Five Top Doctors At Our CT Fertility Clinic
When I say I work for the best fertility doctors in Connecticut, people hearing my words probably think I'm biased. In fact though, their peers agree, they are top doctors according to Castle Connolly Medical Ltd. (See below.) That's not me saying it, that's other doctors in Connecticut saying it.
Clinically, they are excellent, hence their awards. Drs. Mark Leondires, Spencer Richlin, Joshua Hurwitz, Cynthia Murdock and Shaun Williams are a dedicated group of physicians intent on providing the very best fertility treatment possible. Our pregnancy rates are outstanding and are continuing to rise due to innovative and scientific advancements and a fertility program willing to move past accepted ways to treat infertility and sub-fertility. We have doctors who respect what we have learned in the last several decades and are also open to new, research-driven techniques. They are neither bound mindlessly to the past nor are they jumping unquestioningly into new, unproven protocols.
All that and more. Dedicated to creating a program that treats men and women like human beings and not walking fertility diagnoses; we have created teams. Each patient has an award winning, board certified reproductive endocrinologist, plus a nurse coordinator, plus a patient navigator, plus a financial representative. These teams are put together to ensure that each patient at RMACT knows who to ask questions of and who is responsible for their fertility treatment. While patients may get treated as a number in other fertility programs, they most certainly are not treated that way at RMACT.
RMACT takes other steps as well to ensure that patients are taken care of; the Integrated and Fertility Wellness Program offers many free and co-pay dependant services for both patients and non-patients. Mental health professionals offer counseling and coaching so that men and women can thrive during fertility treatment, not simply survive. Our acupuncturists have almost a decade of experience working in both traditional and laser treatments. Our nutritionist, who one can see for a co-pay, creates individualized and specific plans for each and every patient that she sees and has made a big difference in patients reducing fertility-affecting lifestyle choices. Fertile Yoga is offered three days a week, in three separate locations, free of charge, reducing stress and increasing quality of life while in fertility treatment.
Please read below about our award winning doctors. How lovely and affirming that other physicians confirm what we all ready know; that the doctors at RMACT are dedicated to their patients and helping them become pregnant, with fertility treatment and compassion and hope.
All Fertility Doctors at RMACT Named Top Doctors
Castle Connolly Medical Ltd., which conducts a rigorous, peer-reviewed assessment of local doctors, compiles the list of Top Doctors to help patients find the best healthcare providers. All five fertility doctors at Reproductive Medicine Associates of Connecticut (RMACT) are Top Doctors, as decided by their peers in the medical field.
Excellence in Reproductive Endocrinology and Infertility
Dr. Mark Leondires, medical director and fertility specialist at RMACT, was selected in 2013 as a Castle Connolly Regional Top Doctor for his work the field of reproductive endocrinology and infertility. Among Dr. Leondires’ accolades, he was selected in 2012 and 2013 for Best Doctors in America, a database of the country’s top five percent of physicians, as chosen through a peer-review process.
Prior to joining RMACT, Dr. Leondires served as the Director of Assisted Reproductive Technologies (ART) at the Combined Federal Program for Reproductive Endocrinology. While under his direction, the ART Program was one of the most successful in the Washington DC area and in the top tenth percentile nationally. During this time he was an Assistant Professor at the Uniformed Services University of Health Sciences and clinical faculty for the Combined Fellowship in Reproductive Endocrinology. His professional society memberships include the Society of Reproductive Endocrinologists, the American College of Obstetrics and Gynecology, and the American Society for Reproductive Medicine.
Dr. Cynthia Murdock, a fertility specialist at RMACT, was also selected in 2013 as a Castle Connolly Top Doctor in the field of Reproductive Endocrinology and Infertility. Dr. Murdock was chosen by her peers as one of Connecticut’s top fertility specialists based on her outstanding work with patients who need help getting pregnant and building their families.
An experienced researcher, Dr. Murdock has contributed to numerous peer-reviewed studies and presented at several of the most prestigious conferences in the field of reproductive medicine. The focus of much of her research has been on estrogen receptors, hypothalamic neuron function, and precocious puberty. Dr. Murdock is a member of the American Society for Reproductive Medicine and the Society for Reproductive Endocrinology and Infertility, as well as a Fellow of the American College of Obstetrics and Gynecology. Dr. Murdock was previously an assistant clinical professor at Creighton University School of Medicine and a staff physician with Reproductive Health Specialists at Nebraska Methodist Hospital. She has also served as an Assistant Professor of OB-GYN at the National Naval Medical Center and Walter Reed Army Medical Center.
