how father time affects your chances of becoming a mother Your Ovarian Reserve and the Realities of Aging (Cover story begins inside)

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1 Volume 2 Issue 1 Spring 2017 how father time affects your chances of becoming a mother Your Ovarian Reserve and the Realities of Aging (Cover story begins inside) PHYSICIAN PROFILE Andrea DiLuigi, MD, is board certified in Obstetrics & Gynecology and Reproductive Endocrinology & Infertility (REI) HEALTHY TIPS 5 Tips for Maintaining a Steady Blood Sugar Level ZIKA VIRUS UPDATE Information on how the Zika virus can affect infertility treatments ENDOMETRIOSIS Endometriosis and its impact on your infertility FERTILITY 101 VIDEOS Educational videos featuring our staff with answers to some of the most commonly asked questions

2 how father time affects your chances of becoming a mother (Cover story) 12 You ve probably heard the phrase, My biological clock is ticking. But what exactly does it mean? As women age, they typically produce fewer eggs. The quality of their eggs also diminishes. And, the risk for chromosomal abnormalities, which can lead to a miscarriage or birth defects, increases. So the biological realities are clear: Aging has an impact on fertility. HOW OLD IS TOO OLD? Studies indicate that, over the past 30 years, the average age of first-time moms in the U.S. has been rising. There are all kinds of 9reasons to delay pregnancy, but how long can you actually wait? Well, according to the American Congress of Obstetricians and Gynecologists, the fertility of women decreases gradually but significantly beginning at approximately age 32 years and decreases more rapidly after age 37 years. While the ability to have a baby generally decreases in all women as they age, the exact age when a woman can no longer conceive varies from individual to individual. About one-third of couples experience difficulties getting pregnant when the female partner is 35 or older. But some women can experience fertility issues at a much younger age than expected. If your chance for success depends largely on the quantity and quality of your eggs, how can you measure those important factors? TESTING THE QUALITY OF YOUR EGGS Your fertility potential your likelihood of becoming pregnant is called your ovarian reserve. Using a variety of tests, our specialists can evaluate your ovarian reserve and assess your chances of becoming pregnant. As you might expect, certain hormone levels in your blood can be good indicators of your likelihood of developing healthy eggs. Simple blood tests, taken at specific times during your menstrual cycle, can measure those hormones and tell our specialists a lot about how your eggs are developing. 6 3 For example: Your pituitary gland produces a hormone called Follicle-Stimulating Hormone (FSH). A follicle is a small cyst that contains an egg. Typically, your FSH level is lowest at the beginning of your cycle and then increases, causing the follicle to grow and the egg to mature. As the egg matures, the follicle releases another hormone, called Estradiol. In response to the rising level of Estradiol, your pituitary gland in turn makes less FSH. If the delicate balance between FSH and Estradiol levels is upset, or if the timing is off, your eggs will not mature properly. Estradiol levels can also be measured with a blood test. Assessing these hormone levels can tell us whether your ovaries and pituitary gland are working together to produce viable eggs. A TEST TO MEASURE HOW MANY EGGS YOU PRODUCE Another hormone, called Antimüllerian Hormone (AMH), is also produced in the follicles and is related to the number of eggs you produce. A blood test, drawn at any point during your menstrual cycle, can be used to measure your AMH level and, in turn, help us determine how many eggs you re producing. The Center for Advanced Reproductive Services offers free AMH testing twice a year. The next free test will be offered on April 29. For more information, check our website uconnfertility.com or talk with your care provider. KNOWING WHERE YOU STAND IS THE FIRST STEP TOWARD SUCCESS. These and other tests can provide our specialists with critical information about your ovarian reserve and help them determine the best course of treatment for you. Every woman is unique. That s why our approach is to provide the individualized care you need to maximize your chances of starting or adding to your family.

