Hi! I’m Dr. Mark Trolice, an infertility and reproductive endocrinology specialist and the director of Fertility CARE: The IVF Center in Florida. AMA!

Is there anyway for a woman to have "fertility testing" without trying to actively conceive?

For context:

I am a youngish woman with polycystic ovaries and fibrocystic breasts who does not menstruate without birth control. Because of this I have been informed by my gynecologist that I need to stay on hormonal methods permanently to reduce uterine cancer risk. I have tried numerous types, none of which worked well (severe anxiety on combo pills, uterus too small for Skyla/ Kyleena, and (current) Nuvaring causing severe monthly breast pain). So, if I'm not "fertile" anyway, I'd really like to get a hysterectomy as soon as possible- why keep the little shop of horrors open if there's no merchandise, am I right? If I can have a child in the future I will keep my options open, but I'm not ready to "try" for at least another few years.

Thank you for the work you do, even if you can't answer this question. I find endocrinology fascinating and advancing science for women is so, so important, especially now.

Thank you so much for your comments. Fertility testing for woman is limited to ovulation, which can be performed by using an over-the-counter ovulation predictor kit, as well as a hysterosalpingogram (HSG) to determine if the fallopian tubes are open. Ovarian age testing has not been shown to affect natural fertility. We are sending prayers to you to make the right decision. Please visit PCOSchallenge.org for more information

Thank you so much for your reply!

My pleasure. PCOS is a complicated disease with reproductive and metabolic consequences including high blood pressure, diabetes, and increased waist measurement. Once health is optimized, then ovulation induction is the first step. Ultimately you may consider IVF. Success rates depend on age, body mass index, and any other factors.

I was lucky enough for my first round of IVF to be successful, but we are very much "one and done". We still have 4 embryos on ice. What would you recommend we do with them? What are some of the concerns around embryo donation / adoption that we should consider (legal, ethical, etc...)?

Congratulations on your success. Patients with frozen embryos have for options: continue to freeze; donate to research (Univ of MI, Cornell); donate to others; or discard. Embryo donation (ED) may vary among states so please verify. We have performed ED in FL.

Good luck!

What is the consensus on marijuana use and male fertility? Especially for daily smokers who started young (~14) and have continued for 10+ years?

Marijuana has been show to have negative effects on both male and female fertility so we recommend discontinuation. It has been show to affect sperm motility and fertilization.

Can you cite your claims?

Edit: haters gunna hate

Sure, here is one reference https://www.bcmj.org/articles/effects-cannabis-female-and-male-reproduction

Wife and I went through fertility treatment (all the way up to IVF with no luck) and in that time the fertility doc said that less than 20% of the reproductive process is understood even by the most experts. Is this statement solid? Maybe it has changed in the past 12 years?

So sorry for your journey. My interpretation is the percent distal number that represents explained infertility. Approximately 30 to 40% of infertility is explained by female factor, another 30 to 40% is a male factor. I hope you find resolution after your challenge.

How do you decide when a woman is too old to conceive a child?

Very difficult question! Ovarian region can be explained by quality and quantity. Both of these factors declined possible engages. After age 30, fertility begins and continues to decline slowly but more rapidly in her late 30s and early 40s. Success rates above 40 are challenging and miscarriages increase. Above age 42, and most clinics will discuss the alternative option of egg donation. As a pregnancy carrier, we will offer egg donation to a woman up until age 55. Men also have a decline in their fertility beginning at around age 40 and also increase the risk of miscarriage. Hope this helps!

Are twin/multiple pregnancy rates still higher for IVF? Is it the norm now to implant 1 embryo at a time?

Great question! Our society has increasingly gone to a single embryo transfer in order to reduce the complications of a multiple pregnancy. In our program, all women below age 38 usually receive a single embryo as do all women who have had chromosome testing resulting in a normal embryo. With single embryo transfer, the twin pregnancy rate is approximately 1 to 2% whereas with IUI (intrauterine insemination), the twin pregnancy rate is typically less than 5%. The risk of high order multiple pregnancy is typically from IUI because there is no control over the number of embryos that can implanted inside the uterus unlike with IVF. Thank you!

What would you most like to tell us that no one ever asks about?

Challenging question! Very few people talk about the impact of experiencing infertility for many years and when to you think it is appropriate to move on to adoption. It took my life and I 10 years to make that decision. I encouraged all my patients to be open to family building options and my eyes duration of time you are challenged and suffering with infertility. Thank you for the question.

What do you think about tax-funded IVF?

In Europe it is mostly free and covered by national health insurances - however there is an argument that it is not a life saving procedure, it is not essential, and there are free alternatives (such as adoption) and so it shouldn't be on the tax payer.

What do you think?

Hi, I believe infertility is of disease and should be covered by health insurance. This week, New England Journal of Medicine, there is a wonderful article discussing the need for infertility insurance. Adoption is a wonderful option as well. Hope this helps!

How does childhood chemotherapy impact a man's ability to have children later in life? I am a cancer survivor and I had chemo to treat leukemia when I was in kindergarten to third grade.

It certainly on the type of chemotherapy and dosage. Boys are more likely than girls to have fertility problems following chemo.

Good luck!

