than 11 seconds to start talking. I also have 30 minute spots for return visits which typically allows my patients to be heard and me to teach.
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I try so hard not to run behind, but sometimes I do and when that happens I still try and give every patient the time she or he deserves.
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When all is said and done, I will continue to work on addressing the agenda and concerns of my patients.
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#patientcenteredcare #doctor #md #doctorlife #attending #medstudent #premed #medschool #medicalschool #infertility #infertilitysucks #infertilityblogger #ttc #ttcsupport #ttcjourney #houstondoctors #fertilityjourney #fertilityspecialist #fertilityawareness #somedoc #centerofreproductivemedicine
11 seconds. During a medical visit, the clinician interrupts a patient after a median of 11 seconds. . A recent article, published in the Journal of General Internal Medicine, found that medical practitioners seldom elicited the patients agenda (only 36% of the time). They also found that in visits where the agenda was addressed, the clinician interrupted the patient within 11 seconds (range 7-22 seconds). It was worse in specialty clinics compared to primary care. . This is disheartening. In medicine communication is paramount to diagnosis and a strong patient-physician relationship. If the #physician  and patients do not speak, listen and communicate efficiently with each other neither will feel satisfied at the conclusion of the visit. . This article reminds me how lucky I am that I chose to specialize in #fertility  and reproductive medicine. I remember being a resident in #obgyn  - struggling to get through a full clinic, rushing to a delivery and then trying to remember and document everything from the day. Time was the enemy and I definitely did not feel I had the same relationship with my patients that I do now. . I love that a typical day in my office allows me 60 minutes for new patients- which I definitely wait more than 11 seconds to start talking. I also have 30 minute spots for return visits which typically allows my patients to be heard and me to teach. . I try so hard not to run behind, but sometimes I do and when that happens I still try and give every patient the time she or he deserves. . When all is said and done, I will continue to work on addressing the agenda and concerns of my patients. . . . #patientcenteredcare  #doctor  #md  #doctorlife  #attending  #medstudent  #premed  #medschool  #medicalschool  #infertility  #infertilitysucks  #infertilityblogger  #ttc  #ttcsupport  #ttcjourney  #houstondoctors  #fertilityjourney  #fertilityspecialist  #fertilityawareness  #somedoc  #centerofreproductivemedicine 
Some days you need a pick me up. In my opinion, there is not much better than a box of @cravecupcakeshtx.
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Today, I was heartbroken for a patient of mine who did not get pregnant after an #embryotransfer of her only normal embryo. I was sick to my stomach when my nurse told me her hcg level was negative.
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We did everything we could to get her pregnant and still we did not get her there. The pit in my stomach is indescribable.
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As I sat teary-eyed in my office after calling her, my nurse came in and reminded me that we did everything we could to help her conceive.
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She then reminded me that as hard as it is we must accept that we do everything we can and sometimes it just does not work. Do not focus only on the lost pregnancies; remember the many successful pregnancies we see every day.
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Then, just like magic, this box of cupcakes arrived from a patient that graduated from our care on Tuesday. The couple was so ecstatic about their pregnancy their excitement was infectious.
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Thank you very much for reminding me that we try our best and sometimes we succeed. We can mourn the losses, but also must celebrate our successes!
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#ivf #ivfcycle #ivfjourney #ivfsuccess #ivfsupport #ttc #ttcsisters #ttccommunity #ttcsupport #infertility #infertilitysisters #infertilityhurts #infertilitysucks #fertilityjourney #fertilityawareness #fertilitytreatment #houstondoctors #houstonblogger #centerofreproductivemedicine #drperfetto
Some days you need a pick me up. In my opinion, there is not much better than a box of @cravecupcakeshtx. . Today, I was heartbroken for a patient of mine who did not get pregnant after an #embryotransfer  of her only normal embryo. I was sick to my stomach when my nurse told me her hcg level was negative. . We did everything we could to get her pregnant and still we did not get her there. The pit in my stomach is indescribable. . As I sat teary-eyed in my office after calling her, my nurse came in and reminded me that we did everything we could to help her conceive. . She then reminded me that as hard as it is we must accept that we do everything we can and sometimes it just does not work. Do not focus only on the lost pregnancies; remember the many successful pregnancies we see every day. . Then, just like magic, this box of cupcakes arrived from a patient that graduated from our care on Tuesday. The couple was so ecstatic about their pregnancy their excitement was infectious. . Thank you very much for reminding me that we try our best and sometimes we succeed. We can mourn the losses, but also must celebrate our successes! . . . #ivf  #ivfcycle  #ivfjourney  #ivfsuccess  #ivfsupport  #ttc  #ttcsisters  #ttccommunity  #ttcsupport  #infertility  #infertilitysisters  #infertilityhurts  #infertilitysucks  #fertilityjourney  #fertilityawareness  #fertilitytreatment  #houstondoctors  #houstonblogger  #centerofreproductivemedicine  #drperfetto 
What happens after the IVF #eggretrieval?
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These images were provided to me by our Center of Reproductive Medicine #embryologist. These are images that they took in the #ivflab. These are also some of the images that they share with our patients at the IVF Seminar they hold a few times a month.
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Once the oocytes (eggs) leave the operating room, they move to the lab for fertilization and exceptional monitoring and care. Trust me when I say our #embryologists treat your #embabies like they are their very own!
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1. Retrieval day.
