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Dr. Alfred J. Rodriguez Blog

Our blog features important information in the infertility field as well as news and events about Dr. Rodriguez. Please check back often for updated blog entries!

OBESITY’S IMPACT ON HEALTH AND REPRODUCTION

Obesity is a disease of excess body fat that varies by race, gender, age, and individual.  It is becoming increasingly prevalent in our society as well as a major health problem world-wide. 

Obesity is categorized by BMI (body mass index) as follows:

  • Overweight - 25-29.9
  • Obese - >30 (Class 1 - 30-35, Class 2 - 35-40)
  • Extreme (severe) - 40 or higher (Class 3)
  • Super - 50 or higher

The reasons for obesity increasing are complex and are an interplay of cultural, economic, and social forces.  It is estimated that the annual cost of obesity related healthcare issues exceeds 1.4 trillion dollars which is twice what the U.S. spends on defense.  Surprisingly, only 1/3 of obese individuals receive advice from their healthcare providers to lose weight!

Not only does obesity lead to early mortality, cardiovascular disease, diabetes, dyslipidemia, stroke, and cancer, but for REPRODUCTIVE AGE WOMEN  it is associated with:

  • Menstrual cycle irregularities
  • Ovulatory dysfunction - 3 times more likely to be anovulatory
  • Higher doses of ovulation induction medications needed to induce a response
  • Slower ovarian/follicular response to ovulation induction medication
  • Higher cancellation rate of stimulated cycles, fewer number of oocytes, and lower estradiol levels
  • Lower clinical pregnancy rates
  • Linked to increased risk of abnormal chromosome karyotype in offspring
  • Shown to increase spontaneous miscarriage rate
  • Linked to abnormal gene expression in the endometrium thereby decreasing implantation rate.

Obesity in pregnancy leads to:

  • Gestational Diabetes
  • Pregnancy induced hypertension
  • Stillbirth
  • Higher incidence of instrumental deliver
  • Higher incidence of C/Section
  • Higher incidence of post C/Section complication

Fetal complications for maternal obesity:

  • Fetal death
  • Preterm delivery
  • Heart defects
  • Neural tube defects

Written by: Linda Ward, LVN, IVF Nurse Coordinator, TexasIVF

 

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Facts About Recurrent Pregnancy Loss

 

Pregnancy loss is a devastating event for a woman whether she suffers one sporadic miscarriage or recurrent losses.  ACOG, the American College of Obstetricians and Gynecologists, statistics show the 5% of reproductive age women experience two or more miscarriages and 1% experience three or more.  Up to 70% of early losses (under 12 weeks) are due to chromosomal abnormalities, especially if the woman is 35 or older.

 

Until recently, insurance companies did not cover diagnostic testing for recurrent pregnancy loss (RPL) unless three consecutive losses occurred.  This has changed and diagnostics can be performed after two consecutive losses.  Assessment of RPL should focus on the following:

  • Genetic Factors - both parents should have chromosome karyotype testing to determine if any balanced structural abnormalities exist.
  • APA (antiphospholipid) Syndrome - the most widely accepted testing includes lupus anticoagulant (LAC), anticardiolipin antibody (aCL), and anti-B2 glycoprotein 1
  • Uterine anatomy - conditions such as bicornuate, unicornuate, septate.  These are more commonly associated with 2nd trimester losses.  Correction of septate defects has shown to be beneficial
  • Hormonal & metabolic factors - maternal endocrine disorders such as diabetes and thyroid dysfunction should be evaluated.  TSH values above 2.5mIU/ml are outside of normal range and treatment should be considered.  Uncontrolled diabetes is associated with pregnancy loss (PL).  Although ovulatory dysfunction and associated low progesterone levels may contribute to PL the data suggests that empiric progesterone support is ineffective unless three or more losses have occurred.
  • Lifestyle - Obesity is the only lifestyle that has been associated with RPL.  Cigarette smoking is linked to sporadic PL.  Recreational drugs, alcohol, and excess caffeine consumption have been associated with increased risk of miscarriage.

