Online Health Chat with Jeffrey M. Goldberg, MD

April 12, 2017


Description

The human reproductive system is complicated. It doesn’t always work correctly when a couple is trying to become pregnant.

According to the most recent US Centers for Disease Control and Prevention (CDC) study:

  • One in eight couples will have trouble getting pregnant or sustaining a pregnancy.
  • Twenty-five percent of impaired couples have more than one factor that contributes to their infertility.

If you have been diagnosed with infertility or wonder if you or your partner may have a contributing factor, this web chat is for you. Cleveland Clinic infertility specialist Jeffrey M. Goldberg, MD, will answer your questions and discuss the issues surrounding infertility today.

Dr. Goldberg will chat about: Advances in fertility drugs; surgery; determining causation; when it is time to consult a reproductive specialist; terminology such as IUI, IVF, egg freezing and cycles; the role weight, personal health and family history plays in infertility; and more.


About the Speaker

Jeffrey M. Goldberg, MD, is board-certified in obstetrics and gynecology and subspecialty board-certified in reproductive endocrinology by the American Board of Obstetrics and Gynecology. He joined Cleveland Clinic in 1991 and is currently ranked in the top one percent of reproductive endocrinologists in the US by Castle-Connelly. He is the section head for Reproductive Endocrinology and Infertility at Cleveland Clinic and holds the rank of professor with Cleveland Clinic Lerner College of Medicine. He also established and directs the Reproductive Endocrinology and Infertility Fellowship Program.

Dr. Goldberg has published more than 300 scientific articles, abstracts and book chapters, and has co-authored three books on gynecologic endoscopic surgery. He is a Fellow of the American College of Obstetrics and Gynecology, and is a member of the American Society for Reproductive Medicine, The American Society for Reproductive Endocrinologists, the American Association of Gynecologic Laparoscopists and was the president of the Society of Reproductive Surgeons. He is chair of the Minimally Invasive Reproductive Surgery Fellowship Committee and is on the editorial board of several journals, including Fertility and Sterility and the Journal of Minimally Invasive Gynecologic Surgery.

Dr. Goldberg’s clinical interests are advanced endoscopic surgery, microsurgical tubal anastomosis, in vitro fertilization and reproductive endocrinology. His research interests include endometriosis, reproductive surgery and in vitro fertilization.

He was co-recipient of the Computerworld Smithsonian Research Innovation Award for robotic surgery, received the American College of Obstetricians and Gynecologists National Faculty Award for excellence in resident education, and has been selected as a Top Doc in Cleveland and Best Doctors in America since 2001.


Let’s Chat About Overcoming Infertility

 

Risks and Side-Effects

SkinKY25: I heard that some treatments cause multiples. Is this true?

Jeffrey_M._Goldberg,_MD: This is true. The ovulation-inducing drugs may cause multiples. The oral medication Letrozol increases the chance for twins by five percent, and Clomid has a five percent to 10 percent increase for twins. The injectable drugs produce about 20 percent increase for multiples which include triplets or more.

Rana04: Thank you for having this webinar. I am a 33-year-old female, and my husband is 36 years old. We have been trying to conceive for three years. We have been diagnosed with unexplained infertility. Our fertility specialist recommended us to do IVF with ICSI; however, I am concerned with the increased chance of birth defects with ICSI. Also, I am concerned about the fertility drugs with the possibility to get cancer (breast and ovarian) in the long term. Could you advise if ICSI does increase birth defects, and if the fertility drugs do cause cancer in the long term? Also, could you recommend other treatments that do not increase the risk of birth defects and fertility drugs that do not increase the risk of cancer? Thank you.

Jeffrey_M._Goldberg,_MD: The ICSI procedure itself does not increase the risk for birth defects. However, it may transmit the same sperm production problem to a male child who would have not been conceived without ICSI. Also, the data are very reassuring that there is no increased risk for breast, ovarian or other cancers with any of the fertility drugs.


Dealing with Disorders

Martin628: If diagnosed with chronic salpingitis, are you able to still get pregnant naturally on your own? I have lost my left tube due to an ectopic pregnancy, had the HSG test done and was told about the salpingitis, but was told the right tube is open.

Jeffrey_M._Goldberg,_MD: While it may be possible to conceive naturally if you have chronic salpingitis with at least one open tube, the chance for success is lower and the risk for a tubal pregnancy is much higher. In vitro fertilization would be the best treatment option to both improve pregnancy rates and lower the risk for a tubal pregnancy.

rebma02: Which treatments are available for someone with PCOS who has been struggling with weight loss for years? No diet or exercise has helped reduce body weight.