The egg is in the middle of the cumulus cells. The cumulus cells are removed and the egg is identified as mature, immature or atretic.
2. Mature egg. 
The eggs are inseminated via  #icsi (one sperm directly inserted into one egg) or standard IVF (millions of sperm surround an egg) depending on the diagnosis and sperm sample.
3. Fertilization day.
The embryos are checked to see if there are 2 pronuclei- meaning the sperm and egg both contributed DNA to the embryo. We typically expect about a 75% fertilization rate with a normal semen analysis.
4. 8-Cell stage.
This is typically seen on #embryo development day 3.
5. Blastocyst.
This is typically seen on day 5 or 6. This is the day we either perform an #embryotransfer, biopsy the embryo for genetic testing (PGT-A) and/or cryopreserve the #embryos.
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As I mentioned earlier, these pictures are from our #embryology lab. They also run an #ivf seminar for patients proceeding with IVF 4 times a month. This seminar is invaluable- it is educational and prepares our patients for the whole stressful process.
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They review every embryo and personally call our patients every day to update them on how things are progressing. They also keep in touch with us #fertility docs- which is no small feat - to make sure we also know what is going on. I am so very grateful to have such dedicated embryologists!
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It is important for me to point out that I am not an embryologist- specific questions about embryos are not something I can answer. I recommend you speak with your own IVF center or lab if you have those questions. These posts are for educational purposes only.
What happens after the IVF #eggretrieval ? . These images were provided to me by our Center of Reproductive Medicine #embryologist . These are images that they took in the #ivflab . These are also some of the images that they share with our patients at the IVF Seminar they hold a few times a month. . Once the oocytes (eggs) leave the operating room, they move to the lab for fertilization and exceptional monitoring and care. Trust me when I say our #embryologists  treat your #embabies  like they are their very own! . 1. Retrieval day. The egg is in the middle of the cumulus cells. The cumulus cells are removed and the egg is identified as mature, immature or atretic. 2. Mature egg. The eggs are inseminated via #icsi  (one sperm directly inserted into one egg) or standard IVF (millions of sperm surround an egg) depending on the diagnosis and sperm sample. 3. Fertilization day. The embryos are checked to see if there are 2 pronuclei- meaning the sperm and egg both contributed DNA to the embryo. We typically expect about a 75% fertilization rate with a normal semen analysis. 4. 8-Cell stage. This is typically seen on #embryo  development day 3. 5. Blastocyst. This is typically seen on day 5 or 6. This is the day we either perform an #embryotransfer , biopsy the embryo for genetic testing (PGT-A) and/or cryopreserve the #embryos . . As I mentioned earlier, these pictures are from our #embryology  lab. They also run an #ivf  seminar for patients proceeding with IVF 4 times a month. This seminar is invaluable- it is educational and prepares our patients for the whole stressful process. . They review every embryo and personally call our patients every day to update them on how things are progressing. They also keep in touch with us #fertility  docs- which is no small feat - to make sure we also know what is going on. I am so very grateful to have such dedicated embryologists! . . . It is important for me to point out that I am not an embryologist- specific questions about embryos are not something I can answer. I recommend you speak with your own IVF center or lab if you have those questions. These posts are for educational purposes only.
Look at this sweet fellow. Dr. Anu had the best visit not too long ago!
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This little guy visited me at the Memorial City office. He’s particularly special to me because he was the product of my first embryo transfer! I’m so happy I finally got to meet him. I hope we can bring him a little sister sometime soon ☺️ #InfertilityTexas #memorialcity #infertility #embryotransfer #centerofreproductivemedicine #toyhotdog #ivftransfer
Personalized medicine is such an exciting and interesting topic in the medical community.
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We are starting to see how genetic variations, specific tumor markers and individual biomarkers can help guide medical management and cancer treatment. It is exciting to see how precision medicine is advancing and I am eager to see how it will be applied to #fertilitytreatment in the future.
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In a recent publication of Fertility & Sterility (an #infertility journal most fertility doctors follow) there was a section dedicated to #personalizedmedicine. It brought up interesting points and possible challenges for the #fertility community.
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As a positive, it would be great to have specific biomarkers to identify which patients would have higher success rates with specific protocols, medications or timelines. I know I have personally had poor outcomes with one protocol and then switched it to another protocol and seen marked improvement. It would be in everyone’s best interest to start with the best option first, rather bounce between treatments to just find something that will work.
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From a challenge perspective, personalized medicine is likely to be incredibly costly at inception and there will be significant concerns and push-back about personal privacy.
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Whatever your opinion, it is an incredibly thought-provoking topic. It will be interesting to follow the progress of personalized medicine over the next few years to decades.
