General

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FAQ: Anesthesia

Why do I need an anesthetic and what will it be?
Egg retrievals would be quite uncomfortable without an anesthetic of some kind. For several years, Shady Grove Fertility has been using what is called light general anesthesia, “unconscious” sedation, heavy sedation, or total intravenous anesthesia (TIVA)—all the same thing. It is a quick sleep and a rapid wake up with little “hangover” or groggy feeling. We use this as our primary anesthetic because it is very well tolerated and the one our patients prefer. Also, because our pregnancy rate is so exceptional we have chosen to stay with a technique that works. We also use this same anesthetic for cyst and fluid aspirations, hysteroscopies, and D&Cs. All of the drugs we use go through an intravenous line, which we routinely start with a local anesthetic. You will also be breathing oxygen through a nasal cannula.

Male procedures are done with this same anesthetic technique. In addition, the physician uses local anesthetic injections prior to starting the procedure. If the procedure is certain to only be a percutaneous epididymal sperm aspiration (PESA), it can be done with local anesthesia only without any sedation. Check with your physician about your choice of anesthesia. If a PESA is not a certainty it is best to be sedated/anesthetized for the procedure so as not to be uncomfortable and create a delay in going to the next more invasive step, which is usually a testicular sperm aspiration, or occasionally a testicular biopsy

What about eating and drinking before this anesthetic?
Do not eat any food or drink any liquids after midnight on the night prior to your surgical procedure (including no gum or hard candy).

What about non-fertility medicines and supplements I take regularly?
Please discuss all prescription medications and/or supplements with your primary team prior to anesthesia.

Please leave the following items at home:

  • Contact Lenses
  • Elastic bands on dental braces
  • All jewelry except for your wedding ring. This includes: necklaces, bracelets, rings, earrings, and body piercing jewelry of the lip, tongue, and nose.

Going Home After the Procedure
You must go home from the clinic with a responsible adult. You cannot take a cab by yourself. In the case of couples who are each having an anesthetic, a third person must take you home. Driving should be restricted after your procedure, for the remainder of the day. Driving after anesthesia can be extremely dangerous.

Do not plan on making major decisions or going to work that day. If you go to work you may be acting like you are drunk and you are very likely to make mistakes in judgment.

You can have water as soon as you wake up and you can eat as soon as you get home.

Who will care for me in the recovery room when I’m waking up?
You will actually wake up in the operating room at the end of the procedure and move yourself onto the recovery room bed. So you will be quite awake even before you get to the recovery room. You may not remember that however, because the drugs we use do create a considerable amount of amnesia. The Shady Grove Fertility has full time registered nurses that staff the recovery room seven days a week. All of these nurses are well qualified to care for you.

Will I have pain after the procedure?
Women may experience varying degrees of cramping sensations after retrieval. We will give you analgesic (pain killer) medication, as you need it. Most people need nothing or only two acetaminophen (Tylenol). Men usually have no pain after their procedures because the local anesthetic is still working. Women and men who need a prescription for a stronger analgesic will be given one.

Will I have a tube down my throat?
Very rarely. The tube you are referring to is called an endotracheal tube. We usually do not need to intubate our patients. The procedures are very brief and our patients usually have good airways that do not require artificial devices to keep them open. If medically required, we can use intubation.

What are the risks of the anesthetic?
The chance of a life-threatening complication in healthy patients is about one in a quarter of a million. We keep you lightly anesthetized because that is the perfect level for these procedures. If a problem occurs we can quickly wake you up. If we have to use emergency life support equipment we are well trained and experienced in their use.

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Most women have cursed them at some point in their lives. At best, we’ve tolerated or even ignored them. It isn’t until we’re trying to get pregnant that most of us focus intently on our menstrual cycles. Then, suddenly, we’re observing every detail like a wildlife expert on an assignment. We’ve got charts littered with notes and numbers, calendars with stars and smileys, ovulation prediction kits, and a dizzying array of pee sticks we never even knew existed before.

