Ectopic Pregnancy and Fertility

An ectopic pregnancy is one in which the fertilized egg implants in a site other than the uterus. The most common place for an ectopic pregnancy to implant is in the fallopian tube; therefore an ectopic pregnancy is sometimes referred to as a tubal pregnancy. The fallopian tube cannot support a growing embryo, and after several weeks the tube may rupture and bleed, resulting in a potentially serious situation.

Ectopic Pregnancy -Illustration courtesy of ASRM

Ectopic pregnancy can be caused by pre-existing tubal damage. This may stem from prior pelvic infection or inflammation, endometriosis, appendicitis, and DES exposure. Prior pelvic or tubal surgery or tubal ligation which has caused scar tissue or adhesions may also be the reason for ectopic pregnancy. Tubes may also be malformed because of birth defects or other anomalous growths.

Symptoms of ectopic pregnancy include missed menstrual period and bleeding during pregnancy. Pain and cramping may be one sided pelvic pain or pain in the shoulder or neck. Pain may come and go and/or cause nausea and vomiting. Dizziness or weakness may accompany symptoms.

An ectopic pregnancy is usually diagnosed by pelvic exam followed by an ultrasound and serial measurements of human chorionic gonadotropin in the blood.

Because and embryo will not survive outside the uterus and because allowing such a pregnancy to further develop is dangerous to the mother, your doctor must intervene. If there has not been rupture of the fallopian tube, Methotrexate injection is the preferred treatment. Methotrexate is very effective in destroying the ectopic tissue and allowing it to be reabsorbed by the body. It may take several weeks to resolve the ectopic pregnancy with the Methotrexate injection. A large number of early ectopic pregnancies can be successfully treated with the injection, leaving the tube open in a majority of women. Patients who have liver and/or kidney disease are generally not candidates for Methotrexate therapy. Other patients that are not candidates for this injection are those who are breastfeeding, those with an active lung disease, and those with active peptic ulcer disease.

In some cases, surgery to remove the pregnancy may be required. Generally, surgery is performed using a laparoscope which is used through small incisions in the belly button and lower abdomen. Surgery with a larger incision, called a laparotomy, may be needed in some cases.

There is still a good chance you can achieve a normal pregnancy after experiencing an ectopic pregnancy. Talk to your physician about your specific circumstances and when you can try again.

Download our pamphlet about the Methotrexate injection


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Fibroids and Fertility

Uterine fibroids are benign growths of the uterine muscular wall and occur in 25-50% of women. Fibroids can develop within the uterine wall, on the surface of the uterus or within the uterine cavity itself. Although fibroids occur frequently, they rarely require treatment. The most common symptoms that occur as a result of fibroids are heavy menstrual bleeding and pelvic pressure; however, some women with fibroids have no symptoms. Uterine fibroids can be detected through a pelvic exam and confirmed by a pelvic ultrasound.

Most women with fibroids do not have difficulties with conception or pregnancy. However, there are certain situations when the location of the fibroid can lead to infertility or miscarriage. If you have been diagnosed with fibroids during the course of your evaluation, we will counsel you on the effects of the fibroid(s) on your ability to conceive and/or successfully deliver a baby. There is no definitive answer to the effect of fibroids on conception and pregnancy outcome.

Rarely, a fibroid will block one or both fallopian tubes, preventing the egg from passing into the uterus or the sperm from entering the fallopian tube. Surgical removal of the fibroid may improve the chance of pregnancy. In vitro fertilization (IVF) is an alternative treatment to surgical removal in this situation because IVF bypasses the fallopian tube.

A fibroid that grows into the uterine cavity may prevent an embryo from implanting. Surgical removal of fibroids that distort the inside of the uterus may increase your chance of a successful pregnancy.

The fertility specialists at RHS can counsel you on appropriate management of fibroids depending on your individual factors, as well as risks and the potential benefits of surgical removal.

RHS ultrasound image of a uterine fibroid

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Share Your Good News and Join in the RHS Celebrations!

Did you have your baby through IVF? We want to hear from you! Did you have your baby via ovulation induction? We want to hear from you! Did you have your baby with help from an IUI? We want to hear from you! Did you get pregnant on your evaluation cycle? You guessed it; we want to hear from you! Regardless of how your miracle happened we want to share in your joy. So share your good news and join the celebrations!

