General

Shady Grove Fertility’s Reading, PA office has relocated to a new location in Lancaster, PA, the second largest city in South Central, PA providing easier access for patients with appointments available Monday through Friday, early morning monitoring hours and free parking.

About Dr. Kara Nguyen

Dr. Kara Nguyen, who is triple board certified in obstetrics and gynecology, reproductive endocrinology and infertility, and medical genetics, will be seeing patients at this location. Dr. Nguyen earned her medical degree from Jefferson Medical College and her Master’s in Public Health from John Hopkins University. She completed her residency in obstetrics and gynecology at Christiana Care Hospital in Delaware and her subspecialty training in medical genetics at the National Institutes of Health.

Services offered at the Lancaster location include patient consultations for infertility, egg freezing, and oncofertility; comprehensive diagnostic testing including bloodwork, ultrasounds, and semen analysis; low-tech and advanced infertility treatment options such as intrauterine insemination (IUI) and in vitro fertilization (IVF); and cycle monitoring. Any procedures such as egg retrievals and embryo transfers will be performed at SGF’s convenient fully accredited IVF Center in Chesterbrook, PA.

What Patients are saying about Dr. Nguyen

“Dr. Nguyen is an amazing doctor and I would recommend her to anyone. She is extremely knowledgeable and helped us through the beginning of our journey becoming first-time parents. When we found out we were pregnant, she was genuinely so excited for us. If we decide on a second child, I will be going back to her care, for sure. The process was very scary for us as we were never through it before, but she answered all of our questions thoroughly and with care and concern!”

“Dr. Nguyen is THE BEST. She is engaged and truly cares about your journey. She was so kind and patient with me- and trust me, I test that with millions and millions of questions! I highly recommend her to any and everyone seeking infertility treatment.”

“My husband and I can’t say enough about the treatment and hope we received at Shady Grove. Dr. Nguyen was open, honest, and extremely positive. We attempted two IUIs, and two IVFs with remarkably bad outcomes. We were facing a harsh reality, but Dr. Nguyen encouraged us to keep our faith and allowed us to attempt a 3rd IUI. I’m currently 21 weeks pregnant with our miracle baby. “Thank you” will never be enough!”

Patients can schedule an appointment in Lancaster located at 205 Granite Run Drive, Suite 350, Lancaster, PA 17601 by calling the New Patient Center at 1-877-971-7755 or completing this brief online form.

SGF’s Harrisburg, PA office has relocated to a new larger, location in Mechanicsburg, PA, just a few miles away, located on the campus of UPMC PinnacleHealth Fredericksen Outpatient Center.

Drs. Lauren Roth, Melissa Esposito, and Kara Nguyen will be seeing patients at this new full-service location. Services offered include patient consultations for infertility, egg freezing, and oncofertility; comprehensive diagnostic testing including bloodwork, ultrasounds, and semen analysis; low-tech and advanced infertility treatment options such as intrauterine insemination (IUI) and in vitro fertilization (IVF); and cycle monitoring. Any procedures such as egg retrievals and embryo transfers will be performed at SGF’s convenient fully accredited IVF Center in Chesterbrook, PA.

“My husband and I had the best experience from start to finish. Dr. Esposito and the entire Shady Grove Fertility team was dedicated to helping us start our family. I would highly recommend them to anyone having trouble conceiving or even looking for some general advice. They truly made the experience painless and we now have a beautiful little boy because of them! I am truly grateful that we found Shady Grove Fertility!” shared one former patient of Dr. Esposito—double board certified reproductive endocrinologist who completed her medical training at the University of Medicine and Dentistry of New Jersey, her residency training in obstetrics and gynecology from the University of Connecticut Health Center, and her fellowship training in reproductive endocrinology and infertility at the University of Pennsylvania.