For some women, all this attention reveals something they may have suspected but never focused on – that their menstrual cycles are irregular. There are many women who have irregular periods and thus, irregular ovulation. Some women ovulate only occasionally. Some menstruate occasionally but don’t ovulate. Some don’t do either at all.

About half of women with infertility have what are known as ovulatory disorders. Often physicians and healthcare literature will say that these disorders are easy to treat. Dr. Anne Hutchinson, of Shady Grove Fertility’s Newark, Delaware, location clarifies, “The better thing to say is that there are treatments that are very effective in treating ovulatory disorders.”

Pinpointing a couple’s obstacles to conceiving and designing treatment plans that are tailored to each patient are the keys to that success.

What are ovulatory disorders?

For women who are not ovulating regularly, the cause is usually that the ovary is not receiving the appropriately timed signals to mature and release an egg. The pituitary gland, at the base of the brain, produces the hormones that control the ovaries – FSH (follicle stimulating hormone) and LH (luteinizing hormone). If ovulation is not occurring in a regular, timed fashion, it is likely that the ovaries and the pituitary are not communicating appropriately.

Ovulatory disorders broadly break down into two groups: anovulation – where no ovulation at all occurs; and oligo-ovulation – where ovulation occurs infrequently or irregularly.

Polycystic Ovarian Syndrome (PCOS) is the most common cause of anovulation and oligo-ovulation. PCOS can prevent women from ovulating, but can also cause a number of additional symptoms such as small cysts in the ovaries, obesity, and unwanted facial hair.

“Any woman with an ovulatory disorder, regardless of the type, should seek treatment if she wants her chances of becoming pregnant to be similar to the average for women who ovulate regularly,” advises Dr. Hutchinson.

Fertility treatment for ovulation problems

Most women with an ovulatory disorder will begin treatment with their OB/GYN, using oral medications like clomiphene – also known as Clomid or Serophene or Letrozole, also known as Femara. These medications are designed to increase FSH levels released from the pituitary gland, thus signaling the ovaries to produce mature follicles and ovulation to occur. Several studies have shown that the majority of women using clomiphene will respond with regular ovulation and become pregnant within three to six treatment cycles.

Dr. Hutchinson says this finding is extremely important. She explains, “What this says to me is that any woman who has done three cycles of clomiphene and is still not ovulating, or has not become pregnant, should undergo additional evaluation with a fertility specialist.”

When to seek help for ovulation and menstruation

Dr. Hutchinson advises that couples don’t wait too long to see a Shady Grove Fertility physician if they are not having success. “I often see patients who have already gone through six or seven unsuccessful treatment cycles with their OB/GYN. They are frustrated and demoralized, but I know there is more that we can do to help.”

The first thing a fertility specialist will do is determine whether there are any issues in addition to the ovulatory disorder that would affect a couple’s fertility. Often, women who respond to clomiphene by ovulating but failed to conceive, have an additional cause of infertility such as uterine polyps or fibroids, tubal disease, endometriosis, male factor infertility, or a combination of those.

Once a treatment plan has been formulated based on each individual patient’s diagnosis, our physicians will monitor and adjust the plan throughout the patient’s cycle. “We will use blood tests and ultrasounds to closely monitor progress, so a patient will know right away if the treatments making a difference,” explains Dr. Hutchinson.

Medication doses can be adjusted or additional medication added during the cycle, until the patient is able to achieve ovulation. Other advantages of working with a fertility specialist include the ability to time intercourse more accurately, and to add additional treatment methods like intrauterine insemination (IUI) or, if necessary, in vitro fertilization (IVF), to help achieve pregnancy. In fact, Shady Grove Fertility patients who are diagnosed with ovulatory disorders have a 52% chance of having a baby per IVF cycle.

“When treatment is tailored to a woman’s individual response, it greatly increases the chances for success,” says Dr. Hutchinson.