We love to receive birth announcements, private or public messages on Facebook, phone calls, portal messages, or even a personal visit! It doesn’t matter how we hear about your baby news, we will share your announcement with the RHS staff. WE LOVE to ooh and aaah over your gorgeous babies.

How do you join in on the celebrations and fun? It just takes a couple of easy steps to make sure that we have all of the necessary information so that you are able to participate in any current or future RHS celebrations.

First – Complete the pregnancy outcome card (below) that we gave to you when you graduated, and mail it back to us. Has that card gone missing? You can send us a birth announcement, note or call us!

Once the pregnancy outcome card has been received, we’ll mail you the postcard pictured below. Simply click on the link on our “Keep In Touch” page in order to access the “Congratulations – We Heard the Good News” form, enter the password RHSFamily and follow the instructions.  Through this link, you will be able to provide information that allows you to share your joy in a variety of ways.  You can choose to (1) Be invited to the annual RHS party (think zoo!), (2) Add your child to the RHS family tree, or (3) Share pictures to be posted on the RHS website and Facebook.  You can select any or all of these options.  Providing the requested information will permit us to communicate with you regarding any upcoming RHS events. If you have already registered, but wish to make changes to  your preferences, you can do that here also.

We hope to hear from you!

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What do you mean the lab couldn’t inject ALL my eggs during ICSI?

A lot of times the lab hears feedback from the IVF coordinators that patients were surprised, or upset, that when performing ICSI, the embryologist was not able to inject every single egg that was retrieved. The main cause of this is due to the maturity stage of the egg itself.

Females are born with the total number of eggs that they will ever have in a lifetime. Prior to puberty, these eggs are arrested at an early stage of meiosis I, or at an “immature stage”. At this immature stage, the egg has a full set of chromosomes. As a female enters into puberty, luteinizing hormone (LH) surges occur during the menstrual cycle. These LH surges stimulate the resumption of the meiosis process in the egg and prepare the egg for ovulation and fertilization. Meiosis is an essential process that must occur within the egg because it reduces the number of chromosomes of the egg by half. When this meiosis process is complete, the egg is considered to be in the “mature” stage and is now ready to be fertilized. When fertilization occurs, the egg will once again have the proper number of chromosomes, one set coming from the egg and one set coming from the sperm, to form the embryo with a full component of genetic material.

During the IVF cycle when the follicles reach a certain size, an HCG injection is given. This HCG injection functions similarly to the role of luteinizing hormone (LH) in the menstrual cycle; it attempts to induce the eggs to undergo that final maturation step (or resumption of the meiosis process). You are instructed to give this HCG injection at a specific time prior to the egg retrieval so that the eggs have sufficient time and exposure to the HCG in hopes of yielding mature eggs from the follicles.

So, what does the lab look for when it is time to perform ICSI?

In preparation for fertilization, the egg undergoes the meiosis phases to reduce its number of chromosomes by half. The excess DNA or chromosomes are extruded out of the egg as a small cytoplasmic body known as a polar body. When extruded, this polar body sits in the perivitelline space between the oocyte and the zona pellucida and is visible under the microscope. When the embryologist sees the presence of this polar body they consider the egg to be mature and ready to be injected with the sperm to attempt fertilization. If the embryologist does not see this polar body under the microscope they consider the egg to be immature. Immature eggs are not capable of fertilization.

It is possible, however, that immature eggs can mature in the lab. This is called in vitro maturation. For optimal success, it is critical that the ICSI procedure be performed in the IVF lab within a specified time window following HCG injection and egg retrieval. When immature eggs are observed at time of ICSI the embryologist will wait the full allotted fertilization time window to see if the egg will undergo in vitro maturation in the lab. If the embryologist sees the polar body within the allotted time window, ICSI will be performed. If the embryologist does not see the polar body within the allotted time window, ICSI will not be performed and it is considered that the egg has arrested development and will not mature. As per lab protocol, immature eggs are discarded if they do not reach the appropriate stage for ICSI.

It is common to have immature eggs obtained during IVF. Typically about 10-15% of the eggs retrieved are immature. There are times in the IVF lab when all eggs are mature at the time of ICSI. There are times in the IVF lab when in vitro maturation of the eggs occurs and the embryologist is able to perform ICSI. There are times in the lab when ICSI does not occur as the eggs remain immature. Just know that our embryologists do make every attempt to give each egg a chance to mature and a chance to fertilize. It is a challenge that the embryologists are more than willing to undertake especially since sometimes the result is worth every effort in the lab!

