Family Building Guide

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We're Here for Everyone, Everywhere I have been fortunate to spend the last 40 years as a reproductive endocrinologist helping couples and individuals have the babies they so desperately want. I’ve treated tens of thousands of patients, assisted in creating thousands of babies, and throughout this time, I’ve learned a couple of truths: 1.

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While western medicine offers many effective treatment solutions, it does not hold ALL of the answers to fertility challenges. Eastern medicine and alternative therapies have the ability to successfully pick up where western medicine leaves off. Every person’s path to parenthood looks a little different. Their histories, both personal and medical, are unique, and their treatment plans need to be as well. What we eat and how often we eat have a major effect on every organ system in our bodies, including the reproductive organs and endocrine system—and may hold the key to overcoming infertility for so many.

Knowledge is power, and sometimes what you think is true isn’t. That’s part of the reason I believe it’s so important to share all of the information contained in this Family Building Guide with people trying to conceive and anyone focused on living healthier, more balanced lives. Controlling inflammation and its many sources –food, stress, the environment, exercise – is one of the best ways to improve your health and fertility. Inflammation is at the root of so much disease. All of our body systems are interconnected. There’s a domino effect throughout the body. Inflammation in the G.I. tract inevitably spills over to the reproductive organs. Reproductive health goes hand in hand with total body health and this includes positive thinking in the mind as well. CNY Fertility is here to help all patients, no matter where they live or what they’ve been through. We don’t look at age, weight, AMH level, or number of previously failed treatment cycles. We’re proud to be the fertility center so many turn to when they feel they’ve run out of options and (too often) hope. We pride ourselves on being the voices saying “YOU CAN DO IT” when the rest of the world seems to be saying it's impossible. CNY Fertility is a special place. You’ll receive encouragement from our team of doctors, nurses, PAs, nurse practitioners, embryologists, and lab techs. Not to mention our support groups and other “fertile friends”. Whether or not you have the opportunity to meet all of the people involved in your care and that of your future child(ren), you can rest assured that our commitment to helping you achieve your dreams runs deep. This starts with 24/7 access to a nurse who can answer your questions, explain your protocol, and reassure you that how you’re feeling or what you’re worried about is completely normal. Patients near and far have around the clock access to CNY Fertility. We know it’s the little things that can make all the difference, which is why CNY takes an integrative approach to fertility treatment, examining what you’re eating, how you’re thinking, how you’re moving, and all of the ways you can enhance your fertility. We look forward to sharing this incredible journey to parenthood with you and supporting you every step along the way.

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TABLE OF CONTENTS 6

4

Meet Our Team

82

The Fertile Spirit

20

The Human Reproductive Story

84

Fertile Hope Yoga

22

Your First Consultation

88

Virtual Support

24

The Basic Fertility Evaluation

90

Pregmune

26

PCOS

92

Reproductive Immunology

28

Unexplained Infertility

94

The Ketogenic Food Plan

30

Treatment Options

96

Dr. Kiltz's Keto Lifestyle

32

IUI

100

How Do I Get Started

34

IVF

101

Keto Resources

38

Preimplantation Genetic Testing

108

Glycation

40

ZyMōt™ Sperm Processing

112

Kiltz's Keto Ice Cream

42

Egg Freezing

114

Intermittent Feasting

46

Sperm Freezing

116

Fatty, Flavorful and Filling

48

Minimally Invasive Surgery

118

Tips for Vegans & Vegetarians

50

Vasectomy Reversal

120

Success Stories

51

Tubal Ligation Reversal

128

Medicines for Treating Inflammation

52

LGBTQ+ Family Building Options

132

CBD Oil

54

The Donor Decision

134

Nutrients for Male and Fermale Fertility

56

Using a Surrogate

136

CNY Healing Arts

58

Destination CNY

140

Massage

64

Travel Success Stories

142

Acupuncture

66

Adoption

144

Feel the Light

70

Making Priceless Affordable

146

Mind Body Smile

72

CNY Fertile Financing

148

What Are You Breathing?

74

Preparing for Treatment

150

CNY Locations

80

Patient Support at CNY Fertility

160

Dr. Kiltz’s B.E.B.B.I.S. Plan

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Meet Our Team

“Creating miracles for over 20 years” OUR FERTILITY SPECIALISTS

OUR FERTILITY SPECIALISTS

ROBERT J. KILTZ, MD Dr. Kiltz is Founder and Director of Central New York’s first successful IVF center. He is a Diplomate of the American Board of Obstetrics and Gynecology and Fellowship trained and Board Certified in Reproductive Endocrinology and Infertility. A Graduate of the University of Southern California, Dr. Kiltz completed medical school training at the University of California, Davis. He interned in Internal Medicine at UCLA, and in Obstetrics and Gynecology at USC Los Angeles County Women’s Hospital. After residency at the University of Colorado Health Science Center in Denver, he practiced for one year at Kaiser Permanente in California. He then went to Harbor UCLA Medical Center for a twoyear fellowship in Reproductive Endocrinology and Infertility.

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DAVID R. CORLEY, MD Dr. Corley has been helping couples with fertility issues have families for over 24 years. He is board certified in both Obstetrics & Gynecology and Reproductive Endocrinology and Infertility (REI). He is a graduate of Clemson University and obtained his medical degree from the University Of South Carolina School Of Medicine. He completed his OB/GYN Internship and Residency at Portsmouth Naval Hospital. After serving in the Navy at Guantanamo Bay Cuba and Charleston Medical Center, he continued his fellowship training in Reproductive Endocrinology and Infertility at the University Of Louisville School Of Medicine.

MICHAEL P. GROSSMAN, MD Dr. Grossman is a graduate of Michigan State University. Dr. Grossman’s residency was in Saginaw, Michigan, after which he worked at a private infertility clinic in southeast Michigan. He completed his fellowship at the University of Louisville and joined CNY Fertility as our Albany physician. He is a Diplomate of the American Board of Obstetrics and Gynecology, and board certified in Reproductive Endocrinology and Infertility.

EDWARD C. DITKOFF, MD Dr. Ditkoff is a native New Yorker and attended college at Emory University before continuing on to Chicago Medical School. Following his residency training in OB/GYN at the George Washington University Medical Center, he successfully completed a fellowship in Reproductive Endocrinology at USC Medical Center in Los Angeles from 1990-1992.

PAUL C. MAGARELLI, MD, PhD

MARIBELLE VERDIALES, MD

GENNADIY IVANOV, MD

Dr. Magarelli is a BoardCertified Reproductive Endocrinology & Infertility (REI) specialist with national acclaim and was most recently the founder and Medical Director of Magarelli Fertility Centers, LLC. Prior to that, he ran High Quality Affordable Fertility Centers, LLC and Reproductive Medicine and Fertility Centers, LLC. Dr. Magarelli is also Founder, Medical Director, and Advisor to the ABORM and Reproductive Industry Partners, a past faculty member at Yo San University and University of New Mexico, founder of the Institute for Sustained Health, founder of US Military Family Fertility Services 501 c3, recipient of the Pioneers in Integrated Reproductive Medicine Award, and Past President of the Pacific Coast Reproductive Society. He is a graduate of Duke University Health Sciences Residency and UCLA RE Fellowship program. He earned his PhD in Nutritional Biochemistry and Physiology at the University of Arizona and is a frequent presenter on topics such as infertility, PCOS, Menopause, Andropause, and the treatment of Insulin Resistance.

Dr. Verdiales was born in Puerto Rico, where she graduated with honors from University of Puerto Rico School of Medicine. She completed her residency at Jamaica Hospital Medical Center (Jamaica, NY) where she discovered her passion for women’s health. After graduation, she continued to practice in New York and pursued further training in the areas of Robotic Surgery and pelvic reconstruction with and without mesh implants. In 2009, Dr. Verdiales relocated to Georgia with her family. She took advance training in bio-identical hormone therapy, nutrition, weight loss and integrative medicine.

Dr. Ivanov is a Fellow of the American College of Obstetrics and Gynecology (FACOG), a member of the American Medical Association (AMA) and American Association of Gynecological Laparoscopists (AAGL). He is board-certified in obstetrics and gynecology in the U.S. and Ukraine. Dr. Ivanov completed his OB/GYN studies and medical residency in 1999 at Kharkov State Medical University in the Ukraine, where he subsequently practiced as a university faculty physician. In 2009, he completed his U.S. medical residency at the University of Buffalo in New York.

She believes that in order to achieve health, there must be a balance between body, mind and soul. Dr. Verdiales is dedicated to the health and wellness of women and all couples and clients interested in growing their families. In addition to being a doctor, she is also a speaker and wellness coach.

Dr. Ivanov focuses on Gynecology and Women’s Preventive Health. He is passionate about using minimally invasive procedures in gynecology to avoid major surgeries. Dr. Ivanov joined CNY Fertility in 2020 and has received extensive training from some of the nation's leading experts in fertility care. In addition to being the head physician at CNY's Philadelphia clinic, he is an active staff member at St. Mary and Holy Redeemer Hospitals and fluent in English, Russian, and Ukrainian.

SYRACUSE • ALBANY • BUFFALO • ROCHESTER • ATLANTA MONTRÉAL • COLORADO SPRINGS • PHILADELPHIA • SARASOTA

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OUR FERTILITY SPECIALISTS

OUR FERTILITY SPECIALISTS

JASHOMAN BANERJEE, MD

FAEZ FARUQI, MD

ERIC CHANG, DO

JC TRUSSELL, MD

DENISE WALINSKY, MD

CAROLINE A. D’SOUZA, MD

MYRON O. LUTHRINGER, MD

Born in Calcutta, India, Dr. Banerjee completed his medical school and residency in Obstetrics and Gynecology at Calcutta National Medical College and Hospital. He moved to the United States in 2004 as a research fellow at the Cleveland Clinic Department of Reproductive Medicine. Dr. Banerjee completed a second residency in Obstetrics and Gynecology at the University of Toledo Medical Center in Toledo, Ohio followed by a Reproductive Endocrinology and Infertility Fellowship at Wayne State University in Detroit, Michigan.

Dr. Faruqi is a graduate of Université de Montréal and currently teaches gynecology at McGill University. His expertise is in assisted reproductive technology and minimally invasive gynecological surgery. He takes a comprehensive approach to fertility treatment that focuses on medical interventions as well as improving the overall health and well-being of the client.

Dr. Chang is a Diplomate of the American Osteopathic Board of Obstetrics and Gynecology. He is a graduate of Penn State and obtained his medical degree from Des Moines University. Following his OB/GYN residency at Cooper University Medical Center, he practiced obstetrics and gynecology for seven years before entering a fellowship in Reproductive Endocrinology and Infertility at the Philadelphia College of Osteopathic Medicine. He credits his osteopathic training for having encouraged his life-long interest in Asian medicine and alternative therapies, and he takes great pride in treating people as a whole, rather than as a set of lab values.

Dr. Trussell is a urologist specializing in treating conditions affecting the urinary tract in men and women. He is a 1992 graduate of Temple University School of Medicine, did his residency at SUNY Upstate Medical University and internship at Balboa Naval Hospital.

Dr. Walinsky is a graduate of Drexel University College of Medicine in Philadelphia where she also did a research fellowship in the Division of Reproductive Medicine at University of Pennsylvania. She completed her OB/GYN residency in Baltimore and then taught residents there for five years before moving to New Mexico where she was a Laparoscopic Specialist for ten years. She is a diplomate of the American Board of Obstetrics and Gynecology and an active member of the AAGL (American Association of Gynecologic Laparoscopists). Dr. Walinsky is happy to return to her roots in assisting patients with fertility challenges.

Dr. D’Souza was born in London, England but has called Buffalo, NY home for many years. She is a graduate of Canisius College and obtained her medical degree from Jagiellonian University. Dr. D’Souza completed her residency at Hutzel Women’s Hospital at Wayne State University in Obstetrics and Gynecology. She is a practicing Ob/Gyn and is dedicated to the health and well-being of women of all ages.

Dr. Luthringer serves as chief surgeon at the CNY Fertility International Surgical Institute. He joined the team in 2016 and brings 30 years of experience assisting fertility patients to achieve their goals. His passion is the development and advancement of techniques to better the surgical outcomes of his patients. This has led to his expertise in the treatment of endometriosis utilizing both advanced minimally invasive and da Vinci robotic surgery. He routinely performs surgery on patients from across the country and around the world in addition to teaching all aspects of gynecologic surgery.

Dr. Banerjee is Board Certified in Obstetrics and Gynecology and Board Eligible in Reproductive Endocrinology and Infertility. He is a member of the American Society of Reproductive Medicine, American College of Obstetricians and Gynecologists, American Medical Association, and the Society for Gynecologic Investigation. His fertility interests include preservation of oocyte quality, IVF, and recurrent pregnancy loss. He has also published numerous peer reviewed publications. Dr. Banerjee and his wife are parents to two children. In his spare time, he enjoys writing poetry, painting, and is a member of an amateur theatre group.

Dr. Faruqi has a certificate in Reproductive Endocrinology and Infertility and is a fellow of both the Royal College of Surgeons of Canada and the American Board of Obstetrics & Gynecology.

Dr. Trussell has a clinical interest in Andrology, Erectile Dysfunction, Peyronie’s Disease, and Male Infertility. He is a member of the American Urological Association (AUA) and an Associate Professor of Urology at Upstate Medical University.

Dr. D’Souza has a particular interest in fertility and nutrition. She seeks a holistic approach to helping patients in addition to western medicine practices and has completed a certificate program with the Institute of Integrative Nutrition.

Dr. Luthringer completed both medical school and residency at SUNY Upstate Medical Center. He also served as the Felix Rutledge Fellow at MD Anderson in Houston, Texas. He is Board Certified in Obstetrics and Gynecology, a Fellow of the American College of Obstetricians and Gynecologists, and a member of the American Association of Gynecologic Laparoscopists.

Call to book your appointment today! 844-315-2229

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OUR FERTILITY SPECIALISTS

OUR FERTILITY SPECIALISTS

Ashleigh Rausch joins CNY Fertility with an extensive clinical background as a Physician Assistant with over 10 years of experience in Emergency Medicine, Interventional Radiology, and Primary Care with a focus in Women’s Health.

RANDY A. FINK, MD Dr. Fink completed his Obstetrics & Gynecology training at Brown University/ Women & Infants’ Hospital of Rhode Island and medical school at the Medical College of Virginia. He attended graduate school at the University of Pennsylvania and received his undergraduate degree from The American University in Washington, DC. Dr. Fink is a Fellow of the American College of Obstetricians & Gynecologists. He has been named one of “America’s Top Obstetricians & Gynecologists” and is an honored recipient of the Patient’s Choice award. His clinical interests include women’s wellness & sexuality, sexually transmitted infections, bio-identical hormone management, menopause and peri-menopausal concerns, and hysteroscopic surgery. Dr. Fink and his wife Stephanie have three wonderful children who light up their lives.

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R. CHARLES WELLIVER, JR., MD Dr. R. Charles Welliver, Jr. specializes in treating a variety of urologic disorders affecting men. He is fellowship-trained in Andrology and male factor infertility and works closely with CNY Fertility through his office at Albany Medical Center. He has received awards both regionally and nationally for his research. He performs journal article reviews for many urologic journals and has twice been named reviewer of the year in the Journal of Urology for article reviews involving men’s health/infertility. He is a member of the American Urological Association (AUA), American Society for Reproductive Medicine (ASRM), Sexual Medicine Society of North America (SMSNA), a founding member of the Society for Benign Prostatic Diseases (SoBPD), and an Associate Professor in Urology.

JAMES D. KONDRUP, MD

WERNER NEUHASSER, MD

Dr. Kondrup is board certified in Obstetrics and Gynecology and is recognized both nationally and internationally as a leader and trainer in Minimally Invasive Surgery for women. He is the past Chairman of the Lourdes Hospital Robotics Committee and present Chairman of the Lourdes Hospital Minimally Surgery Committee (now encompasses the Robotics Committee). He is dedicated to providing women with the latest options in Minimally invasive Gynecologic Surgery, Infertility, and Hereditary Cancer screening and treatment.

Dr. Werner Neuhausser received his medical degree from Oxford University followed by an academic internship at Imperial College in London (UK). He completed his residency in Obstetrics and Gynecology at Columbia Presbyterian Hospital in New York and a fellowship in Reproductive Endocrinology and Infertility at Beth Israel Deaconess Medical Center/Boston IVF in Boston.

Dr. Kondrup specializes in the areas of endometriosis, fibroids, adhesions and pelvic pain. Dr. Kondrup brings with him over 35 years of infertility evaluation and treatment experience and is committed to helping anyone who needs assistance achieving their dreams of creating a family.

He graduated Summa Cum Laude with a Master's degree in Physics from Vienna Technical University and, as a Fulbright Fellow, went on to receive a PhD in Biomedical Sciences working with Dr. David Julius at the University of California, San Francisco (UCSF). He was a faculty member at Beth Israel Deaconess Medical Center and Harvard Medical School where he was an instructor and continued to pursue research focusing on early human embryonic development and human gametogenesis. He is a member of the American College of Obstetricians and Gynecologists (ACOG), the American Board of Obstetrics and Gynecology (ABOG), the American Society for Reproductive Medicine (ASRM), and the New England Fertility Society (NEFS). He is also a Fellow with the American Congress of Obstetricians and Gynecologists (FACOG). In his spare time, Dr. Neuhausser enjoys mountaineering, climbing, skiing and wildlife photography. He is a certified ski instructor.

ASHLEIGH RAUSCH, PA-C Physician Assistant, Buffalo

JENNIFER PHILLIPS, RPA-C

Ashleigh earned her PA degree from Rochester Institute of Technology,

where she completed specialized clinical training in Reproductive Endocrinology and Infertility. She also completed a Medical Immersion Program in Guanajuato, Mexico where she became fluent in Spanish. Ashleigh enjoys reading, traveling and spending time with her family and friends.