 

Miscarriage is heartbreaking and a tragic loss for women  and all too often they end up blaming themselves, feeling guilty because they fear the loss occurred from something they did, something they ate or drank, or possibly postponing pregnancy for career reasons. The fact is that 50-75% will end up with no apparent causative factor identified. The reassuring fact is that 50-60% will go on to successful outcome depending age and number of pregnancies. 

 

Statistics in the information provided was obtained in part from The Practice Committee of the American Society for Reproductive Medicine and from the American College of Obstetricians and Gynecologists.

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Dr. Rodriguez Awarded Dallas Magazine "Best Doctor" for 2016

Dr. Rodriguez Awarded Dallas Magazine "Best Doctor" for 2016

We are proud to announce that Dr. Alfred J. Rodriguez has once again been named as one of Dallas Magazine's "Best Doctor's" for 2016 in the field of infertility.

How are the "Best Doctors" chosen?

The final "Best Doctors" list is comprised by a peer-review voting processes. Dallas Magazine states "We rely on the doctors’ expertise to determine who deserves to be on the list, just like a doctor would recommend a specialist to a patient."

Click here to view Dr. Rodriguez's listing on Dallas Magazine.

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Obesity-A Very Sensitive Subject

Obesity - A Very  Sensitive Subject!

 

Everyday we meet with couples where one or both partners is significantly overweight and we know that even outside the world of "infertility" being overweight has  significant health implications. Obese patients have an increased risk of diabetes, hypertension, heart disease, and even cancer! We tend to focus mostly on the female but obesity in the male certainly has an impact on hormonal regulation that has a direct impact on sperm production.

 

But lets focus on the female. Not only do we have to consider response to ovulation meds, whether for intrauterine insemination or super ovulation for in-vitro fertilization, but we have to consider the impact her weight may have on pregnancy should it occur.  Did you know that if you are "obese" your chance if success in your age group could be reduced by as much as 65%?

 

We try to maintain a BMI cut-off of 39 prior to initiation of treatment but we do take individual patient situations into consideration. For example, we cannot expect a 41 year old female that is attempting pregnancy with her own eggs to take up to 6 months to lose the amount of weight needed to obtain a  target BMI. She likely does not have 6 months due to diminished ovarian reserve. As long as the patient is willing to accept that success rates are decreased by as much as 65%, we may still move forward. If a patient's BMI is >40, this is considered too high and too much overall risk involved.  After all, the first rule of medicine is "do no harm". Everything we do is elective therefore we must set and adhere to guidelines for patient safety.

 

Patients that are obese or extremely obese are subject to numerous complications.  Those include:

 

  1. Decreased response to medications used to initiate follicular recruitment and maturation.
  2. More complicated IVF cycles because of greater difficulty retrieving eggs because of technical difficulties in being able to access ovaries.
  3. Increased anesthesia risks that include maintaining airway and possible aspiration.
  4. Fewer number of eggs retrieved because of decreased response to meds & difficult retrieval.
  5. Difficulty with embryo transfer because of difficulty in visualizing endometrial cavity under ultrasound guidance.
  6. Decreased embryo implantation/placentation.
  7. Lower IVF success rates even with genetically tested embryos.

 

Should pregnancy occur in the obese or extremely obese patient- more problems are ahead.  Those include:

 

  1. Increased miscarriage rate.
  2. Increased risk of pregnancy induced hypertension, gestational diabetes, pre-eclampsia, and stillbirth.
  3. Increased probability of Cesarean Section which also carries an increased anesthesia risk (as stated above) plus surgical complications and post-operative complications such as pulmonary embolism.

 

Reproductive treatment is considered elective and we would be remiss in not providing patients with the above information. We can only do so much to help couples accomplish their dream of a baby.  Patients MUST take control of their personal situation by making the necessary lifestyle changes with diet and exercise.

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Preimplantation Genetic Screening-Who is it for?

Preimplantation genetic screening-PGS- tests embryos for normal chromosome numbers. Does this testing improve IVF success rates and if so, who is this testing for?

 

The answer is "yes" it does improve IVF success rates and we feel PGS should be offered to all couples undergoing advanced reproductive technologies!