Getting pregnant with ovulation disorders

Ovulatory disorders are the most common and treatable causes of infertility, but this doesn’t mean that everyone has success right away. Dr. Hutchinson advises that couples be aware of the many possible causes of infertility and the benefits they can gain from the monitoring and treatment provided by a fertility specialist.

“Most patients we see at Shady Grove Fertility do overcome ovulatory disorders and have successful pregnancies,” Dr. Hutchinson says. “This is a great source of hope for all couples struggling with this issue.”

Related Content:

Watch our On-Demand Webinar on PCOS. During this free, on-demand event, viewers will learn about the symptoms of PCOS, the role they play when trying to conceive, and treatment options that are available to help women overcome their infertility caused by this condition.

Editor’s Note: This post was originally published in October 2014 and has been updated for accuracy and comprehensiveness as of November 2021.

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To schedule a virtual consultation with an SGF physician, please call our New Patient Center at 1-888-761-1967 or submit this brief form.

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Across the fertility community we are all saddened to learn of the recent report in California of an error during fertility treatment affecting two separate couples. Such an error is an incredibly rare event given over 2.5 million IVF cycles are performed annually worldwide.

At Shady Grove Fertility, we have one of the most stringent, long-standing chain of custody protocols in the industry that was developed and continuously refined over the past 30 years. The system uses three unique identifiers along with two embryologists independently confirming the providence of the sperm, eggs, and embryos in each case. Additionally, chain of custody at SGF is maintained using an electronic witnessing system, RI Witness. This technology enables every sperm, egg, embryo, test tube, and petri dish to be electronically connected to the specific patient. Electronic witnessing creates a detailed, time-stamped log of the step-by-step movement of a patient’s genetic material and has an unignorable alert should there be a possibility of an incorrect mix. This alarm occurs prior to not upon a potential mix-up. Final approval and validation are performed by the physician performing the procedure.

We regret and recognize the impact such rare events have on the confidence of patients receiving care. Over the past 30 years at SGF we have constantly strived to provide the most comprehensive and successful fertility care. We recognize that the trust patients place in SGF is sacred. We are confident that our proven process enables us to minimize risk, avoid errors, and help patients successfully and safely achieve their family building dreams.

*SGF is not affiliated with the clinic mentioned in this story.

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Medical contribution by Naveed Khan, M.D.

Naveed Khan, M.D., is board certified in obstetrics and gynecology and reproductive endocrinology and infertility. He provides fertility care for SGF patients at the Leesburg and Dulles-Aldie, Virginia, offices.

There are always new articles popping up about what a woman can do to enhance her fertility potential. These enhancements run from the practical—eating healthy, exercising, having an ideal BMI—to the more superstitious—eating exotic fruits and nuts or standing on your head after sex. What’s often left out of this conversation, though, is what the male partner should be doing to prepare for conception.

While the man will not be carrying the baby, male factor is the cause of infertility in 40 to 50 percent of couples and male infertility may arise if his sperm count is low or the sperm have mobility issues.

The fact that men produce millions of new sperm every day makes it highly beneficial to men who want to alter their lifestyle habits. Sperm take about 74 days to mature, which means that men who do make lifestyle changes only need to wait about three months before seeing improvements in sperm quality–increasing their chances for reproductive success.

5 ways to improve sperm count

Here are some suggestions from Dr. Naveed Khan of Shady Grove Fertility’s Leesburg, Virginia office on how to improve sperm count:

1: Make physical fitness and healthy eating a priority to reverse male Infertility

As with women who have fertility complications from being under or overweight, men suffer from similar complications. By maintaining a healthy diet and staying active, though, these potential risks can be alleviated. Abnormal semen parameters (i.e., low sperm counts and low sperm motility) increase with obesity. Overweight men have been found to have decreased levels of testosterone and elevated levels of estrogen, an issue that may impair signals from the brain that regulate sperm development. Overweight men are also at risk for impaired spermatogenesis, the process by which sperm are formed, due to increased scrotal temperatures.