Jennifer is a 1999 graduate of the D’Youville College Physician Assistant program. She has worked in women’s health since 2001, and prior to that practiced family medicine. She regularly attends continuing education seminars to keep up to date on new medical advances. Jennifer enjoys working with women of all ages and abilities to improve their

quality of life. She feels patient education is key to good healthcare. Jennifer remains active in the education of PAs as a student mentor and clinical lecturer. She is a former secretary and member of the WNY PA Association, as well as a fellow of the American Academy of Physician Assistants.

Rebecca is a graduate of Binghamton University with a BS in Nursing and a BA in Psychology and Biology. She worked for eight years as a Labor and Delivery Nurse at Bellevue Woman’s Hospital and then chose to fulfill a lifetime career goal and graduated from Baystate Medical Center becoming a Nurse Midwife and OB/

GYN Nurse Practitioner in 1999. She has spent most of her career working as a Nurse Midwife, helping women deliver their babies. She was excited to make a slight career change when she joined CNY Fertility and enjoys helping clients achieve their dreams of becoming parents.

Niccole earned her nursing degree at Samaritan Hospital School of Nursing in Troy, NY in 2012 and started her career at CNY Fertility in 2013. She received her Bachelor of Science in Nursing from the State University of New York at Delhi in 2014. While continuing her work at CNY Fertility as a Registered Nurse, Niccole completed the Family Nurse Practitioner program through the State University of

New York Polytechnic Institute. Niccole is board-certified by ANCC and a member of Sigma Theta Tau, The National Honor Society of Nursing. She serves as a preceptor for nurse practitioner and physician assistant students. Niccole has spent her entire career in reproductive health and finds nothing more rewarding than helping people become parents.

Physician Assistant, Rochester

REBECCA ESKIN, CNM , NP Nurse Practitioner, Albany

NICCOLE DAVEY, FNP-BC Nurse Practitioner, Albany

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OUR FERTILITY SPECIALISTS

OUR FERTILITY SPECIALISTS

Leigh completed her Bachelor of Science degree in Nursing at Binghamton University in 1999 and her Nurse Practitioner degree from the University of Rochester in 2004.

She joined the CNY Fertility team in 2011 and has worked in the women’s health arena for the past 18 years. She lives in Rochester with her husband and two daughters.

MARGARET MARNELL, MS, FNP- BC

LEIGH HOUGHTON, RN, NP

Nurse Practioner, Syracuse

Nurse Practioner, Rochester

CATHERINE FALCON, WHNP

Katy graduated from Loyola University Chicago with a Bachelor of Science in Nursing and worked as a Labor & Delivery nurse for nearly 10 years prior to pursuing her Master’s degree. In 1994, she completed her Master’s Degree in Women’s Health at the University of Rochester and worked in OB/GYN private practice as a Nurse Practitioner.

Katy joined CNY Fertility in 2013 and couldn’t be happier. She has spent her entire career in women’s health and finds it to be tremendously rewarding.

GRACE MICHEL, RN, MSN, FNP - BC

Nurse Practioner, Rochester

KRIS ZIEGLER, RNC, MSN, WHNP Nurse Practioner, Buffalo

JESSICA WOOD, APRN, FNP-C Nurse Practioner, Sarasota 12

Margaret earned her Baccalaureate of Science in Nursing from Niagara University, completed the Community General Hospital Family Nurse Practitioner Program, and received her Master’s Degree with Distinction from Upstate Medical University.

Nurse Practioner, Syracuse Kris earned her Baccalaureate of Science in Nursing from Niagara University. She completed the Women’s Health Nurse Practitioner Program and received her Master’s Degree from The State University of New York in Buffalo. Kris is an active member of ASRM and has been NCC certified in Reproductive Endocrinology since 1989. She has taught at D’Youville College as an adjunct faculty member and has been a Nurse Practitioner and Physician Assistant student preceptor at SUNY Buffalo, Daemen College, Dyouville College and St. John Fischer College.

Kris was the Clinical Director of the Department of Reproductive Medicine at St. Francis and Kenmore Mercy Hospital, until entering private practice in 1994.

Jessica is a board-certified Family Nurse Practitioner. She received her MSN from Bradley University and her BSN from East Carolina University. She has worked in surgery for the last 26 years in the areas of OB/Gyn and laparoscopic, robotic, general, and vascular surgical procedures.

Jessica enjoys spending time with her children and grandchildren and enjoys helping countless couples and individuals on their family building journeys.

Kris joined CNY Fertility in 2012, working part time out of the Rochester office, and then became fulltime in 2016 when the Buffalo office opened. She loves providing care to couples trying to achieve a pregnancy and is honored to be part of the CNY Fertility team, working with Dr. Kiltz and a talented group of compassionate professionals

KELLY TESTA, RNC, MSN, WHNP-BC Nurse Practioner, Syracuse

KAYLA COOK, FNP-C Nurse Practitioner, Syracuse

Board certified by the ANCC and an active member of ASRM and ANCC, Margaret is a preceptor faculty member at Le Moyne College and Upstate Medical University, assisting Nurse Practitioners and Physician Assistant students.

Margaret has been practicing with Dr. Kiltz for over 15 years. She completes initial client consultations and is an active member of the clinical team. Margaret is responsible for initiating the CNY Fertility’s office-based surgery centers in our Syracuse and Albany locations, manages the centers through the American Association for Ambulatory Surgery Facilities. Margaret loves working with Dr. Kiltz and is proud to be part of the CNY Fertility family.

Grace is a graduate of LeMoyne College, where she received a Bachelor of Science Degree in Nursing with a minor in Psychology. While working at CNY Fertility Center as a Registered Nurse, she completed the Le Moyne Family Nurse Practitioner Program.

professional organizations, including the American College of Nurse Practitioners, the American College of Nursing, and the International Honor Society of Nursing, Grace was inducted into Sigma Theta Tau, the National Honor Society of Nursing.

Grace is a Board Certified Family Nurse Practitioner and licensed in New York State. She works primarily with patients undergoing Reproductive Endocrinology and Gynecological care. An active member of several

Through many years of hands-on experience, hard work and professional study, Grace has gained substantial knowledge and experience with fertility patients.

Kelly received her Bachelor’s Degree in Nursing from Syracuse University at Utica College and her Master’s Degree in Nursing from Stony Brook University.

active member of the American Society of Reproductive Medicine (ASRM).

She is Board Certified by the National Certification Corporation and an

Kayla has a bachelor’s degree from Keuka College and graduated with honors from the Le Moyne College Family Nurse Practitioner Program. She worked as an RN at St. Joseph’s Hospital for over ten years before joining CNY Fertility. Kayla is board certified by ANCC and an active member of ASRM, ANCC, and Sigma

Kelly specializes in Women’s Health and has spent more than 13 years practicing in that specialty.

Theta Tau, the International Honor Society of Nursing. She is happy to be a member of the CNY team, handling consultations, follow-ups, pre-admission testing, post-operative appointments, and obstetric and follicular monitoring.

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OUR FERTILITY SPECIALISTS

OUR FERTILITY SPECIALISTS

JENNIFER ANDERSON, FNP-C

Jennifer has a degree in Psychology from the University of Colorado at Boulder as well as a Bachelor of Science in Nursing from the University of Alaska at Anchorage. She worked in Labor & Delivery for 6 years before joining CNY Fertility in 2013 as an OR Nurse. Jennifer recently completed her

Master of Science in the Family Nurse Practitioner Program at Le Moyne College and is honored to be a part of the CNY Fertility team helping couples achieve their goals of parenthood.

DONNA MILLER POLITO, RNC Nurse Manager, Syracuse

Nurse Practitioner, Syracuse Amy recently joined CNY Fertility as a board-certified family nurse practitioner. She has worked in primary care and women’s health for 5 years. She is a graduate Mercy College of Health Sciences nursing program and the of University of Hawaii at Manoa Masters program.

AMY JENKINS, RN, MSN, FNP-BC

has experience in Emergency/Flight Medicine and Labor and Delivery. She has always had a passion for women’s health and is very fulfilled in helping women with fertility and family planning. Amy lives in Colorado Springs with her husband, daughter, and two dogs.

JUSTINE TAYLOR, BSN, RN

She started her nursing career in 2004 in the United States Navy and continues as a Naval Reservist. She

Nurse Manager, Albany

Nurse Practioner, Colorado Springs

Martha graduated from Felician College in Lodi, NJ with an ADN in nursing. She worked in family planning, fertility practices, and labor and delivery prior to pursuing her Masters of Science.

Martha then worked in a private OB/ GYN practice, gynecologic oncology, and breast health prior to joining CNY. She is fluent in Spanish and has spent her entire career in women’s health.

Kimberly has dedicated her career to women and women’s health. She graduated from Mercer University with a Bachelor of Science in Nursing. She was a Labor & Delivery/Antepartum nurse at Piedmont Hospital for over 10 years. She received a Master of Science in Nursing degree from Georgia State University, majoring in the Women’s Health Nurse Practitioner/Perinatal Clinical Nurse Specialist program.

She worked as a Nurse Practitioner in Gynecology/Urogynecology prior to joining CNY Fertility.

Donna has been working in the fertility field as a Reproductive Nurse for the past 22 years. She has been at CNY Fertility Center since its inception and has significantly contributed to its growth and development. Earlier in her career, she was the IVF and Oocyte Donor Program Coordinator. She transitioned to the Clinical Nurse Manager for the Syracuse location as the business expanded. Realizing that she was able to assist clients from across the country and beyond to

Justine is a graduate of Samaritan Hospital School of Nursing and received a Bachelor’s Degree in Nursing from the State University of New York at Utica/ Rome. She began her career in women’s health at Bellevue Women’s Hospital in June 1989 as a labor and delivery nurse. In September 1994, Justine assisted with the development of an IVF program at Bellevue Woman’s Hospital, and in January 2006, she joined Dr. Robert Kiltz and the CNY Fertility family with the opening of the Latham location.

achieve their dreams of having a family, she established the Global Fertility Program. Donna understands the challenges faced by those experiencing infertility, particularly those coordinating cycles from afar, and supports them throughout their journey. She continues to enhance her fertility knowledge by attending Post Graduate courses at ASRM on a yearly basis and staying up-to-date with assisted reproduction publications and articles.

With 23 years of experience in assisted reproductive technologies, she feels very fortunate to absolutely love the role she is in today. Helping couples and women to achieve their dreams of parenthood is incredibly rewarding. It is a privilege and honor to support CNY Fertility’s clients as they navigate one of the most difficult times in their lives. It is also Justine’s sincere pleasure to lead a team of professionals who provide the most compassionate, advanced care to each and every client.

MARTHA JARAMILLO, APRN Nurse Practitioner, Atlanta

KIMBERLY MATHIS, NP 14

Nurse Practitioner, Atlanta

Kim enjoys helping women of all ages address whatever gynecologic challenge they may be facing. Whether it is heavy or painful periods, difficulty getting pregnant, or pelvic floor weakness postpartum and beyond, Kim is an expert in women’s issues.

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HOLISTIC FERTILITY SPECIALISTS

Donald has been helping couples build families for over 22 years as an Acupuncturist. He joined the team at CNY Fertility/ He aling Arts 14 years ago. Donald is a graduate of Bastyr University, where he completed his training in Chinese Medicine.

HOLISTIC FERTILITY SPECIALISTS

Donald helps clients navigate their fertility journeys using Chinese Medicine, Meditation, and Lifestyle adjustments. His specialties include follicular, endometrial, and sperm cell development. When not sitting with clients, you can find Donald at home in his garden with his daughters.

DONALD CLARKE, L.Ac Dr. Cridennda has been in private practice as an Acupuncturist and Chinese Herbalist since 1995. She spent twenty years in western medicine working as a Radiological Technologist. She made a career change after being treated with acupuncture to overcome a debilitating illness. Dr. Cridennda has spent years training in Traditional Chinese Medicine (TCM). She

graduated from the International Institute of Chinese Medicine with a Masters of Oriental Medicine and trained in Beijing. several studies on outcomes of combining acupuncture with ART (assisted reproductive techniques).

MICHAEL SERRANO, LMT Jennifer has a degree in Traditional Chinese Medicine (TCM), is a Certified Arvigo Therapist trained by Dr. Rosita Arvigo, and completed the Integrating Functional Medicine with TCM Program with Dr. Jake Fratkin. She lives in Upstate NY where she has practiced Zen Buddhism with Shinge Sherry Chayat Roshi for over 30 years.

JENNIFER WATERS, L.Ac, DIPL.AC

Jennifer is a regular contributor to Acupuncture Today with her column, “Talking with Masters”, which led her to author “Welcome The Pain: The Life and Work of Master

Muhua is a graduate of Beijing University of Traditional Chinese Medicine (one of the top Acupuncture Schools in China) and specializes in acupuncture therapy that is a combination of modern anatomy and kinesiology, including

to serve the community she grew up in with Acupuncture and Chinese Medicine. Ronda specializes in treating anxiety, pain, and fertility. She also offers herbal consultation/ herbal therapies as well as dietary therapy.

Michael Serrano is an award winning NYS Licensed Massage Therapist with 17 years’ experience. Michael provides a customized blend of therapeutic massage techniques and reiki to relax the body. This includes 6 years at a world class resort and spa where Michael provided over 4,000 treatments to satisfied guests, 5 years providing in home palliative care for children with life shortening illness throughout central NY and 2 years providing in home Massage Therapy for the elderly. He has 3 years’ experience working in chronic pain management prior to massage therapy.

His direct patient care training started in the United States Air Force 18 years ago as a dental surgery assistant.

Using an integrative massage that’s nurturing, Kathy looks forward to helping clients increase their body awareness to better identify and alleviate sources of pain, tension and stress.

massage session. Kathy’s beliefs on nurturing the body makes her able to connect with each client to increase body awareness and have a clear mental state to open the chances of fertility.

RONDA DARBY, L.AC

She is NCCAOM-certified and has authored

DIANE K. CRIDENNDA, MD, L.Ac

Ronda graduated from the Finger Lakes School of Acupuncture and Oriental Medicine. She is also an herbalist and has a passion for planåts and nature. Ronda was born and raised in the Finger Lakes. She is especially excited

Acupuncturist Zion Yu” with Balboa Press. She incorporates Photobiomodulation/ LED Light Therapy in clinical practice and was featured in the Oriental Medical Journal with her compelling article, “Does LED Light Have a place in TCM?”, Earth/Late Summer 2018. She has a no-nonsense, common sense approach to real health which integrates the highest quality Functional and Chinese Medicine supplements on the market today.

KATHY SCHOLL, LMT

The body is more than just the sum of its parts! She believes massage therapy is a valuable tool physically and mentally and encourages it as a vital part of every health and wellness plan. Achieving an overall sense of well-being is the ultimate goal of every

Michael’s soothing hands combined with extensive experience makes him a great massage therapist for aiding patients going through infertility. He is a healer at heart

Pre- and Post- IVF Transfer Treatment. She has over 20 years of clinical practice and has treated over 100,000 patients.

MUHUA QIU, BTCM 16

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HOLISTIC FERTILITY SPECIALISTS Amanda graduated from the Finger Lakes School of Massage. She learned Craniosacral therapy in 2000 through the Upledger Institute, and fell in love with energy work. She is trained in Reiki(I+II), Meridian Massage (Cindy Black), Aromatherapy (Aromahead), and Herbalism (7song).

HOLISTIC FERTILITY SPECIALISTS The infertility journey can cause tremendous stress on the body. Amanda’s aim is to reduce that stress through massage to bring the body back to balance and create a safe, healthy, and happy home for new life.

Amy is a graduate of the Onondaga School of Therapeutic Massage and was as valedictorian of her class. Amy was drawn to massage therapy by her passion for holistic health, aspiring to help people achieve optimal wellness in a way which facilitates the body’s ability to heal itself. She is skilled in the art of transporting clients to a state of deep relaxation as well as utilizing a variety of massage techniques to relieve pain and

discomfort in the body caused by muscle tension, injury, trauma and stress. Amy is proficient in Swedish, deep tissue, hot stone, prenatal and fertility massage. She has been practicing therapeutic massage since 2010.

AMY LARATTA, LMT

Warren is a NCCAOM Board Certified acupuncturist. He graduated from Southwest Acupuncture College in Santa Fe, NM in 1999 and received further education at Chakra Traditional Tai Massage School in Hadrin, Thailand.

Warren has also apprenticed in Chengdu, China and has formally studied with Tibetan monks at the Litang Monastery. He has worked at CNY for 12 years.

Leah is an acupuncturist and Chinese herbalist who is excited to introduce you to a new approach to whole body health. Using the Eastern understanding of the body, she looks at each person as an individual with their own unique set of symptoms. She will work with you to develop a wellness plan specific to

your needs. Together, you can move towards a healthier and more comfortable life. As a graduate of the leading Chinese medical school, the Oregon College of Oriental Medicine, Leah is happy to be part of fostering a community of wellness in the Capital Region.

Karen is a graduate of Finger Lakes School of Oriental Medicine and furthered her education at the Zhejiang Provincial Hospital of Chinese Medicine in Hangzhou, China with an emphasis on Gynecology and pediatrics.

She received her Doctorate at Pacific College of Health and Science in San Diego, CA. Karen is also a certified Reiki practitioner.

WARREN MCNAUGHTON, L.AC

Jessica is a graduate of Onondaga School of Therapeutic Massage. While Jess thoroughly enjoys practicing deep tissue massage because of the benefits clients receive from it, she also understands the perspective of those going through the infertility journey.

Jess went through it herself and feels as though it helps put patients at ease knowing that she understands everything they are going through.

JESSICA KNAPP, LMT

LEAH RAINER, L.AC, MAOM

Heather is a passionate bodyworker. She has been a Reiki Master Teacher since 2006. Her ability to combine the healing properties of Reiki with her massage takes the experience to a whole new level. Helping clients to relax and unwind or helping with a problem area is why Heather became a Massage Therapist.