Dr. Joshua M. Hurwitz, a partner at RMACT, was also selected in 2013 as a Castle Connolly Top Doctor in the field of Reproductive Endocrinology and Infertility. Since joining RMACT seven years ago, he has helped thousands of patients realize their dreams of having a baby.
In addition to his responsibilities with RMACT, Dr. Hurwitz is Division Director of Reproductive Endocrinology and Infertility (REI) services in the Department of Obstetrics, Gynecology and Reproductive Sciences of Danbury Hospital, where he has been teaching residents during his entire tenure. He is also an Assistant Professor of Obstetrics, Gynecology and Women’s Health at the Albert Einstein College of Medicine. During residency training, Dr. Hurwitz was named Best Laparoscopic Surgeon, and has received many teaching awards. He is a member of the Society of Reproductive Endocrinologists, Fellow of the American College of Obstetrics and Gynecology, and the American Society for Reproductive Medicine.
Top Docs of Fairfield County
Two of the Board Certified reproductive endocrinologists of RMACT – Dr. Spencer Richlin, Surgical Director and Fertility Specialist, and Dr. Shaun Williams, fertility specialist – have been honored by their peers by being rated “Top Docs” of Fairfield County in 2014.
Dr. Spencer Richlin, who made the Castle Connolly list for the third consecutive year, is a partner with RMACT. “My patients, whether they are couples, oncology patients or single women, all have the same dream – to have a family,” says Dr. Richlin, who is the Division Chief of Reproductive Endocrinology and Fertility at Norwalk Hospital along with his responsibilities at RMACT. “This intuitive human need is powerful, and I’m proud to help them have the families they dream of.”
Dr. Richlin is a member of the American College of Obstetrics and Gynecology (ACOG) and of the American Society for Reproductive Medicine (ASRM). He has published several articles and is on the writing committee for the upcoming 2015 Reproductive Endocrinology & Infertility PROLOG sponsored by the ACOG.
Dr. Shaun Williams’ peers also rated him as a “Top Doctor” for Castle Connolly’s 2013 list of Fairfield County’s Top Doctors. “This award speaks to the hard work and care of our entire team,” says Dr. Williams, who joined the RMACT team in 2012. “I’m proud of our team’s success rates and that we are helping patients to improve their overall health through nutrition, stress management, and of course advanced medical treatment.”
Dr. Williams has been published numerous times, and has presented five of his abstracts at American Society of Reproductive Medicine’s annual conference for professionals in the infertility field. He is a member of ASRM, Fairfield County Medical Association, Fellow of American College of Obstetrics and Gynecology, and associate member of Society for Reproductive Endocrinology and Infertility.
Anyone out there agree about our wonderful doctors? Care to share a few words? We would love to hear from you! ~Lisa Rosenthal
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Our Reproductive Endocrinologist and CT Fertility Specialist
A new year. A new opportunity to introduce the medical team at Reproductive Medicine Associates of Connecticut (RMACT). We have the best of the best: five award-winning, board-certified reproductive endocrinologists. They are excellent in both their clinical expertise as well as their understanding of the stress that their patients are under. Wonderful doctors as well as wonderful human beings. Each week for the next five weeks, I'll share with you who they are.
Drum roll please. Introducing Dr. Mark P. Leondires, Medical Director and lead infertility doctor with Reproductive Medicine Associates of Connecticut (RMACT), is board-certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility. ~Lisa Rosenthal
Board-Certified Reproductive Endocrinologist: CT Infertility Doctor
Among Dr. Leondires’ accolades, he was chosen by his peers as a Castle Connelly Regional Top Doctor for his work in the field of reproductive endocrinology and infertility. He was also selected in 2012 and 2013 for Best Doctors in America, a database of the country’s top five percent of physicians, as chosen through a peer-review process.
Prior to joining RMACT, he most recently served as the Director of Assisted Reproductive Technologies at the Combined Federal Program for Reproductive Endocrinology. While under his direction, the ART Program was one of the most successful in the Washington DC area and in the top tenth percentile nationally. During this time he was an Assistant Professor at the Uniformed Services University of Health Sciences and clinical faculty for the Combined Fellowship in Reproductive Endocrinology. His professional society memberships include the Society of Reproductive Endocrinologists, the American College of Obstetrics and Gynecology, and the American Society for Reproductive Medicine.
He received his undergraduate degree in biochemistry and history from Colby College in Waterville, Maine. He earned his medical degree from the University of Vermont College of Medicine in Burlington, Vermont. He completed his residency in Obstetrics and Gynecology at Maine Medical Center in Portland, Maine, which was followed by a fellowship in Reproductive Endocrinology and Infertility at the National Institutes of Health in Bethesda, Maryland.
