General

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Dr. Ricardo Yazigi

by Dr. Ricardo Yazigi, MD

Every so often I get calls or see women who have had their tubes tied in the past and are now interested in pursuing pregnancy. Many of these patients request a tubal reversal, but although some of them can be good candidates for surgery, there are many variables that need to be evaluated before moving forward.

Tubal Reversal Process

First, while a tubal ligation is frequently performed in a matter of minutes through an outpatient laparoscopy (by a small cut at the level of the navel), a tubal reversal may require a larger “bikini” cut, which may mean a longer operative time and a hospital stay. While recovery from the tubal ligation is quick, the recovery time for the reversal is generally longer. In an effort to simplify the surgery, a tubal reversal may also be performed by laparoscopy or by the newer “Da Vinci” robotic surgery. Some limitations to these seemingly simpler procedures may be: an even longer operative time, somewhat lower success rates, and costs that may not be significantly different from the traditional “bikini-cut” technique.

Secondly, whether the tubes were cut, tied, clipped or burned, and whether this was done in one or more areas of the tubes has an impact on success. If the sterilization shortened the tube significantly, the repair may not be successful.

Evaluating your Chances of Success

Following tubal reversal, it may take a young healthy couple a few months to up to a year to conceive. However, sometimes the tubes can close again. In other cases, a tubal (ectopic) pregnancy may occur. This is a condition in which the fertilized egg implants itself in the tube. In some tubal pregnancies, the tube may rupture and there is a chance of internal bleeding.

For women in their 20s or early 30s, a tubal reversal may be appropriate, as the time it may take them to conceive is unlikely to take a toll on her reproductive capabilities.  However in women over 35, waiting may not be appropriate and should be discouraged. In that case, in vitro fertilization (IVF) is a much better alternative. IVF is a faster, outpatient procedure, and the success rates per attempt are higher than those achieved monthly after a tubal reversal. Very importantly, and contrary to people’s perception, multiple pregnancies can be kept down to a minimum with IVF.

IVF is also a better alternative for young women desiring only one more child because after delivery there are no concerns about birth control.

When it comes to making a choice, every couple deserves individual evaluation according to their personal needs and desires. For that reason, a thorough consultation with a fertility specialist is best when a tubal reversal is being considered.

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As Shady Grove Fertility approaches our 20th anniversary, we have been reflecting on our past and what brought us to where we are today. Currently, with 23 physicians and over 300 staffers, we have far exceeded the expectations of our founders, Dr. Michael Levy and Dr. Arthur Sagoskin, but have held strong to the belief that fertility treatment is more than just injections and IVF, it is about treating the patient as a whole person. We have long offered a multitude of services for our patients including support groups, financial programs, events and much more. Whether you are dealing with PCOS, coping with a pregnancy loss, or considering donor egg, there is someone, not so far away, that is going through the same struggle.

In 2008, we launched our updated website, ShadyGroveFertility.com, designed to make your online experience as informative and helpful as possible. Soon after we began to share with you on Twitter and Facebook. Today, our online community, over 6,000 people strong, continues to grow as patients share their journeys and our expert physicians provide you with the answers to all your pressing questions.

The next step in keeping connected with you, is this “Insider’s Guide to Fertility”. Our physicians, staff, and patients will be sharing their experiences with you. Answering your questions outside the walls of a doctor’s office, and explaining what infertility is without a slew of clinical words that require a search on Wikipedia to understand.

So let’s make this official – Welcome to the Insider’s Guide to Fertility! You can read our current posts covering topics such as ‘Fertility & Weight Loss’, ‘Your First Doctor’s Visit’, and ‘Does Everyone Have Infertility?’

Thank you for coming and we look forward to sharing more with you. (And share with us, please let us know if you like this site and what is on your mind in the comments section below!)

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by Dr. Anitha Nair

Couples hoping to conceive often hold the misconception that body weight has nothing to do with getting pregnant. In reality, there is a clear association between weight and fertility and your doctor may encourage, or, as necessary, require a program of weight normalization combining dietary modification as well as exercise prior to embarking on conception.

Patients with weight abnormalities find it hard enough to see a physician about something as intimate as trying to get pregnant. Their worries about weight can compound the emotional discomfort. What most patients don’t know is that obesity is a very common problem and weight counseling is a routine part of most doctor visits. It is surprising to many patients what weights are medically considered overweight, obese and extremely obese. Obesity is defined by a measure calculated by the height and weight of the patient to give the body mass index or BMI. Normal BMI is defined by an index of less than 25; overweight patients are defined by a BMI 25 or greater; obesity is defined as a BMI of greater than 30.

>Click here to find your BMI.

