Thank you all for outstanding questions! I hope this was helpful and I wish you tremendous success if you are on the journey of building your family!

After my wife and I struggled with infertility for over a decade, I decided to start a compassionate, patient-centered IVF practice. I founded Fertility CARE: The IVF Center in 2003, an established IVF practice in Central Florida with success rates well above the national average.

In my new book, The Fertility Doctor's Guide to Overcoming Infertility: Discovering Your Reproductive Potential and Maximizing Your Odds of Having a Baby, I tell patients what they need to know—and avoid—in their quest for parenthood.

I’m called up by the media to give actionable advice on medical breakthroughs on the subject of infertility and assisting couples in their quest to become parents. Ask me Anything!

Follow Me: https://twitter.com/drmarktrolice

Proof: https://i.redd.it/zr8et1wvhyi41.jpg

Comments: 210 • Responses: 26  • Date: 

twoleggedgrazer88 karma

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.

DrTrolice46 karma

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

twoleggedgrazer7 karma

Thank you so much for your reply!

DrTrolice12 karma

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.

ChillBlossom81 karma

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...)?

DrTrolice28 karma

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!

annagrace20680 karma

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

DrTrolice171 karma

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.

zoobdo-9 karma

Can you cite your claims?

Edit: haters gunna hate

beer_demon48 karma

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?

DrTrolice48 karma

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.

sonia72quebec37 karma

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

DrTrolice80 karma

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!

crode08030 karma

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

DrTrolice53 karma

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!

Chtorrr24 karma

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

DrTrolice83 karma

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.

Fucking_Mcfuck23 karma

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?

DrTrolice85 karma

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!

cowfish1586919 karma

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.

DrTrolice15 karma

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

Good luck!

brosbe4gnomes14 karma

[deleted]

DrTrolice14 karma

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!

sppburke13 karma

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.

DrTrolice22 karma

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!

Peengwin12 karma

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

DrTrolice22 karma

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!

nektdeep10 karma

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

DrTrolice15 karma

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!

villagerblue9 karma

Hi thanks for doing this!

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

DrTrolice14 karma

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!

jimmyp96086 karma

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!

DrTrolice6 karma

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!

threewhiteroses6 karma

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.

DrTrolice10 karma

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!

coryrenton5 karma

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

DrTrolice16 karma

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!

TheTrueLordHumungous2 karma

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

DrTrolice13 karma

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!

sojaytay1 karma

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?

DrTrolice2 karma

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.

Rumblepuff1 karma

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?

DrTrolice1 karma

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!

iamrubberyouareglue81 karma

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.

DrTrolice1 karma

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.

Robertdigitalorgasm1 karma

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

DrTrolice2 karma

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

OlRoyBoi1 karma

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

DrTrolice1 karma

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!