- Osteoporosis
- Medical Weight LossPolycystic ovary syndrome (PCOS) is the most common hormonal disorder in reproductive aged women, which is closely associated with obesity and ovulation dysfunction. Obese women with PCOS have higher risk of having miscarriages, but regular exercise with dietary modifications can result in better fertility outcomes. It has been documented that weight loss of as much as 5-10% of total body weight along with exercise is sufficient enough to restore normal ovulation.
- Sleep DisordersExercise has many benefits that include increasing energy levels, improvement of general mood, self-confidence and posture. Additionally, regular exercise may improve sleep disorders, bloating, constipation and headaches. In the long run, the risks of having cardiovascular disease and diabetes decrease significantly.
- Male InfertilityMale factor infertility represents 35% of all infertility cases and the diagnosis is made by the presence of abnormal parameters on a semen analysis. Semen analysis has four main parameters which include the volume (≥ 1.5-2 mL), count (≥ 20 million/mL), motility (active/forward moving sperm ≥50%) and morphology (normal appearance ≥14% by Kruger’s criteria and >30% by the old WHO criteria). Male infertility can be divided into three major categories that include: abnormalities of sperm production, abnormalities of sperm function, and obstruction or absence of the ductal system. Unfortunately, majority of male factor infertility is idiopathic (cause unknown).
- High Cholesterol
- Emergency CareEctopic pregnancy can be managed expectantly, medically by the use of Methotrexate or surgically through laparoscopy or open abdominal surgery called laparotomy. Expectant management includes careful monitoring of symptoms, measurement of beta hCG levels and ultrasound examinations. If there is no change in the clinical status and beta hCG levels are steadily decreasing, expectant management is appropriate. Approximately, 10-15% of all ectopic pregnancies can be managed expectantly and the long term outcome for pregnancy (risk of ectopic or intrauterine) is similar to medical and surgical interventions. Medical management of ectopic pregnancy includes the administration of a chemotherapeutic agent called Methotrexate (MTX) intramuscularly in clinically stable patients. MTX destroys rapidly dividing cells, such as those present in an early pregnancy and side effects are limited because of the low dose of medication used. In some cases, multiple injections of MTX may be necessary if the beta hCG levels do not decrease over time. However, in most cases a single injection is adequate enough for complete resolution of symptoms. The chances of success depend on many variables but mostly the initial beta hCG level with higher success rates observed with lower beta hCG levels. Blood work is done prior to administration of the drug, and beta hCG levels are checked 4 and 7 days following MTX injection. If the beta hCG levels do not drop at least 15% from day 4 to 7, a second injection is given and hormone levels are checked again in a similar schedule to make sure that the levels are decreasing. Following administration of the drug, patients need to be monitored for signs of rupture. In some cases, ectopic pregnancy can tear/rupture the tube despite medical intervention. Some pain and bleeding following MTX treatment is relatively common, but if it’s excessive, patients need to go to the nearest emergency room for immediate evaluation and treatment. In IVF cases, embryos are injected into the uterine cavity and one or more embryos can be sucked back into the fallopian tubes (due to the negative pressure in the abdomen). In such cases, treatment is the same as a naturally occurring ectopic pregnancy. Medical management is not suitable for all ectopic pregnancies. The following include contraindications to medical management and require surgical intervention...
- Constipation
- GynecologyEmbolization is a procedure in which small particles are injected into the arteries of the fibroid under radiological guidance to shut off the blood supply to the fibroids, in the hope that they will shrink. Embolization is relatively new to the field of gynecology and may have potential adverse effects on future fertility. Currently, embolization is not a recommended therapy for fibroids in women who still wish to conceive. It may be considered as an option for the treatment of fibroids in women who do not desire future fertility or have completed child bearing.
- Female Infertility
- ObstetricsDr. Sher is a long considered a pioneer in the field of reproductive medicine and has been influential in assisting more than 18,000 women to have babies following IVF treatment. He received his medical training in South Africa and is a Fellow of the Royal College of Obstetrics and Gynecology, a Fellow of the American College of Obstetrics and Gynecology and is sub-specialty boarded in Maternal and Fetal Medicine. Dr. Sher was also an Associate Professor of Obstetrics and Gynecology at the University of Nevada School Of Medicine.