Along with numerous teaching and research activities, Dr. Leondires has published numerous articles in professional medical journals, as well as abstracts, articles and book chapters.
His research interests include IVF, endometriosis, polycystic ovarian syndrome, the role of hormones in brain function, and reduction in higher-order multiple gestations.
A few words from Dr. Leondires on his award, our launching the RMACT website in Spanish and on his involvment with GayParentstoBe, an RMACT website:
“I’m honored that my peers have named me a Top Doctor,” says Dr. Leondires, who is Board Certified in both Reproductive Endocrinology and Obstetrics and Gynecology. “This is an exciting time to be in the fertility field because there have been impressive advances, particularly in the past 10 years. It has been a privilege to bring those advances to my patients, as well as the hope that comes with these scientific advances to help them succeed in their dream of having children.”
“For many of our patients, online research is their first step to learning about infertility and to making a plan for starting a family,” says Dr. Mark Leondires, Medical Director of RMACT. “We hope that this website can help Spanish-speaking patients understand their options and help them feel less isolated. It is important for patients to have a firm understanding of their diagnosis and to feel confident in their treatment plan.”
“I am proud to share my opinions and expertise as both a dad and a physician at a larger fertility center. I hope to offer to insights, support, and professional expertise to the LGBT community,” says Dr. Mark Leondires, a board-certified reproductive endocrinologist. “As a father and husband, I want to share the joy of being a parent with others in the LGBT community. While it was a hurdle to get started, the rewards are boundless. I hope to use my experience as a fertility doctor to help others understand their medical options when it comes to LGBT family building.”
Contact us to book an appointment with RMACT lead infertility specialist Dr. Leondires in our Connecticut or New York fertility centers.
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A Love Letter to CT Fertility Program
Every so often I write a love letter to CT fertility program, RMACT. Here's why.
They are a fertility program with a tremendous amount of heart, integrity and compassion. They, we, put the patient first. We consider your medical needs, your emotional needs, and yes, your spiritual needs. We do not see you as a walking infertility diagnosis. We see you as a whole and complete human being. I see that every day at RMACT. I hear about it when Fertile Yoga students mention their nurses calling them back at 6:45 PM on a Saturday night or one of our five board certified reproductive endocrinologists going the extra mile to explain the results of a test that is troubling you. I feel it when I see the love that is expressed by our patients talking about the time and care that our patient navigators took in walking them through a difficult process.
When I got the following email from Dr. Mark Leondires, Medical Director at Reproductive Medicine Associates, I was struck by his concern for his patients, which prompted me to respond and ask him if I could use it here, on PathtoFertility.
Of course he said yes.
So here we have an internal email, shared with permission with you. An email that was prompted by his concern with a patient that he had just seen.
I added a comma or two. Otherwise, this email is being published as it was sent to the RMACT staff.
Not too often you get an inside view. Enjoy! ~ Lisa Rosenthal
* * * * * * * * * * *
Inside Letter from Dr. Leondires on Infertility Support Services
We are so happy that Melissa Kelleher has joined us. As a social worker, she is in a position to be helpful to patients who are in need of emotional support, a hand to hold, or as a sounding board for their anxiety, or other mental health support needs.
We are also able to have many patients be seen under their insurance plan. This should dramatically increase the utilization of mental health support services by our patients, I hope. We should all recognize that having the availability to talk to a mental health professional covered by your insurance plan is a great opportunity to get more of our patients the support and help that they need, without them having to undergo more out of pocket expenses.
I encourage all of you to consider referring many types of patients to Melissa to be seen. These patients could include:
- Infertility patients who are struggling with the process
- Recurrent pregnancy loss patients who need extra support
- Newly diagnosed cancer patients accessing fertility preservation
- Polycystic ovarian syndrome patients dealing with their diagnoses
- Patients being seen for weight loss in need of extra support
- Patients considering using donor sperm
- Patients considering using donor egg
- Patients considering any aspect of third party reproduction
With Melissa we have an expanded complement of mental health counseling services available to our patients. Melissa works 4 days per week in Norwalk, Danbury, and Trumbull, which is awesome.
I am so excited to offer expanded mental health and support services on insurance platforms and strongly encourage all referrals. Dr. Tuttle continues to be a integral part of our practice and will continue screening egg donors, carriers, and providing psychological support counseling and services. I know they will work together to be able to get more of our patients the help they need.