 

Mistakenly, PGS is thought to be only for those couples where the woman is of advanced reproductive age or who has undergone multiple pregnancy losses or who has had repeated IVF failures. Why limit the offering to just those groups? There is no reason! PGS  is now more affordable than ever with genetic labs offering "a la carte" pricing when limited numbers of embryos are tested.

 

Did you know that 80 % of Down's syndrome babies are born to women under the age of 35? Of course, that is because younger women have more births than women over the age of 35. At age 30, the risk of having a baby born with a Down Syndrome is 1/900, by age 35 the risk is 1/350, but by age 40, that risk is 1/100! 

 

Some may consider PGS an extreme for the younger patient and contend that prenatal genetic testing by cell-free DNA test is a better option BUT that information is AFTER the fact- the pregnancy is now a reality. How accurate is the test? What can it detect? Does it detect all pregnancies with Down syndrome?  Cell- free DNA is thought to detect 99% of all Down syndrome pregnancies (trisomy 21), greater than 98% of all trisomy 18 pregnancies, and about 65% of all trisomy 13 pregnancies. When the test result indicates a high risk, further diagnostics such as CVS (chorionic villi sampling) or amniocentesis is used to confirm.  If results are validated, the patient then must face whether to continue or terminate the pregnancy. Many obstetricians will not perform terminations and will refer out to "abortion clinics". Not the first choice for most patients. Consider that PGS would have eliminated this scenario altogether!

 

Studies have shown that up to 50% of embryos from IVF that are screened are chromosomally abnormal. This rate is largely affected by the age of the female. It is fact that the eggs of older women are more prone to chromosomal abnormalities, and although the exact reason is unknown, research has shown that the meiotic spindle that is critical in organizing chromosome pairs, is abnormal in older women.  PGS affords the advanced reproductive age patient the advantage of screening embryos before implanted, dramatically reducing the risk of early pregnancy loss.

 

We have talked a lot about the screening process identifying abnormal embryos but the key factor is that PGS affords us a very high pregnancy rate by implanting a single, genetically tested embryo. Single blastocyst transfer of a normal tested embryo is virtually eliminating multiple births, dramatically reducing obstetrical complications associated with multiples, and will reduce NICU need down to all time lows.

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Dr. Rodriguez Named to "The Best Doctors in Collin County for 2015" by D Magazine

Dr. Rodriguez Named to "The Best Doctors in Collin County for 2015" by D Magazine

This year, D Magazine mailed a letter to 8,938 local doctors from their online directory, inviting them to vote using a ballot on their website. They could vote for up to three doctors in 38 categories using the following metric: which would you trust with the care of a loved one? We are proud to announce that Dr. Alfred J. Rodriguez is once again on the list.  Here is more information on the award and the results.

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Implantation-it's close to a "Lunar Landing"

Implantation -it's close to a "Lunar Landing"

You have gotten so far as embryo transfer and been told you have an"excellent blastocyst" embryo, or take it a step further. You have done preimplantation genetic testing on your embryos and know you are transferring a reportedly "genetically normal"embryo. Well, that's a slam dunk-right? Not so fast!! The embryo has many difficult obstacles to overcome!

Implantation-placentation, two very important events for the success of a pregnancy. Not only for the initial stages of early pregnancy but for the entire pregnancy to have a successful outcome.

The embryo makes it to the endometrial lining approximately 5-7 days after fertilization if the pregnancy occurs naturally and day 5 if placed in uterus with IVF/embryo transfer. It's not simple placement at this point.

The embryo faces much stress during this time to find its apposition.

Apposition is a "shaky touchdown" that relies on cytokines & chemokines to mediate the communication between the embryo and endometrium to guide it to it's "docking station".  It is imperative that the "window of implantation" is accurate. Many factors are involved at this time making the communication between the embryo and endometrium successful.  The 2nd step is attachment or adhesion of the blastocyst to the endometrium. The final step is invasion in which penetration occurs to such a degree that it places the placental trophoblast directly in contact with the maternal blood supply firming up that final, albeit critical step of establishing blood supply. Think if it simply as seed - "embryo" & soil - "endometrium". Healthy seed in a rich soil environment certainly implies the importance of the "window if implantation".