- EndometriosisDamage to the fallopian tubes as a result of prior infection, endometriosis or previous pelvic surgery is one of the most common causes of infertility. Tubal blockage can occur in several locations. Often the ends of the tubes are obstructed, while the openings into the uterus are still patent/open. In many cases the tube is filled with fluid which is called a hydrosalpinx. Whereas surgery is not indicated to improve fertility outcome in the era of IVF for patients with significant tubal disease, the exception is the presence of hydrosalpinges.
- Pelvic Pain
- PregnancyWhereas neosalpingostomy may allow natural conception, the chances of a spontaneous pregnancy are very low and the risk of having an ectopic pregnancy (tubal pregnancy) is high. Therefore, this treatment method is no longer favored, except in a few cases in which the prognosis is high (such as very young patients with mild tubal disease, one sided blockage with no other identifiable pathology and those who cannot afford IVF treatment).
- Internal MedicineDr. Brody is the only physician in the United States who has been Board Certified in four different areas of specialty: internal medicine, endocrinology and metabolism, obstetrics and gynecology, and reproductive endocrinology and infertility.
- Ovarian CancerA blood test called CA-125 can be elevated in some endometriosis patients, but is not a good test for screening or diagnosis of the disease. It is a cell surface antigen that can be measured in blood and is most useful in patients with certain types of ovarian cancer who are being followed up after treatment. Its use in endometriosis is very limited and routine testing is not recommended.
- AutismGozde also specializes in working with children or adults who are diagnosed with Autism Spectrum Disorder (ASD) or Social Communication Disorder (aka Asperger’s Syndrome). Gozde approaches ASD with a cognitive style and helps her clients to develop coping skills around their diagnosis, and strategies to manage their life with less anxiety and worry.
- Attention Deficit Hyperactivity Disorder (ADHD)We are excited to announce the addition of, Gozde Gokozan, LMFT, LPCC, an experienced licensed psychotherapist to the LA IVF team. Gozde works independently and brings vast knowledge, experience and compassion to our practice and will help patients navigate through the stressful times while undergoing fertility treatments. As a licensed marriage and family therapist, she focuses on how to cope with issues among family members when dealing with infertility. Her additional skills include treating children, adults and couple who deal with anxiety, mood disorders, depression, ADHD, grief and attachment issues. We welcome Gozde to our team!
- Depression
- Anxiety
- Diabetes Care
- EndocrinologyWomen with regular menstrual cycles should attempt pregnancy for one year before starting infertility work up if they are under the age 35. Over 35, it is recommended to start evaluation after 6 months of unprotected intercourse. If there are medical problems, a known male issue or a history of irregular menstrual cycles or pelvic infection, the workup needs to be initiated immediately. If pregnancy is not accomplished based on the above criteria, a consultation with a fertility specialist is recommended. A fertility specialist is a four-year residency trained obstetrician and gynecologist who received fellowship training for three additional years in reproductive endocrinology and infertility.
- HypothyroidismMost patients with hypothyroidism will not ovulate and have infertility, but some may ovulate irregularly and conceive spontaneously. If maternal hypothyroidism is untreated in pregnancy, it may have significant adverse effects on the fetus, such as mental and physical disability. Hyperthyroidism can also result in ovulatory dysfunction and eventually infertility, with other adverse effects if left untreated.
- ThyroidPCOS can be associated with other diseases, such as thyroid disease and elevated prolactin hormone levels (the hormone that makes the breast milk). Women should be tested for the presence of these disorders if they have PCOS type symptoms. Additionally, PCOS patients are at an increased risk for pre-diabetic conditions that can be diagnosed by an elevated insulin level and/or elevated glucose level (glucose intolerance) or even may have frank diabetes at the time of the diagnosis of PCOS. Therefore, it is very important to screen patients for diabetes at the time of diagnosis of PCOS. Patients who are overweight or obese are at a higher risk for having or developing diabetes in the future.