Let’s all try to get our patients the mental health support services that they need. If you are struggling as to how to make or whether to make the referral please talk to Melissa or Lisa so they can help you.
Happy Holidays to all and let's have a GREAT New Year!
Mark Leondires, MD
RMA of Connecticut
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Preparing for A Healthy Pregnancy
It seems like the Monday after Thanksgiving might be a good time for a reminder about what to think about BEFORE you try to become pregnant. It's never too late to start new habits for a healthy pregnancy and make more conscious decisions about your lifestyle.
CT fertility specialist Dr. Mark Leondires, Medical Director of Reproductive Medicine Associates of Connecticut (RMACT), talks about the choices that we can make when we are considering having a baby. As he advises below in the blog that he wrote for the Norwalk Patch, 90 Days Preconception: Habits for Optimal Fertility and a Healthy Pregnancy, better to think ahead. Of course you want to make healthy choices when you are trying to conceive; even better though if you know ahead of time. Ninety days ahead of time, according to Dr. Leondires, can make a real difference.
~ Lisa Rosenthal
CT Fertility Specialist Dr. Mark Leondires On Optimizing Fertility
However, instead of jumping immediately into a treatment plan, I believe in treating the whole patient. My partners and I find that patients are most likely to successfully get pregnant when their physical and mental health is at its best.
Patients should consider their health and lifestyle habits 90 days before conception. This is about more than fertility health. This includes nutrition, mental health, stress management, physical activity… all of it affects a person’s fertility and, upon conception, it affects the health of mother and baby.
Some of our patients are able to get pregnant simply by changing their lifestyle habits – without assisted reproductive technology. As little as a 5 percent reduction in weight can lead to more regular ovulatory cycles, improved insulin sensitivity and an improved chance of pregnancy. Sometimes patients are too lean and their hormonal balance can be restored with weight gain.
Preconception Health Tips - A Checklist
Here are examples of how to improve lifestyle habits (and therefore improve fertility while decreasing the risk of birth defects) from the preconception health checklist that we use with our patients at Reproductive Medicine Associates of Connecticut (RMA of CT).
- Eat a balanced diet that exemplifies the USDA’s balanced plate full of vegetables, fruit, whole grains, lean protein, heart healthy fats
- Test for risk factors: hemoglobin A1c, vitamin D, blood pressure, cholesterol – these are simple tests that can be performed by your family doctor
- Start to take prenatal vitamins (800 mcg of folic acid)
- Drink water (not soda and minimize caffeine).
- Boost important vitamins and minerals: calcium (dairy, leafy greens), folic acid (citric fruit, fortified breads, lentils), iron (spinach, beans), omega-3 (low-mercury fish such as salmon)
- Limit alcohol
- Quit smoking
- Avoid exposure to environmental risk factors (e.g., gardening chemicals, cleaning products)
- Lower caffeine intake to less than 150 mg per day, which is equivalent to two 8 oz cups of coffee
- Try to get to a healthy weight and body mass index (BMI)
- Be physically active with low impact activities such as swimming, walking and restorative yoga
Mental Health & Partner Relationship
- Identify stress management method (e.g., yoga, meditation)
- Communicate with your partner about your dreams of a family
- Identify your network of friends and family – and consider talking to them when you are stressed
- Talk to a professional when going through extreme challenges or making life-changing decisions
- Consider support groups with other fertility patients. RMACT has monthly free support groups for fertility patients
- Check your health insurance. Is family planning covered? Are there restrictions (e.g., age)?
- Schedule a preconception visit with your OB/GYN and be up to date on PAP smear and mammogram
- For women: FSH and/or AMH, which are simple blood tests that help guage ovarian reserve; hysterosalpingogram (HSG), which is a non-invasive test to check the fallopian tubes and uterus
- For men: schedule a semen analysis, limit alcohol, quit smoking, work towards a healthy weight
Simple lifestyle changes have the power to improve fertility and the health of the baby. Sometimes assisted reproductive technologies are still needed for a couple to get pregnant. But improving a couples’ health (yes, the woman and the man) doesn’t have a downside. Best of all, many of my patients like being proactive – this is something within their control.
Understanding Fertility Testing from Reproductive Endocrinologist Dr. Mark Leondires
My patients are in their 20s, 30s or 40s; they can be healthy and fit or obese; they can be any race or religion. I am a reproductive endocrinologist, and I’m reminded daily that infertility does not have one look. Even patients who are generally healthy can struggle to get pregnant.