Jeffrey_M._Goldberg,_MD: Problems with PCOS include absent, infrequent and/or irregular menstrual cycles (which can cause excessive bleeding and infertility due to not ovulating, and increase the risk for uterine cancer), acne, scalp hair loss or excessive facial or body hair growth. Weight loss may correct the condition for some overweight PCOS patients. Treatment options depend on whether they are trying to conceive at the time. If pregnancy is not desired, birth control pills can regulate the cycles and improve the skin symptoms. The first line treatment for infertility is an oral fertility drug such as Clomid or Letrozole to induce regular ovulatory cycles. If those are not successful in regulating the cycles, injectable fertility drugs or an outpatient laparoscopic procedure called ovarian drilling usually enable ovulation to occur. Some PCOS patients may be insulin resistant, in which case Metformin may be added to the above treatments.

rebma02: Would it ever be necessary for someone who has had ovarian drilling done for PCOS treatment and responded well, but has since stopped ovulating with and without medications, to need the ovarian drilling to be done again? Also, how important is taking Metformin in helping with PCOS symptoms? Are there any other medications that help reduce symptoms, while still TTC? I had been taking Metformin, but my insurance has stopped covering it.

Jeffrey_M._Goldberg,_MD: Ovarian drilling is a minor outpatient, laparoscopic procedure for treating infertile PCOS patients who’ve failed to ovulate in response to oral fertility drugs. While injectable fertility drugs provide the same ovulation and pregnancy rates without surgery, they require daily injections and frequent visits for monitoring with ultrasounds and blood work, carry risks for multiple pregnancy and over-stimulating the ovaries (a potentially serious condition), and the cost to achieve a pregnancy is usually higher. The beneficial effect of ovarian drilling often lasts for many years, but the data are scarce on repeat procedures.


Getting There

SHann2sleep: Does age play a role in IVF or other treatment options? What would you say is the ideal age to have a baby?

Jeffrey_M._Goldberg,_MD: The age of the woman is the strongest predictor for success with any infertility treatment, as well as with natural conception. Pregnancy rates start to progressively decrease each year starting in the early 30s. At the same time, the risks of miscarriage and birth defects are increasing. For women in their late 20s to early 30s who will be delaying conception for several years, either due to lack of a partner or pursuing a career, freezing their eggs can preserve their fertility potential.

LauraLs28: We have been trying to have a baby for some time now. I was wondering if there is an ideal sexual position for conception.

Jeffrey_M._Goldberg,_MD: There are many myths that have been circulating for decades. Among those that make no difference are sexual position, lying around with the hips elevated after intercourse, taking cough syrup and the type of underwear the male wears.

LauraLs28: Hi. Thanks for this opportunity. If I get my period regularly, does that mean I’m ovulating and fertile?

Jeffrey_M._Goldberg,_MD: Regular monthly cycles are indicitive of normal ovulatory function but  infertility may be impaired byby other factors such as abnormal sperm production,  tubal disease, fibroids or endometriosis.

RoadWarrior24: I heard that having an orgasm during sex can help you conceive. What do you think: Does having an orgasm help you to get pregnant? Is there any research that backs this?

Jeffrey_M._Goldberg,_MD: While this is a very interesting question, there is no evidence that orgasm affects pregnancy rates, as it would be a very difficult study to perform.


Trying and Timing

Dizzy Lizzy: My husband and I have been trying to have a baby since the beginning of 2017. We talked about it over Christmas and New Year’s and decided to have a baby. How long should we try before we seek the help of a doctor?

Jeffrey_M._Goldberg,_MD: We recommend timed intercourse for a year before seeking infertility testing and treatment, as it can take fertile couples that long to conceive, since fertile couples only have a 20 percent chance of success each month. However, if there is an obvious problem, such as irregular cycles, we would initiate treatment right away. Also, we recommend testing and treatment after six months of trying if the woman is 35 years of age or older.

Britt14825: My husband and I have been trying to have a baby for over a year now. We have not consulted a doctor about the issue because we are scared to find out if there is something wrong. Could you talk about the most common problems you see day to day? Also, what options are there for couples if they have one of these problems?

Jeffrey_M._Goldberg,_MD: There are several potential problems that can lead to infertility. Treatments options are individualized based on the results of fertility testing. Some problems include: not ovulating, blocked fallopian tubes, scar tissue in the pelvis, endometriosis, fibroid tumors and sperm production problems. The cause of infertility is unexplained in about 25 percent of couples.

Rana04: Thank you. Would you recommend IVF with ICSI for us as well?