2: Kick the smoking habit and improve sperm count and quality

Smoking cigarettes can cause a decrease in the three main factors that determine a man’s sperm quality: sperm count, shape (morphology), and movement (motility). Studies have shown that damage from smoking is not necessarily permanent and may vary by the quantity and length of smoking history. A man’s fertility rate can completely return to normal within a year of quitting smoking.

Other drugs, including marijuana, have been shown to decrease sperm counts. About 33 percent of chronic users will have low sperm counts and men should avoid use when trying to get pregnant.

Read more about the impact of smoking and drugs on fertility.

3: Reduce alcohol consumption

Excessive consumption of alcohol in men has been seen to have an impact on fertility in several studies. Men who consume large quantities of alcohol (five or more drinks per day) may have lowered testosterone levels and reduced sperm quality and quantity.

Alcohol is also linked to erectile dysfunction (also called ED or impotence) in men, which is defined as the inability to maintain an erection firm enough for intercourse. It has been shown, though, that reducing the amount of alcohol consumed can quickly reverse these side effects. 

4: Too much heat can be dangerous

Sperm counts and sperm quality may be affected by frequent or long visits to saunas, steam rooms, and hot tubs (although occasional heat exposure like this should not have adverse long-term effects). This exposure to heat does not have a permanent impact on sperm though, and sperm should return to normal quality and quantity within a few months of discontinuing excessive heat exposure.

Additionally, men should be wary of common household ‘heats’ like resting their laptops on their laps — an issue that can easily be resolved by using a laptop lap board or cooling pad.

5: Low T medications can create unintended consequences

Low T, or low testosterone, occurs when a man has testosterone levels that are below normal levels. While some men do have this condition, the vast majority do not, but advertising has led them to believe otherwise. In the British Medical Journal’s European Male Ageing Study, they found that low T (which they defined as a combination of sexual symptoms and measured testosterone level) was found in only:

  • 0.1% of men in their 40s,
  • 0.6% in their 50s,
  • 3.2% in their 60s, and
  • 5.1% of men in their 70s.

Pharmaceutical companies have taken advantage of men’s concerns about Low T, using low energy, a drop in sexual interest, and other symptoms as potential clinical indicators. While these may be attributable to actual conditions, it is not necessarily Low T, and a physician should always be consulted before trying any medications. What does this have to do with fertility? Low T medications have actually been found to sometimes cause a low sperm count, creating the exact opposite effect of what was intended.

Free male fertility resources

Watch below as Maria and Areen share their story and how they overcame male factor infertility:

While there are many unknown factors that can cause male infertility, the lifestyle tips listed above have been shown to make a remarkable difference in men whose habits are affecting their fertility and sperm count. It is beneficial for any man who is trying to conceive with his partner to keep a healthy lifestyle: minimizing alcohol intake, quitting smoking, and eating healthy and exercising.

The Center for Male Fertility at Shady Grove Fertility offers a range of services including basic evaluation and testing to state-of-the-art microsurgical techniques. The program’s team includes reproductive urologists, Paul R. Shin, M.D., Cori Tanrikut, M.D., and Russell Hayden, M.D., who care for patients in our Maryland, Virginia, Pennsylvania, and Washington, D.C. locations. 

To watch our On-Demand Webinar on Male Fertility, click here. During this free on-demand event, viewers will learn about the simple tests used to evaluate male fertility, common causes of male factor infertility, lifestyle changes that can improve a man’s fertility, effective treatment options, and treatment success rates.

To schedule a virtual consultation with an SGF physician, please call our New Patient Center at 1-888-761-1967 or click below.

Schedule an Appointment

Editors Note: This post was originally published in March 2015 and has been updated for accuracy and comprehensiveness as of November 2021.