At my practice, we determine a woman’s level of fertility based on her medical and family histories, age, basal antral follicle count, day 3 follicle stimulating hormone (FSH) and anti-mullerian hormone (AMH) level. Collectively these factors give us a complete picture of a woman’s reproductive health; however, AMH testing, which is relatively new, is generally considered to be very reliable.
AMH levels are measured by a simple blood test. Because AMH tests measure a protein as it secretes in to ovaries, it is not affected by estrogen and other hormones, and can therefore be tested at any point in the menstrual cycle and even in patients on birth control pills.
Options for Women with Low Ovarian Reserve
Women with low ovarian reserve have several options. If they are considering having a family, they may decide they are ready to start trying. If they are not ready to start a family, they can freeze eggs for the future. Alternatively, they can continue to monitor their egg reserve or seek further testing to get a better understanding of their reproductive health. All of these options benefit from early detection; the earlier we know if there is an issue, the more we can help.
While it is true that the likelihood of getting pregnant decreases dramatically after 35 years of age, any woman in her reproductive years can be affected by infertility. Women should be able to get pregnant within a year of trying. If they have not, then they should see a fertility specialist. If they are over 35 years old, they should see a reproductive endocrinologist after trying for six months. It is also important to know that male partners contribute up to 40 percent of infertility issues; both partners should see a fertility specialist for diagnostic testing.
Free AMH Testing Details
Reproductive Medicine Associates of Connecticut (RMA of CT) is hosting two events in October with free AMH testing. Each event will include an opening presentation about infertility, including an explanation of the AMH test. Attendees will then have a blood test taken and a nurse will call with the results within 10 business days. The events are being held:
RMA of CT Stamford Office
1290 Summer Street, suite 3200
October 11, 2012 at 6 p.m.
RMA of CT Danbury Office
67 Sand Pitt, suite 300
October 11, 2012 at 6 p.m.
Preregistration is encouraged: www.rmact.com/amh.
We hope women in the area take advantage of this event to learn more about infertility and to have a free AMH test, even if their plan is wait to start a family.
This blog post appeared originally on the Stamford Patch.
Fertility and Adoption Conference Take-Aways
A Family of My Own had its fertility and adoption conference in Rye Brook, New York this past Saturday.
Kudos to the organizers, Preya Shivdat, Elizabeth Carellas and Nina Antolino. It was a well-organized, well-thought out and well-executed conference.
I had the pleasure of listening to Dr. Mark Leondires speak that day. His topic was "Finding Hope: Working Together to Understand Your Fertility and Treatment Options in the Age of Modern ART."
His presentation was compassionate and scientific and thoughtful. He reminded all of us that no one really wants to be in fertility treatment. We all wish that conceiving happened outside of a doctors office, at home. He spoke about alternative paths to creating our families and ways in which we can adjust our vision to include paths that we had previously rejected.
The day also included one of RMACT's Finance Managers, Natesha Lane, sharing her expertise about fertility insurance coverage and the state mandates. Her audience was most appreciative to have heard her, as she was thorough, helpful and informative.
I enjoyed speaking on Fertile Yoga and the different aspects of mind/body techniques that I bring into the classes.
We recorded our sessions, so look forward to seeing them, edited, on the blog site soon.
Fertile Lessons from Yoga
Jump to the next day, when I taught yoga to a very experienced group of yogis. The focus of the class is a vigorous physical challenge, with heart and breath wide open--a pleasure to teach. My focus for the class was on the questions that come up and to allow answers to come to us as they may: To notice what the questions are, first and foremost; To recognize that the questions themselves often hold the answers; And that the answers are not always what we think they will be.
One student, during a particularly challenging pose, when told about doing handstand next, blurted out "no." We all laughed. She finished the sequence. We moved to headstand and handstand.
Loved her next comment.
She amended her initial response to this: "No, moving toward maybe."
I just love it.
Fertility Treatment Mindfulness
I remember being in fertility treatment and swearing that I would do what I was doing, but I would never do "that." You know what I mean. "That," being the next step, the next medication, the next procedure.
If you are like me, you probably have said that too, especially about fertility treatment. If you are like me, you probably have amended that "no" to a "maybe" and even changed it to a "yes" and gone on to treatment that you had previously rejected.
We all need to get there in our own time. It takes, as Dr. Leondires so eloquently put it on Saturday, self-reflection and self-care to be able to move on in fertility treatment. Whether that's moving from an IUI to IVF or from IVF to donor egg or to start speaking to adoption agencies or consider childfree living.
I do love that.
"No, moving to maybe."
Next place to go?