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Dr. Wang has written many books, has been practicing for 32 years, and with CNY for 15 years.

DR. YARONG WANG, OMD, PhD

AMANDA WELLS, LMT

HEATHER CACCIONE, LMT

Dr. Wang is a graduate of Beijing University. She is NCCAOM certified in Acupuncture, Herbology, and Chinese Medicine.

Her passion for helping people heal and her mothering instincts makes her a great addition to the Healing Arts team in helping CNY Fertility patients achieve their goals of having a child.

DR. KAREN WILLIAMS, DACM, L.AC 19


The Human Reproductive Story CONSIDER THE CHALLENGE When you consider the complexity involved in human reproduction, you begin to realize it’s a miracle that we exist at all. That a tiny oocyte (the egg) – a cell the size of a grain of sand – and a mature human sperm cell (which is one hundred times smaller than the oocyte) manage to find each other and combine to create a human child is one of the most amazing creations of the universe. The average chances of conceiving naturally and delivering a baby are about 20% per cycle in the first 6 months of trying, rates go down to 1-5% after about 18-24 months, and significantly diminish after age 40.

INFERTILITY FACTORS Our ability to answer the question why couples struggle to conceive or carry a baby to term is somewhat limited. Factors such as hormonal, anatomic, immunologic and genetic/ chromosomal dysfunction are just a few of the causes we may identify. Since a woman is most fertile in her teens and early 20s, we know that the postponement of childbearing is a major cause of infertility. Failed implantation and repetitive early and late pregnancy loss are

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" You are not alone. Nearly 1 out of every 8 couples of reproductive age is affected by infertility."

also likely related to infertility and have similar and overlapping causes. In general, there are four main contributing factors to infertility: Ovulatory factors, Tubal and Uterine factors, Male factors, and Unexplained factors. A couple facing infertility may be experiencing one or more of these obstacles in both the male and female partner. But, you are not alone. Nearly 1 out of every 8 couples of reproductive age is affected by infertility.

OUR MISSION Our mission at CNY Fertility is to guide you on your journey with a comprehensive evaluation and treatment options while integrating both eastern and western methods. Increasingly, we are seeing that our food is both a medicine and a toxin. By incorporating functional medical ideas to healing, you can enhance your chances of success for both natural conception and assisted techniques.

“OUR MISSION AT CNY FERTILITY IS TO GUIDE YOU ON YOUR JOURNEY”

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Your First Consultation Telefertility, Video Chat, or In-Person Whether in person or over the phone, your initial fertility consultation is an important one. We want you to feel comfortable and able to ask any questions you may have. For many, your initial consultation with one of our physicians, nurse practitioners, or physician assistants is really just a discussion. The primary goal is for us is to listen and understand your hopes and expectations so that we can collectively create a suitable plan of action. A provider will review your chart and discuss your medical history. Those coming to our office for an in-person consultation often take advantage of the opportunity to have bloodwork, a semen analysis, HSG, or other female and male testing done during their consultation. You can expect your initial consult to last around 30-60 minutes. If you suspect or know that you are suffering from infertility, it is best if both partners (if applicable) are able to be present during the office appointment or phone consultation. The focus of this initial consultation is you, and ultimately you are in control of every decision that is made. With the incredible online resources available these days, many clients come to us already knowing what treatment they want. Others, however, require more guidance. Regardless of where you are in your understanding of your fertility issues, we are here to answer any and all of your questions as well as educate you on all of your treatment options. After discussing your medical history and goals, we may recommend a certain course of action, but we will never force anyone away from the treatment they desire. 22

At CNY Fertility, our focus is always YOU. We don’t focus on boosting our “success rates,” and have never found the need to artificially inflate our numbers by denying treatment to those with “lower chances of success”. Remember, odds and chances of success are merely statistics. Statistics are based on populations, but you are a unique individual. A Financial Counselor will also be available to review your insurance coverage and the costs involved in any agreed-upon treatments. If you don’t have insurance coverage, financing options can be explored as well. You will also have the opportunity to learn about Eastern holistic therapies that can improve your chances of conceiving—Yoga, Acupuncture, Massage, and Meditation.

PREPARING FOR YOUR CONSULTATION Here is a list of things we recommend you have prepared for your initial consultation: • A copy of your medical records from your OB/GYN, primary care physician (PCP), or any other fertility center. • Insurance cards for both partners (if applicable) if your consultation is in office. • Insurance authorizations (if applicable) • A list of questions: many couples and individuals find it helpful to write down a list of questions beforehand so they don’t forget anything during their consultation. We are happy to answer your questions at any time, but your consult is a great time to get as many of them answered as possible.

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The Basic Fertility Evaluation

FEMALE At this first visit, the woman will be asked about the regularity of her periods, if she experiences severe menstrual cramps, pelvic pain, vaginal bleeding, her method of contraception, any history of surgeries and infections. If previous fertility evaluation and treatments have been performed, these will be reviewed and the results evaluated. A painless vaginal ultrasound will be performed as well. There is no need to reschedule this appointment if you are currently menstruating. Preconception baseline bloodwork will also be drawn at your first visit.

SPERM COUNT

RECOMMENDED DIAGNOSTIC TESTING FOR FEMALE •

Preconception baseline blood work (yearly) includes CBC (complete blood count), CMP (complete metabolic panel), Hepatitis, HIV, Cystic Fibrosis, Estrogen, FSH (follicle stimulating hormone), Progesterone, HCG (pregnancy hormone), TSH(thyroid), Testosterone, Rubella, Varicella, LH (lutenizing hormone), and Prolactin.

If you have recurrent pregnancy loss or continuous failed implantation, additional testing will included: Lupus, NKC (natural killer cells), Karyotype (male and female), and ANA (antinuclear antibody).

Autoimmune testing for recurrent pregnancy loss (if necessary).

Hysterosalpingogram/Saline Sonohysterogram (HSG/SHG yearly) –to check condition of fallopian tubes and uterus.

Physical exam and pelvic ultrasound (monthly). Hysteroscopy / Laparoscopy (diagnostic) –A surgical procedure done under anesthesia (general) to evaluate uterus for polyps, fibroids, endometriosis and adhesions.

Normal

Low

SPERM MORPHOLOGY

Normal

MALE

The man will be asked questions regarding current and past medical conditions, past surgeries, infections, drug and medication use. A semen analysis should be performed to determine the likelihood of the man’s ability to reproduce. This analysis can also help to determine appropriate next steps.

Normal

Abnormal

The quality of the movement of the sperm (rated from 0-4. A score of 2 or more is satisfactory.)

Morphology: examines the shape and size of the sperm head. Normal results are when 14% or more of the sperm have normal shaped heads. Men with less than 4% of normal shaped sperm may have a significant infertility problem.

Semen Analysis: A typical semen analysis will evaluate all of the following: Total Volume: 2-5 milliliters is a normal volume. A very low volume indicates that the seminal vesicles may not be making enough fluid or that these ducts may be blocked. It may also indicate a problem with the prostate gland.

Sperm Count: 40 million to 300 million is the normal range for the number of sperm per milliliter. Counts below 10 million are considered poor; counts of 20 million or more may be fine if motility and morphology are normal. Motility and Velocity: 2 aspects of motility will be evaluated: •

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Abnormal

SPERM MOTILITY

RECOMMENDED DIAGNOSTIC TESTING FOR MALE • • • •

Semen analysis (yearly) Chromosome testing / male hormone blood work (if necessary) Possible testicular/scrotal ultra sound to rule out varicocele Preconception baseline blood work drawn at consultation (with male factor infertility) TSH (thyroid), Testosterone, Prolactin, LH (lutenizing hormone), and FSH (follicle stimulating hormone)

The number of active cells as a percentage of the total number of cells (rated from 0-100%, at least 50% should be active) 25


Polycystic Ovarian Syndrome (PCOS) Polycystic Ovarian Syndrome or PCOS is one of the mostcommon hormonal endocrine disorders in women. Many women have it, and yet we don’t know why, nor do we know the cause. In general, PCOS is really just that –polycystic ovaries. The basic difference between polycystic and normal ovaries is that although the polycystic ovaries contain many small follicles with eggs in them, the follicles do not develop and mature properly, so there is no ovulation.

PCOS is one of the leading causes of infertility among women and is responsible for 70% of infertility issues in women who have difficulty ovulating. It affects nearly 10 percent of women before they hit menopause. Postmenopausal women can also suffer from PCOS. There is some degree of heredity with PCOS. Some studies have found that if a mother has PCOS, there is a 50% chance that her daughter will have PCOS.

Women suffering from PCOS may experience high testosterone levels, which cause other signs and symptoms such as Hirsutism (excessive hair growth), male pattern baldness and acne. This high level of testosterone can prevent the ovaries from releasing an egg each month causing irregular menstrual cycles and, ultimately, infertility.

SYMPTOMS OF PCOS

Many women struggle with PCOS for years, and it’s only when they have difficulty conceiving and seek fertility assistance that they learn the reason for so many of their symptoms. In fact, it is estimated that more than 50 percent of PCOS cases remain undiagnosed.

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Although many of its symptoms are unnoticeable, PCOS can affect a woman’s fertility, menstruation, hormone levels, and physical appearance. Infertility can result from low levels of the hormones necessary to create an egg. If ovulation doesn’t occur, progesterone, a hormone that thickens the lining of the uterus, is not produced. A woman’s cycle will be irregular or absent without progesterone. Women with PCOS are at additional risk for insulin resistance, type 2 diabetes, high cholesterol, high blood pressure, and heart disease.

PCOS TREATMENT SUCCESS RATES Treatment for PCOS

Expected “Monthly” Success Rate

Metformin Alone

About 1-2%

Clomid

15% - if ovulating

Femara

15% - if ovulating

Injectable gonadotropins

20%

IVF, In vitro fertilization

50%

Many may be overweight and have difficulty with weight control, although you can be lean and still have PCOS.

body weight, and lower percent free testosterone, LH/FSH ratio, and fasting serum insulin in as little as six months.

PCOS cannot be diagnosed with one test alone, and symptoms vary from woman to woman. Additional warning signs include: • PMS or pelvic pain • Weight gain • Acne • Increased hair growth on face, back or chest • Sleep apnea • Thinning hair/baldness • Dandruff • Elevated cholesterol • High blood pressure • Type II Diabetes

CONCEIVING WITH PCOS

Women with PCOS often have higher levels of insulin in their blood than normal. Insulin regulates the amount of sugar in the bloodstream. Researchers believe that the overproduction of this hormone causes women’s bodies to respond by producing excessive amounts of the male hormone androgen. In a healthy body, the ovaries make a tiny amount of androgen. But with PCOS, they start producing too much. This often causes you to stop ovulating, grow excessive facial and body hair, acne, and makes it difficult to sustain a healthy body weight. That is why proper diet is critical to those who suffer from PCOS.

Some women do not respond and ovulate with Clomid, but will respond well to letrozole. Injectables can also be used. For women who do not ovulate with Clomid or Femara, the traditional next step is to use injectable gonadotropins. The woman takes daily shots of FSH hormone for about 10 to 12 days in order to stimulate mature follicle development.

TREATMENT

There is no known cure for PCOS, although it is possible to manage its symptoms medically and through lifestyle modifications. The Ketogenic diet has produced very good results in managing the symptoms of PCOS. By reducing or eliminating carbohydrates altogether and increasing consumption of saturated fats, a ketogenic diet can lead to significant reductions in

The good news is that your chances of getting pregnant with PCOS using fertility treatments are very good. The great majority of women with PCOS will be able to have a baby. Women with PCOS generally need ovulation induction in order to get pregnant. This can be accomplished through the use of oral medications such as metformin, Clomid or Letrozole (Femara). These medications can be effective in stimulating ovulation in some women with polycystic ovaries and anovulation. Metformin is used to reduce high insulin levels and stabilize your hormones. It can be used alone or in combination with Clomid or Femara.

Progressing to IVF is usually recommended after ovulation induction with intercourse and induction with IUI have not resulted in pregnancy. There are also some surgical interventions, including ovarian drilling. This is when a doctor punctures the ovary with a small needle carrying an electric current to destroy a small portion of the ovary. This surgical procedure may lower male hormone levels and help with ovulation, but it also carries a risk of developing scar tissue on the ovary and the benefits may only last a few months. Both the risks and the benefits of ovarian drilling should be discussed with your doctor to determine if it is the right treatment for you. 27


Inflammation = Unexplained Infertility A diagnosis of unexplained infertility or idiopathic infertility is usually made when all of our testing is complete and there is not an obvious source of the problem. The man’s sperm count looks reasonably normal in volume, motility, concentration and morphology. The woman has regular menstrual cycles which indicate she is likely ovulating. The hysterosalpingogram shows that the fallopian tubes and uterus are in normal condition. And, there are no obvious, systemic diseases (such as autoimmune diseases, diabetes, or previous history of cancer, radiation or chemotherapy) that may explain a history of infertility. Ovarian reserve is good and the woman has an AMH (Anti-Müllerian Hormone) level of greater than 1. It is important to understand what unexplained infertility really means:

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The diagnostic testing we have available will only identify the major reasons why a couple may have a difficult time getting pregnant and staying pregnant, but it certainly cannot identify all of the reasons. About 20-30% of couples will have no definitive diagnosis after completing a standard infertility evaluation. True unexplained infertility may be related to egg and sperm dysfunction, among other causes. These conditions are difficult to establish through conventional testing. If the fallopian tubes are blocked or there is no sperm, these are obvious major obstacles to becoming pregnant. Unfortunately, there are no tests available for more subtle infertility factors such as inadequate egg quality which could result in fertilization failure.

In today’s fast-paced treatment paradigm, some patients prefer to move forward with treatment without further clarification. Although oftentimes appropriate, this strategy should not be applied to every patient/couple. Laparoscopy and hysteroscopy are minimally invasive, out-patient surgeries that can provide a diagnosis and sometimes even offer improved pregnancy rates if scar tissue or endometriosis is found and treated at the time of surgery. It is humbling to put into perspective that even among fertile couples who have no issues getting pregnant, they only have a 20% chance of achieving pregnancy any given month they try. In otherwords, they are unsuccessful 80% of the time! Dr. Kiltz believes that unexplained infertility is likely related to our daily environment, major and minor stress factors, and diet. Stress and our environment are known to affect cortisol and epinephrine levels, and have a significant effect on the immune system.

"Unexplained Infertility is complex and likely related to our daily environment, major and minor stress factor, and diet" There is considerable evidence that diets high in carbohydrates have not only created the significant obesity problem in our modern world, but also an explosive number of autoimmune issues that affect every organ system, including both the female and male reproductive systems. It is our belief that inflammation is probably the number one source of fertility dysfunction. This means reduced chances of conceiving and implanting, and a significant increase in miscarriages. It may even be related to spontaneous chromosomal abnormalities with DNA damage due to chronic or acute inflammation.

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Treatment Options After thorough testing of both partners and identifying potential factors contributing to a couple’s infertility, treatment options will be recommended based on their individual needs. If my uterus/fallopian tubes/ovaries are normal, with normal sperm and I appear to be ovulating, my per cycle success is: Continued trying on own/month Intercourse Cycles with Fertility Medications Intrauterine Insemination (IUI) with Fertility Medications In Vitro Fertilization (IVF) with Fertility Medications

1-5% per cycle 1-5% per cycle 10-20% per cycle 20-50% per cycle

Donor Eggs

40-60% per cycle

OVULATION INDUCTION

INTRAUTERINE INSEMINATION (IUI)

For those women with ovulation disorders, Polycystic Ovarian Syndrome, or irregular menstrual cycles, an oral hormone medication such as Letrozole (Femara) may be prescribed. These medications are designed to stimulate ovulation. Letrozole is often combined with ultrasound to monitor the ovaries and blood tests to monitor hormone levels. Letrozole can be used in conjunction with both timed intercourse or intrauterine insemination. Gonadotropins are injectable fertility medications that work directly on the ovaries to produce follicles/eggs. The injections are given daily for approximately 10-12 days. During gonadotropin treatment, frequent monitoring with ultrasounds and blood hormone levels is necessary to closely monitor egg/follicle development. If a couple does not conceive after 3-6 cycles of gonadotropins, it is time to reevaluate and move on to alternative treatments.

For those women whose tubes are not severely damaged and have a normal HSG, intrauterine insemination (IUI) may be an option. In this fairly simple procedure, sperm is placed within the uterus around the time of ovulation. The woman’s eggs are allowed to travel down her tubes on their own. Ovulation induction combined with IUI is often the first course of treatment. IUI alone offers a 3-6%* conception rate per cycle while combining Letrozole with IUI may boost this up to 9%*. Gonadotropins combined with IUI offers a 15-20%* per cycle conception rate (*minimal to mild tubal damage, normal to mild sperm abnormalities and women less than 40 years old.)

DONOR EGGS / SPERM

For couples and individuals who experience a lack of eggs or sperm, or whose eggs or sperm will not allow development into viable embryos, using donated eggs or sperm (or both in some cases) is a course of treatment worth consideration. Donors are usually anonymous, though not necessarily so– as in cases using family members or significant others. Egg donation is a viable option for women whose ovaries no longer produce eggs or whose eggs cannot develop into viable embryos. It is also an option for those couples who wish to maintain a biological link by using the partner’s sperm. Sperm donation has been around for many years and has been socially acceptable for some time. Not only can a single woman, or women who do not have male partners, become pregnant using donated sperm, but males who have severe sperm abnormalities or no sperm

Embryo Donation is now another option available to our clients seeking to either create, or expand their families. Often when families undergo IVF treatments, they are left with remaining fertilized eggs (embryos). This can place the parents in a difficult position when they begin to discuss what to do with the remaining embryos. Previously, the only options available have been to donate the remaining embryos to research, keep them frozen indefinitely, or to dispose of them. We are now able to add a fourth option, Embryo Donation.