Jeffrey_M._Goldberg,_MD: ICSI stands for intracytoplasmic sperm injection and involves injecting a single sperm into each mature egg with IVF. It is primarily used for couples with a severe male factor problem. Our IVF lab performs ICSI on all of the mature eggs to assure optimal fertilization rates at no extra charge.

principal11: Can you talk about gender selection? If you go through the process of IVF, are you able to select your child's gender for family balancing? Are there any doctors who offer that service? Thank you.

Jeffrey_M._Goldberg,_MD: Sex selection is done by biopsying a few cells from each embryo for genetic testing five or six days after the eggs are collected and inseminated for IVF. While genetic testing of embryos is usually done for patients at an increased risk of producing genetically abnormal embryos, such as those with advanced maternal age, the sex of the embryos is also known and couples can choose which embryos to transfer. IVF with genetic testing and sex selection can also be performed solely for the purpose of family balancing. Most IVF programs, including ours, offer sex selection.


Interested in Information

Margie4529: Is there a resource I can use to find an infertility specialist in my area?

Jeffrey_M._Goldberg,_MD: Yes. You can go to asrm.org. It is the website or our national infertility society. It is a great resource for finding more information about infertility, as well as finding providers in your area.


Closing

That is all the time we have for questions today. Thank you, Dr. Goldberg, for taking time to educate us about Infertility.

On behalf of Cleveland Clinic, we want to thank you for attending our online health chat. We hope you found it to be helpful and informative. If you would like to learn more about the benefits of choosing Cleveland Clinic for your health concerns, please visit us online at http://my.clevelandclinic.org.

For Appointments
To make an appointment with Dr. Goldberg or any of the other specialists in Cleveland Clinic’s Fertility Center, please call 216.444.6601, toll-free at 800.223.2273 (extension 46601) or visit us at http://my.clevelandclinic.org/departments/obgyn-womens-health/depts/fertility-center for more information.


For More Information

About the Cleveland Clinic Fertility Center
With numerous locations throughout Northeast Ohio, our highly trained team of specialists will provide collaborative care at a location that is convenient for you.

Fertility services, including andrology, are available at the Beachwood Family Health & Surgery Center and Laboratory, as well as at Cleveland Clinic Main Campus or any of our family health centers in Avon, Solon, Strongsville and Twinsburg. In addition to these sites, we can facilitate monitoring for fertility treatments at other locations, both in state and out of state to ensure a stress-free experience. Patients living outside of Cleveland can enjoy the advantages of care from our Cleveland Clinic fertility team with a minimal number of visits to the Cleveland area.

Although many people associate infertility treatment with in vitro fertilization, our Fertility Center provides the full range of services, from simple evaluations and recommendations to state-of-the-art reproductive technologies. In our experience, most patients can be effectively treated with simpler means than in vitro fertilization. However, should you require in vitro fertilization, our program is one of the largest in the state, and is equipped with some of the most advanced technologies available. Patients are seen in a caring environment, where the major emphasis is placed not only on technological excellence, but also on accessibility, personal attention and emotional support.

About Cleveland Clinic Ob/Gyn & Women’s Health Institute
The Ob/Gyn & Women’s Health Institute is designed to meet the unique and changing medical needs of women from adolescence to mature adulthood. Our team offers coordinated and supportive care for the programs that affect women’s lives, from infertility, incontinence, gynecologic cancers, pelvic floor disorders, menopause and more. We are committed to providing world-class care to women of all ages.

The Ob/Gyn & Women’s Health Institute offers a full complement of subspecialty services that fall within the field of women’s health, from general gynecologic care to complex oncology surgery for gynecologic malignancies. The institute model has streamlined the care of women, enhanced research opportunities, and improved the education of physicians, nurses and other health care professionals. Services are available on the main campus, as well as in family health centers and hospitals throughout the region.

In 2015, the Department of Obstetrics and Gynecology was the top-rated program in Ohio and ranked number three nationally by U.S. News & World Report.

Cleveland Clinic Health Information
Learn more about symptoms, causes, diagnostic tests and treatments for Infertility.

Cleveland Clinic Research & Innovations
https://my.clevelandclinic.org/departments/fertility/research-innovations

Clinical Trials
For additional information about clinical trials, visit ClinicalTrials.gov.

Your Health
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A remote second opinion may also be requested from Cleveland Clinic through the secure Cleveland Clinic MyConsult® website. To request a remote second opinion, visit eclevelandclinic.org/myConsult.


This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician’s independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of the Cleveland Clinic institution or other Cleveland Clinic physicians. ©Copyright 1995-2016. The Cleveland Clinic Foundation. All rights reserved.