Dr. Mark Leondires to Speak on Male Infertility for RESOLVE
April is a busy month for Reproductive Medicine Associates of CT. We're participating in many regional and national events, including the male infertility TeleSeminar, hosted by RESOLVE, with guest speaker Dr. Mark Leondires, RMACT's very own Medical Director. Please read below for details about attending this seminar, specifically on male factor infertility issues. RSVP's are necessary, so read through to the bottom of the blog to find out how to attend. Click here for a complete calendar of events upcoming at RMACT.
Male Factor Infertility TeleSeminar
Thursday, April 19, 2012
9:00PM ET/ 8:00PM CT/ 7:00PM MT/ 6:00PM PT
Male Factor Infertility From the Man’s Perspective
Infertility is not just a woman's issue
Guest Speaker: Dr. Mark P. Leondires
Medical Director of Reproductive Medicine Associates of Connecticut (RMACT)
Topics to be covered during this session are:
Dr. Mark P. Leondires is the Medical Director and lead infertility doctor with Reproductive Medicine Associates of Connecticut (RMACT), and is board-certified in both Obstetrics and Gynecology and Reproductive Endocrinology and Infertility.
RSVP online for this male factor TeleSeminar.
RESOLVE's TeleSeminar Series occurs on the first and third Thursday of each month at 9:00PM Eastern time during 2012; all are free of charge. RESOLVE works with our corporate partners and professional members to provide you with the latest research, tips, and advice to help you resolve your infertility. Check out the TeleSeminar schedule here.
RESOLVE: The National Infertility Association
In order to continue to be able to provide free programs and support groups as well as low-cost educational programs, we encourage you to visit our web site to learn more on how you can support RESOLVE's mission.
As a volunteer non-profit consumer organization, RESOLVE is committed to providing unbiased information and support. Participation as a sponsor or presenter at this event does not imply endorsement by RESOLVE for any person or entity in any fashion. RESOLVE encourages its members to be educated consumers and to fully investigate any and all information available on the options available or presented to them.
For more information on local events, support groups, electronic bulletin boards, and other information relevant to your family building journey, please visit RESOLVE online.
Again, to attend "Male Factor Infertility From the Man's Perspective," on Thursday, April 19, 2012 at 9 p.m. RSVP online.
New Year's Eve Message from Medical Director of RMACT
Who would ever think that they would get hundreds of holiday cards with children on them every year?
Since 2002, I have looked forward to the holiday cards I receive from all over the world from patients of RMA of CT. As a staff we look forward to them. We oooh, and ahhh over each one. At times we giggle at the utter adorableness and there are times we are simply humbled by the stories which accompany these cards.
Perhaps the most amazing aspect of this holiday bounty is that these are cards from couples from all walks of life who may have never had a family, celebrating theirs with us. I recently received a card from a patient from2002. They continue to remember us and share their family with us, even 8 years later. The picture of their now family of four is so special to me as a reminder of how the work that we do creates on-going joy for families. I am constantly touched by the humanity and passion of all of our patients. I have heard from several patients that they have their children wave when they drive past the office. When I went into medicine I wanted to be a pediatrician. The path I took is more fulfilling than I imagined, helping people make their little one’s.
So I thank all of you who send cards and notes and SO look forward to more. It is amazing to think that we have helped bring over 2,500 children in to families where they were so very wanted. Truly, we have a magical responsibility, as the birth and growth of a child is a magical journey.
Please share this with those who want children; that there are many paths out there and to seek help if they are having difficulties.
Happy New Year to All....
Mark Leondires, MD
Dr. Mark Leondires, Medical Director of Reproductive Medicine Associates of Connecticut, talks about stress and infertility. Read below:
Stress and Infertility
It’s a hot topic among those who talk about fertility, as seen last month at the fertility field’s most prominent and prestigious professional group, the American Society for Reproductive Medicine (ASRM). Reproductive doctors from around the world – from Greece to Japan to several of the U.S.’s most respected institutions – made presentations about their recent studies concerning stress.
These clinical studies examined stress and infertility from nearly all angles: whether stress resulted from infertility and its complicated emotions, whether negative stress resulting from life-events impacts the success of in-vitro fertilization (IVF), even whether patients were able to accurately asses their own stress.