“Dr. Nguyen is an incredible mix of knowledge and genuine care for her patients. We asked a ton of questions and she was right there throughout the beginning of our journey to guide us and offer us the best knowledge and care that we could ever ask for at such a scary and unfamiliar time. I would recommend her wholeheartedly and I will definitely be returning if we try for baby #2 in the future!” said a former patient of Dr. Nguyen—triple board certified reproductive endocrinologist who completed her medical training at Jefferson Medical College, earned her Masters in Public Health from Johns Hopkins University, completed her residency training in obstetrics and gynecology at Christiana Care Hospital in Delaware, and completed her subspecialty training in medical genetics at the National Institutes of Health.

“Dr. Roth was wonderful. She helped us conceive our third child after a devastating ectopic pregnancy. She remained optimistic even though my maternal age proved to be an obstacle with my egg numbers and viability. She was almost as excited as I was when we saw my son’s heartbeat for the first time. She really cares about her patients and helping them bring children into this world. She’s awesome,” shared one former patient of Dr. Roth—double board certified reproductive endocrinologist who completed her medical training at the University of Maryland, Baltimore, and continued on to the University of Colorado, Denver where she completed her residency in obstetrics and gynecology and a 3 year fellowship in reproductive endocrinology and infertility.

Patients can schedule an appointment in Mechanicsburg located at 2005 Technology Parkway, Suite 340, Mechanicsburg, PA by calling the New Patient Center at 1-877-971-7755 or completing this brief online form. 

We are excited to offer the most highly advanced fertility care in Silver Spring with the opening of our newest satellite location. The Silver Spring office now joins the 4 full-service Maryland locations and 2 satellite locations throughout D.C., and Montgomery County.

Fertility Care in Silver Spring

The Silver Spring location will offer new patient and follow-up appointments, egg freezing consultations, and oncofertility consultations. For high and low-tech fertility treatment monitoring, diagnostic evaluation, and other appointments, patients will visit the full-service Rockville, MD location.

Located in Third Space Wellness at 8001 Kennett Street, patients can now schedule an appointment with Dr. Lauren Roth in Silver Spring by calling 1-877-971-7755.

As part of a blog series on fertility nutrition, we interviewed SGF’s Executive Senior Medical Officer, Dr. Eric Widra, to discuss the difference between preconception vitamins and traditional prenatal vitamins.

We have known for years that a woman’s nutrient needs prior to conception are different than they are throughout pregnancy. Dr. Widra recommends that all SGF patients take an appropriate preconception vitamin while trying to conceive.

What is the main difference between preconception vitamins and prenatal vitamins?

According to Dr. Widra, “Preconception vitamins are designed to set the stage for a healthy pregnancy. As women transition into pregnancy their requirements are different.”

It is important to start taking a preconception vitamin as soon as you begin trying to conceive.

Taking a high-quality preconception vitamin, along with eating a healthful diet, helps prepare your body for conception and a healthy pregnancy.

What nutrients do you think are most important to prepare any woman’s body for pregnancy?

A preconception vitamin should provide a complete range of nutrients including folate (folic acid), choline, iodine, and vitamin D. Dr. Widra explains that the primary requirements for a preconception vitamin include having adequate folic acid and vitamin D, and overall good nutritional support.

Folic acid is a B vitamin that is involved in many of the body’s normal processes. Reducing the risk for certain birth defects is perhaps folic acid’s most well-known benefit. These birth defects are called neural tube defects.

The neural tube, which eventually forms into the brain and spinal cord, closes at approximately 28 days after conception. A neural tube defect results when the tube does not close properly. Because the neural tube closes during the early weeks of pregnancy, taking folic acid while you are trying to conceive is very important. Research shows that taking 400 mcg of folic acid for at least 1 month before pregnancy can reduce the risk of neural tube defects by about 36 percent.

When a person consumes folic acid, the body converts it to the metabolically active form called methylated folate. Although Dr. Widra points out that most patients have normal folate metabolism, some women have a genetic defect (called MTHFR polymorphism) that reduces their ability to activate folic acid. A preconception supplement with methylated folate may be of benefit for these women, particularly while trying to conceive and through early pregnancy.