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#infertility #infertilitysisters #infertilityhurts #ttc #ttccommunity #ttcjourney #fertilityspecialist #fertilityawareness #fertilityjourney #ivf #iui #obgyn #surgery #doctor #medstudent #premed #premedstudent #medicalschool  #medschool #infertilityblogger #houstondoctors #somedoc #centerofreproductivemedicine #drperfetto
Personalized medicine is such an exciting and interesting topic in the medical community. . We are starting to see how genetic variations, specific tumor markers and individual biomarkers can help guide medical management and cancer treatment. It is exciting to see how precision medicine is advancing and I am eager to see how it will be applied to #fertilitytreatment  in the future. . In a recent publication of Fertility & Sterility (an #infertility  journal most fertility doctors follow) there was a section dedicated to #personalizedmedicine . It brought up interesting points and possible challenges for the #fertility  community. . As a positive, it would be great to have specific biomarkers to identify which patients would have higher success rates with specific protocols, medications or timelines. I know I have personally had poor outcomes with one protocol and then switched it to another protocol and seen marked improvement. It would be in everyone’s best interest to start with the best option first, rather bounce between treatments to just find something that will work. . From a challenge perspective, personalized medicine is likely to be incredibly costly at inception and there will be significant concerns and push-back about personal privacy. . Whatever your opinion, it is an incredibly thought-provoking topic. It will be interesting to follow the progress of personalized medicine over the next few years to decades. . . . #infertility  #infertilitysisters  #infertilityhurts  #ttc  #ttccommunity  #ttcjourney  #fertilityspecialist  #fertilityawareness  #fertilityjourney  #ivf  #iui  #obgyn  #surgery  #doctor  #medstudent  #premed  #premedstudent  #medicalschool  #medschool  #infertilityblogger  #houstondoctors  #somedoc  #centerofreproductivemedicine  #drperfetto 
This is reminding us that our #infertilityjourney isn’t always easy and most days it’s tougher than the one before, but where it leads us is often one of the most amazing places we’ve ever been.
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#ivfwarriors #ttc #ttccommunity #ttcsisters #fertility #infertilitysucks #infertility #infertilitytexas #centerofreproductivemedicine
Today I am taking a slight detour from our conversation about #ivf to discuss #diminishedovarianreserve (DOR). A lot of patients are confused about what it is, how it is diagnosed and what can be done about it.
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Just for basic knowledge- women are born with all the eggs we will ever have and we lose them throughout our reproductive years, until menopause when we no longer have eggs. The number and quality of eggs a woman has is considered her #ovarianreserve.
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Diminished ovarian reserve refers to a lower than average number of eggs or quality of eggs in a patient. The risk of DOR increases with advancing age, but can also be identified in younger patients as well (many of which have no risk factors). Other reasons patients may have DOR include a history of chemotherapy, genetic abnormalities, ovarian surgery or even #endometriosis. It is also more common in smokers! One of many reasons to quit!!
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To date, there is no universal DOR criteria, but most of us use a low AMH (<1.0 ng/ml), high FSH, low antral follicle count (<6) or previous poor response to an #ivfcycle to identify patients at risk.
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Most importantly, if we think you have DOR it does not mean you cannot get pregnant, you must do IVF immediately or you will not qualify for IVF at all. It may indicate it you will have a lower response to meds, you may need more aggressive protocols or you may need more treatment cycles to conceive.
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There is nothing you can do to change your ovarian reserve. You are born with a certain number of eggs and you lose them over time. You can however optimize your health to improve your pregnancy outcomes: maintain a normal BMI, reduce EtOH and caffeine, exercise moderately, take a daily PNV and Vitamin D. If you get #pregnant we want to optimize the chance of a live birth!
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All posts are for educational purposes only. They are not medical advice.
Today I am taking a slight detour from our conversation about #ivf  to discuss #diminishedovarianreserve  (DOR). A lot of patients are confused about what it is, how it is diagnosed and what can be done about it. . Just for basic knowledge- women are born with all the eggs we will ever have and we lose them throughout our reproductive years, until menopause when we no longer have eggs. The number and quality of eggs a woman has is considered her #ovarianreserve . . Diminished ovarian reserve refers to a lower than average number of eggs or quality of eggs in a patient. The risk of DOR increases with advancing age, but can also be identified in younger patients as well (many of which have no risk factors). Other reasons patients may have DOR include a history of chemotherapy, genetic abnormalities, ovarian surgery or even #endometriosis . It is also more common in smokers! One of many reasons to quit!! . To date, there is no universal DOR criteria, but most of us use a low AMH (<1.0 ng/ml), high FSH, low antral follicle count (<6) or previous poor response to an #ivfcycle  to identify patients at risk. . Most importantly, if we think you have DOR it does not mean you cannot get pregnant, you must do IVF immediately or you will not qualify for IVF at all. It may indicate it you will have a lower response to meds, you may need more aggressive protocols or you may need more treatment cycles to conceive. . There is nothing you can do to change your ovarian reserve. You are born with a certain number of eggs and you lose them over time. You can however optimize your health to improve your pregnancy outcomes: maintain a normal BMI, reduce EtOH and caffeine, exercise moderately, take a daily PNV and Vitamin D. If you get #pregnant  we want to optimize the chance of a live birth! . . . All posts are for educational purposes only. They are not medical advice.
My patients and staff are the best! I had a great birthday yesterday! I’m lucky to be surrounded by such kindness. Thanks for making my birthday a special one! 
#Infertilitytexas #corm #centerofreproductivemedicine #beststaffintheworld #birthday #almost40 😮 #wonderfulpatients🌹 #memorialcity #houston
In Vitro Fertilization 101🍍
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Let me start by saying there are MANY different #ivf protocols out there and hundreds of variations on each of the protocols. Every #fertilityspecialist and clinic may do things slightly different.
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That being said, in general, IVF works by using hormonal medications to increase the number of follicles (and eggs) you produce in a menstrual cycle. In a normal (unmedicated) cycle, a woman will produce 1 egg; in an IVF cycle she should produce more and that number varies depending on the patient’s #ovarianreserve.