Fertility researchers have found both negative and positive correlation when they study stress and infertility. The real question is what marker does one use to study stress, as everyone’s stress response is unique. One study’s conclusion reads: “Logistic regression analyses revealed that [both] infertility-specific stress and non-specific stress were negatively associated with a pregnancy outcome after IVF. Psychological stress was negatively associated with IVF outcome, after controlling for biomedical variables. Fertility treatment protocols should consider including counseling interventions to potentially mitigate adverse effects of stress.” (The relation of psychological stress to pregnancy outcome among women undergoing in-vitro fertility and intracytoplasmic sperm injection; Gourounti, K. et al. ASRM Meeting 2011)
It is very clear that infertility increases stress on relationships between partners. In addition, as a couple enters treatment there are scheduling demands, anxieties about treatment options, financial stressors, and worries about potential for success. It appears to me that what my colleagues at ASRM were grappling with is what we know in our hearts versus what we can prove through science in a clinical study.
Our patients report benefits from learning to manage their life stressors. Whether patients are stressed as a result of infertility or if stress is one variable causing infertility is actually immaterial. My patients who manage their stress are more likely to get pregnant.
Since there is no downside to learning how to manage stress and improving overall health, there is no reason to resist recommending stress management options to patients. Although these interventions may or may not increase the likelihood of getting pregnant, there are two important known benefits: fertility patients have something to take control of and it improves their overall ability to manage stress in their lives.
Managing stress can be accomplished in different ways; and for most patients there are many approaches that are effective. First, I believe in having a strong network – patients need to talk to their partners, family, and friends. And when this is uncomfortable (many fertility patients hesitate to share private details with someone who has not experienced infertility), then share your thoughts and emotions with a support group or a therapist.
Second, find a release such as meditation, yoga or exercise in general. This will also help patients optimize their health, which is important for achieving a healthy pregnancy.
That leads me to the third approach: reduce the outside stressors (e.g., unhealthy foods) on a patient’s body and mind which can be mediated by working with a nutritionist or an acupuncturist.
Over the past several years, my partners and I have incorporated adjunct services such as these into our practice at Reproductive Medicine Associates of Connecticut (RMA of CT). We started with Fertile Yoga, and based on positive patient feedback we added an acupuncturist to the staff. Then patients expressed other needs and we began peer-led support groups and added a nutritionist to our staff. There are four key services – Fertile Yoga, acupuncture, nutrition counseling and therapy for individuals and couples – as well as several related workshops and seminars. Some are free of charge, some are covered by insurance and some are paid for out of pocket. Patients rave about them all.
This month we launched the RMA of CT Integrated Fertility and Wellness Center. It marks a symbolic stand, as well as a practical one. Patients will have greater ease in finding a practitioner and a time for appointments. At the core of our fertility treatment remains advanced reproductive medicine – but our method is to treat the whole patient.
Read below what the medical director of Reproductive Medicine Associates of Connecticut (RMACT) and the team of board certified reproductive endocrinologists in the program have to say about frequently asked questions.
"Infertility can be confusing, and people frequently ask questions because they want to know if they should seek help from a fertility specialist," says Dr. Mark Leondires, Medical Director. "The questions and answers below are intended to give some basic knowledge. Many couples put off seeing a fertility specialist when they are having trouble getting pregnant, but they are typically reassured after being diagnosed and starting a treatment plan."
What is infertility?
Infertility is a disease or condition of the reproductive system often diagnosed after a couple has had one year of unprotected, well-timed intercourse, or if the woman has been unable to carry a pregnancy that results in a live birth.
Is infertility a "women's problem"?
Infertility is a medical problem. Approximately 35% of infertility is due to a female factor and 35% is due to a male factor. In the balance of cases, infertility results from problems in both partners or the cause of the infertility cannot be explained.
How long should we try before we see a doctor?
In general, if you are less than 35 years old and have been trying for more than one year you should schedule an appointment with a fertility specialist. If you are greater than 35 years old we would like to see you after at least six months of timed, unprotected intercourse. However, if you have a reason to suspect you may have a problem getting pregnant such as a history of pelvic inflammatory disease, painful periods, miscarriage, irregular menstrual cycles, or if your partner has a low sperm count, you should seek help sooner. Many couples have a hard time admitting that there may be an infertility problem, but be reassured there are often many things we can do to help.
What is a Fertility Specialist?
A fertility specialist, or Reproductive Endocrinologist, is a medical doctor who has been specially trained in the complex issues that can contribute to infertility. In addition to being trained as an Obstetrician/Gynecologist which requires a four-year residency a fertility specialist must complete an additional two to three year fellowship in reproductive endocrinology. This fellowship training is highly specialized to focus on the diagnosis and treatment of infertility and female endocrinology.. A physician can become Board Certified in Reproductive Endocrinology by successfully completing the fellowship as well as written and oral examinations.
Currently in the Unites States, there are only about 1,000 Board Certified Reproductive Endocrinologists. Specifically for infertility related to males, Urologists with a sub-specialty in Andrology are the most qualified experts as they have often completed two-year fellowships and passed exams to become Board Certified in Andrology.