Why is vitamin D so critical for preconception?

Believe it or not, vitamin D is still a somewhat controversial topic. However, studies have generally demonstrated better in vitro fertilization (IVF) success rates in women with normal vitamin D levels (>30 ng/ml) compared with those with low levels. One study found a 6 percent increase in clinical pregnancy rate with each ng/ml increase in vitamin D level.

Dr. Widra explains, “With those data in hand, and the very low cost and low risk associated with using vitamin D, Shady Grove Fertility tests patients’ vitamin D level and recommends supplementation if it is low.”

Do you recommend any specific supplements for women with advanced maternal age or diminished ovarian reserve?

There are limitations to the data supporting the routine recommendation of any specific supplements for these patients. However, for patients who really want to do something, or have found their way to the supplement world on their own, we do offer them coenzyme Q10 or DHEAS.

Coenzyme Q10 (CoQ10)

Many women look to CoQ10 because it plays a crucial role in energy production inside cells (including egg cells). CoQ10 levels decline with age. Therefore, a woman’s eggs become less efficient at producing energy as she ages. This is thought to contribute to poorer egg quality, which can adversely affect fertility and pregnancy outcome.

This Fertility and Sterility study explains that nutrients such as CoQ10 can increase cellular energy production, which may have a positive impact on fertility in older women trying to conceive. Animal data also supports CoQ10’s role in promoting egg quality as women age.

Enrolling participants in fertility studies can be difficult, and there has only been one human study examining CoQ10 supplementation for female fertility. Although the results were promising, the study was too small for the findings to be statistically significant.

DHEAS

Dehydroepiandrosterone Sulfate (DHEAS) is a hormone produced in the adrenal glands. DHEA production declines with age. Although the use of DHEAS for female fertility is somewhat controversial, research has shown that it may improve IVF success in women with diminished ovarian reserve.

When appropriate, women can take 75 mg of DHEAS for at least 4 weeks, and up to 4 months prior to IVF.

Do you see a benefit of using inositols for your patients with PCOS?

Yes. The studies on inositols and PCOS are relatively convincing that they help promote ovulation and an ovulatory response to medications. Therefore, SGF recommends inositols for its patients with PCOS.

In addition, studies have found that inositols reduce insulin resistance and decrease testosterone levels in women with PCOS. Inositols may also promote egg quality and ovarian response to medications in women undergoing IVF.

Research shows that taking a combination of two forms of inositol (myo-inositol and D-chiro-inositol) in the body’s naturally occurring ratio of 40:1, is more beneficial than taking either form alone.

When do you recommend that your patients switch to a traditional prenatal?

A woman’s nutritional needs change as she transitions from preconception and early pregnancy to the second trimester. Therefore, all SGF patients are advised to switch to a traditional prenatal vitamin by 10 weeks of pregnancy.

What do you tell your patients to look for in a traditional prenatal that they might not need in their preconception vitamins?

Dr. Widra explains that there is good evidence that supplementing with DHA after the first trimester has benefits for pregnancy in terms of both fetal development and reduction in preterm labor and delivery. Also, a woman’s iron requirements increase during the second and third trimesters of pregnancy.

Docosahexaenoic acid (DHA)

DHA is an omega-3 fat found in certain fish and algae. DHA supplementation during pregnancy has been associated with improved birth weights and a reduced risk for preterm delivery. DHA may also support fetal mental and visual development. A traditional prenatal should meet the recommended daily intake of 250-300 mg a day.

Iron

A woman’s iron needs are generally the same while trying to conceive and during the first trimester of pregnancy as they are for any premenopausal woman. A preconception supplement should contain 18 mg, the Recommended Dietary Allowance (RDA) for premenopausal women.