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When choosing a protocol the #fertilitydoctor will typically take into account the patient’s age, ovarian reserve and sometimes the preference of the practice. The protocols I use most commonly are antagonist cycles (birth control or estrogen) or a flare cycles. I choose my protocol and med doses based on my patient.
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Typically, a patient will start birth control pills or estrogen during the menstrual cycle prior to the #ivf cycle. These are taken to stop your body from pre-selecting one dominant follicle during your #ivfcycle.
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You then stop those pre-IVF meds, start your period and then start ovarian stimulation medications. These are FSH and LH based meds- they basically mimic your own hormones (at higher doses). They are what stimulate your ovaries to produce more follicles.
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After a few days of stim you will be seen for an ultrasound and bloodwork to assess how you are responding. We will then adjust the meds up or down according to your response. We will also start a medication to stop your from ovulating the eggs at some point in the cycle - all based on your monitoring visits.
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We typically see you for monitoring every other day until your follicles are large enough to have a mature egg inside. At this time we will trigger your body to “release” the eggs. But right before you release them we will take them out using a transvaginal ultrasound approach (more on that later).
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Now this is just a brief description of IVF. It actually involves more details and visits than I can describe here. If you are interested in IVF I recommend you speak with your #doctor. These posts are for educational purposes only.
In Vitro Fertilization 101🍍 . Let me start by saying there are MANY different #ivf  protocols out there and hundreds of variations on each of the protocols. Every #fertilityspecialist  and clinic may do things slightly different. . That being said, in general, IVF works by using hormonal medications to increase the number of follicles (and eggs) you produce in a menstrual cycle. In a normal (unmedicated) cycle, a woman will produce 1 egg; in an IVF cycle she should produce more and that number varies depending on the patient’s #ovarianreserve . . When choosing a protocol the #fertilitydoctor  will typically take into account the patient’s age, ovarian reserve and sometimes the preference of the practice. The protocols I use most commonly are antagonist cycles (birth control or estrogen) or a flare cycles. I choose my protocol and med doses based on my patient. . Typically, a patient will start birth control pills or estrogen during the menstrual cycle prior to the #ivf  cycle. These are taken to stop your body from pre-selecting one dominant follicle during your #ivfcycle . . You then stop those pre-IVF meds, start your period and then start ovarian stimulation medications. These are FSH and LH based meds- they basically mimic your own hormones (at higher doses). They are what stimulate your ovaries to produce more follicles. . After a few days of stim you will be seen for an ultrasound and bloodwork to assess how you are responding. We will then adjust the meds up or down according to your response. We will also start a medication to stop your from ovulating the eggs at some point in the cycle - all based on your monitoring visits. . We typically see you for monitoring every other day until your follicles are large enough to have a mature egg inside. At this time we will trigger your body to “release” the eggs. But right before you release them we will take them out using a transvaginal ultrasound approach (more on that later). . Now this is just a brief description of IVF. It actually involves more details and visits than I can describe here. If you are interested in IVF I recommend you speak with your #doctor . These posts are for educational purposes only.
I have received a lot of questions recently about #ivf. Given this interest I am going to try and discuss it over the course of a few posts.
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Today, I will discuss the differences between #fertility treatment options. Later, I will discuss some of the protocols and medications common in ivf, what typically occurs during an #ivfcycle and what to expect at the #eggretrieval and #embryotransfer.
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Most patients have options when it comes to treatment: ovulation medication, intrauterine insemination (#iui ) or in vitro fertilization.
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Ovulation induction includes taking medications to help you ovulate 1 to a few eggs. I typically use either Letrozole or Clomid- which are oral medications. I may add a few days of injectable medications- which are actually IVF medications, but I give them at lower doses and for a shorter amount of time.
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IUI is usually added to ovulation medications. It involves taking a sperm sample, cleaning it up and then injecting it directly into the uterus. It puts the better looking sperm in the uterus, removing the non-moving and abnormal looking sperm from getting in the way.
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The above options are best and have the highest success rate if a female patient is not ovulating on her own (ie. #pcos) or the male has mild semen analysis abnormalities. Other couples can choose these options as well, but their chance of success may be lower.
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IVF is a more involved form of treatment. The above options augment a “normal” menstrual cycle, whereas IVF takes over the cycle. Similarly, an IUI cycle will take about 4weeks from start to +pregnancy test, whereas an IVF cycle can take 6-12weeks (depending on the protocol chosen and if genetic testing of the embryos is performed).
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IVF is typically the only option for a female with blocked fallopian tubes or a severely abnormal sperm analysis. It also may be the best option for other diagnoses. No matter what your fertility diagnosis IVF usually has the highest success rates of all treatments- so if the goal is the highest chance of conception then IVF is the best bet. That being said it may not be perfect for everyone.
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These posts are for educational purposes only. I cannot give medical advice.