At what time of the month is a woman fertile?
The most fertile time of a woman's cycle is just before or the of day ovulation. Ovulation usually occurs two weeks before a period starts, so it is necessary to count backwards from the anticipated start of the next period in order to find the most fertile time. Take the number of days in the usual cycle (from the beginning of one period to the beginning of the next) and subtract 14. For example, a woman with a 32-day period would likely ovulate around day 18 (32-14=18), while a woman with a 28-day cycle would ovulate around day 14 (28-14=14). We recommend every other day intercourse around the day of ovulation. That would mean days 12, 14 and 16 for women with 28 days cycles.
It is best to have intercourse before ovulation rather than afterwards, so a woman who ovulates on day 14 would have a good chance of conceiving if she has intercourse on either day 13 or 14. For women with irregular cycles you can extend the period of having sexual relations to every other day from day 11 to 18 ( 11-13-15-17). In order to better understand what day you ovulate take your average menstrual cycle length (for example 32 days) and subtract 14 and that will give you that day you ovulate around (that would be about day 18). Therefore you would have relations days 15-17&19 to cover all your bases.
Alternatively, women with irregular cycles may want to use an ovulation predictor kit, which can be purchased over the counter at most local pharmacies. This involves testing your urine around the time of ovulation using a detector stick, which give you a visual reading. Additionally, there are electronic monitors which detect ovulation by tracking two hormones (estrogen and luteinizing hormone) starting with urine testing on day one of your menstrual cycle. The methods that utilize urine predictor sticks or urine ovulation detector machines are usually highly sensitive, accurate, and reliable.
How can a woman tell if she ovulates?
The simple, inexpensive way of finding out the approximate time of your ovulation is to take your basal temperature (that is, your body temperature at rest) every morning and record it on a chart. You can buy a Basal Body Thermometer at your local drug store. Save all your charts so you can review them with your doctor. Three or four months of charting should be adequate. If your temperature goes up after the middle of your menstrual month you likely do ovulate. In general you ovulate about two days prior to the temperature rise.
How often should we have intercourse?
It is a good idea to have intercourse every other day around the time you ovulate. Remember, every woman is different, and may not ovulate exactly on "Day 14." And, just because you ovulated on "Day 14" this month, doesn't mean you will next month. It is preferable to have intercourse every other day rather than every day so that sufficient sperm will be available. To increase your chances of the egg becoming fertilized, do not douche or use lubricants immediately before having intercourse.
What fertility testing should our fertility doctor perform?
Your doctor will likely do the following:
- Blood tests to check reproductive hormone levels in the woman; estradiol (E2), progesterone, follicle stimulating hormone (FSH), luteinizing hormone (LH), thyroid hormone, prolactin, and possibly male hormone levels.
- Complete semen analysis on the male partner
- Hysterosalpingogram (HSG), an x-ray exam to evaluate if the woman's fallopian tubes are open
- Ultrasound to confirm the normal appearance of your uterus and ovaries in the woman
What about smoking and drinking alcohol and caffeine?
There is evidence linking reproductive impairment with exposure to alcohol, tobacco, and caffeine.
Alcohol and tobacco use have been demonstrated to affect the reproductive capacities of both men and women, and tobacco is an especially potent reproductive toxin that negatively effects female fertility by damaging eggs. In men there is a direct effect on sperm quantity, quality, and reproductive function. In general we ask that women consume less than 150 mg of caffeine per day which is equivalent to two small 8 oz cups per day. Remember sodas and tea also contain caffeine. In addition, it is wise to be in the best physical shape possible while you attempt to conceive and, of course, to ensure a healthy pregnancy and baby.
Are hot tubs really bad for a man?
Yes. High temperatures can damage sperm. That is why the scrotum is located outside the body - to act as a kind of "refrigerator" to keep the sperm cool. So, it is a good idea to avoid hot tubs, saunas, and steam rooms when men are trying to help in the pregnancy pathway.
What else can we do?
Learn as much as you can about infertility.
- Get and read good, reliable information (not just from popular magazines) from your doctor, library, or trusted friends or family.
- RESOLVE (http://www.resolve.org/) and the American Fertility Association (AFA - www.theafa.org) has over 60 fact sheets on different topics related to infertility, and support groups in many areas.
- Also visit the ASRM (http://www.asrm.com/), SART (http://www.sart.org/), ACOG (www.acog.org) and CDC (http://www.cdc.gov/) web sites for more information.