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The Impact Of Smoking, Alcohol, And Drugs

We’ve all heard the saying, there is happiness in moderation; however, when it comes to fertility and alcohol, smoking, or illegal drugs, it’s best to err on the side of safety and avoid altogether. Since there is no confirmed “safe” threshold of consumption, the U.S. Surgeon General recommends complete alcohol abstinence in women planning pregnancy, at conception, and during pregnancy.

Fertility, Alcohol, And Women

While “light” drinking (fewer than five drinks per week) is probably not detrimental, “heavy” drinking (two or more drinks per day) or binge drinking (five or more drinks at a time) can not only cause serious harm to a developing fetus but can also negatively impact your chance of conception by causing:

  • Higher rates of menstrual problems
  • Increased chance of miscarriage
  • Increased rate of birth defects (including fetal alcohol syndrome, or FAS)
Fertility, Alcohol, And Men

Excessive consumption of alcohol in men may impact fertility as well. Men who consume large quantities of alcoholic drinks (five or more drinks) may have lowered testosterone levels and reduced sperm quality and quantity. Alcohol is also linked to erectile dysfunction, or impotence, in men. For men, reducing the amount of alcohol consumed can quickly reverse these side effects.

Fertility, Smoking, And Women

Most people know that smoking can have an effect on their health. However, many don’t realize this includes their reproductive health. Compared to non-smokers, many smokers can experience up to a 54 percent higher chance that conception will take 1 year or longer. This delay in conception correlates with the daily quantity of cigarettes smoked. Smoking can also increase the rate of follicular depletion and reduce the levels of estrogen in the body.

Fertility treatment is also greatly impacted when the female partner smokes. Studies cite the following as side effects from smoking:

  • Decreased response to ovarian stimulation medications
  • Decreased number of eggs available for retrieval
  • Increased number of cancelled cycles
Fertility, Smoking, And Men

Smoking cigarettes can cause a decrease in the three main factors that determine a man’s sperm quality: sperm count, morphology (sperm shape), and motility (movement). Studies have shown that damage is not necessarily permanent and may vary by the quantity and length of smoking history. In general, a man’s fertility rate can completely return to normal within 1 year of quitting smoking.

Visit smokefree.gov for tips to help you quit smoking.

Fertility And Illegal Drugs

It’s well documented that illegal drug use can have a negative impact on a person’s life and well being; the same is true for its adverse effects on fertility. Illegal drugs, including marijuana, cocaine, heroine, and steroids, to name a few, have been shown to:

  • Decrease sperm counts and motility, making it less likely the sperm will fertilize an egg
  • Decrease a man’s ability to maintain proper testosterone levels, which can affect sperm quality
  • Interrupt normal ovulation
  • Prevent implantation
  • Inhibit the ability to maintain a healthy pregnancy
  • Increase erectile dysfunction and reduce sexual performance
  • Increase rate of miscarriage, premature birth, low birth weight, and bleeding in the brain

You should discuss any drug use—prescribed or illegal—with your physician before attempting to become pregnant. Treatment to overcome a drug addiction is available and will significantly improve the likelihood of becoming pregnant and having a healthy baby.

Did You Know?

Smoking cigarettes has substantial harmful effects on fertility. Couples undergoing in vitro fertilization (IVF) who smoke have approximately HALF the rate of success per cycle compared with non-smoking couples.

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Prepare Your Body For Conception

Shady Grove Fertility offers these important preconception tips to help you reach optimal health before you become pregnant.

Take A Preconception Supplement.

Taking a combination of several key vitamins and minerals— folate; vitamins A and D; iron; B6; B12—in adequate amounts before getting pregnant can maximize the health of the pregnancy and the baby. Doing so will give your baby the best start at a healthy life. Click here to learn about the difference between preconception and prenatal vitamins.

Maintain a healthy weight.

It’s important to prepare your body for conception. One way to do this is to achieve an optimal weight through exercise and a healthy diet. Obesity and borderline obesity convey many risks to both mother and baby that you can reduce or eliminate with weight loss. Studies show that losing as little as 5 percent of your body weight may increase your chances of pregnancy. Underweight individuals also are predisposed to risk factors that you can remedy with proper nutrition and achieving an optimal weight.