3 FIVE TIPS FOR MAINTAINING A STEADY BLOOD SUGAR LEVEL For some women, weight issues may be a contributor to their fertility diagnosis or compromise their ability to receive the treatments they need. Maintaining a steady blood sugar level is a key factor in keeping your energy up and mood level steady, as well as helping to reduce cravings that have you diving for the 3pm coffee and sweet treat. Our Health Coach Ami Chokshi shares five tips for keeping that blood sugar in check. Winter 2016 Sleep. 7-9 hours of shut-eye is best to maintain your body s hormone levels and fight excess weight, including stubborn belly fat. (Watching TV, scrolling your newsfeed, and reading in bed do not count) Carbs. Quality counts here, so you will feel more energy, and full longer if you eat carbs like quinoa or sweet potatoes at lunch, rather than that grinder. Refined carbohydrates like bread and pasta spike your blood sugar more rapidly than slower carbs. H 2 0. Drink ½ your body weight in ounces per day to increase the water volume, and decrease sugar concentration, in your blood. Herbal teas and sparkling waters are okay, but watch those dehydrating caffeinated drinks like coffee and tea. Meet Dr. Andrea DiLuigi Dr. DiLuigi is a lead physician at the Center. Board certified in both Obstetrics & Gynecology and Reproductive Endocrinology & Infertility (REI), Dr. DiLuigi has specialized in REI since Dr. DiLuigi is a caring, compassionate and knowledgeable clinician who has published numerous articles and presented her research at national conferences. Her special interests include IVF, ovulation introduction, egg donation, and polycystic ovarian syndrome. Move! Contracting your muscles during exercise allows your body to use glucose for energy, which can help lower blood sugar. A simple way to incorporate exercise is by taking a walk after you eat. Fiber. Healthy sources of fiber like veggies, fruits in moderation, and small portions of whole grains like oatmeal and quinoa can help slow the absorption of sugar in your blood system and keep you feeling full. I really get to know my patients throughout the process and their journey to conceive, and one of the best things about my job is receiving pictures of babies after they re born, or having a patient bring a baby in for us to meet. There s no feeling like it.

4 Spring 2017 A very big thank you to everyone who made us feel so supported and cared for. We feel so lucky to have two beautiful children that mean the world to us. Love Sharing Our Patients Every day we have the honor of helping patients through their journeys to become families, and often we get to see those patients again as they continue to expand their families. Our entire staff is thrilled when our patients share messages of their exciting news with us. We are so grateful for all of the caring doctors and staff that helped us travel this path again. We can t wait to introduce our second miracle to his very anxious big sister! Read more on our Facebook page We can t express enough how blessed we feel to be able to say that we are expecting a new addition to our family. We are truly Join Us In Recognizing National Infertility Awareness Week We have several events currently scheduled during the week of April 23rd. Please check our website for the most up to date information and new additions. We do request pre-registration for the events as there is limited space available. { Approximately 10% of women probably have some form of endometriosis, but it s even more common amongst women during their reproductive years, and can be a significant contributor to infertility. In fact, it s estimated that 30 to 50% of infertile women have some degree of endometriosis. Though there aren t always symptoms, there are signs that you can look for and ask your doctor about. Some women may experience severe menstrual cramps, chronic pelvic pain, or pain during intercourse. Determining whether or not you have endometriosis is impossible without undergoing certain medical tests. An ultrasound can usually show whether or not you have an ovarian cyst caused by endometriosis. The presence of other types of endometriosis, however, can only be confirmed through a minimally invasive surgical procedure called laparoscopy. For many women, the chances of getting pregnant following a laparoscopy to remove endometriosis are greatly improved. Endometriosis & Infertility There is a correlation between the degree of endometriosis and its impact on your fertility. If your condition is minimal you are more likely to become pregnant naturally than you might be if you have a more advanced condition. Even so, patients with more advanced endometriosis can still benefit from surgery because by restoring their pelvic anatomy the surgery can allow their ovaries and fallopian tubes to function normally. The thing to remember is that surgery for endometriosis is just one option. At the Center, your treatment will be highly individualized. Whether you have endometriosis or some other condition, we will work with you, examine every option, and determine which ones are most likely to help you achieve your goal. Check out our Video Library to see Dr. Luciano talk more about Endometriosis. { Helping you Clear a Path Through the Financial Jungle The dream of having a baby can be difficult to plan for financially, and we understand how stressful fertility treatments can be, especially for those who don t have insurance coverage for the treatments they need. At the Center, we have experienced financial counselors who help patients navigate through the many different programs we offer including: IVF FINANCIAL SHARE: An upfront, discounted fee which allows for up to three fresh attempts at IVF treatments and up to three frozen embryo transfers. MEDICAL LOANS FOR FERTILITY: Our partnership with CapexMD allows us to offer our patients the most comprehensive financing options available. POSSIBILITIES PLANS FOR SELF-PAY: We offer many selfpay options with clear outlines so patients know what to expect financially before beginning treatment. IVF POSSIBILITIES PLUS PLAN: This plan provides increased savings to self-pay patients based upon economic need. DISCOUNTED FERTILITY MEDICATION PROGRAMS: We work with patients who don t have a fertility drug benefit to identify the best, low-cost option. VETERANS PROGRAMS: We proudly offer a reduced cost fertility program for eligible military veterans and their spouses. FINANCIAL GRANTS: We are affiliated with the Nest Egg Foundation, an organization that provides financial grants for IVF treatment to Connecticut residents. For more information on our programs visit the Affording Treatments section at uconnfertility.com. Free Fertility Testing (April 29) Time Out Couples Session (April 29) Community Fertility Acupuncture (April 30) National Infertility Awareness Week (NIAW) is a movement that began in The goal of NIAW is to raise awareness about the disease of infertility and encourage the public to understand their reproductive health. RESOLVE: The National Infertility Association founded this movement and continues to work with the professional family building community, corporate partners, and the media to: Ensure that people trying to conceive know the guidelines for seeing a specialist when they are trying to conceive. Enhance public understanding that infertility is a disease that needs and deserves attention. Educate legislators about the disease of infertility and how it impacts people in their state. 35YEARS PROVIDING EXPERT FERTILITY CARE Everything You Want To Know ABOUT FERTILITY We know people have many questions about fertility problems and the tests, exams, medications and procedures that are part of fertility treatment. So we ve put together an extensive Video Library to educate and answer any questions you may have. We are adding new videos with the most updated information all the time. Here are three brand new topics you will find informative. * The Center has just released a new television ad campaign. Look for it on channels NBC and CBS ,000 CALL STARTS YOUR JOURNEY If you re looking to start a family, talk to us (844) HOPE IVF 1uconnfertility.com DEDICATED STAFF MEMBERS FOCUSED ON YOUR DREAM BABIES BORN... AND STILL COUNTING! Meet Carissa Spada Carissa understands the difficulties of infertility because she has experienced the journey of fertility treatment herself. Carissa is a yoga instructor who teaches classes at the Center. She also volunteers for RESOLVE, the National Infertility Association. As a former patient I understand how challenging it is, and how difficult and stressful the journey is at times, but I also know how joyful and amazing it can be. My role is to teach relaxation and provide techniques for stress reduction, so at the start of class I talk not just about my experience in instructing, but I also share my experience as a patient. I have two children as a result of IVF and I m delighted I get to help others as they journey down this path. There is nothing more rewarding than that, says Carissa. Carissa s yoga classes at the Center are held the first and third Wednesday of every month from 5:30-6:30pm. Visit uconnfertility.com for preregistration information. Mosaic Embryos and PGS with Dr. Benadiva Intrauterine Insemination (IUI) with Dr. DiLuigi Zika Can Affect Infertility Treatment If you are planning to get pregnant and live in an area with active Zika virus, or have possibly been exposed to the virus, the CDC recommends that women wait at least 8 weeks after symptoms start or the date of last possible exposure (and 6 months for men) before trying to conceive. Because these CDC recommendations will affect a patient s personalized infertility treatment schedule, this can be extremely stressful for a couple going through the program. If you, or your partner, are planning to travel to Zika active areas, discuss your pregnancy planning with your doctor in advance. Find the most current information about Zika here: Or sign up to receive Zika updates with CDC s new text messaging service. Text PLAN to to subscribe. Hysteroscopy and Endosee with Dr. Benadiva uconnfertility.com