Fertility Treatment Options OPTION

DESCRIPTION

SUITABLE FOR

Trying naturally for a further number of months

Ovulation Induction

• • • •

May use drugs to promote egg production May or may not include injections Have sex to become pregnant May or may not be part of a monitored cycle

• • •

Women who don’t ovulate Women with short cycles Women with short duration of unexplained infertility

Intrauterine Insemination (IUI)

• •

Preparing sperm in lab Selecting best sperm for implantation in uterus May be combined with fertility drugs such as Clomiphene to increase the number of eggs available Can be conducted over course of several cycles

• •

Mild male factor infertility Short duration of unexplained infertility

Drugs to increase number of eggs that mature Eggs collected Sperm added in lab Best embryo selected to replace (Any additional can be frozen for later use)

Nearly any cause of infertility- tubal damage, endometriosis, unexplained infertility, ovulation problems

• •

Repetitive IVF failure Woman of advanced age or with Diminished Ovarian Reserve (DOR) Cancer survivors Male couples/single men using a surrogate Genetic reasons

Trying Naturally

• •

IVF

In Vitro Fertilization (IVF) offers a much higher chance of success per cycle for tubal damage than surgery. Tubal scar tissue is often inside the fallopian tube, but laparoscopic surgery can only repair the outside of the tube. During IVF, ovaries are stimulated to develop eggs and then the eggs are collected. The eggs are injected with sperm and incubated overnight to fertilize. The resulting embryos are incubated for up to 5 days and are placed in the woman’s uterus.

at all, or even potentially serious genetic traits they do not wish to pass on, can benefit. Donors are screened for STDs, heredity and genetic diseases and blood disorders. Donors can be found who are a close physical and mental match of the recipient.

IVF

• • • •

Donor Egg IVF

IVF as per the above, using eggs from a young. fertile donor and partner or donor sperm.

• •

• • •

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When there is no diagnosed cause for infertility The woman is relatively young Seek help after 6-12 months of trying without success, sooner if there’s a known cause for infertility

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Intrauterine Insemination(IUI) INTRAUTERINE INSEMINATION IUI is one of the least invasive fertility treatments available and can be pretty successful in certain situations. It’s a good starting treatment for many women and couples, particularly those with mild male factor infertility, ovulatory dysfunction, or unexplained infertility. If diagnosis allows, it is usually tried before proceeding to IVF. While IVF generally achieves pregnancy much faster, speedier results come at a higher cost, and IVF is a more complicated process. IUI is primarily a facilitator of natural conception. The goal of IUI is to increase the number of sperm that reach the fallopian tubes and subsequently increase the chance of fertilization. IUI provides sperm with a head start in that they don’t have to travel from the vagina and through the cervix, but it still requires a sperm to reach and fertilize the egg on its own. IUI circumvents the vagina and cervix by placing concentrated sperm right into the uterus where it’s closer to the egg. IUI can be used with women who ovulate normally as well women who don’t. And it can be used with medication and without as long as there’s adequate sperm from a partner or donor. IUI generally has a success rate of around 10-20% per cycle, however, like 32

most fertility treatments, success rates depend on a lot of different factors and will vary for every patient based on age, medical history, and diagnosis. Statistically, IUI becomes a less successful treatment option as patients get older. And if IUI is going to work, it usually happens in the first few cycles of treatment. Who Should Consider IUI: The most common reasons for IUI are low sperm count or decreased motility. IUI may be a good fit for those with the following circumstances: •

• • • • • •

Ovulatory Factor Infertility – those with no or irregular periods or PCOS Mild Male Factor Infertility Ejaculation Dysfunction Cervical Factor Infertility Sperm Allergy Single and Lesbian Women needing donor sperm Unexplained Infertility

Who Shouldn’t?: Fertility providers don’t typically recommend IUI to patients with fallopian tubes that are completely blocked, partially blocked, or open but diseased. In

these cases, conception is challenging and can result in an ectopic pregnancy. If the male partner has a low sperm count (e.g., less than 10 million motile sperm) or the couple has been attempting to conceive for a long time with a male partner who has a normal semen analysis, IUI is usually not the first treatment of choice.

TYPES OF IUI There are four different “types” of insemination cycles, categorized by the medications that can be used. Your preferences, fertility testing results, and medical history will help decide which type of IUI cycle is best for you. • Natural Cycle – No medications are used. • Trigger Cycle – Medication is used to trigger ovulation at a specific time in order to optimally time insemination, further increasing odds of pregnancy. IUI typically occurs 12-36 hours after the trigger medication has been taken orally or injected. • Oral Medication Cycle – Clomid or letrozole is given to enhance egg development and ovulation. Oral medication decreases the risk of multiples when compared to injectables. • Injectable Medication Cycle – Injectable gonadotropin medications stimulate the ovaries further than oral medications can, however, the risk of multiples is greater with injectables. No matter what type of IUI cycle you choose, your cycle is monitored either with regular blood work and ultrasounds or at home via an ovulation predictor kit. If your IUI cycle includes medications, you can plan to be monitored with bloodwork and ultrasounds to ensure a safe and effective cycle.

THE IUI PROCESS: IUI Preparation – Before your IUI procedure, men and women can make many to their diet, add beneficial supplements or medications, and utilize holistic therapies like acupuncture and

massage to ensure the best possible outcome. Taking this time to focus on improving the quality of your eggs pays off exponentially because it’s something you have the power to change. Best results are seen if these changes are adopted for 90 days prior to treatment. Egg Development – This step is either part of the woman’s natural egg development or stimulated with medications and lasts roughly 10-14 days. Once your follicles are optimal size, a trigger medication may be given to finalize egg maturation and trigger ovulation. This phase of egg development may or may not be accompanied by ultrasound and bloodwork monitoring.

INSEMINATION The insemination is performed as close to the day of ovulation as possible. Concentrated sperm from a partner or donor is injected into the top of your uterus through a small catheter inserted through your vagina and into your cervix. Doing this increases the odds of conception by reducing the distance the sperm must travel to meet the egg. Once injected, the catheter is removed. The insemination itself takes just a few minutes. It’s possible to experience mild cramping post-procedure. The sperm used in your IUI can usually be collected at the office performing the IUI (preferred if possible), frozen and shipped to the center, collected fresh at your home and shipped to our centers using our sperm shipping kits (not advised), or ordered and sent to our office from a donor agency. Fresh sperm samples are prepared in our laboratory to obtain a concentration of active sperm. If the IUI is successful, a blood pregnancy test will be positive in two weeks. Once a heartbeat is detected via ultrasound, the pregnancy has a 90-95% probability of resulting in a live birth. Statistics show that 90% of IUI pregnancies occur in the first three cycles of IUI. Knowing when to move on to more advanced treatment like IVF is important for the emotional and financial well-being of both partners. 33


STEP ONE: Ovarian Stimulation

During a woman’s normal ovulation cycle, only one egg matures each month. With IVF, it is best to have multiple mature eggs available, as this increases your chances of success. To do this, the ovaries must be stimulated to release additional eggs. During the stimulation phase of an IVF cycle, you will use injectable medications to stimulate the ovaries to produce eggs. Follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which are both produced naturally within the body, may be used. During this part of your cycle, you will need to come into the office several times for regular monitoring, which allows us to track the progress of follicle development using an ultrasound and adjust medication as needed. Stimulation typically occurs for 10-12 days.

IVF: WHAT’S REALLY INVOLVED? In Vitro Fertilization (IVF) is the process during which a physician removes one or more eggs from a woman’s ovaries and then, in an embryology laboratory, uses sperm to fertilize, or inseminate, them. In recent years, IVF has become synonymous with fertility treatment due to its high rate of use by fertility clinics and its success rate. First performed successfully in 1977, IVF is now the most commonly used assisted reproductive technology (ART) procedure, with data indicating nearly 1.5 million ART cycles are performed globally each year. Estimates suggest between one and two percent of all births in the United States now occur as a result of IVF, and that number only appears to be growing due to significant technological advances. IVF is commonly indicated for a variety of diagnoses, including: • • • • • •

Advanced maternal age Unexplained fertility Fallopian tube damage or tubal ligation Male factor infertility Endometriosis Recurrent pregnancy loss

Genetic abnormalities. At CNY Fertility, IVF is performed as an out-patient procedure in our offices. A Typical IVF Calendar (based on 28-day menstrual cycle). See diagram on page 31.

THE PROCESS An IVF cycle begins with the onset of your menstrual period. You will need to call our office on the first day of your menstrual cycle to schedule a baseline exam for days 2, 3 or 4 of your cycle. Your appointment will also include blood work and a trans-vaginal ultrasound. At this appointment your treatment protocol will be outlined, and we will give you oneonone instructions about administering your medications that you will begin taking that evening. Your appointments for follow-up monitoring will be scheduled, and we will monitor your progress every 2-4 days during your stimulation.

Once your follicles grow to approximately 13 mm and/or your estrogen level reaches a certain level, the staff will instruct you to begin your antagonist injection (Cetrotide or Ganirelix). The final step in the stimulation phase of treatment is the trigger shot.

procedure is possible because the ovaries are located directly next to the vagina. The needle enters the follicles and removes the follicular fluid which contains the eggs. The fluid is then examined under a microscope to identify the eggs.

The trigger shot helps the developing eggs complete the maturation process and begins ovulation. You will use either a human chorionic gonadotropin (hCG) or Lupron trigger shot. Egg retrieval will be scheduled 35 hours after this injection. You should not have intercourse during the time between the trigger injection and egg retrieval.

Recovery takes about 30 minutes, and you will be able to walk out on your own. A responsible adult should drive you home after the procedure as it is unsafe to drive after receiving anesthesia. Egg retrieval is a very safe procedure and serious complications are rare.

STEP TWO: Egg Retrieval

Egg retrieval is an office procedure that requires a sterile environment, which is why partners are not allowed to be present in the room. During the procedure, you will be temporarily put to sleep, and you will not experience any discomfort. Prior to your retrieval, you will meet with your doctor and an anesthesiologist, who will review your medical history and administer intravenous fluids.

Egg retrieval can take anywhere from 5-20 minutes. Using ultrasound as a guide, a thin

STEP THREE: Fertilization

The number of eggs retrieved will depend upon your age and response to hormones. But on average, 6 - 12 eggs are developed. As soon as the eggs are identified under the microscope, they are placed in Petri dishes which contain a culture medium that very closely resembles your own body’s fallopian tube secretion. The eggs,

and subsequently the embryos, will develop in the Petri dishes just as they would in your own body. The dishes are kept in an incubator at a constant temperature of 37ºC, 100% humidity and 5% CO2 concentration.

needle is passed through the top of the vagina and into the ovarian follicles. This nonsurgical

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At the time of egg retrieval, the male partner will collect his sperm by masturbating into a clean cup. If you’re using a frozen sperm sample or donor sperm that was previously collected, the technician will verify those details with you. The semen is then washed and processed to remove the seminal fluid to get the highest quality sperm possible for fertilization. It takes about four to six hours after retrieval for the eggs to finally mature to the point that they are ready for insemination. There are two ways that fertilization can occur: conventional insemination or intracytoplasmic sperm injection (ICSI). In conventional insemination, an embryologist isolates the healthiest sperm and then combines the eggs and sperm in a Petri dish. They are left together in an incubator for about 18 hours, giving them time to combine on their own and fertilize. During ICSI, a single sperm is directly injected into the center of an egg using an extremely small glass needle under a microscope. Although ICSI was originally developed to help couples with male factor infertility or previous low or failed fertilization, we are using ICSI even in normal cases to ensure that the best eggs are indeed fertilized. The fertilized eggs, now called embryos, continue to grow in our IVF laboratory. In three to five days, you will return for embryo transfer.

STEP FOUR: Embryo Development

It’s our goal to transfer the highest-quality embryo(s) in order to give you the greatest chance of reproductive success. Embryo development begins immediately after fertilization. An embryologist will examine each developing embryo during the 5 to 6 days following insemination, looking for progressive development. They look for a two- to four-cell embryo on day 2 and a six- to eight-cell embryo on day 3. After the eight-cell stage, rapid cell division continues and the embryo enters into what is called the blastocyst stage around day 5 or 6. 36

STEP FIVE: Embryo Transfer One of our practitioners, along with the​ embryologist team, will examine the embryos​ before transfer to determine the likelihood that​ any given embryo will implant. The quality of​ the embryos is very important. We generally transfer one embryo to avoid the risk of multiple​ pregnancies. Additional healthy embryos can be frozen for future use. The actual transfer is a brief procedure. The embryos are “loaded” into the tip of a catheter along with a very small amount of transfer medium. The catheter is then gently passed through the cervical canal and into the uterus. You usually won’t feel this. The embryos are slowly expelled near the top of the uterus. This transfer only takes a few minutes. You will rest in our office for approximately 15 minutes and be discharged home to rest the remainder of that day.

STEP SIX: Establishing Pregnancy

To help your body prepare itself for the embryos, you will be given daily progesterone to supplement your own. This additional progesterone starts the day after egg retrieval and continues for at least two weeks. Progesterone is a hormone which transforms the lining of the uterus to be an ideal receptor for the embryos, increasing the odds of implantation, and assisting in establishing pregnancy. After the embryo transfer, it’s now up to nature. The front and back walls of the uterus gently squeeze the embryos and keeps them in the uterine cavity. Your embryos cannot fall out, so there is no need to restrict physical or sexual activity. Even so, it is wise to wait a few days before resuming any strenuous activity.

STEP SEVEN: The Pregnancy Test

Two weeks after embryo transfer, you will need to have blood drawn so that a blood pregnancy test can be performed. Because the hormones used to trigger ovulation can still be in your system, at-home pregnancy tests can yield a false positive and should not be used. Often called a “beta” because it measures the beta chain portion of the hCG hormone emitted by

the developing embryo, a blood pregnancy test will give a reliable indication of whether you are pregnant or not. This can be done at any lab of your choice. Your results should be available the same day. If the pregnancy test is positive, we will repeat this test in 2-3 days to ensure an appropriate rise. An ultrasound will be scheduled for one week later to determine the implantation site and to detect a heartbeat, if possible. The heartbeat should be seen by four weeks after a positive pregnancy test. At this time, you will be given instructions regarding progesterone or other medication use.

There are several factors to consider before deciding on how many IVF cycles you will try before moving on to other treatments. These factors include your response, age, previous number of IVF cycles, and the number of years you have been infertile. Just because you do not become pregnant after one, two or even three tries, does not mean your chances of becoming pregnant are slim.

Once a heartbeat is detected, there is a 90-95% probability that the pregnancy will continue to a live birth. There is only a 5-10% chance of miscarriage. IVF pregnancies are no higher a risk than natural pregnancies. Around 12 weeks into your pregnancy, you can return to your obstetrician for routine prenatal care. If the pregnancy test comes back negative, you can stop taking progesterone. Your period should start in a few days. You can begin another IVF cycle as soon after as you desire.

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Preimplantation Genetic Testing (PGT) has been determined that what’s on the inside— the embryo’s genetic makeup—may be an even better predictor of an embryo’s chance of implanting and leading to pregnancy. PGT-A is a test performed on embryos prior to transfer to determine the number of chromosomes present, providing important information about their genetic health. This information can help your care team decide which embryo has the best chance of success.

WHAT IF YOU COULD FIND OUT ABOUT THE HEALTH OF YOUR BABY BEFORE YOU WERE EVEN PREGNANT? Preimplantation Genetic Testing (formerly known as PGS and PGD) are genetic tests that can be performed alongside IVF to provide important information about your embryo’s health.

PGT-A: PREIMPLANTATION GENETIC TESTING FOR ANEUPLOIDIES Which Embryo Should I Transfer? After egg and sperm collection, fertilization, and several days of growth, IVF embryos are ready for transfer. Traditionally, embryos are graded based on morphology (shape, size, and appearance) as well as other visible characteristics; then, the one(s) with the best grade is transferred. However, in recent years, it 38

Why Are Chromosomes Important? Chromosomes are the structures within our cells that hold our genetic information. Humans typically have 46 chromosomes divided into 23 pairs. One chromosome in each pair is inherited from the egg and the other from the sperm. Because chromosomes are essential to development, embryos with missing chromosomes (referred to as monosomy) typically fail to implant, while embryos with extra chromosomes (referred to as trisomy) typically result in a miscarriage. There some cases in which embryos with extra or missing chromosomes can lead to a live birth, but often the child will be affected with a genetic condition that impacts their health and well-being. One trisomy that can result in a liveborn child is trisomy 21, also known as Down syndrome. While everyone is at risk of producing embryos with the incorrect number of chromosomes, this risk increases as a woman gets older. How can PGT-A Help? By identifying embryos with the correct number of chromosomes (also called euploid embryos), PGT-A can: • Increase the chance of implantation • Reduce the risk of miscarriage • Reduce the risk of having a child with a genetic condition

Is PGT-A Right for Me? PGT-A is appropriate for the vast majority of patients undergoing IVF. You may consider PGT-A if: • You want to increase the chance of IVF success and potentially reduce the number of cycles required to achieve success • You have previously had a miscarriage or failed IVF cycle • You are 35 years old or older PGT-A is an IVF add-on that does not require any extra medications or procedures other than an embryo biopsy to collect the samples for the lab.