Revamp your diet.

Remember to treat food as fuel and opt for healthier alternatives. Reach for an apple or a handful of almonds when mid-day hunger strikes, and try trading the fries on the side for a fresh seasonal veggie or a salad. Meeting with a nutritionist from the Wellness Center can help you ensure that your new eating plan is balanced and provides adequate caloric and nutrient intake. Nutritionists can also help with meal ideas and snack tips to make it easier to stick with your plan.

Get in shape.
  • Intense physical activity, such as that of competitive female athletes, can disturb the menstrual cycle, but moderate activity has little effect on your cycle.
  • Obesity is associated with decreased fertility. Weight loss in obese women can improve their fertility. Weight loss can also improve menstrual regularity in obese women with polycystic ovary syndrome (PCOS).

You don’t have to become a gym rat or a Zumba instructor to incorporate a little fitness into your routine. An easy way is to take the stairs instead of the elevator and walking to pick up lunch during the day.

Quit smoking and other bad habits.

Smoking also contributes to a higher rate of miscarriage. The label says it right on the box—smoking and pregnancy don’t mix. Studies have shown that chromosomal and DNA damage from smoke exposure increase birth defects and miscarriages. In fact, one study done with female smokers 14 to 39 years of age showed smoking accounted for 16 percent of miscarriages.

Quitting smoking and certain risk behaviors such as excessive drinking and use of illegal substances are critical to both minimizing your chances of miscarriage and promoting a healthy pregnancy.

Reduce stress.

Reducing stress is desirable while trying to conceive. Whether it’s sharing your experiences with others in a group setting or seeking acupuncture and other complementary therapies, finding a way to reduce stress will increase your likelihood of continuing your course of treatment and promote a healthy pregnancy.

Be sure your medications are appropriate to take during pregnancy.

Review your current medications, including any herbs or supplements, with your physician to ensure proper dosages and to determine if your medications are safe to take during pregnancy. There may be alternatives to current medications that are safe during pregnancy and others that should change prior to conception.

Know your medical history.

It is important to review with your physician your medical history, including past immunizations. We encourage patients to get up to date with their immunizations for such conditions as influenza, chicken pox, measles, mumps, and rubella, to name a few.

Seek physician care for undiagnosed and untreated medical conditions.

There are a number of medical conditions that may negatively affect pregnancy, including prediabetes, asthma, high blood pressure, and a low-functioning thyroid gland. It is important to have a physical examination by either a gynecologist or your primary care physician before trying to conceive or beginning fertility treatments. A physician can easily test for and treat conditions before you become pregnant. The result of treatment can greatly improve your fertility, diminish the chance of miscarriage, and promote a healthy pregnancy.

Time sexual intercourse for procreation not recreation.

The next tips are about how you and your partner are actually working to make your baby. Everyone’s has at least one friend who is more than happy to tell you exactly which position is most likely to result in conception but there’s no evidence that position has any effect on fertility. Timing rather than position has much more to do with conception. It is advised to have intercourse during the 5 days leading up to ovulation and the day you ovulate. For some, sex every day can be stressful so focus on the last 2 or 3 days of thatovulation window.

While we’re on the topic of intercourse, your choice of lubricant may be impacting conception. Certain components of water-based lubricants can make it more difficult for sperm to make their way into the cervical canal. These lubricants include many of the popular drugstore brands, so couples who are trying to conceive should use lubricants designed to mimic natural fluids or mineral oil.

Get enough sleep.

We all know how important it is to get a good night’s sleep, but did you know that you’ll get a much better quality of sleep if you sleep in total darkness? According to studies published in Fertility and Sterility,melatonin production can be lowered by artificial light including the light emitted from your smartphone or tablet. Melatonin is the sleep hormone that helps boost fertility, so remember to get your z’s and turn out the lights!

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