5 MONTHLY EVENTS An academic affiliate of UCONN School of Medicine FIRST & THIRD Wednesdays YOGA 5:30-6:30pm The Center continues to demonstrate success: Not only in the percent of live births achieved, but also in our ability to lessen the potential for pregnancies with twins, triplets or more. As the largest fertility center in the state with 1,275 IVF cycles in the last year, we continue to lead in both the region and the nation. To learn more about our success rates and those of other programs, please visit the Society for Assisted Reproductive Technologies website ( Click on IVF Success. A comparison of clinic success rates may not be meaningful because patient medical characteristics and treatment approaches may vary from clinic to clinic. THIRD Thursdays RESOLVE Infertility Peer Support Group 7-9pm NATIONAL INFERTILITY AWARENESS WEEK APRIL Events: FREE FERTILITY TESTING Saturday, April 29, 10-2pm Time Out: Couples Session Saturday, April 29, 2 4pm Community Fertility Acupuncture April 30, 2 4pm Please check our website for more information and to register (limited space for all events!). Like our Facebook page for the most up-to-date information. uconnfertility.com 844.HOPEIVF FARMINGTON 2 Batterson Park Road Farmington, CT (844) OUR STORY: The Center is an academic affiliate of the UCONN School of Medicine. We are a specialized program of the division of Reproductive Endocrinology and Fertility and one of the largest and most successful IVF programs in the Northeast. We offer one of less than 40 postgraduate fellowships for Reproductive Endocrinology and Infertility (REI) in the United States. Due to our national reputation as a "Center of Excellence," in ongoing clinical research. This has resulted in several first author publications and national conference presentations for our fellows. Over the past three years, the fellows have presented 18 abstracts at national meetings and have published 13 articles in peer reviewed journals. Plus, we not only have REI fellows, but also Ob/Gyn residents and medical students training here as well. NEW LONDON 4 Shaws Cove Suite 201 New London, CT (877) HARTFORD 50 Columbus Blvd. Suite 2 Hartford, CT (860)