PGT-M: PREIMPLANTATION GENETIC TESTING FOR MONOGENIC/SINGLE GENE DEFECTS PGT-A & PGT-MWhat’s the Difference? Unlike PGT-A, in which all of an embryo’s chromosomes are screened, PGT-M involves testing embryos for an already known chromosomal or genetic abnormality. While PGT-A is appropriate for almost any IVF patient, PGT-M is an option for families who know they are at risk of passing on a specific inherited genetic disease. This includes families in which: • Both partners are carriers of an autosomal recessive condition • The female partner is a carrier of an X-linked condition • One partner has an autosomal dominant condition • One or both partners carry a chromosome rearrangement Couples undergoing PGT-M often decide to add on PGT-A testing as well to gain even more information about their embryos’ health. What Diseases can PGT-M Test for? PGT-M can be performed for almost any condition in which the specific mutation or alteration is known, including cystic fibrosis, Fragile X syndrome, Huntington’s disease, and inherited cancer syndromes (e.g. BRCA).

because the PGT-M test is created uniquely for each family. First, the family will speak with a genetic counselor to determine if PGT-M is appropriate for them. If they decide to move forward, the PGT-M laboratory will begin to build the family’s unique PGT-M test. Sometimes this involves getting DNA samples from other family members. Then, the couple will undergo IVF and a small sample of cells will be taken from the resulting embryos and sent to the laboratory for testing. Once the PGT-M procedure has been performed and embryos free of the genetic condition have been identified, an unaffected embryo is transferred to the uterus. Any additional unaffected embryos may be frozen for future use. While PGT-M helps reduce the chance of conceiving a child with a genetic disorder, it cannot completely eliminate this risk. Prenatal testing is recommended for any resulting pregnancies to confirm the health of the pregnancy.

PGT-SR: PREIMPLANTATION GENETIC TESTING FOR CHROMOSOMAL STRUCTURAL REARRANGEMENTS PGT-SR is a genetic test designed to detect inherited rearrangements and increase the chance of a successful pregnancy. Chromosomal rearrangements are due to changes in the arrangement and/or size of the chromosomes. These types of rearrangements result in an increased risk of producing embryos with the incorrect amount of genetic material. If you or your partner are a carrier of an inversion, reciprocal translocation or a Robertsonian translocation, PGT-SR can be performed to improve the chance of a healthy pregnancy. If you think PGT may be right for you, talk to your care team about getting started. CNY Fertility partners with CooperGenomics, the leading reproductive genetics laboratory, to offer the highest quality Preimplantation Genetic Testing to our patients. --Content for this article provided by

How is PGT-M Performed? PGT-M is a more involved process than PGT-A 39


AVOIDING DNA FRAGMENTATION AND OXIDATIVE STRESS ZyMōt ICSI Sperm Separation Devices have been shown to separate sperm with very low levels of DNA fragmentation compared to traditional sperm separation techniques. In an independent study from Midwest Fertility Specialists, ZyMōt Sperm Separation Devices showed statistically significant improvements in three DNA- and stress-focused indicators of sperm health and function, when compared to traditional, centrifugation-based methods.

DELIVERING SUPERIOR MOTILITY AND MORPHOLOGY

ZyMot Sperm Processing ®

CNY Fertility is now offering ZyMōt™ Sperm Processing as an add-on service for IUI and IVF patients. As part of both fertility procedures, semen must be processed to find sperm that can fertilize an egg to form an embryo. Using your healthiest sperm increases the likelihood of creating a healthy embryo and having a successful pregnancy. ZyMōt offers a new approach that may be healthier for your sperm.

THE NEED FOR HEALTHY SPERM Using healthy sperm for IUI and ICSI procedures is more important than ever. In new research from scientists at Imperial College London, recurrent pregnancy loss was directly connected to the presence of elevated sperm DNA fragmentation and reactive oxygen species, along with a lower percentage of normal morphology. This follows a growing body of

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evidence that links improved sperm health to better pregnancy outcomes. ZyMōt devices may help in the identification of sperm with the lowest levels of DNA fragmentation and oxidative stress.

BETTER SPERM SELECTION BY MIMICKING NATURE

ZyMōt Sperm Separation Devices were designed and developed to aid reproductive medicine professionals in the selection of healthy sperm for use in assisted reproductive technology (ART) procedures. ZyMōt helps specialists select sperm with the lowest possible levels of DNA fragmentation and oxidative stress which may help increase fertilization and euploidy rates. Processing with ZyMōt has also been shown to increase the proportion of sperm with normal morphology. Using ZyMōt devices shows statistically significant improvements in sperm motility and progression, enriching a sample for improved sperm performance and better clinical outcomes. Interested? Discuss ZyMōt™ Sperm Processing with your fertility provider. To learn more, scan to watch this video or visit zymotfertility.com.

Select Your Champions! ZyMōt devices offer your fertility team a new option for selecting healthy sperm and improving your odds of success.

SCAN HERE

ZyMōt Multi Sperm Separation Devices prepare motile sperm from semen for use in IUI and ICSI procedures. These revolutionary tools simulate the natural barriers of the cervical and uterine pathway that sperm must overcome to fertilize an egg and enables the separation of functional sperm without the use of density gradient centrifugation. ZyMōt Sperm Separation Devices help ensure you are using healthy sperm.

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Before Medical Treatment

Egg Freezing Many people aren’t ready to start a family during their most fertile years, and there are lots of reasons to preserve your fertility until the time is right. Freezing your eggs or embryos is a way to protect and insure your family-building options for another time. We are further empowering women to take charge of their future. Whatever your reason – the opportunity to pursue other goals, military service, or medical treatment -we’re creating options for those who might not otherwise have them.

• • •

Wanting or needing to delay childbearing in order to pursue educational, career or other personal goals After receiving a cancer or other serious medical diagnosis Prior to military service You have diminished ovarian reserve and may need extra stimulation over time in order to get the number of eggs or embryos needed for the highest chances of future pregnancy.

When Delaying Childbearing High quality doesn’t have to mean high cost. CNY Fertility offers affordable care starting with a complimentary consultation.

CNY PRESERVE

WHEN SHOULD YOU CONSIDER FERTILITY PRESERVATION? There are a number of situations and reasons why someone might consider freezing their eggs or embryos. Some of the most common are:

Many women focus on building careers not families during their prime reproductive years, ultimately delaying parenthood until egg quality is not optimum. Failure to find an ideal partner with whom to have and raise children can also be a factor. Choosing to preserve eggs or embryos while in your 20s or early 30s is a way of ensuring that the family of your future can become a reality.

We are proud to provide discounted egg freezing for oncology patients. 42

When you receive a cancer diagnosis or any serious medical diagnosis, your focus is likely on treatment, success rates, and processing the emotions of what it all means. It’s easy to overlook future fertility preservation. But if you haven’t started a family yet or have dreams of growing the one you have, it is an important consideration. For women who are about to begin medical treatment, time is of the essence. An unfortunate side effect of many chemotherapy drugs, radiation treatment, and surgical interventions is infertility. It’s important to investigate all of your options prior to beginning any treatment. CNY Fertility will work with your medical team throughout the process to ensure your treatment and fertility goals do not negatively impact each other.

Prior to Military Service Serving in the military can sometimes result in injuries or other impairments that negatively affect your ability to have a family. Freezing eggs or embryos prior to deployment is a wise choice for many military personnel who may be in harm’s way while serving our country and want to protect and preserve their future ability to have children.

HOW DOES IT WORK? To give you the best chances of conceiving after treatment is completed, we recommend egg or embryo freezing. In order to freeze eggs (also called oocytes) and/or embryos, the eggs must first be retrieved. This part of the process is identical to IVF and can be completed in as little as two weeks. Patients take hormone injections to stimulate the ovaries and allow a greater than normal number of eggs to develop. Once the eggs have adequately matured, they are removed with a needle using ultrasound for guidance. This procedure is done under sedation and is not painful.

Women not currently in a committed relationship may opt to have the eggs frozen unfertilized. Later, when the patient is ready to attempt pregnancy, the eggs will be thawed, injected with a single sperm in a process called Intracytoplasmic Sperm Injection (ICSI) to achieve fertilization, and transferred to the uterus as embryos.

Embryo Freezing If a patient wishes to freeze embryos, eggs are removed from the patient and fertilized in a test tube with the sperm from a partner or donor. The resulting embryos are then frozen approximately 3-5 days after fertilization and stored as long as necessary. To give you the best chances of conceiving in the future, we freeze eggs and embryos in a flash freezing process called vitrification. Oocytes and embryos are immersed in a series of solutions which dehydrate the cells and replace water molecules with cryoprotectant or “anti-freeze” to prevent the formation of ice crystals and protect the integrity of the cells during the freezing process. The eggs or embryos are loaded into specially designed straws and placed in liquid nitrogen tanks for storage.

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Once you decide to move forward with treatment, it generally takes 10 to 14 days to complete stimulation of the ovaries for the egg retrieval.

that any hormones used in the process do not stimulate unwanted cell growth. Due to the time sensitivity, you can expect an accelerated treatment plan.

Pregnancy rates from frozen eggs depend on the women’s age at the time they are frozen and not the age at which she thaws, fertilizes, and transfers the resulting embryo. We see the best results for women younger than 35 at the time of egg freezing.

How Many Eggs Should I store?

Preservation of embryos has a higher success rate of future pregnancy than preservation of eggs, so if you have a partner or might consider a sperm donor, this is a great option to discuss with your provider.

As a general rule, we recommend women store at least 10 eggs for each pregnancy attempt. Studies indicate that egg thaw survival rates average around 75% and fertilization rates are expected to be 75% in women 35 years old and younger. In real terms, if 10 eggs are frozen, 7 are expected to survive the thaw, and 5 to 6 are expected to fertilize and become embryos. We generally transfer one embryo in women 35 and younger.

Plans & Pricing If you’re about to begin cancer treatment, we will work directly with your oncology team to ensure your fertility preservation is expedited so your treatment can begin quickly and to ensure

CNY Fertility provides the highest quality fertility care at a cost that is less than one-third of the national average.

CNY SUCCESS STORY “CNY made it possible for me to freeze my eggs at a time in my life when it otherwise wouldn’t have been an option. I am so grateful that it is their mission to make this process affordable for women like me who might not have the resources to make this choice. Egg Freezing has allowed me to invest in my future so that I can invest in myself today. Thank you CNY.” – Julia, Venice, CA

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CNY Fertility provides the highest quality fertility care at a cost that is less than onethird of the national average.


Sperm Freezing PRESERVING FERTILITY IN MEN Fertility preservation in men is generally much easier and quicker than with women. It involves collecting a sample of semen and freezing it. In men about to begin medical treatment, sperm must be banked before any chemotherapy or pelvic radiation therapy begins in order to avoid damaging the sperm. Sperm can be frozen the same day you contact us. Once vitrified, the sperm can be stored indefinitely. Sperm can be thawed later and used for intrauterine insemination or in vitro fertilization. Even if a man has only a few live sperm in his semen, they can be used for in vitro fertilization (usually ICSI) and offer a good chance of pregnancy. In this situation, when the sample is thawed, the healthiest sperm are captured and injected into the woman’s harvested eggs in the laboratory. For men storing sperm, a single ejaculation sample will produce an average of 5 vials of sperm. It is typical to use 1-3 vials for each artificial insemination attempt. For best results, we recommend men store multiple samples.

HOW LONG CAN SPERM REMAIN FROZEN? Sperm are stored in a liquid nitrogen tank at -196° C for long-term storage. Our experience is that long-term storage does not affect sperm quality and when stored correctly, they can remain frozen indefinitely.

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We Know Endo CNY Fertility

International Surgical Institute PROVIDING MINIMALLY INVASIVE SURGERY FOR OUR FERTILITY PATIENTS Specializing in Minimally Invasive Surgery (MIS), our expert surgeons at the CNY Fertility International Surgical Institute are recognized as leaders in the fields of laparoscopic and da Vinci robotic surgery. Sometimes referred to as “keyhole” surgery, MIS utilizes small incisions, tiny fiber optic lights and high definition monitors which allow our surgeons to correct many conditions without requiring patients to undergo major surgery or large incisions. Patients go home the same day and recovery time is generally shorter and less painful with minimal scarring.

Endometriosis causing ovarian and pelvic adhesions

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These include: • crippling menstrual pain • pelvic pain lasting throughout the month • chronically heavy or long menstrual periods • painful sexual activity (particularly with penetration) • significant lower back pain with menses • bowel or bladder disorders associated with periods • allergies, migraines, or fatigue that tends to worsen around menses Many women experience no symptoms and are affected by “silent endometriosis”. There is no definite non-surgical diagnostic test to confirm the presence of endo. Occasionally, an ultrasound or pelvic exam can raise the suspicion if there are fixed, tender, nodular, or enlarged pelvic organs. Surgical observation and biopsy are the gold standards for diagnosis and treatment. Endometriosis starts when endometrial cells gain access to the abdominal cavity establishing a blood supply for survival.

We perform: •

The scientific community has yet to establish the exact cause and progression of endometriosis. Though many questions remain, we are able to identify and successfully treat this common disease. Endometriosis (or “Endo”) is a leading cause of infertility and may run in families. Up to 50% of affected patients may experience fertility issues. There is also a great variety of symptoms that may or may not be present in each patient. Many symptoms are not normal and should raise suspicion for endometriosis.

Diagnosis and Treatment of Endometriosis Treatment of Fibroids (Myomas) Tubal Reversal Vasectomy Reversal

Solitary endometriosis nodule

This causes a local inflammatory response leading to adhesions and scarring. There exists a poorly understood association with infertility at the chemical and immunologic levels. The pelvic reproductive organs (uterus, tubes, ovaries) are affected most often. Severe disease may involve the bowel, bladder, and distant parts of the body. Endometriosis can influence fertility in multiple ways: • distorted anatomy of the pelvis • adhesion formation • scarred fallopian tubes • inflammation of pelvic structures • altered immune system functioning • changes in the hormonal environment of the eggs • disrupted fertilization • impaired implantation of a pregnancy Many different patterns of endo may be observed in the operating room. The surgical treatment will vary depending on the type and degree of the lesions encountered. The main goal of minimally invasive surgery (MIS) is to restore normal anatomy and function, leading to an increased pregnancy rate. One treatment plan does not fit all patients. Medical therapy to suppress hormones and regrowth may be used in combination with surgery. Even with the best medical and surgical treatment, reoccurrence may require repeat surgery in the future. Patients are encouraged to see their gynecologic provider should they demonstrate any of the above-mentioned symptoms.

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Tubal Reversal with IVF

Vasectomy Reversal When a man undergoes a vasectomy, it is most often used as a permanent form of birth control. However, life changes and many men decide they would once again like to have children. In this situation, a vasectomy reversal is often the preferred solution, however, another option includes a TESA/PESA in combination with IVF. In short, a vasectomy reversal is a surgery that reconnects the vas deferens, which was surgically severed during the vasectomy, once again allowing sperm (male gamete cell) to enter the semen (ejaculate). The vas deferens are the tubes that bring sperm from the testicles to seminal vesicles where they are allowed to mix with semen and become part of the ejaculate. By severing this tube, sperm is still produced in the testicles, but during orgasm, they can no longer be transported, mixed with semen, and ejaculated.

How will i know if it was successful?

The Surgery

Other Alternatives Men who have undergone a vasectomy and now wish to father a child have other options besides Vasectomy Reversal. if you hope to conceive naturally through intercourse, then having a vasectomy reversal is your only option. However, for those who this is not a concern, a Percutaneous Epididymal Sperm Aspiration (PESA) and Testicular Sperm Aspiration (TESA) coupled with In Vitro Fertilization (IVF) is also an effective option and offers a high chance of success at a more affordable cost. Consult with your doctor to decide which is the best option for you.

Very simply, during a vasectomy reversal, the surgeon will surgically reconnect the two halves of each vas deference, thereby allowing sperm to once again travel freely and mix with semen prior to ejaculation.

Recovery

Surgery usually takes about 2 to 4 hours, and you are able to go home the same day. Recovery takes about 2 weeks. Men should not have sex or ejaculate until your doctor tells you it is okay. Most doctors recommend that you wait 2 to 3 weeks to have sex. 50

You’ll know your vasectomy reversal was successful if sperm appear in your semen after a few months. Your doctor will collect semen samples and examine them regularly for 4 to 6 months after surgery, which is usually enough time for your counts to stabilize, although sometimes it takes longer.

Cost

The self-pay price for a Vasectomy Reversal is $7,900 and includes: the cost of anesthesia, the surgery itself, a 2-week post-operative check-up, and regular sperm analysis/testing post-surgery. There may be additional fees based on your unique situation. After your initial consult, a $4,000 down payment is required prior to scheduling surgery. In-house financing is available.

Many women decide to forgo the continuous and prolonged use of birth control and elect to have a tubal ligation after giving birth and completing their families. Having your “tubes tied”, as it’s commonly called, to prevent pregnancy is a fairly common procedure, but sometimes the unexpected happens or circumstances change within a family or with a partner, and a woman wishes to re-establish her ability to have children. If you’ve had a tubal ligation procedure and wish to reverse it, CNY Fertility can perform tubal ligation reversal surgery on an out-patient basis at our Center of Superior Surgical Care using laparoscopic techniques that enable us to restore your fertility in a minimally invasive way. A tubal ligation reversal (TR), medically known as the Tubal Anastomosis, is the procedure by which a surgeon repairs a woman’s fallopian tubes, thus restoring her natural fertility so that she will be able to again become pregnant. This microsurgery procedure enables us to reduce recovery time, makes the procedure affordable, and allows women to achieve high pregnancy rates post-surgery.

The Surgery

During a TR, our surgeon will reconnect both your left and right fallopian tubes by making careful incisions to reopen the surgically closed portion of your tubes. After ensuring that each tube is open by flushing them with colored water, the surgeon will then use sutures to reconnect the tubes. Once again, the surgeon will flush both tubes with liquid to ensure that each reconnected tube allows for sperm, egg, and embryo to flow freely through each tube without obstruction.

The surgery itself takes approximately 90 minutes. Tubal reversal enables most women to conceive naturally and without the use of fertility medications. Our medical team will consult with you to see if you’re a good candidate for tubal reversal surgery or if you should choose In Vitro Fertilization (IVF), and to discuss the pros and cons of both options.