Iron needs increase during the second and third trimesters of pregnancy due to greater iron use by the developing baby. A traditional prenatal should contain 27 mg of iron, the RDA for pregnant women.

Why do you choose to recommend Luminary Vitamins to your patients?

Shady Grove Fertility is proud to recommend Luminary Vitamins and Theralogix to offer high-quality, evidence-based nutritional supplements patients can trust. 

Nutritional supplements can be an important complement to your fertility treatment but they do not replace fertility evaluation and care.

You should have your fertility evaluated if you are under 35 years old and have been trying for 1 year, after 6 months if you are between the ages of 35-39 and after 3 months if you are 40 and over. Women should consult their reproductive endocrinologist before beginning any vitamin regimen.

To learn more about preconception and prenatal vitamins, or to schedule an appointment, please call our New Patient Center at 1-877-971-7755 or click here to complete our online form. 

Medical contribution by Eric A. Widra, M.D.

Eric A. Widra, M.D., is the Executive Senior Medical Officer for Shady Grove Fertility and the associate director of the Combined Federal Fellowship in Reproductive Endocrinology and Infertility—a post-graduate training program for future leaders in this subspecialty, operated through the National Institutes of Health, Walter Reed National Military Medical Center, and Shady Grove Fertility.

Recent research conducted by RESOLVE: The National Infertility Association, of whom Shady Grove Fertility is a visionary partner, reveals the overwhelming majority of fertility patients who responded (n=416) wished they had known more about their fertility when they were younger and were not fully aware of the link between female age and fertility potential.

What is the link between age and fertility?

Our mission is to take an active role in educating our community about the link between age and fertility. This important message is intended to educate and empower women and men about the importance of early fertility intervention. “Many people wait to seek fertility treatment thinking conception will happen on its own, regardless of age. The reality is, the longer you wait to seek fertility care, the fewer treatment options that will be available to you,” reminds Naveed Khan, M.D., of SGF’s Leesburg, VA office.

“Age is the biggest factor affecting a woman’s egg supply. The older a woman gets, the fewer eggs she has left, and the more likely those eggs will be affected by a chromosomal abnormality,” says Shruti Malik, M.D., of SGF’s Fair Oaks, VA office. “Unfortunately, no treatment exists that will increase the quantity or quality of your egg supply,” adds Malik.

“For women, the ability to conceive is tied to the quality of her eggs. A woman’s fertility peaks in her mid-20s, begins to decline around 27, and drops off more steeply after age 35. A woman’s fertility is measured by her ability to achieve a pregnancy on a given month. As women age, hormonal changes begin to take place. There is a lot going on but of particular interest are the two main hormones controlling the development and release of the egg each month. These are follicle-stimulating hormone (FSH) and luteinizing hormone (LH),” adds Dr. Malik.

Another factor to consider is the quantity of eggs. “As a woman ages, the number of eggs in her ovarian reserve continually declines,” says Frank Chang, M.D., of SGF’s Rockville, MD location. “Women are born with their lifetime supply of eggs—generally around 1 to 2 million. By the time a woman reaches menopause, typically in her early- to mid-50s, as many as a few hundred remain, potentially even less,” adds Chang. “To illustrate this point, the natural pregnancy rate for women older than 30 is 20 to 30 percent per month but by age 40 the likelihood of conception occurring naturally drops to less than 5 percent per month,” adds Dr. Chang.

When to Seek Help

SGF remains committed to informing, connecting, and empowering our patients about the importance of early fertility intervention and the direct impact of age on fertility. This is why we adhere to the guidelines of infertility that indicate the length of time trying to conceive based on a woman’s age and when to seek help.

We believe a more informed patient is a more confident patient.  Connect with us through our live webinars, on-demand webinars, in-person seminars, blog posts, patient stories, social channels, and email communication.

To learn more about the relationship between age and fertility or schedule an appointment with an SGF fertility specialist, please contact the New Patient Center at 1-877-971-7755 or complete our brief online form.