I have received a lot of questions recently about #ivf . Given this interest I am going to try and discuss it over the course of a few posts. . Today, I will discuss the differences between #fertility  treatment options. Later, I will discuss some of the protocols and medications common in ivf, what typically occurs during an #ivfcycle  and what to expect at the #eggretrieval  and #embryotransfer . . Most patients have options when it comes to treatment: ovulation medication, intrauterine insemination (#iui  ) or in vitro fertilization. . Ovulation induction includes taking medications to help you ovulate 1 to a few eggs. I typically use either Letrozole or Clomid- which are oral medications. I may add a few days of injectable medications- which are actually IVF medications, but I give them at lower doses and for a shorter amount of time. . IUI is usually added to ovulation medications. It involves taking a sperm sample, cleaning it up and then injecting it directly into the uterus. It puts the better looking sperm in the uterus, removing the non-moving and abnormal looking sperm from getting in the way. . The above options are best and have the highest success rate if a female patient is not ovulating on her own (ie. #pcos ) or the male has mild semen analysis abnormalities. Other couples can choose these options as well, but their chance of success may be lower. . IVF is a more involved form of treatment. The above options augment a “normal” menstrual cycle, whereas IVF takes over the cycle. Similarly, an IUI cycle will take about 4weeks from start to +pregnancy test, whereas an IVF cycle can take 6-12weeks (depending on the protocol chosen and if genetic testing of the embryos is performed). . IVF is typically the only option for a female with blocked fallopian tubes or a severely abnormal sperm analysis. It also may be the best option for other diagnoses. No matter what your fertility diagnosis IVF usually has the highest success rates of all treatments- so if the goal is the highest chance of conception then IVF is the best bet. That being said it may not be perfect for everyone. . . . These posts are for educational purposes only. I cannot give medical advice.
Thank you to everyone that entered to win our New Patient Consultation #giveaway. We are so happy to announce the 5 winners below. Please PM us directly so that we can schedule your appointments today.
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@kodalymusicteacher
@krystal_garner
@🎀Mizz_6ossladii_👑
@_casandraa.s_
@rebukeyouinjesusname
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#Infertility #ivf #ttc #ttccommunity #ttcsisters #CenterOfReproductiveMedicine #infertilityjourney #infertilityhurts #infertilitysucks #fertility #fertilitytreatment #onegoaltwolines #Houston #Beaumont #Pearland #MemorialCity #ClearLake #Webster
Thank you to everyone that entered to win our New Patient Consultation #giveaway . We are so happy to announce the 5 winners below. Please PM us directly so that we can schedule your appointments today. . . . @kodalymusicteacher @krystal_garner @🎀Mizz_6ossladii_👑 @_casandraa.s_ @rebukeyouinjesusname . . . #Infertility  #ivf  #ttc  #ttccommunity  #ttcsisters  #CenterOfReproductiveMedicine  #infertilityjourney  #infertilityhurts  #infertilitysucks  #fertility  #fertilitytreatment  #onegoaltwolines  #Houston  #Beaumont  #Pearland  #MemorialCity  #ClearLake  #Webster 
The goal of cycle management with #iui is recruitment of 1-2 follicles (if you do not ovulate) or 2-3 follicles (if you do ovulate). When you recruit more than 3 mature #follicles from the stimulation medications there is a concern about a pregnancy with multiple babies.
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The goals for #fertilitytreatment have shifted drastically since the first #ivfpregnancy 40 years ago. What used to be a goal of ANY #pregnancy is now one of a healthy singleton pregnancy. The reason for this shift is that success rates are so much higher now and the risks of multiples are markedly higher for both the mother and babies. These risks are high for twins, even higher for triplets!
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This is the reason that I will occasionally convert a patient from IUI to #ivf. It’s actually an easy process and it can save the patient a lot of $ (fewer meds and less monitoring).
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Typically a patient will come for a mid-cycle ultrasound and if she has >4 follicles over 14mm and more mid-sized follicles (12-14mm) right behind those, we can consider converting to an IVF cycle. Importantly, the hormone levels cannot indicate an LH surge.
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Now, this does not happen frequently. It is actually quite rare, but in my patients <35 with a healthy response to the meds I have never regretted the decision to convert. The only other option is to cancel the IUI cycle and that is incredibly disappointing.
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Another important note is that not every practice will or can convert to an #ivfcycle. It takes a lot of work from my #nurse, admin team and #embryologist to make this happen.
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When it happens and it works for the patient I am so very happy. Like today- 11eggs!!!
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#ivfjourney #ivfcommunity #infertility #infertilitysisters #infertilityawareness #fertility #fertilityjourney #ttc #ttcsupport #ttcjourney #ttcwithpcos #ohss #twinpregnancy #pcos #pcossupport #onegoaltwolines #centerofreproductivemedicine #drperfetto
The goal of cycle management with #iui  is recruitment of 1-2 follicles (if you do not ovulate) or 2-3 follicles (if you do ovulate). When you recruit more than 3 mature #follicles  from the stimulation medications there is a concern about a pregnancy with multiple babies. . The goals for #fertilitytreatment  have shifted drastically since the first #ivfpregnancy  40 years ago. What used to be a goal of ANY #pregnancy  is now one of a healthy singleton pregnancy. The reason for this shift is that success rates are so much higher now and the risks of multiples are markedly higher for both the mother and babies. These risks are high for twins, even higher for triplets! . This is the reason that I will occasionally convert a patient from IUI to #ivf . It’s actually an easy process and it can save the patient a lot of $ (fewer meds and less monitoring). . Typically a patient will come for a mid-cycle ultrasound and if she has >4 follicles over 14mm and more mid-sized follicles (12-14mm) right behind those, we can consider converting to an IVF cycle. Importantly, the hormone levels cannot indicate an LH surge. . Now, this does not happen frequently. It is actually quite rare, but in my patients <35 with a healthy response to the meds I have never regretted the decision to convert. The only other option is to cancel the IUI cycle and that is incredibly disappointing. . Another important note is that not every practice will or can convert to an #ivfcycle . It takes a lot of work from my #nurse , admin team and #embryologist  to make this happen. . When it happens and it works for the patient I am so very happy. Like today- 11eggs!!! . . . #ivfjourney  #ivfcommunity  #infertility  #infertilitysisters  #infertilityawareness  #fertility  #fertilityjourney  #ttc  #ttcsupport  #ttcjourney  #ttcwithpcos  #ohss  #twinpregnancy  #pcos  #pcossupport  #onegoaltwolines  #centerofreproductivemedicine  #drperfetto 
What is your favorite #inspirational quote? Please share it with us below. There are so many that give us all the feels, but today this one is putting a smile on our face. Plus isn’t pineapple the mascot fruit in our sweet #ttccommunity?