Success Rates

TR surgery at CNY Fertility offers our clients a fantastic opportunity to restore their natural fertility, with roughly a 60-80% chance of

attaining a natural pregnancy within two years of their surgery date. Your chance of becoming pregnant and delivering a baby is highly dependent on your personal fertility health and history. Our doctors will be happy to discuss your individual situation further during your consultation.

Recovery

Most women can resume walking the day of their operation and return to an exercise free version of their normal daily routine the next day. Still, we generally recommend those undergoing this surgery take off at least a week of work and abstain from all exercise for at least two weeks post-surgery. Recovery time is generally 10-14 days.

Costs

Because tubal reversal is considered an elective procedure, it is unlikely to be covered by health insurance, Medicare or Medicaid.

THE SELF-PAY PRICE OF $4,995 FOR TUBAL REVERSAL INCLUDES: • • • •

The cost of anesthesia The surgery itself A 2-week post-operative check-up A discounted IVF cycle ($2,995) if you are unable to achieve pregnancy within 12 months of the surgery if under 35, or 6 months if over 35

There may be additional fees based on your unique situation. In-house financing is available. Prior to surgery, patients are required to consult with one of CNY Fertility’s doctors and have an ultrasound. We also require all surgical patients to have preoperative bloodwork. You will be given prescriptions for an antibiotic, pain medication, and possibly antinausea medicine. Insurance may cover some of these additional fees. After your initial consult, you will be required to make a deposit or first month’s payment prior (if financing) prior to scheduling your surgery. We can usually schedule your surgery within a few months of your initial payment. 51


LESBIAN WOMEN

LGBTQ+ Family Building Options CNY FERTILITY IS FOR EVERYONE At CNY Fertility, we believe families are defined by love, not gender, sexual orientation, or gender identity. We work every day to ensure that all of our clients have the opportunity to love, nurture, and grow the family of their dreams. We are proud to serve the LGBTQ+ community and couples who are seeking to become parents. We are committed to helping you find the family-building option that best suits your unique circumstances and is as inclusive and encompassing as possible.

GAY MEN The path to parenthood for same sex male partners requires a surrogate or gestational carrier along with an egg donor. In this process, we use an egg from a donor and sperm from either male partner to create an embryo, which is then placed inside the uterus of a gestational carrier. When gay men choose to have a baby using a surrogate or gestational carrier, pregnancy is usually achieved through in vitro fertilization (IVF). During the IVF procedure, sperm (usually 52

from one of the male partners, but sometimes from a donor) is combined with the egg to produce one or more embryos. To produce multiple eggs for use in this procedure, the donor’s ovaries are stimulated with the help of fertility medications. The eggs are harvested and combined with sperm to produce embryos, which are then transferred into the woman’s uterus to achieve a pregnancy.

After a thorough fertility evaluation, some lesbian couples will proceed with a natural intrauterine insemination (IUI) with donor sperm, where we follow the progression of your natural menstrual cycle but help time the IUI so that it falls within the window during which you are most fertile. Some couples will proceed with an IUI but also utilize gentle stimulating medication. These medications will usually generate more than one egg, giving the couple a greater chance of fertilization and implantation during that cycle. Other couples might proceed with IVF or reciprocal IVF. Lesbian couples may choose to proceed with an in vitro fertilization cycle (IVF) in order to retrieve the eggs from one partner, inseminate the eggs with donor sperm, and then transfer the embryo(s) into the other partner’s uterus, who then carries the pregnancy. This is called reciprocal IVF and allows both partners to play an active role in the conception process.

Fertility preservation options may include sperm, egg, embryo, ovarian tissue or testicular tissue cryopreservation. For transgender females, the process of fertility preservation is actually relatively straightforward. Before starting hormones, these patients can freeze their sperm at CNY Fertility and store it indefinitely for potential use in the future. Transgender males have a slightly more complicated process, because they have to consider whether to freeze their eggs before starting hormones like testosterone that will make it much less likely, and even impossible, to retrieve eggs in the future. Egg retrieval does require certain medications to ensure an adequate number of eggs are available along with a short surgical procedure. We advise our transgender clients to carefully consider how important a biological connection to future children might be to them down the road before proceeding with any treatments.

FERTILITY PRESERVATION PRIOR TO TRANSITIONING Transgender people planning a medical transition face an important decision about future family planning and fertility preservation.

In some cases, gay men choose a woman they know to be their carrier. Others are able to find a surrogate by using an agency or attorney that specializes in this service, or even via websites that link prospective parents with women who want to be carriers. The decision to have a baby using a surrogate or gestational carrier should be made thoughtfully and after careful consideration. We also strongly recommend all patients work with an experienced reproductive attorney who can provide legal counsel and prepare the necessary agreements, even in cases where a friend or relative serves as the gestational carrier. 53


The Donor Decision SELECTING AN EGG DONOR At CNY Fertility, our goal is to make the egg donor selection process as smooth as possible for our clients. One way we do this is by ensuring all of our donors have been through a rigorous screening process before they ever appear in our donor database. CNY Fertility actively recruits and screens young, healthy fertile women between the ages of 20 and 32. Although egg donors are compensated financially, we have found that the majority of women who donate their eggs are motivated by a strong altruistic desire to help others have families.

Making the decision to use donor eggs, sperm or embryos is a complex and important one. When a couple decides to move forward with donor egg treatment, we provide them with a specialized donor care team featuring the following members: • Donor nurse • Clinical assistant • Recipient liaison • Financial coordinator • Psychologist/social worker with expertise in fertility and third-party reproduction Though the patient will not be using her own eggs, she will still be carrying the child, so she must undergo the same screening as all infertility patients (the same goes for her partner). After you have completed all testing and the physician has reviewed your results with you, you will then need to decide on a financial program. This is a situation unique to donor egg treatment, in that the financial program chosen can directly impact the treatment schedule. 54

The recruitment process includes medical, genetic and psychological screening as well as personal interviews, routine bloodwork and lab tests. In addition, all donors must test negative for the AIDS virus, Hepatitis B and C, Syphilis, CMV and STDs such as gonorrhea and Chlamydia. All ethnic donors are tested for Tay Sachs (Jewish donors), Thalassemia and Hemoglobinopathies (Mediterranean descent), and Cystic Fibrosis. These tests are repeated every six months or before any donation for as long as the donors participate in the program. Donors are screened and selected according to the regulations of the New York State Department of Health, standards of the AATB and guidelines of the American Society of Reproductive Medicine. Our donor process is anonymous, but completely transparent, and the donor database provides patients with a wealth of information. Each donor has a profile featuring demographic characteristics (eye color, race, ethnicity, etc.) Additionally, some recipients may opt for a known donor (i.e., a friend or family member) or go through an agency. In either instance, donors will still undergo the same medical and psychological screening as donors recruited by CNY Fertility.

DONOR SPERM If you experience infertility due to a low sperm count, a complete lack of sperm or are a same sex couple or single parent, you can often still achieve a pregnancy using donor sperm. We can recommend several reputable sperm banks so you have a choice of donors. The sperm banks we recommend follow FDA guidelines when testing for infectious disease prior to releasing the sperm. Donor sperm can be used for insemination (IUI) or in vitro fertilization (IVF). Choosing a sperm donor is a very important decision, and each person brings their own perspective to this challenge. You will select your sperm donor using the sperm bank’s website. Sperm donors may or may not be anonymous, but donors often provide a childhood picture. The donor database offers personal demographics (i.e., hair color, height, ethnicity, etc.), and sometimes essays written by the donor. Some sperm banks even offer voice recordings of interviews with the donor. In some cases, recipients can find out if previous pregnancies have resulted from that donor’s sperm. In the case of a known donor (i.e., a friend or family member), you will still need to have an

infertility work-up and the required FDA testing. From there, you will undergo an intrauterine insemination (IUI) or in vitro fertilization (IVF) cycle using the donated sperm. Additional frozen sperm specimens can be stored at our center for future use.

DONOR EMBRYOS Often when families undergo IVF treatments, they are left with remaining embryos. This can place parents in the difficult position of deciding what to do with them. Previously, the only options available were to donate the embryos to research, keep them frozen indefinitely, or dispose of them. There is now offer a fourth option: embryo donation. Because of these parents’ generosity, we are able to provide other clients the opportunity to use donor embryos for their cycle(s). While it can be difficult to come to terms with the emotions of not having your own biological child, using donated embryos can eliminate the imbalance of only one-half of the couple having a genetic connection to their child. Using donated embryos can also be less expensive than using donor eggs. And, since the embryo is already created, another step in the process is eliminated. 55


Using a Surrogate The terms surrogate and gestational carrier are often used interchangeably for a woman who carries a baby for someone else. While very similar, they actually refer to something slightly different. A surrogate is someone who in addition to carrying the pregnancy also acts as the “egg donor,” meaning the child is genetically related to her. A gestational carrier uses eggs from the intended parents or a donor and is not genetically related to the child she is carrying. Gestational surrogacy is the most common type of surrogacy today. In either situation, some type of reproductive assistance is required: IUI, IVF, or Donor Egg IVF. Surrogacy is a complex medical and legal process, as well as an emotional one, and the path to surrogacy looks a little different for everyone who decides to pursue it.

WHY CONSIDER SURROGACY? Parents who wish to have a biological connection to their child may prefer surrogacy over adoption where there is no genetic link

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between your child and you or your partner. For couples who want a child but are unable to give birth, surrogacy is a viable solution. Surrogacy is an ideal option for women who have had a hysterectomy or endometrial ablation and want to have a child. Women who’ve experienced numerous miscarriages with unsuccessful immunological treatment may also consider using a gestational carrier, along with women who have preexisting medical conditions like diabetes or a heart condition that make pregnancy dangerous or those who have a nonfunctioning uterus. Same sex male couples will also need to use a surrogate to have a child of their own.

USING AN AGENCY Most intended parents choose to work with a full-service surrogacy agency to help them find a gestational carrier and guide the entire process. Using an agency can actually save time and money by avoiding legal problems and potential pitfalls that could derail your surrogacy journey.

CNY Fertility can assist you in finding a reputable agency to help you find a suitable surrogate.

expectations from the start, which can lead to misunderstandings and frustration on both sides.

HOW IT WORKS

Due to the legal complexities involved in surrogacy, we highly recommend contacting a reproductive lawyer who will help you find answers to questions you didn’t even think about asking. As much as you may feel this isn’t necessary, it is, and it will protect all parties involved.

When working with an agency to find a surrogate, the process is designed to go smoothly and accommodate all of your needs. Here’s how it works: • The intended parents have a consultation with a provider at CNY. • Parents connect with surrogacy agency • Receive surrogate profiles and meet your surrogate in person or via video call • Escrow is opened • Psychological examination of surrogate • Medical screening/fertility evaluation of surrogate • Legal documents are finalized and signed • Preparation for embryo transfer including mock IVF cycle • Embryo transfer • Regular post-transfer/OB appointments • Pregnancy is achieved • Pre-Birth order • Delivery • Birth Certificate issued • Passport and travel documents issued • Baby comes home!

FIND OUT MORE The timing for all of the stages of surrogacy can vary significantly. Ready to learn more? Your first official step is setting up a consult by calling us at 844-315-2229. But if you’d simply like more information on surrogacy, feel free to contact us at surrogacy@cnyfertility.com.

FINDING YOUR OWN SURROGATE Intended parents can also choose to locate a surrogate on their own and pursue independent surrogacy with the help of an attorney specializing in third-party reproductive law. When searching for a surrogate, many parents consider using close friends or family members. While this sounds appealing, you should take into account how this incredible undertaking will change your relationship. Each relationship is different. Some people find that surrogacy strengthens their bond with their friend or loved one. Others find surrogacy puts a strain on their relationship. This can happen particularly when you do not clearly spell out your

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In preparation for any fertility treatment, we recommend women begin a high-fat/low carbohydrate (keto) diet as well as a host of supplements, including: Peak Prenatal, Ovarian Bloom, VIVOMEGA Fish Oil, Fertile Guard Immunoglobulin IgG, and Myo-D-Chiro Inositol.

Destination CNY:

For men, we recommend the same high-fat/low carbohydrate diet, Male Preconception (if no diagnosed male factor), Male Preconception+(if male factor or attempting IUI), VIVOMEGA Fish Oil, and Fertile Guard Immunoglobulin IgG. These supplements are available for purchase on the Molecular Fertility website. ®

TRAVELING FOR FERTILITY TREATMENT

Many people hear about CNY Fertility, our affordable pricing and flexible payment plans and wonder “Too good to be true?”. Then they do some research about CNY Fertility, discover our patients receive incredible care, our providers are dedicated to every client with 24/7 on-call nurses to answer urgent questions or resolve critical matters, and CNY Fertility is among the top 10 fertility clinics in the nation. The next question is usually “Can I travel to CNY for an IUI, IVF, Tubal Reversal or other fertility treatment?” The simple answer is yes. In fact, over one-third of our clients come from outside the State of New York and about 3-5% from outside the United States. Fertility treatment can be a stressful time, and certainly traveling for care can add an additional stressor, but most clients find the benefits of traveling to CNY Fertility far outweigh any additional inconvenience. Most of your treatment and all of your monitoring can be done remotely, so you only need to travel to CNY for your actual fertility procedures (insemination, egg retrieval, embryo transfer, tubal ligation reversal, etc.). In fact, CNY Fertility makes the process as simple and smooth as possible through our dedicated travel team. Our dedicated travel 58

team will guide your remote treatment every step of the way from beginning to end. Even though your monitoring is done elsewhere, we will always be in control of what’s happening. Our team will instruct you as to what tests are needed, make any necessary medication changes, answer your questions, and closely guide your treatment.

HOW IT WORKS You might be asking, how does this even work, how often/when do I travel, how do I plan? To help explain it all, here are CNY Fertility’s 9 Steps for Traveling to CNY Fertility for IVF.

Step One: Schedule Your Consultation This may seem like a no-brainer, but the first step toward becoming a travel client at CNY Fertility is to schedule your initial consultation. We typically schedule appointments multiple months in advance, so we recommend you schedule your consultation as soon as you know it’s something you’d like to pursue. You can schedule your phone consultation by calling us at 844-315-2229 or by filling out an online appointment request form. If you leave a message or fill out the form, please allow up to one week for our team to respond. After you have scheduled your appointment, you can focus on writing down a list of questions you and your partner have so you don’t forget to ask anything during your consultation.

Additionally, if you have any medical records from prior treatment (including but not limited to blood work, ultrasounds, HSG, or semen analysis), it is very helpful to fax them to our office. Fax numbers can be found on our website at the bottom of every page.

Step Two: Your Phone/Video Consultation Your initial consultation will most likely be over the phone. While you are welcome to come for an in-person consultation, the vast majority of our travel clients opt to have a phone/Facetime/ Skype consultation and forego the additional expense of travel. This is your time to ask all of those questions you’ve written down. You may also find it beneficial to record your consultation so that you don’t have to worry about taking notes or remembering everything that was said (of course, we will be taking notes on our end, but your own record will be beneficial for referencing in the weeks and months to come). After your initial consultation, a nurse will call you within a week to review your treatment protocol, order your medications, answer any other questions, and prepare you for the beginning of your treatment cycle. If you don’t hear anything after one week, please message or call us to check in and get started. Prior to starting your treatment cycle, you will need to have all of your medications and an established relationship with a local fertility clinic, OB/GYN, hospital, or other laboratory capable of providing same-day blood and ultrasound results. After your medications and

monitoring facility are in order, you can start treatment at the beginning of your next cycle. You will be instructed to call our offices with the first day of your cycle. If you do not have regular cycles, you will just need to have all of your meds and a monitoring facility lined up to get started. During this time, our financial team will review your insurance coverage and determine what costs are covered and which will be out of pocket. We are happy to share details about our interest-free financing options as well.

Step Three: Begin Local Monitoring Monitoring refers to the appointments you will need to have at your local fertility clinic or OB/GYN in order to check on your blood hormone levels as well as follicle and uterine lining development. You will receive a call the day of your baseline appointment to go over your medications, injection instructions, answer any new or remaining questions, and provide you with a rundown of what your monitoring schedule might look like. Most patients need to have monitoring done every few days once they start taking medications right up until their trigger. During this time, our team will be continually reviewing your results, updating any medications, instructing you on next steps, and answering all of your questions. 59


day (NOTE: you can NOT drive yourself). If you are staying in the area for a fresh transfer, then the day is yours to rest and relax.

Step Six: Embryo Transfer How far away you live and whether you are doing a frozen or fresh transfer will dictate many of the logistics surrounding your embryo transfer. If you’re doing a fresh transfer, many clients within driving range return home, while those requiring air travel often stay locally for another 3-5 days to complete their transfer in the same trip as their egg retrieval. If doing a frozen transfer, nearly everyone returns home for FET monitoring, choosing to return to CNY the day before their transfer. If this is the case, we again recommend not booking any flights until a transfer day is determined.

Step Four: Booking Travel to CNY We encourage you not to book your flights until you have a date scheduled for retrieval. Usually a retrieval date is scheduled about halfway through your stimulation as we need to see how your follicles/eggs are developing. The number of and duration of your trips to one of our offices in Syracuse, Albany or Colorado Springs depend on whether you are doing a Fresh Transfer or a Frozen Embryo Transfer (FET). You’ll need to be in the area the day before any procedure and should not leave until the day after any procedure. If someone else is driving you, it is okay to begin your drive home the same day as your procedure.