How can we influence this all important "window"? We believe that proper selection of the most competent embryos-both by morphological grading  and /or by preimplantation genetic screening is the first step. Secondly, allowing the proper "staging" of the endometrium, without the influence of the hyper-estrogenic state that occurs during IVF stimulation.

Again, our practice philosophy of frozen transfer over fresh, allows for very careful preparation of the endometrium. During this process, we perform an endometrial "scratch" approximately 4-5 weeks prior to transfer. The endometrial scratch is a simple 5 minute procedure in which a thin catheter is placed in the uterine cavity and gently "scratches" the 4 quadrants of the endometrial cavity, triggering production of the all important growth factors, cytokines, chemokines, and gene expressions which are all so important in "jump starting" this all intricate communication process.

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“Tick-Tock, Tick-Tock” – Now MAY BE THE TIME TO STOP YOUR CLOCK!

No longer is it only single women in their mid to late thirties considering the need to assess and preserve their fertility for when “the time is right or Mr. Right comes along”. We are now seeing a much younger patient population, both married and single, with questions about and interest in ovarian reserve evaluation. These are women that want to take control of their future and be proactive in finding out about their fertility potential, providing them with peace of mind in deciding when “the time is right”. We consider this a necessary evaluation for women that have a family history of premature menopause or premature ovarian failure (i.e. mother, grandmother, sibling).

We offer the following diagnostics for ovarian reserve evaluation:

• Initial consult with Dr. Rodriguez
• Ultrasound to evaluate the uterus, ovarian volume, antral “resting” follicle count
• Day 3 FSH,LH, E2 – to assess egg quality
• AMH – the Anti-Mullerian Hormone is produced oocytes and is used to correlate with antral follicle count in assessing ovarian reserve.
• Return consult to explain results and how it relates to individual potential

The above work-up would normally cost self-pay patients $1350.00, but we are now providing the above at a 50% discount package price of $675.00.
Call 972-981-7800 to schedule your appointment.

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Doctor Rodriguez has been named Best Doctor in Dallas County for 2014

Dallas Magazine - Best DoctorsWe are proud to announce that Dr. Rodriguez has been selected as one of the Dallas and Collin County "Best Doctor's" in 2014 by Dallas Magazine.  

Dr. Rodriguez has received this award before in 2013, 2012, 2011, and 2009.  For more about this prestigious award and to view Dr. Rodriguez's profile on Dallas Magazine, please click here

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Dr. Alfred Rodriguez Named as one of Castle Connolly Medical Ltd. "Top Doctors" for 2011

Dr. Alfred J. Rodriguez has been selected by Castle Connolly Medical Ltd. as one of the southwest region "Top Doctors" for 2011Click here for more on this award.

Dr. Alfred Rodriguez named as Castle Connolly Medical, Ltd

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Dr. Rodriguez Selected as a "Top Doctor in America" by Peers

Dr. Alfred J. Rodriguez has been selected and nominated by his peers as being one of the "Top Doctors in America". Congratulations to Dr. Rodriguez and his staff on this outstanding honor!

Dr. Rodriguez selected as a

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Dr. Rodriguez Named as "Patient Choice Award Winner" for 2008

The Dallas area patients have selected Dr. Rodriguez, for the Patients' Choice Award for 2008. This is a wonderful achievement as more than 400,000 patient reviews and ratings were gathered, and this top rating was awarded to a select few of the nation's most beloved doctors. The patients of Dr. Rodriguez have taken the time to compliment him in areas such as: bedside manner, the amount of time spent with them, the courtesy of the staff, appropriate follow-up, and their overall opinion of him as a physician. Quite simply, he is one of the best!

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Dr. Rodriguez Named to "Top Doctor's in Dallas" list for 2009

Dr. Alfred Rodriguez Named to We are proud to announce Dr. Rodriguez has once again been included in the D Magazine "Top Doctor's in Dallas" list for 2009.  Dr. Rodriguez had previously been distinguished with this honor since 2003.  For more information, please visit the D Magazine website located here.

Congratulations Dr. Rodriguez and the Texas IVF Staff!

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Contact Info

6130 West Parker Road
Suite 215
Plano, TX 75093-8185

Telephone: 972-981-7800
1-866-IVF TEXAS
(1-866-483-8392)
Fax: 972-981-7814

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