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“Be a pineapple. Stand tall. Wear a crown. And be sweet on the inside"
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#ownyourstory #selfappreciation #strengthfromwithin #warriors #ivfsisters #ttcsisters #continuethefight #onedayatatime #selflove #believeinmiracles #havefaith #infertility #infertilitysucks #pineapple #welovepineapples #infertilitytexas #centerofreproductivemedicine
What is your favorite #inspirational  quote? Please share it with us below. There are so many that give us all the feels, but today this one is putting a smile on our face. Plus isn’t pineapple the mascot fruit in our sweet #ttccommunity ? . . . “Be a pineapple. Stand tall. Wear a crown. And be sweet on the inside" . . . #ownyourstory  #selfappreciation  #strengthfromwithin  #warriors  #ivfsisters  #ttcsisters  #continuethefight  #onedayatatime  #selflove  #believeinmiracles  #havefaith  #infertility  #infertilitysucks  #pineapple  #welovepineapples  #infertilitytexas  #centerofreproductivemedicine 
Did you know...? Thyroid disease is an important part of the evaluation for #infertility, #recurrentmiscarriage and a #healthypregnancy.
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The treatment goals for those #ttc are slightly different than those for patients who are currently #pregnant. In those women who are trying to conceive I typically check a TSH (thyroid stimulating hormone) and Free T4. If abnormal, I recheck them as they can fluctuate (especially in those women with #hashimotosdisease).
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Most reproductive aged women diagnosed with a thyroid condition will have #hypothyroidism - which is an underactive thyroid (your body is not producing enough of the hormone). Hyperthyroidism (a thyroid gland that is working too hard) is much less common and if I find you have an overactive thyroid I typically send you to a thyroid specialist.
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In those women with abnormal thyroid labs we typically sit down to talk about symptoms, medications and treatment goals. The treatment goals are actually different in women who are pregnant vs. not pregnant.
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A “normal” TSH level in a non-pregnant woman is usually reported as less than 4.5. The goal when pregnant is a TSH less than 2.5 in the first trimester. Given this difference and because most women have a higher TSH once pregnant, I usually advise my patients with a TSH between 2.5 and 4.5 that they have a high chance of being on thyroid meds once they conceive.
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We could talk for hours about the thyroid, how it impacts your #health, #qualityoflife, #pregnancy, #postpartum, etc. You name it the thyroid plays a role in it. I am in no way a thyroid expert, but I do feel comfortable managing the majority of “typical” hypothyroid conditions. Beyond that I always ask for help from my #endocrinology friends and experts.
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Do you all have thyroid docs or specialists you follow on IG? Please share! .
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#hashimotos #thyroidproblems #infertilityawareness #infertilitysisters #fertilityspecialist #fertilityjourney #fertilitytreatment #fertility #ttcwithpcos #ttccommunity #ttcsupport #ttcjourney #ttcaftermiscarriage #miscarriage #obgyn #medstudent #centerofreproductivemedicine #drperfetto
Did you know...? Thyroid disease is an important part of the evaluation for #infertility , #recurrentmiscarriage  and a #healthypregnancy . . The treatment goals for those #ttc  are slightly different than those for patients who are currently #pregnant . In those women who are trying to conceive I typically check a TSH (thyroid stimulating hormone) and Free T4. If abnormal, I recheck them as they can fluctuate (especially in those women with #hashimotosdisease ). . Most reproductive aged women diagnosed with a thyroid condition will have #hypothyroidism  - which is an underactive thyroid (your body is not producing enough of the hormone). Hyperthyroidism (a thyroid gland that is working too hard) is much less common and if I find you have an overactive thyroid I typically send you to a thyroid specialist. . In those women with abnormal thyroid labs we typically sit down to talk about symptoms, medications and treatment goals. The treatment goals are actually different in women who are pregnant vs. not pregnant. . A “normal” TSH level in a non-pregnant woman is usually reported as less than 4.5. The goal when pregnant is a TSH less than 2.5 in the first trimester. Given this difference and because most women have a higher TSH once pregnant, I usually advise my patients with a TSH between 2.5 and 4.5 that they have a high chance of being on thyroid meds once they conceive. . We could talk for hours about the thyroid, how it impacts your #health , #qualityoflife , #pregnancy , #postpartum , etc. You name it the thyroid plays a role in it. I am in no way a thyroid expert, but I do feel comfortable managing the majority of “typical” hypothyroid conditions. Beyond that I always ask for help from my #endocrinology  friends and experts. . . Do you all have thyroid docs or specialists you follow on IG? Please share! . . . #hashimotos  #thyroidproblems  #infertilityawareness  #infertilitysisters  #fertilityspecialist  #fertilityjourney  #fertilitytreatment  #fertility  #ttcwithpcos  #ttccommunity  #ttcsupport  #ttcjourney  #ttcaftermiscarriage  #miscarriage  #obgyn  #medstudent  #centerofreproductivemedicine  #drperfetto 
Depression and #mentalhealth is very important when #ttc and when undergoing treatment for #infertility. Depression is the most common mood disorder experienced in #pregnancy, affecting approximately 1 in 5 women.
