Genetic Testing and Counseling
With advancements in technology we are now able to screen for genetic conditions that individuals or couples may carry. Genetic testing can be done if there is a specific known genetic mutation that runs in the family or can be done as a general screening test.
Patients with a known genetic mutation can utilize IVF with Preimplantation Genetic Testing for Monogenic/Single Gene Defects (PGT-M) to screen embryos for the presence or absence of the specific genetic mutation.
Genetic carrier screening involves testing your blood to see if you “carry” recessive gene changes (mutations) that can be passed down to offspring. “Carriers” of a recessive gene mutation only have one copy of a gene mutation. In order to develop a recessive genetic condition, one must have two copies of the gene mutation – one from the biological mother and one from the biological father. If you are a carrier for a disorder and your reproductive partner is a carrier for the same disorder, each offspring has a 25% chance to have the genetic condition.
The American College of Obstetrics and Gynecology (ACOG) and the American College of Medical Genetics (ACMG) recommend that all patients be offered carrier screening for a small panel of genetic disorders. These include cystic fibrosis (CF), spinal muscular atrophy (SMA), and others depending on your ancestry. We also offer an expanded carrier screening option which evaluates at 283 genetic disorders.
Your provider will discuss genetic screening options with you at the initial consult appointment or at any time in the future as requested. All genetic screening is optional and we encourage our patients to ask questions to make sure they are making an informed decision to either opt for or against testing. The CRM has access to genetic counselors through the contracted screening laboratories and also through the Ob/Gyn Department to help discuss your results with you as needed.
Nutrition Counseling
Our goal at the end of the infertility treatment journey is to have a healthy mom, healthy pregnancy, and healthy baby. Currently the clinic has BMI restrictions for both general infertility treatment and IVF. We require a BMI <45 for general infertility treatment and <40 for IVF. We know weight and weight loss is a sensitive subject and we strive to work together with you on this process. Our registered dietician, Helenia Sodoski works closely with our patients to assist them with their desired nutritional and weight loss goals. If surgical treatment or bariatric surgery, is indicated then we can refer you to the appropriate providers.
Obesity is the most common chronic disease in the United States and has increased dramatically over the past two decades. Almost 67% of women and 75% of men are overweight (BMI 26-29) or obese (BMI ≥30), as are nearly 50% of women of reproductive age. In addition to increased general health risks discussed below, obesity is frequently associated with menstrual cycle disturbances. Overweight or obese women have a longer time to conception.
The probability of conception declines by 4% per kg/m2 in women with BMI >29 kg/m2. It has been observed that the time to pregnancy is increased to >12 months when both partners are obese. Obesity has been associated with longer duration and increased amounts of gonadotropin stimulation with an increased frequency of cycle cancellation for inadequate response. Obesity in men can also have an adverse effect on semen/sperm parameters. In obese men, the scrotum remains closer to the surrounding tissue, predisposing to increased scrotal temperatures that may adversely affect semen parameters.
Obesity not only affects the ability to get pregnant but also the pregnancy and delivery process too. Obesity is strongly associated with pregnancy and perinatal complications, including gestational diabetes and hypertension, pre-eclampsia, preterm delivery, stillbirth, cesarean or instrumental delivery, shoulder dystocia, fetal distress, early neonatal death, small and large-for gestational age infants. Obese women who conceive via IVF are also at increased risk for pre-eclampsia, gestational diabetes, preterm delivery, and cesarean section.
Obesity has profound general medical complications outside of reproduction. Obesity causes or contributes to a large number of health problems including type II diabetes, hypertension, coronary heart disease, dyslipidemia, respiratory dysfunction, sleep apnea, osteoarthritis, urinary incontinence, and increases in breast, endometrial, ovarian and colon cancers.
Reproductive Urology
Male factor infertility, either alone or in combination with female factors, is a common cause of infertility. Our providers evaluate and treat conditions associated with abnormal sperm conditions, erectile dysfunction, prior vasectomy, sperm freeze, and fertility preservation.
Social Work and Grief Support
It is not uncommon for individuals and couples to struggle dealing with their infertility and treatments. Even after getting pregnant couple can experience miscarriage or recurrent miscarriages. The process may be long and taxing from emotional, physical, financial, and relationship standpoints. We, at the CRM, want you to know that you don’t have to go through it alone. Our team is dedicated to helping patients navigate through the difficult times.