Step Five: Egg Retrieval Your egg retrieval will take place in either our Albany or Syracuse office. You must be in the area the day prior to your egg retrieval in order to avoid any travel delays and to make your day as stress-free as possible. You can not have anything to eat or drink from midnight on starting the evening before your surgery. Before your retrieval, you will have some basic bloodwork performed as part of your pre-op work up, as well as meet with a nurse, embryologist, doctor, and anesthesiologist. You will be placed on monitors and put under MAC anesthesia (no tube down your throat 60

like general anesthesia) for the duration of the procedure. The procedure itself only takes around 10-15 minutes from start to finish. You will likely wake up afterward thinking “That was it?” Most clients take around 30 minutes to recover from their egg retrieval (of course, this varies, but you will never be rushed or pushed out of our office before you are fully ready to go). After your retrieval, you will be given instructions, and we’ll discuss your options of having a fresh or frozen transfer. If your hormone levels are off or if your uterine lining is not prepared for a transfer on the day of your retrieval, we will highly recommend proceeding with a frozen embryo transfer (FET), thereby allowing your body to reset and providing a more comforting home for your embryos. During this discussion, we will review any medications you will be taking prior to and after your transfer. We encourage you to rest and relax as much as possible following your retrieval. The following day, you may resume your normal daily routine (minus any intense exercise). If you are flying, we urge you not to leave the area until the day following your procedure to avoid any complications. If you traveled by car, you may have someone else drive you home the same

Similar to the Egg Retrieval, you will need to be in the area at least one day prior to your transfer. If you are driving, you may return home the same day. If you are flying, we recommend you wait until the day after your transfer. The embryo transfer itself is a simple procedure that takes only a few minutes. No anesthesia or recovery time is needed. To help your body prepare itself for the embryos, you will be given daily progesterone to supplement your own. Many clients also choose to do acupuncture and/or intralipids prior to transfer. The day of your transfer, one of our practitioners, along with the embryology team will examine the embryos to determine the best embryo to transfer. By the time of your transfer, we will have reviewed the quantity and quality of embryos as well as the number of embryos that you would like to have transferred. During the transfer, the embryos are “loaded,” into the tip of a catheter along with a very small amount of transfer medium. Your physician, a member of the embryology team, and a nurse will confirm your identity to ensure the embryos are properly matched. The catheter is then gently passed through the cervical canal and into the uterus using an abdominal ultrasound to provide visual guidance during the transfer. The embryos are slowly expelled near the top of the uterus. After

carefully removing the catheter, an embryologist will double check that the embryos indeed left the catheter using a microscope. At this time, a nurse will provide you with instructions for the two-week wait.

Step Seven: The Two-Week Wait (TWW) This is quite an exciting time, but it can be very stressful and anxiety provoking as you (and your partner) await the results of your first pregnancy test. We recommend abstaining from any intense exercise and instead focusing on spending time with your partner. Light exercise like yoga and walking is recommended.

Step Eight: Your Pregnancy Test Your pregnancy test will be done at a local lab near your home two weeks after your transfer (hence the two-week wait). We highly recommend patients not use over-the-counter pregnancy tests. Trigger shots and fertility meds can produce false positives. After a BFP (Big Fat Positive), you will continue to be monitored by your OB/GYN with CNY overseeing your care for 6-8 weeks. 61


WHY TRAVEL TO CNY? There are many reasons to come to CNY for your treatment, but it mostly boils down to the incredible care you receive at CNY Fertility for a fraction of the cost of most fertility centers in the country. According to FertilityIQ, the average IVF cycle costs $23,474. That includes $5,000 for genetic testing (which is an additional service and at CNY Fertility costs substantially less – roughly $300/embryo tested) and $5,000 for medications. Subtracting the costs of both of these, the average IVF cycle costs around $13,500. At CNY Fertility, IVF is only $3,995 while still maintaining the highest industry standards. When factoring in $1,500 for potential travel expenses (air travel and hotel accommodations), you are still looking at a cost of only $5,400. That translates into savings of $8,000 or an extra IVF cycle and a half, which can make the difference between walking away after a failed cycle or having the opportunity to do multiple cycles and ultimately walking away with a baby in your arms.

Step Nine: Discharge from CNY Fertility At 6-8 weeks of pregnancy, you will officially be discharged from CNY Fertility and continue care for the rest of your pregnancy with your local OB/GYN. By this time, you will likely have seen your OB/GYN already for your first prenatal appointment, but this marks your official release from CNY Fertility’s monitoring and care. Last but not least, we do have some ADDITIONAL NOTES REGARDING COMMUNICATION: We have a 24/7 on-call nurse that can truly be used 24/7 for urgent matters and questions. The patient portal web correspondence is for general questions and will be replied to within 24 hours. If you are having an emergency, you need to go to your local emergency department or urgent care facility.

“At CNY Fertility, IVF is only $3,995 while still maintaining the highest industry standards".

Making Priceless Affordable ®

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Destination CNY: Travel Success Stories

To all the couples out there struggling with infertility, don’t give up! The hundreds of shots, the meds, the sleepless nights, the worry, and the many, many tears will all be worth it! Just lean on God and he will provide.

Ronnie started a new job, so I made the drive to Syracuse myself and went through the frozen transfer (I also did the acupuncture). It was great! I knew this was it. I felt it!

knew someone at her church who knew someone, who knew someone that had used a fertility clinic out of New York, CNY Fertility. I started doing some research. They were much more affordable than the clinics in Columbus and Atlanta, and their success rates were just as good! So, we gave it a shot! We did a retrieval in February of 2019 and followed that with two unsuccessful transfers. To say we were devastated both times is an understatement! You try to hold onto your faith, but you start to question will we ever be parents? Will we ever know that feeling? We started looking into other options.

AMANDA AND DANIEL'S STORY: Thanks to CNY, we have our little miracle! Wanted to share our journey with you all and a few pictures of our precious baby! Four and a half years ago when Daniel and I got married, we knew right away we wanted to start a family. So, we started trying! Fast forward a year . . . nothing had happened, so my OBGYN recommended that we go see a fertility specialist. Not the words you really ever want to hear, but we took her advice and went! We were told our only option was IVF. IVF is extremely costly, and that was just not in our cards at the time. We tried a few other things. I spent periods of time on clomid; we did two rounds of IUI and lots of home remedies. Nothing seemed to help! My grandmother

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We went to a couple of local meetings about fostering and adopting. That seemed like it was going to be our next step. My doctor at CNY called me in October of 2019 and said he wanted me to go get tested for Endometriosis. So, in December, I had surgery and sure enough, I had endo. My local doctor performed my surgery and considered it a successful surgery! In January we went ahead with another transfer (this time transferring 2 embryos) and praise God, WE ARE PREGNANT!! I cannot even begin to explain the emotions we felt on January 30th when we got the call! Still to this day, it doesn’t even seem real! On September 12, 2020 our precious Wills made his arrival a month early! 5 pounds, 12 ounces, and healthy as can be. This journey has taught us both so much about ourselves! It has brought Daniel and I closer together. We have become so much closer to God. I have never prayed and talked to God so much in my entire life. Looking back, I would ask God, WHY?? Why us? Will we ever have a baby? What are you waiting on? I will never know why he waited four years, but I do know his timing is perfect and I really am thankful for our journey! I have met some wonderful women and created beautiful friendships, and for that I am so thankful! Our friends and family have been so wonderful, loving and supportive during this long journey! We couldn’t have done it without them! Truly!

the holidays, I really buckled down. I started keto. And WOW... my body started ovulating on its own... my skin cleared, my mood improved, I lost some extra weight. We had decided after saving some more money for medication that we’d go back for a frozen transfer.

I couldn’t wait for the blood test. I just had to take an at home one. There it was: a faint positive. I cried. I felt so much happiness. My pregnancy was great, but anytime I was unsure or scared something wasn’t going right, CNY staff were there to answer any of my questions and ease my mind. Fast forward to January 2020, and I was in the hospital delivering our beautiful baby girl. She’s almost 8 months now, and I can’t believe our dream came true. She’s amazing, and I feel so honored and blessed to be her mommy.

KRISTEN & RONNIE'S STORY: Ronnie and I married in 2012 and had always talked about having a baby together. He had a vasectomy in his previous marriage and because of the length of time that had passed the success rates of a reversal were low. I had always thought I had PCOS - hair growth, weight gain, etc., so we made an appointment with a local facility, and it was confirmed by ultrasound that I did have PCOS.

Never give up. Keep pushing forward, and keep dreaming. We’ve met some amazing couples along our journey and some strong women. Thank you, CNY for making my dream come true. She’s more than I could have ever imagined.

With the price of IVF, I thought it was all just a dream . . . that is until I stumbled across CNY in 2016. The rates seemed unreal! The thought that we could have a baby of our own together seemed possible. I followed Dr. Kiltz and CNY. I attended all of his Fireside Chats and joined some amazing Facebook groups of other women going through treatments with CNY. In June of 2018, we made the trip to Syracuse, and Ronnie underwent PESA. In November of 2018, we made another trip to Syracuse, and I had my egg retrieval and a fresh transfer. We had so much hope and happiness. Unfortunately, our first attempt didn’t take. I was pretty upset but powered through. After

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Adoption

CNY Fertility Center is committed to offering information about each family building option. Some of our clients have found adoption to be their most promising path for creating a family. There are many things to consider when planning to adopt: eligibility, financing, domestic or foreign, adoption provider, and if embryo adoption is a possibility. There are many children who need loving homes. Adoptions can be performed by a private agency, public agency or through an adoption lawyer. Choosing a reputable adoption provider is important for a positive adoption experience. When deciding to adopt a child from the US, there are many avenues available. There are different types of agencies which provide domestic adoptions. You may choose to use a private agency or to use an adoption attorney for an independent adoption . Adopting a child from a foreign country is another way to build your family. International adoptions must comply with the laws of the adoptive child’s country, and typically require travel to that country. 66

There are also many children in foster care awaiting safe and happy homes. The parental rights of many children who are placed in foster care will eventually be terminated, allowing them to then be adopted. The majority of these children are older and have special needs, however infants are sometimes available.

CREATING HOPE FOR OVER 20 YEARS

EMBRYO ADOPTION Couples who have completed their family building after fertility treatments may have extra frozen (cryopreserved) embryos. Some couples decide to give their extra embryos to an embryo adoption agency. Following a screening and qualification process, a recipient couple can adopt the embryos and have a frozen embryo transfer. Legal documents and agreements will be signed by all, the embryo adoption agency will step couples through this process.

CNY Fertility is happy to provide additional information about all of these alternatives.

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The CNY Fertility Alliance is a network of Reproductive Endocrinologists and OB/ GYNs that have partnered in their mutual commitment to providing top-quality family building options priced well below the national average. Alliance members are committed to every patient and working in cooperation to ensure quality care for everyone. Choosing to receive care from the CNY Fertility Alliance and its members means choosing the nation’s most innovative fertility care network. Alliance members provide local

testing and cycle monitoring, minimizing the inconvenience and expense of travel to Central New York for IVF or other procedures. If you or your care provider would like additional information on becoming a patient or member of the Alliance, please call 844315-2229 (patients) or 530-400-3864 (providers).

BUILDING FAMILIES, BUILDING DREAMS FOR OVER 20 YEARS

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Self-Pay Treatment Pricing* While CNY Fertility works with and accepts dozens of insurances, the fact remains that around 75% of Americans lack fertility coverage. Even states that mandate IVF coverage have loopholes that leave upwards of 50% uncovered. With that, we are incredibly proud to be the most affordable fertility clinic (at 1/3 to 1/2 the national average cost) and the only fertility clinic in the nation to offer in-house financing to everyone—no credit checks, no problems.

$650

IUI

IVF

Donor Eggs

$3,995

$9,950

W H AT ’ S I N C L U D E D

W H AT ’ S I N C L U D E D

W H AT ’ S I N C L U D E D

Sperm Wash & Prep Insemination

Retrieval - Anesthesia - ICSI |Assisted Hatching - Fresh Transfer Cryopreservation - Storage for 1 year

6 Mature Eggs - ICSI fresh or frozen transfer Cryopreservation - Storage for 1 year

ADD ONS In-house monitoring - $995 Remote cycle mangement - $150

ADD ONS Frozen Transfer: $695 if within a year, $1995 if after a year In-house monitoring - $995 Remote cycle mangement - $150

ADD ONS In-house monitoring - $995 Remote cycle mangement - $150

Medication estimate: $200-1,500*

Medication estimate: $1-6,000*

Medication estimate: $1,200*

Largely not controlled by CNY, prices vary and could be outside of estimate given above.

Genetic testing: $3-600 per embryo*

Genetic testing: $3-600 per embryo*

Largely not controlled by CNY, prices vary and could be outside of estimate given above.

Largely not controlled by CNY, prices vary and could be outside of estimate given above.

Egg Freezing

Sperm Freezing

Tubal Reversal

$2,995

$100

$4,995

W H AT ’ S I N C L U D E D

W H AT ’ S I N C L U D E D

W H AT ’ S I N C L U D E D

Retrieval - Anesthesia Crypreservation - Storage for 1 year

Sperm Wash & Preparation Crypreservation - Storage for 1 year

ADD ONS In-house monitoring - $995 Remote cycle mangement - $150 Storage after 1st year - $450/yr

ADD ONS Storage after 1st year - $450/yr

- Anesthesia - Surgery - 2-week postoperative check-up - A discounted IVF cycle if unable to get pregnant within a year of the surgery if 35 or younger and 6 months if over 35.

Medication estimate: $1-4,000* Largely not controlled by CNY, prices vary and could be outside of estimate given above.

Sample Payment Calculator In Vitro Fertilization National Average

Affording Treatment We offer payment plans up to two years in length for all of our fertility treatments. We require no credit check and have a 100% approval rating. We require a 25% deposit for most treatments.

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For more information on insurance coverage, pricing, financing, and other financial programs like our Money Back Guarantee Program and our IVF Grants, head to our website www.cnyfertility.com/affording-treatment/.

Affordable Medications CNY Fertility also works with several outside programs and pharmacies to bring you the best pricing for your medications. As one of the largest fertility clinics in the nation and because of our successful donor program, we have negotiated the best prices in the country from pharmacies on behalf of our clients. We also work with a number of medication discount programs. The Compassionate Care Program is designed to help uninsured, income eligible patients overcome financial barriers and better afford fertility medications. Eligible patients may save 25%, 50%, or 75% off the self-pay price of Gonal-F, Cetrotide, and Ovidrel.

*Current pricing subject to change

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+

Remote cycle management

$3,995 $12,000

$150

Monitoring estimate, paid to a local facility, $1500 non financeable Medications: Paid to pharmacy, non financeable

$2,000

Financing Fee

$1000

Total to CNY Estimated 3rd Party Costs

$5,145 $3,500

Grand Total:

$8,654

National Average

$16,500

Down Payment to CNY Monthly Payment

$1036.25 $171.2

CNYFERTILITY.COM/AFFORDING-FERTILITY-TREATMENT


CNY Fertile Financing

How to Estimate Your Monthly Payment:

TM

MAKING PRICELESS AFFORDABLETM There is the overwhelming impression that fertility treatment is cost-prohibitive and only celebrities and the very wealthy can afford to pay for this type of medical care. At CNY Fertility, this is not the case. Dr Kiltz founded CNY Fertility with the mission of making fertility treatment affordable to all. You will find that most fertility centers around the country are 2-3 times more expensive than CNY Fertility. CNY Fertility Center provides affordable and compassionate fertility care without sacrificing quality. In addition to participating with and accepting most insurance plans, we offer multiple cycle discount plans, Fertile Financing options that are interest free, and an IVF Refund Plan. Our goal is to provide affordable fertility care, so that your dreams can come true. Prior to your first visit, a CNY Fertility financial counselor will evaluate your insurance coverage so you have a better understanding of which costs are covered and which will be out of pocket. We strive to work with clients to find the financial arrangement that best suits you.

PAYMENT PLANS CNY Fertility offers payment plans for most treatments, including IVF, FETs, Donor IVF, Tubal Ligation Reversals, Vasectomy Reversals and more. As part of our mission to provide accessible, state-of-the-art fertility care, we allow all of our clients to establish very simple payment plans for up to two years.

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What You Need to Know: •

• • • • •

All of our payment plans, whether for IVF or other fertility treatment, have the same payment structure. Once you understand how it works for one treatment, you understand how it works for all treatments. There is a $250 fee for every 6 months you finance. This equates to approximately $40 a month. There are no other fees or interest payments. There is no credit requirement. You must have an active credit or debit card. A 25% deposit is required for each treatment cycle. Vasectomy Reversals and Tubal Reversals require a 50% deposit prior to scheduling. You can pay any amount up front and finance the remaining balance. For example, if you want to pay $2,000 toward your IVF treatment upfront and then finance the rest for two years, you would need to pay off $2,900 over two years (that is a $1,900 balance from the IVF treatment and $1,000 in account management fees) If you pay off your balance before your agreement is over, you do NOT have to pay the monthly management fee for any months remaining.

Step 1: Add up the total for your treatment. Step 2: Add the account management fee to the number above. Step 3: Divide the number obtained by adding the first steps together by the number of months you want to finance payments over (up to 24 months). Step 4: You should now have an estimate of your expected monthly payment.

Example using IVF: Step 1: $3,995 (IVF) + $995 (monitoring) $4,990 total treatment cost Step 2: $4,990 + $1,000 because I want to finance for 24 months, so that is $250 x 4 = $1,000 = $5,990 total amount to be financed Step 3: $5,990 x 25% = $1,247.50 required down payment Step 4: $4,742.50/24 months =$197.60 monthly payment to CNY

THE FERTILE GUARANTEE PROGRAM Having a child is one of the most significant decisions you will make in your lifetime. At CNY Fertility, we understand that the price of IVF treatments can be a barrier for couples that are struggling with infertility. That’s why Dr. Kiltz and his team are working every day to continue Making Priceless Affordable™. However, some people want more assurance that their investment will result in a successful pregnancy. That is why CNY Fertility offers The Fertile Guarantee. The Fertile Guarantee program includes all of these services: • 75% refund if you don’t bring a baby home in your arms • Up to 6 IVF cycles (must complete all Frozen • Embryo Transfers before moving on to the next fresh IVF) • Cryopreservation of embryos from those 6 cycles • 1 yr storage of embryos • Egg Retrieval

• • • • •

Anesthesia ICSI Assisted hatching Embryo Transfer FET’s of embryos created during these cycles

Excludes: Medications, Monitoring ,IVF screening tests prior to the initiation of medications, such as, hysterosalpingogram, and non-IVF surgeries. Initial pregnancy test and early pregnancy bloods and ultrasounds. It is important that you understand the total cost of treatment up front. Many IVF centers advertise a low cost estimate that does not include many essential aspects of treatment such as monitoring, retrieval anesthesia, ICSI, assisted hatching, cryopreservation of embryos and FET’s. Our guarantee program price varies depending on the age of the patient. Patients must apply for the Fertile Guarantee Program prior to beginning treatment.