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One of the most common questions I get at a new patient visit is- should I stop my #antidepressant meds?
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This is a complicated question and there is no one answer fits all. To help determine what is best for my patient I consider and discuss these things:
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1. Have you advised your psychiatrist or therapist of your desire to conceive? 
2. What is your mental health diagnosis? Do you have major depressive disorder or bipolar disorder?
They are very different diagnoses, with different treatments, options for weaning vs. change of medications.
3. What medications are you on? Can you wean off them or decrease your dose?
4. Can you manage your depression with counseling?
Some patients with mild depression do great with counseling alone, but others do not.
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No matter what, our first step is always to get your psychiatrist involved.
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There are no “safe” antidepressant medications in pregnancy, but some are better than others. Also, I believe that if a patient needs an antidepressant then she should be on one while ttc or pregnant.
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Untreated depression is not without risks. In the mother: increased stress, poor weight gain, suicidal thoughts/risk and self medication with drugs and alcohol. For the infant: preterm birth, growth restriction, post-delivery issues with bonding and increased risk of personal battles with depression and #suicide.
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Each patient is different. Some patients can stop meds, some can wean, others excel with counseling and others need their meds. This is not cookie cutter medicine, but our goal is a healthy mommy and baby.
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If you or someone you know is suffering or suicidal please call the national #suicideprevention hotline at 1-800-273-8255.
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This is not medical advice. Please speak with your doctor about any concerns you may have.
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#mentalhealthawareness #mentalhealthsupport #depressionawareness #ttcsupport #ttccommunity #ttcwithpcos #fertility #fertilityjourney #somedoc #centerofreproductivemedicine #drperfetto
Depression and #mentalhealth  is very important when #ttc  and when undergoing treatment for #infertility . Depression is the most common mood disorder experienced in #pregnancy , affecting approximately 1 in 5 women. . One of the most common questions I get at a new patient visit is- should I stop my #antidepressant  meds? . This is a complicated question and there is no one answer fits all. To help determine what is best for my patient I consider and discuss these things: . 1. Have you advised your psychiatrist or therapist of your desire to conceive? 2. What is your mental health diagnosis? Do you have major depressive disorder or bipolar disorder? They are very different diagnoses, with different treatments, options for weaning vs. change of medications. 3. What medications are you on? Can you wean off them or decrease your dose? 4. Can you manage your depression with counseling? Some patients with mild depression do great with counseling alone, but others do not. . No matter what, our first step is always to get your psychiatrist involved. . There are no “safe” antidepressant medications in pregnancy, but some are better than others. Also, I believe that if a patient needs an antidepressant then she should be on one while ttc or pregnant. . Untreated depression is not without risks. In the mother: increased stress, poor weight gain, suicidal thoughts/risk and self medication with drugs and alcohol. For the infant: preterm birth, growth restriction, post-delivery issues with bonding and increased risk of personal battles with depression and #suicide . . Each patient is different. Some patients can stop meds, some can wean, others excel with counseling and others need their meds. This is not cookie cutter medicine, but our goal is a healthy mommy and baby. . If you or someone you know is suffering or suicidal please call the national #suicideprevention  hotline at 1-800-273-8255. . This is not medical advice. Please speak with your doctor about any concerns you may have. . . . #mentalhealthawareness  #mentalhealthsupport  #depressionawareness  #ttcsupport  #ttccommunity  #ttcwithpcos  #fertility  #fertilityjourney  #somedoc  #centerofreproductivemedicine  #drperfetto 
Happy Birthday America! We are so grateful for the brave men and women who have served this amazing country to allow us our freedom! ♥️🇺🇸💙🇺🇸♥️🇺🇸💙
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#Happy4thOfJuly #freedom #USA #Texas #InfertilityTexas #infertility #IVF #ivfwarrior #centerofreproductivemedicine
What are your go to #summer snacks for the #July4th holiday? This looks pretty delish and healthy too. Summer #pizza at its finest… Sweet pizza dough with homemade coconut yogurt and your favorite fruits.
Yes pls! 
Tag someone who needs to try this out asap 🍕🍉🍒🍓🍍
Created by @vegan.dy
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#vegandy #pizzalover #healthyeating #happy4th #infertility #ivf #centerofreproductivemedicine #infertilitytexas
Thyroid disease is an important part of the evaluation for #infertility, #recurrentmiscarriage and a #healthypregnancy.
.
The treatment goals for those #ttc are slightly different than those for patients who are currently #pregnant. In those women who are trying to conceive I typically check a TSH (thyroid stimulating hormone) and Free T4. If abnormal, I recheck them as they can fluctuate (especially in those women with #hashimotosdisease).