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Listen Up! It’s NIAW 2017


The CDC tells us that is 15% of couples in America. Infertility does not discriminate based on race, religion, sexuality or economic status. You never know how badly you want something until you are told that it may not be possible. It is up to all of us to transform how others view infertility. One that will help educate and provide resolution to the millions of Americans impacted. Be part of a movement that wants to remove barriers that stand in the way of building families during National Infertility Awareness Week (NIAW)®.

This year, RESOLVE: The National Infertility Association wants you to “Listen Up!” when it comes to issues around infertility and family building. This public awareness campaign is created so anyone who cares about the infertility community can feel empowered to do something that makes a difference, either in your own family building journey or to help someone else. Infertility impacts millions of Americans and does not discriminate based on race, religion, socioeconomic status or sexuality. “Listen Up!” and become part of the movement.

How can you help spread the message?

Listen Up! It’s time to understand how infertility can affect you.
Listen Up! People with infertility matter. Join the movement to help build a community that understands their needs and supports their efforts to build a family.
Listen Up! Infertility takes away the right to build a family. You can help those that struggle, join the RESOLVE community.
Listen Up! Policies and legislation can impact access to many family building options. Help us stop these anti-family laws.
Listen Up! Do you know when to see a fertility specialist? Learn more here.
Listen Up! There are many ways to resolve infertility. Learn more at


Source: RESOLVE: The National Infertility Association

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The Latest 2017 Zika Virus Update

zikaupdate185pxThe scientific community’s understanding of Zika transmission and the impact on pregnancy are constantly evolving. This is our latest Zika virus update.

What we know about Zika virus:
• Zika virus can be passed from a pregnant woman to her fetus.
• Zika infection during pregnancy can cause a birth defect called microcephaly and other severe fetal brain defects.
• Many people who are infected with Zika have no symptoms, or their symptoms are mild. When symptoms are present, they include fever, rash, joint pain, muscle pain and red eyes.
• Zika primarily spreads through infected mosquitoes, but the virus can also be transmitted sexually. This is possible even if the infected person does not have any symptoms.
• There is no vaccine to prevent Zika or medicine to treat it.
• Testing for Zika is not universally available and is not always covered by insurance. Routine testing is not currently recommended for women who are not pregnant. Testing is also not recommended for men who may have been exposed to Zika virus unless they have clinical symptoms of infection (fever, rash, joint pain, muscle pain and red eyes). This is because accuracy of the test in people without symptoms is unknown, and results might be difficult to interpret. False positive tests result in avoidable stress and expense, and false negative tests provide incorrect reassurance, possibly leading to inadvertent fetal exposure to Zika virus.

Zika and Infertility Treatment
There have been no reported cases of Zika virus transmission through assisted reproductive technology (ART), but Zika virus has been detected in semen, and sexual transmission has occurred. Therefore, it may be possible to transmit the virus through the use of donated eggs, sperm or embryos. With this in mind, RHS is following FDA guidelines for both anonymous and directed egg donation

These guidelines state that donors will be considered ineligible if they have any of the following risk factors:
1. Medical diagnosis of Zika infection in the past 6 months
2. Residence in, or travel to, an area with active Zika transmission within the past 6 months
3. Sex within the past 6 months with a male who is known to have either of the risk factors listed in items 1 or 2

Any couple planning to conceive through fertility treatment should follow these guidelines:
• Before planning any travel, check the CDC’s travel website for areas with Zika risk.
• Please consider avoiding nonessential travel to areas with a CDC Zika travel notice. If you must travel, talk to your doctor before your trip.
• If you do travel to a CDC Zika travel notice area, it is important that you take steps to prevent mosquito bites
• If a woman visits a Zika travel notice area, she should wait at least 8 weeks before attempting pregnancy. During this waiting period, the couple should use condoms or should abstain from intercourse.
• If a man visits a Zika travel notice area, he should wait at least 6 months before attempting pregnancy. During this waiting period, the couple should use condoms or should abstain from intercourse.
• If either has had an active Zika infection, wait 6 months after its onset to attempt conception. During this waiting period, use condoms or should abstain from intercourse.