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Hi thank you! While I do not see many PAs in our field, NP's are fairly common and we are in the process of bringing on her own. They are a great opportunity for increased patient education. As far as education, I provide clinical rotation for the OB/GYN residents and fourth year medical students at the University of Central Florida. He also had many research projects. Thank you!

With the process of women freezing their eggs, is there an age by which a woman should attempt IVF ? I'm wondering if biological age affects the ability to grow an otherwise healthy fertilized egg.

The highest pregnancy rates with IVF are for women less than 30-35. Social egg freezing is increasing in popularity and is a personal decision but requires extensively counseling on realistic expectations. There is no guarantee of outcome. The American Society for reproductive medicine discourages the use of social egg freezing remaining above age 37-38 due to poor success rates. The primary use of ovarian stimulation and egg retrieval has not been shown to have any subsequent impact on fertility. Hope this helps!

Hi Doctor, can you please comment on the possible effects of Hashimoto's on fertility?

Great question! Thyroid dysfunction particularly with thyroid antibodies as an Hashimoto's has been shown to decrease pregnancy rates and increased risk of miscarriage. Fortunately, with medication to control her thyroid hormone, outcomes are improved. Thank you!

how difficult is it to harvest eggs from a woman’s ovary and does that affect her hormones?

Hi, an egg retrieval is a relatively simple outpatient procedure. It is performed after ovarian stimulation with hormones. After the procedure, when we will remain on hormones to support the lining of the uterus in anticipation of the embryo transfer. If the cycle is unsuccessful, she will experience a menstrual bleed with no subsequent impact on her hormones. Hope this helps!

Hi thanks for doing this!

In your experience do you see correlation between alcohol use and infertility in women?

There was a medical article that discussed any amount of alcohol in the woman trying to conceive can reduce fertility. Certainly no amount of alcohol during pregnancy is appropriate due to the risk of fetal alcohol syndrome. Well woman is trying to conceive I would clearly minimize the amount of alcohol intake. Thank you!

Hi, I am currently an undergraduate Biotechnology and economics student and am very interested in the further development of the IVF field. Although I don't think I'll be pursuing a medical degree I want to get further educated and even see myself working in this field. Besides the medical doctor route, how can I gain the necessary skills to be involved? Will there be post secondary degrees that will be focused on this field? Any advice is greatly appreciated!

Hello, thank you for your passion. Resources for you are not the American Society for Reproductive Medicine as well as the American Association of Bioanalysts. Good luck!

A friend just had her retrieval this morning to find out that her body had already ovulated and the eggs were gone. How often does this happen and what should she plan to do next? She is 41 and time is short.

I am so sorry! This occurs in the very low percentages, despite ovulation blocking medication. If she repeats the cycle, her doctors will probably monitor her even more close with ultrasounds and hormone testing and possibly an early a day for egg retrieval. Good luck to her!

Have you seen any uptick in couples seeking IVF for the purposes of genetic enhancement rather than infertility issues?

If "genetic enhancement" represents gene altering, this is not allowed in the United States. This technology called CRISPr has been compliant to embryos but he has been very carefully analyzed as to be application indication, if pending, on embryos. Thanks for the question!

Sr Trolice, any thoughts on the decades long trend in plummeting male sperm counts?

Great question! Today I posted a video on Facebook reviewing an article on how the Western diets have the worst impact on sperm testing. We have seen declining sperm counts over the last decades however this has not coincided with declining male fertility. Certainly a healthy diet, as the video discusses, appears to maintain normal sperm analysis. Good luck!

How many eggs and fertilized embryos would you guess your facility destroys each year? Why aren't these numbers being recorded at most facilities like this?

Following egg retrieval, a viable embryo is transferred into a woman’s uterus or they are frozen. Eggs are also frozen based in the direction of the patient. The disposition of the eggs/embryos are under the purview of the patient. They may either save them to remain frozen, donate them to research, donate them to other couples or discard. Fertility clinics function at the request of patients.

Thank you for your question.

I have gotten a woman who was using the nuva ring pregnant. Was it my superior sperm, or was something else at play?

No contraception is 100% effective. You clearly had adequate sperm numbers when your partner was ovulating.

Why do people have such a visceral need for this service and its results?

There are evolutionary reasons for procreation to ensure our continuation as well as to maintain the replenishment rate (births exceeding deaths in a population. Then there is simply the love of children which is the emotional component. Thanks!

We have had embryos frozen for 10 years now after the birth of our daughter. We were looking at donating them so that a couple that might not be able to afford the retrieval might be blessed with a child. After 10 years are the embryos still viable or should we dispose of them?

Currently, we know of no limit on the duration of embryos, eggs, or sperm frozen for their subsequent viability. Thank you for your generous offer to help others!

Why is Pergonal so expensive in the USA? We bought it 90% cheaper in Europe. I met Dr. Lunnenfeld a few years ago and was able to thank him and show him a picture of my daughter, but he had no explanation for the price gouging of American pharma.

Currently, fertility injectable medications in the U.S. are Menopur, Follistim and Gonal-F. Yes they are less expensive in other countries but the FDA only has oversight in the U.S. so we only prescribe the medications available in this country.