.
Most reproductive aged women diagnosed with a thyroid condition will have #hypothyroidism - which is an underactive thyroid (your body is not producing enough of the hormone). Hyperthyroidism (a thyroid gland that is working too hard) is much less common and if I find you have an overactive thyroid I typically send you to a thyroid specialist.
.
In those women with abnormal thyroid labs we typically sit down to talk about symptoms, medications and treatment goals. The treatment goals are actually different in women who are pregnant vs. not pregnant.
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A “normal” TSH level in a non-pregnant woman is usually reported as less than 4.5. The goal when pregnant is a TSH less than 2.5 in the first trimester. Given this difference and because most women have a higher TSH once pregnant, I usually advise my patients with a TSH between 2.5 and 4.5 that they have a high chance of being on thyroid meds once they conceive.
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We could talk for hours about the thyroid, how it impacts your #health, #qualityoflife, #pregnancy, #postpartum, etc. You name it the thyroid plays a role in it. I am in no way a thyroid expert, but I do feel comfortable managing the majority of “typical” hypothyroid conditions. Beyond that I always ask for help from my #endocrinology friends and experts.
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Do you all have thyroid docs or specialists you follow on IG? Please share!
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#hashimotos #thyroidproblems #infertilityawareness #infertilitysisters #fertilityspecialist #fertilityjourney #fertilitytreatment #fertility #ttcwithpcos #ttccommunity #ttcsupport #ttcjourney #ttcaftermiscarriage #miscarriage #obgyn #medstudent #centerofreproductivemedicine #drperfetto
Thyroid disease is an important part of the evaluation for #infertility , #recurrentmiscarriage  and a #healthypregnancy . . The treatment goals for those #ttc  are slightly different than those for patients who are currently #pregnant . In those women who are trying to conceive I typically check a TSH (thyroid stimulating hormone) and Free T4. If abnormal, I recheck them as they can fluctuate (especially in those women with #hashimotosdisease ). . Most reproductive aged women diagnosed with a thyroid condition will have #hypothyroidism  - which is an underactive thyroid (your body is not producing enough of the hormone). Hyperthyroidism (a thyroid gland that is working too hard) is much less common and if I find you have an overactive thyroid I typically send you to a thyroid specialist. . In those women with abnormal thyroid labs we typically sit down to talk about symptoms, medications and treatment goals. The treatment goals are actually different in women who are pregnant vs. not pregnant. . A “normal” TSH level in a non-pregnant woman is usually reported as less than 4.5. The goal when pregnant is a TSH less than 2.5 in the first trimester. Given this difference and because most women have a higher TSH once pregnant, I usually advise my patients with a TSH between 2.5 and 4.5 that they have a high chance of being on thyroid meds once they conceive. . We could talk for hours about the thyroid, how it impacts your #health , #qualityoflife , #pregnancy , #postpartum , etc. You name it the thyroid plays a role in it. I am in no way a thyroid expert, but I do feel comfortable managing the majority of “typical” hypothyroid conditions. Beyond that I always ask for help from my #endocrinology  friends and experts. . . Do you all have thyroid docs or specialists you follow on IG? Please share! . . . #hashimotos  #thyroidproblems  #infertilityawareness  #infertilitysisters  #fertilityspecialist  #fertilityjourney  #fertilitytreatment  #fertility  #ttcwithpcos  #ttccommunity  #ttcsupport  #ttcjourney  #ttcaftermiscarriage  #miscarriage  #obgyn  #medstudent  #centerofreproductivemedicine  #drperfetto 
Monday morning pick me up! I had such a great time with my family last week and I am energized to be back in #Houston seeing patients today.
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I’m also super excited about this starbucks #soylatte. I will say the coffee on the ship left a lot to be desired! As a self-proclaimed #coffeelover I really missed the good stuff.
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Quick reminder that when #pregnant or #ttc you should limit your caffeine to under 200mg a day. That is usually 1-2 small cups of coffee a day. If it’s #starbucks it is going to be 1 max! You can actually check out all the nutrition info (including caffeine) on their website or app.
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Cheers to a great week back!
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#mondayvibes #ttccommunity #ttcsisters #infertility #infertilityhurts #infertilityawareness #recurrentmiscarriage #miscarriage #doctor #doctorlife #houstondoctors #houstonblogger #somedoc #doctorsofinstagram #centerofreproductivemedicine #onegoaltwolines #drperfetto
Monday morning pick me up! I had such a great time with my family last week and I am energized to be back in #Houston  seeing patients today. . I’m also super excited about this starbucks #soylatte . I will say the coffee on the ship left a lot to be desired! As a self-proclaimed #coffeelover  I really missed the good stuff. . Quick reminder that when #pregnant  or #ttc  you should limit your caffeine to under 200mg a day. That is usually 1-2 small cups of coffee a day. If it’s #starbucks  it is going to be 1 max! You can actually check out all the nutrition info (including caffeine) on their website or app. . Cheers to a great week back! . . . #mondayvibes  #ttccommunity  #ttcsisters  #infertility  #infertilityhurts  #infertilityawareness  #recurrentmiscarriage  #miscarriage  #doctor  #doctorlife  #houstondoctors  #houstonblogger  #somedoc  #doctorsofinstagram  #centerofreproductivemedicine  #onegoaltwolines  #drperfetto