The CDC will continually update guidance as new information becomes available. RHS physicians remain educated about new developments and will relay this information to patients as it becomes available.

CDC Fertility Treatment

CDC Attempting to get pregnant

FDA: Donor Screening Recommendations to Reduce the Risk of Transmission of Zika Virus by Human Cells, Tissues, and Cellular and Tissue-Based Products

ASRM Guidance for Providers

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Tax Time Tips for Deducting Medical Expenses-Updated for the 2016 Tax Year

It’s tax season (collective groan!), but one silver lining may be the possibility of deducting irs_logo_0_1444394444[1]medical expenses, including expenses related to fertility treatment. According to the IRS guidelines for 2016 filing, “You can deduct on Schedule A (Form 1040) only the part of your medical and dental expenses that is more than 10% of your adjusted gross income (AGI).” When you are in fertility treatment, you can reach that 10% quickly. We recommend consulting with your tax accountant and referring to IRS Publication 502 for the most accurate advice and information.

You will have to itemize deductions when you file. Here are some tips for getting the most out of that deduction!

  • Receipts are the key! Save them all and make sure they are itemized. Keep receipts you may think you don’t need; sometimes you can be surprised at what is deductible. Hang onto your receipts for 7 years in the event that the IRS has questions. RHS and some pharmacies can print you an itemized yearly receipt for your records.
  • Keep a detailed log or diary throughout the year instead of trying to reconstruct it a year later. Note each date of service, the reason for that service and your mileage to the physician’s office, pharmacy or clinic. (Mileage reimbursement for 2016 is $0.19 per mile, down from $0.23 per mile in 2015). Don’t forget tolls, parking, and other travel expenses. Log your prescription medication expenses also.
  • You can include some insurance premiums, but “You can’t include in medical expenses insurance premiums that were paid and for which you are claiming a credit or deduction.” (Publication 502, page 8). These are usually employer based premiums, but read Publication 502 for the very detailed instructions on insurance premiums.
  • Remember that expenses paid through your HSA or FSA are NOT deductible. You already received a tax credit by establishing these plans (Publication 502, page 16).
  • Expenses that can be deducted: copays and deductibles, IUI and IVF expenses, sperm and egg temporary storage fees, diagnostic services, lab fees, “surgery, including an operation to reverse prior surgery that prevented the person operated on from having children”, prescription medications for which you were not reimbursed through insurance, travel expenses such as mileage and lodging, acupuncture, counseling and psychologist fees. Pregnancy test kits are also deductible, as are smoking cessation program costs. Don’t forget to track ALL of your medical expenses, not just those fertility related. Don’t forget your dental expenses too. Deductions are listed on Publication 502, pages 5 through 15.
  • Spouse’s and dependents‘ medical expenses may also be deducted, depending on how you are filing.

Don’t forget you can amend last year’s return if you were unaware or forgot to itemize your medical expenses. Link to Form 1040X on the IRS website for more information. Tax filing, just like fertility treatment, is unique to the individual. Consult your tax professional for advice on the best method for you to file.

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What Does Infertility Treatment Cost?


Approximately one in ten couples will experience difficulty conceiving due to infertility, but with appropriate diagnostic evaluation and treatment, many may achieve their dream of having children.  Treating infertility can be an expensive undertaking, but our team at Reproductive Health Specialists can discuss treatment cost and provide financial planning options to meet your specific needs. By providing comprehensive and complete fertility services on site, we are able to maintain very competitive fees. RHS Financial Counselors can assist patients by exploring available insurance coverage, reviewing financial payment options for treatment and costs and helping patients select the best payment options available for their treatment plan.

We participate with several insurance plans. RHS is contracted with most plan products from UPMC, out-of-state and Highmark Blue Cross/Blue Shield, Aetna, United Healthcare, and Cigna. Benefits vary widely and are often employer based. Because these plans are selected by your employer, it is important to call and get specific information about coverage, and in some cases to obtain authorization, before you begin treatment. Our financial counselors will work with you to help determine your covered services. You can use our worksheet to assist you in determining your benefits when you contact your insurance carrier.

Our highly-trained, full-time financial department offers one-on-one financial consulting with patients in order to review all treatment costs. We provide this general estimate to patients (All prices provided are based on current pricing available. Please check with your financial counselor to verify that no pricing changes have occurred.  Medication cost not included.):

  • Initial physician consultation: $125 – $250*
  • Intrauterine Insemination: $295 – $1,200**
  • IVF – Individual cycle: $12,250 – $14,000**

*Depending on time spent.
**Depending on individual treatment plans.