Ideal body weight results in the best outcome for fertility therapy and for both mother and baby. For those with abnormal weight who do conceive, greater complications of pregnancy exist including:

  • Higher frequency of early pregnancy loss (miscarriage)
  • Greater anesthesia and surgical complications if any surgery required
  • Greater frequency of hypertension, gestational diabetes, pre-eclampsia, stillbirth and other complication of pregnancy (rates of stillbirth are twice as high in obese patients compared to normal weight patients)
  • An increased risk of requiring a caesarean section delivery. The caesarean section rate is almost 50% in obese women and the postoperative complications following C Section are significantly higher.
  • Higher infant birth weights correlate with a greater delivery complication rate for those delivering vaginally.

Both underweight and overweight women and men suffer from a higher incidence of infertility. Normal BMI optimizes fertility treatment success. Modifying your weight may be the simplest, most cost-effective first step in improving your chance to conceive. In many cases, this can mean no additional treatment is needed.

Overweight or underweight women may have hormonal disorders, which may cause them to ovulate infrequently or not at all.

Generally, underweight patients (BMI less than 19) can be encouraged to gain more weight, and this alone often increases their fertility significantly or makes hormonal therapy more successful.

On the other side of the spectrum, many studies have demonstrated a clear and consistent decrease in fertility with increasing female weight. Overweight women who undergo weight loss (even as little as 10% of total body weight) may ovulate without the need for fertility medications.

Severe obesity in men has been shown to alter fertility due to imbalances in hormone regulation tied to sperm production. A simple reduction in weight may improve semen parameters.

Our goal at Shady Grove Fertility Center is to provide you with the best and safest outcome possible. Just as serious medical conditions like diabetes, hypertension or cardiac disease require treatment before embarking on fertility therapies, so should abnormalities in weight. Your doctor will discuss with you the importance of your weight as part of the overall review of your medical records and history. We will use this information and have a discussion on the serious impact of being underweight or overweight on your general health as well as your fertility care.

It is not uncommon that patients are counseled that their treatments must be held until they achieve a target weight. In many cases, these couples will conceive spontaneously during this period. The good news is that normalization of BMI is very effective in yielding significant improvements to success rates for conception and with the proper motivation and help most patients can achieve their goals of normalizing their weight.

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by Dr. Eric Levens

So let’s get started at the beginning! Many people are surprised to learn that infertility is a medical disease, defined as the inability to conceive after 12 months of unprotected intercourse (after 6 months for women ≥35 years of age).

For many having difficulties conceiving, one of the greatest hurdles is making the first step: Scheduling an appointment to see an infertility specialist. This is understandable, given so few other events in life are so deeply personal and, no-doubt, fundamental to our sense of self as our ability to reproduce.

As a result, making that first appointment to see an infertility doctor often seems like a gigantic leap. If you’re contemplating taking this step, it might be comforting to know the things that would likely occur at your first visit.

Your First Visit: What Happens?

Infertility may be the result of many different conditions, all ending up in that same frustrating situation: no pregnancy. To get a better understanding of your individual condition, some initial testing may be required.

For some women, it may be that ovulation (producing an egg) isn’t occurring on a regular basis. This may be the result of several conditions such as polycystic ovary syndrome (PCOS) or be due to an accelerated or age-related depletion of the eggs in the ovary. For others, ovulation may be occurring regularly, but the Fallopian tubes are blocked which means the ovulated egg isn’t getting fertilized by sperm in the tube. Another very common cause of infertility is that there are insufficient numbers of normal sperm to achieve a pregnancy.

At your initial visit, your physician wants to determine whether there are things in your or your partner’s history that may herald an underlying medical condition that is presenting as infertility that may require further evaluation. The next steps can be largely broken down into evaluating the following: 1) the ovaries; 2) the Fallopian tubes; 3) the sperm count.

Checking Your Ovaries

Without bogging you down with too many details, ovarian function is controlled by an area of the brain called the pituitary. The pituitary produces several hormones, but the one most critical to fertility is follicle stimulating hormone (FSH). This hormone stimulates the ovary to develop a follicle that contains an egg. If FSH is elevated too early in the menstrual cycle, it may indicate that the ovary is having a hard time responding to this signal. One way to test the function of the ovary is to determine the FSH hormone on day 3 of the menstrual cycle along with assessing the amount of estrogen (produced by the ovary) in the blood.

These hormones give an indication of how the ovaries are functioning, something we refer to as the “ovarian reserve” which is the quality of the pool of eggs within the ovary.

Checking Your Fallopian Tubes

Another important test is called a hysterosalpingogram. While this test may sound intimidating, it is simply an x-ray of the outline of the uterine cavity (where implantation of an embryo occurs) and the Fallopian tubes to determine if the tubes are open. If the Fallopian tubes are blocked, then in vitro fertilization (IVF) would likely be the most successful option for achieving pregnancy.

Checking His Semen

A semen analysis is another important component of the initial evaluation to determine whether there is a male partner component resulting in infertility and if so, whether it is treatable. Fortunately, with the development of techniques in the last two decades, the sperm from men with some of the most severe sperm abnormalities can be used to achieve a pregnancy. Once the results of these tests are available, an Infertility specialist can recommend an appropriate treatment for you.

2026 Shady Grove Fertility

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