- UltrasoundEctopic pregnancy is defined as a pregnancy that occurs outside of the uterus. The most common site is in the fallopian tube, but sometimes it can occur in the ovary, the cervix or anywhere in the abdominal cavity. The incidence of ectopic pregnancy is 1% of all pregnancies and for in vitro fertilization (IVF) cases it is estimated to be 1-3%. Ectopic pregnancy is one of the most dangerous complications of pregnancy and the number one cause of death in the first trimester. If undetected, the ectopic pregnancy will continue to grow inside the tube and eventually tear the tube and result in excessive intra-abdominal bleeding, which can result in death. It is possible to detect an ectopic pregnancy at an early stage with a vaginal pelvic ultrasound and beta hCG hormone measurements. Ectopic pregnancy historically has been treated with laparotomy (open abdominal surgery) and removal of the fallopian tube. But more recently, laparoscopic removal of the ectopic mass and conservation of the fallopian tube is the most common type of surgery performed. Medical treatment of ectopic pregnancy has largely replaced surgical treatment in clinically stable patients, using the drug called Methotrexate (MTX).
- MRIIn men with elevated levels of prolactin (allows lactation in women), a magnetic resonance imaging (MRI) of the brain is necessary to rule out a tumor. These cases are typically treated with medications called bromocriptine or cabergoline. Once the prolactin level returns back to its normal levels, FSH and LH production should be back to normal along with normal testosterone and sperm production. In men with thyroid abnormalities (low or high), thyroid function is normalized with medications and reproductive hormones are also expected to improve with adequate sperm production.
- X-Rays
- Minimally Invasive SurgeryProximal ligation and salpingectomy can be done via laparoscopy, a minimally invasive surgery that allows patients to be discharged home the same day. It is often difficult for patients to accept that their tubes will be removed, as it means that conception is impossible without assistance. However the presence of hydrosalpinges means that the tubes are non-functional and even if these tubes could be rendered patent (open), the likelihood of pregnancy occurring would be remote. Treatment options for hydrosalpinx should be discussed with patients and the appropriate method selected for each individual case.
- Cyst RemovalWe first sought out treatment through using our insurance and were not given a choice but to do Intrauterine Insemination (IUI) even though I had a diagnosis of endometriosis and a history of 2 cyst removal surgeries. After 2 failed IUI cycles, we sought out non-insurance options.
- VasectomyAbnormalities of the sperm production can be due to testicular failure (Y chromosome microdeletions or Klinefelter’s syndrome), damage to the testes (varicocele, cryptorchildism), toxins, radiation, infections (mumps), insufficient hormone production from the pituitary gland (FSH and LH) and use of androgenic compounds (testosterone). Abnormalities of sperm function can be due to an infection of the genital tract (prostatitis), varicocele (enlargement of the veins in the scrotum), anti-sperm antibodies, failure of sperm to attain the fertilization potential (acrosome reaction) and failure of sperm to bind and penetrate the egg (fertilization). Obstruction of the ductal system includes prior vasectomy (as a contraceptive approach), blockage of the ejaculatory or epididymal ducts and absence of the vas deference from birth (congenital absence of the vas deferens – CAVD).
- LaparoscopyDistal blockage of fallopian tubes (hydrosalpinx) results in accumulation of toxic fluid inside the tube that can drain back into the uterine cavity. Such drainage of toxic fluid can result in the diminishment of embryo binding sites called integrins in the uterine lining and result in no implantation, thin endometrial lining or miscarriages. It is almost standard practice currently to remove such diseased tissue [removal of blocked tube(s) – salpingectomy] by laparoscopy. Once the drainage of toxic fluid is eliminated, it has been shown that integrins (embryo binding sites) are replenished and pregnancy rates significantly increased.
- Acne Treatment
- Cyst
- LesionsHormonal dysfunction is a common cause of infertility. The most common reproductive disorder in young women is polycystic ovary syndrome (PCOS). Irregular ovulation can lead to irregular menstrual cycles, disruption of normal life-style, excessive blood loss, anemia, fatigue, precancerous lesions in the uterus and infertility. Menstrual cycles may be irregular in the first few years, but afterwards they should be in a regular monthly pattern. It may be convenient not to have periods, but the consequences can be devastating such as estrogen deficiency, bone loss, infertility, endometriosis and endometrial cancer. If your menstrual cycles are irregular, you should be evaluated by a reproductive endocrinologist to identify the cause and start treatment as soon as possible.
- Shoulder Pain
- Back Pain