Unfortunately, IVF is a costly procedure that is often excluded from coverage by health insurance plans.  Due to this lack of coverage by insurers, infertility patients are left with the financial burden of infertility treatments with no assurance of conceiving. To help you with this struggle, RHS offers two innovative cost-sharing programs   where we share some of the financial risk of IVF.  These initiatives were the first of their kind in western Pennsylvania.  There are extensive details about these plans on our website. In addition, we offer a discount structure for patients who opt to pay for each cycle individually. All of these plans can help you reduce some of your financial stress related to treatment.  Each program allows you to:

  • Identify a finite cost for treatment
  • Pursue treatment(s) that give you the best chance of success
  • Significantly reduce the out-of-pocket cost if treatments are unsuccessful, allowing you the option of pursuing adoption, if you so desire.

RHS can also provide information for financing through a banking institution that RHS has developed an affiliation. The Hebrew Free Loan Association of Pittsburgh provides interest free loans for permanent residents of Allegheny County.  For more details about HFLA, and the assistance they provide, visit their website.

Allow us to help ease your financial stress. If you have any questions for our financial counselors, please feel free to contact us.  They will return your call or you can make an appointment to come in to the office to discuss your questions.

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Is It OK to Get a Flu Shot While Pregnant or Trying to Conceive?

It’s time for a refresher since our first flu shot blog. People often ask us whether it’s safe to get a flu shot while pregnant or trying to conceive. The answer is a very big Yes! Not only is it ok — it’s important that you do it, and it’s not too lateflu-shot.

In past years, peak flu season has been from December through March, and it sometimes lasts as late as May. If you haven’t received your flu shot yet, you still have time to build immunity.  It only takes about two weeks to make antibodies after receiving the flu vaccine.  These powerful antibodies can then be passed on to your developing baby and protect your newborn baby for up to six months.

Antibodies can also be passed on to your child via breast milk. All of this is important because babies under six months of age are too young to receive the flu shot. Strongly encourage caregivers and family who come into contact with your baby to receive the flu vaccine also.

Pregnant women are considered to be at high risk for developing flu-related complications. “Flu is more likely to cause severe illness in pregnant women than in women who are not pregnant. Changes in the immune system, heart, and lungs during pregnancy make pregnant women (and women up to two weeks postpartum) more prone to severe illness from flu, as well as to hospitalizations and even death. Pregnant women with flu also have a greater chance for serious problems for their developing baby, including premature labor and delivery.” (

The flu shot has been given to millions of women over the years and has not been shown to harm either women or their unborn babies.  It is safe to receive at any time during pregnancy, although the flu mist nasal spray vaccine is not recommended in pregnancy.  In the 2015-2016 flu season, only half of pregnant women received the flu vaccine and this was a significant leap from the 2007-2208 flu season. (

Do your part to protect you and your unborn baby.  Don’t wait until the peak of flu season.


Source: The CDC website.

For more information link here

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Dr. Kubik Lectures on the History of IVF. Watch It Here!

picture1Incredible strides have been made in the brief history of IVF! On October 14, 2016 Dr. Kubik was honored to speak at the 41st Annual Magee Alumni Day of the Department of Obstetrics, Gynecology and Reproductive Sciences.  Dr. Kubik delivered the Dr. David Katz Minimally Invasive Lecture, entitled, “The History of In-Vitro Fertilization-We Have Come a Long Way”.

In her lecture, she discusses the history of IVF from the 1981 birth of Elizabeth Carr, the first IVF baby born from a US IVF program, to the over 5 million IVF babies there are today.  She also addresses the contribution IVF has made to the understanding of follicle development, egg fertilization and embryo development.  Finally she explains the application of lessons learned from IVF to the diagnosis and treatment of couples experiencing infertility.

This is a great lecture for getting some background information on IVF and you certainly don’t need to be a doctor to understand it.  Link here or visit our YouTube channel to see it in its entirety.

Please be aware, most couples experiencing infertility issues will not need IVF.  In 2014, the latest year with data available, 33,866 IVF babies were born, less than 1% of all US births. Contact Us if you want more information about treatment options.


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