Board Certified and Trusted Reproductive Medicine Specialist

Dr. Bradley Miller is a Reproductive Endocrinologist who has been in practice for 18 years. Throughout his career over 2,000 babies have been born as a result of his care. He is the Managing Partner at Reproductive Medicine Associates of Michigan, one of the leading fertility centers in Michigan. Learn more about Dr. Miller and follow his blog to discover more answers to your infertility needs and questions.

Archive for August, 2012

Cancer and Fertility Preservation

Friday, August 31st, 2012

There are approximately 800,000 reproductive-aged men and women who have been diagnosed with cancer and over 60% are expected to survive.  The lifetime probability of developing cancer is 50% for men and 30% for women.  The first concern of any cancer patient is curing the cancer, but once they have achieved that goal quality of life issues like fertility become a concern. Unfortunately, the life-saving cancer treatments can affect future fertility by destroying the sperm or eggs and the uterus in some cases. The most severe damage comes from high dose radiation to the ovaries or testicles. Also, chemotherapeutic cancer drugs like cyclophosphamide, mechlorethamine and melphalan can be destructive depending on dose and number of cycles. In some cases it is possible for sperm and egg production to return to near normal levels.  For men new sperm is produced every day while on the other hand women were born with a set number of eggs that cannot regenerate. The bottom line is a certain percentage of men and women will become sterile after having their cancer treatment. The good news is that there are several options that may help preserve fertility before treatment.

Men can have semen samples frozen at a sperm bank or a local fertility center before they start treatment. If sperm counts are normal inseminations can be done or if they are low or very low either in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) can be done. Women can undergo an IVF cycle if time allows. Embryos created by IVF are frozen and can be stored for years. If radiation will be localized to the pelvis then the ovaries can be surgically repositioned so they are out of the field of radiation or placed behind the uterus for protection. Of course, factors such as time, expense, availability of sperm and delay due to cancer treatment can limit options.We always encourage Oncologists/Radiologists to talk to their patients who are of reproductive age before they begin treatment so that they know ahead of time what their options are. The patient can always contact a reproductive endocrinologist on their own as well. When a cancer patient contacts our office for an appointment they are considered an emergent patient and are seen within a day or two.

If you would like to schedule an appointment with Dr. Bradley Miller, please visit the contact section of his blog.

Success Rates – What You Need To Know

Friday, August 17th, 2012

An important factor when it comes to choosing an IVF center is their success rates. Patients want the best chance for success so they look for centers that have high success rates. However, these rates can be confusing and it is important that you understand how to interpret them. First you want to look for clinics that are performing a substantial number of IVF cycles a year. Typically 200 or more total IVF cycles or more per year is an adequate amount to determine success rates by age group. When a clinic has a small number per age group success rates will vary greatly based on a difference of only one or two pregnancies, which can be misleading.

Success can vary due to many factors. Age is the most important factor, when women are using their own eggs. Success rates decline as women age, and success rates drop off even more dramatically around age 37. Part of this decline is due to a lower chance of getting pregnant from ART, and another  part is due to a higher risk of miscarriage, especially over age 40. However, there is no evidence that the risk of birth defects or chromosome abnormalities (such as Down syndrome) is any different with ART than with natural conception.

Success rates vary with the number of embryos transferred. However, transferring more embryos at one time does not continue to increase the chance of success, but may only increase the risk of a multiple pregnancy, which is much more complicated than a singleton pregnancy and is more likely to result in babies with severe medical problems.

Day 3 follicle-stimulating hormone (FSH) levels are also critically important in evaluating your potential for successful conception in an assisted reproductive technology program. This blood test is typically drawn on the third day of a woman’s menstrual cycle. Day 3 FSH levels have been shown to be an incredibly accurate predictor of IVF success, independent of age. Essentially, an elevated Day 3 FSH value indicates a very poor prognosis for conception through IVF and a high risk of pregnancy loss should the rare conception occur. Every IVF program establishes a “threshold” FSH value unique to their laboratory, above which pregnancies are very rarely conceived despite great effort and repeated IVF attempts. At RMA, we have determined that an FSH value of 15 or higher predicts that IVF will have little or no chance in helping to achieve pregnancy.

The Society for Assisted Reproductive Technology (SART) is the primary organization that collects cycle data and creates guidelines and standards for the centers to follow. Visit SART’s website at to get more information and review the most recent 2010 success rates.