AFFORDABLE MEDICATIONS CNY Fertility also works with several outside programs and pharmacies to bring you the best pricing for your medications. The Compassionate Care Program is designed to help uninsured, income eligible patients overcome financial barriers and better afford fertility medications. Eligible patients may save 25%, 50% or 75% off the self-pay price of Gonal F, Cetrotide and Ovidrel.

WE STRIVE TO WORK WITH CLIENTS TO MAKE CARE AFFORDABLE AND TO FIND THE FINANCIAL ARRANGEMENT THAT BEST SUITS YOU. 73


To learn more about how plants can damage our bodies and reproductive systems, please read the following articles: Phytochemical Mimicry of Reproductive Hormones, Dietary Pesticides, and Poisonous Plant Research.

Preparing for Fertility Treatment 30-90 Days Prior to Scheduled Treatment Through decades of clinical experience, CNY Fertility has discovered that our external environment often creates a hostile internal environment that causes inflammation and leads to infertility. Inflammation and the subsequent infertility it creates are pervasive opponents that are best treated with a multipronged approach. Treatment can include dietary changes, nutritional supplements, pharmacological immunology, mind-body and “eastern” therapies, along with surgical interventions for both men and women. We recommend clients begin to prepare for fertility treatment 30-90 days prior to their scheduled treatment. We have seen many clients adopt some of these recommendations and call the following month to cancel their appointment because they became pregnant naturally. If this happens, it is important to stay on the inflammation-reducing plan. There may 74

also be other treatments we can recommend to reduce the chances of miscarriage and premature delivery.

When it comes to food, less is best. By not putting these inflammation-causing food groups into your body in excess variety and frequency, you allow your body to heal and do what it naturally wants to do. Fasting and intermittent feasting is an ideal solution. By eating once or twice a day at most and allowing 12 to 24 hours between feedings, you provide the body with time to rest and digest. Eating the B.E.B.B.I.S. Diet (pronounced “babies”) - bacon, eggs, butter, beef, Kiltz’s ice cream, and salt - is one lifestyle adjustment so many CNY clients have embraced with incredible success. Maria Emmerich is our keto food guide. We recommend following her and considering having a one-on-one coaching session via her website.Modern medicine is still an effective complement to the natural healing and wellness practices that have been available for thousands of years. CNY suggests adding an immune protocol, which may include

Intralipids, Lovenox, Prednisone, Low-dose aspirin, and Plaquenil to your treatment plan. Some more aggressive treatments may include IVIG, Humira or Paternal Leukocyte Immune Treatment (LIT), also known as the male immunization treatment. We often recommend 1.5 to 4.5 mg of Low Dose Naltrexone (LDN) a day. LDN is known as the “miracle drug” because of the way it simply reduces inflammation. Similarly, cannabidiol or CBD is an ancient herbal remedy that can also play an important role in reducing inflammation.

MIND SET Your faith and belief in a positive outcome will guide you and help you on the way. Keep the faith! Know and imagine you are already fertile and a beautiful child is coming into your life. Joining a supportive community like those in our support groups and fertility mentorship program can be an important part of your success. Yoga for fertility in person at our centers and online at Fertile Hope Yoga, can be another great way to improve fertility. Join a supportive community and foster your belief in a positive outcome. If you have not read The Secret by Rhonda Byrne, you should check it out. Dr. Kiltz’s book The Fertile Secret is also a good resource.

Inflammation likely originates from many of the foods we eat. We are unknowingly placing an excessive amount of these environmental toxins into our bodies in the form of fruits, vegetables, fiber, and lean meats. We don’t realize that they are all converted to simple sugar and that plants have defense systems too. They are foreign particles to the human body and cause a constant inflammatory response. Excess glucose causes glycation and fermentation in the belly, creating heat, methane gas, alcohol, and acetyl aldehyde (similar to the compost pile in your yard that steams with a foul smell), which are destroying the gut and sending this destruction throughout the entire body including the ovaries, testis, and all reproductive organs. 75


The simple guide to improving your fertility in preparation for care at CNY Fertility

Ideally begin 30-90 days prior to the start of treatment

Preparing for Treatment: for Everybody The simple dietary and supplement guide to improving your fertility in preparation for care at CNY Fertility & Preserve

Welcome to CNY, My hope is that we can be helpful, and I want you to know that the CNY Fertility team is here to assist you in every way possible. Through decades of clinical experience, CNY Fertility has discovered that our external environment often creates a hostile internal environment that causes inflammation and leads to infertility. Inflammation and the subsequent infertility it creates are a pervasive opponents that are best treated with a multi-pronged approach that can incorporate dietary changes, nutritional supplements, pharmacological immunology, mind-body and "eastern" therapies, along with surgical interventions for both males and females. The origin of inflammation is best understood through the recognition that we are unknowingly placing an excessive amount of these environmental toxins into our bodies in the form of fruits, vegetables, fiber, and lean meats. We don’t realize that they are all converted to simple sugar and that plants have defense systems too. They are foreign particles to the human body and cause a constant inflammatory response. Excess glucose causes glycation and fermentation in the belly, creating heat, methane gas, alcohol, acetyl aldehyde (similar to the compost pile in your yard that steams with a foul smell), which are destroying the gut and sending this destruction throughout the entire body including the ovaries, testis, and all reproductive organs. To learn more about how plants can damage our bodies and reproductive systems, I highly suggest reading the following articles: Phytochemical Mimicry of Reproductive Hormones, Dietary Pesticides, and Poisonous Plant Research. In my opinion, when it comes to food, less is best. By not putting these food groups into your body in excess variety and frequency, you allow your body to heal and do what it naturally wants to do. Fasting and intermittent feasting is my solution. By eating once or twice a day at most and allowing 12 to 24 hours between feedings, you allow the body time to rest and digest. The B.E.B.B.I. Diet - bacon, eggs, butter, beef, and ice cream (Kiltz’s ice cream), pronounced “baby”, is one of those “opposites” that I have seen so many clients embrace with incredible success. Maria Emmerich is our keto food guide. We recommend following her and considering having a one-on-one coaching session via her website. Still, modern medicine is a great complement to the natural healing and wellness practices that have been with us for thousands of years. I recommend adding some level of an immune protocol (see below) which may include Intralipids, Lovenox, Prednisone, Low-dose aspirin and Plaquenil to your treatment. Some more aggressive treatments may include IVIG, Humira or Paternal Leukocyte Immune Treatment (LIT), also known as the male immu-nization treatment. We often recommend 1.5 to 4.5 mg of Low Dose Naltrexone (LDN) a day. LDN is known as the “miracle drug” because of the way it simply reduces inflammation. Similarly, Molecular Fertility's product Fertile Guard contains immunoglobulins (antibodies) that may help suppress inflammation and support immune health.. Also, cannabidiol or CBD is an ancient herbal remedy that may also play an important role in reducing inflammation. To further assess your fertility, a laparoscopy and hysteroscopy can be done to look for intraabdominal endometriosis and scar tissue that may be impeding your fertility due to the inflammation in and around the ovaries, tubes and uterus. This is a silent disorder and can be present without you

Women

Men

BEBBIS (Kiltz’s keto, bacon, eggs, butter, beef, ice cream, Salt). See doctorkiltz.com and Dr. Kiltz’s Keto Lifestyle

BEBBIS (Kiltz’s keto, bacon, eggs, butter, beef, ice cream, Salt). See doctorkiltz.com and Dr. Kiltz’s Keto Lifestyle

Peak Prenatal and Fish Oil (the foundations of fertility and pregnancy)

Male Preconception+ (male fertility vitamin with CoQ10, Shilajit, selenium, L-Carnitine, Lycopene, Vitamin D, inositol, and more) and Fish Oil for super sperm

CoQ10 or Ubiquinol (not both) + Vitamin D: To improve egg quality. Myo + D-Chiro Inositol: Improves ovulation and pregnancy rates (especially important in those with PCOS). Fertile Guard Immunoglobulins (aka Antibodies): Reduces inflammation by trapping antigens (bacteria, viruses, and toxins) before they enter the bloodstream. CBD: Like the ketogenic diet and fertile guard, CBD helps reduce inflammation. Low Dose Naltrexone LDN 1.5 to 4.5 mg per day Human Growth Hormone (HGH) 6-24 units per day (for low egg reserve or poor quality) or topical HGH (Somaderm gel or serovital for OTC form)

Fertile Guard Immunoglobulins (aka Antibodies) and CBD: To reduce inflammation and improve blood flow to testes. Low Dose Naltrexone LDN 1.5 to 4.5 mg per day Clomid 25 qd (improves sperm production and function) hCG 250 units per day (improves sperm production and function) Human Growth Hormone (HGH) 6-24 units per day (to improve testosterone levels and sperm concentration, motility, and maturation) or topical HGH (Somaderm gel or serovital for OTC form) Avoid high impact exercise, keep it cool

Avoid high impact exercise, keep it cool

SHOP SUPPL EM ENTS

SHOP SUPPLE ME NTS

knowing. Often the only symptoms are infertility, miscarriage, or failed implantation. Additionally, the use of donor eggs, sperm, embryos or gestational surrogacy may assist your journey significantly. CNY Fertility’s donor team is

*LDN is a prescription medication that can only be prescribed by your local provider or by CNY after your consultation.

*LDN, Clomid, & hCG are prescription medications that can only be prescribed by your local provider or by CNY after your consultation.

happy to discuss these options with you further if desired. Attached to this document is a quick reference guide with links for more information on all of the things I recommend for preparing your body for fertility treatment. I have seen many clients adopt some of these recommendations and call the following month to cancel their treatment because they became pregnant naturally. If this happens, it is important to stay on the

Helpful Resources

inflammation-redu-cing plan. There may also be other treatments we can recommend to reduce the chances of miscarriage and premature delivery. Your faith and belief in a positive outcome will guide you and help you on the way. Keep the faith! Know and imagine you are already fertile and

Dr. Kiltz Fireside Chat

a beautiful child is coming into your life. Seeking fertility specialised counseling or joining support groups like that offered at The Fertile Spirit can be very helpful. Yoga for fertility in person at our centers and online at Fertile Hope Yoga, can be another great way to improve fertility, join a supportive community, and foster the belief in a positive outcome. If you have not read The Secret by Rhonda Byrne, you should check it out. My book, The Fertile Secret is also a good resource. Please visit CNY Fertility’s website for blog posts and information on lots of fertility topics, and take a look at our Family Building Guide.

Dr. Kiltz’s

KETO A Health and Wellness Guide to: What you Put in Your Mind, Your Mouth, and How to Move Your Body

Thank you for sharing your journey. I look forward to helping your dreams become your reality.

LIVE every Sunday Morning 10 AM EST

Dra. Verdiales Gotitas del Saber LIVE Los Miércoles a las 8PM EST.

Dr. Robert Kiltz 315-416-9872 (cell)

www.cnyfertility.com

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Sample Stimulation Protocols IC

IUI

IVF

Check List of implantation treatments and oocyte quality and quantity boosting supplements, mostly with inflammation reduction

F ET NS

Natural stim

Aspirin 81 mg start of cycle or earlier

Oral Low

Letrozole or Clomid with trigger

Prednisone, 5-20 mg qd or bid, start of cycle or before

Mini

Letrozole 10 mg x 5 d fsh 150 x 10 d

antag/hcg 10k trigger

Doxy 100 mg bid or zpack, start of cycle for 5 days Weekly intralipids, 100ml 20% may be given to 12 weeks or longer

fsh/hcg

fsh/menopur

150/20

75/75

antag/hcg lupron trigger

Standard

300/20

225/75

antag/hcg lupron trigger

Moderate

450/20

300/150

antag/hcg lupron trigger

Plaquinil 200 mg bid

High

600/20

450/150

antag/hcg lupron trigger

Prograf 0.5 to 1 mg bid

Super High

900/20

450/450

antag/hcg lupron trigger

Humira 40 mg x 2, 2 weeks apart, or cimzia 400 mg x 2 q 2 weeks then 200 mg q 2-4 weeks

Lovenox 30-40 mg qd vs bid, beginning of cycle and continue up to term pregnancy Low

FET Medicated

fsh stim

Neupogen 60 mcg qd, with stim or with transfer preparation HGH 6u, Somaderm, or Serovital per day pre stim or with stim or transfer

IVIG 20-40 grams q 2-4 weeks

Estrace / Progesterone

Hysteroscopy d and c (scratch) / +/- era

Sample Immune Protocols (in addition to stimulation protocol)

Laparoscopy for endo adhesions myoma, or empiric use of orilissa / lupron for 30-60-909 days Prp (platelet rich plasma) wash Hcg (Human Chorionic Gonadotropin) wash

L EVE L 1

LEVE L 2

L EVEL 3

L EVEL 4

Hcg sq boost 250 qd

Aspirin 81 mg qd

Aspirin 81 mg qd

Aspirin 81 mg qd

Aspirin 81 mg qd

Neupogen wash

Prednisone 5 mg bid

Prednisone 5-10 mg bid

Prednisone 10 mg bid

Prednisone 10-20 mg bid

Metformin, 500 mg to 2000 mg per day

Z pack or doxy

Z pack or doxy

Z pack or doxy

Z pack or doxy

Orilissa 150-200 mg qd and letrozole 5mg 1-3 months

Antihistamine (Pepcid, Claritin, Benadryl)

Antihistamine (Pepcid, Claritin, Benadryl)

Antihistamine (Pepcid, Claritin, Benadryl)

Antihistamine (Pepcid, Claritin, Benadryl)

Antihistamine protocol (claritin - 10mg am / pepsid 20 mg / benadryl 25 mg)

Dietary and supplementary support

Dietary and supplementary support

Dietary and supplementary support

Dietary and supplementary support

Intralipids, weekly

Intralipids, weekly

Intralipids, weekly

Lovenox 30 mg qd

Lovenox 30 mg qd

Lovenox 40 mg bid

Plaquenil 200 mg qd or Prograf 0.5 - 1 mg bid

Plaquenil 200 mg qd or Prograf 1 mg bid

CBD Rich Hemp Oil (THC-free), 15-30-60 mg per day, anti-inflammatory, start low and up dose if tolerated well

Neupogen sq 60 mcg qd

Neupogen sq 60 mcg qd

Keto , look at drkiltz.com for full advice and start immediately, best diet for health and wellness for all, even with pregnancy

hCG Boosters 250

hCG Boosters 250

Yoga / tai chi / light easy workout

PRP / HCG wash

PRP / HCG wash

Meditation / prayer / positive vision practice

HGH 6u, Somaderm, or SeroVital

HGH 6u, Somaderm, or SeroVital

Slow down and cool down

LIT IVIG 20-40 grams q 4 weeks Humira 40 mg x2 q 2-4 weeks

Female Supplements: Peak Prenatal, Fish Oil, CoQ10 or Ubiquinol (not both) + Vitamin D, Myo + D-Chiro Inositol, Fertile Guard, CBD, Somaderm gel or serovital Male Supplements: Male Preconception+, Fish Oil, Fertile Guard, CBD, Somaderm gel or serovital, and consider CoQ10 or Ubiquinol and Vitamin D LDN, low dose naltrexone, anti inflammatory, 1.5 to 4.5 mg per day, night best

Acupuncture / massage Natural / mini stim / standard stim / moderate stim / high stim Gestational carrier / donor oocytes / donor sperm / donor embryo Guys, hcg 250 boosters, clomid 25 mg, keto, LDN, CBD oil, slow down, cool down, massage , acupuncture Viagra vaginal suppositories to improve blood flow to uterus

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You’re Not Alone SUPPORT AT CNY FERTILITY It goes without saying that infertility can be a stressful experience. Experts often say that infertility is a life crisis for some couples. The emotions that arise are very real and can be difficult to navigate. Caring for your emotional well-being is as important as treating your infertility, and we understand that each couple’s experience and needs are different. CNY Fertility provides the support you need to help you and your partner through all stages of your fertility journey. Often couples struggling with infertility find it difficult to confide in friends and family. And sometimes wellintentioned comments such as “When are you going to start a family?” or “Just relax and it will happen” only make the situation more stressful. Sharing your frustrations, anxiety, and sadness with others enduring the same struggle can help. Whether you’re more comfortable in a group setting, one-on-one or as an observer, CNY Fertility has the support you need to reduce the stress associated with infertility from a medical, emotional, and financial perspective.

Fertile Friends One-On-One Program Fertile Friends pairs clients together based on their experiences with infertility. This program was created because many clients have said that friends and family who have helped them cope with other life issues just can’t compare to the understanding and support provided by another person who is going through the same struggle to conceive.

moderated by one of our team members, and is open to all clients. During the group session, clients are invited to share their personal experiences, seek support, and gain helpful tools for coping with the emotional ups and downs of infertility. Guest speakers will also occasionally join the group to share knowledge and their own personal journey.

Fertile Hope Yoga Fertile Hope Yoga offers comprehensive online yoga courses and private coaching for women who believe in aholistic approach to fertility wellness. It is a sacred space to share stories, focus on the power of positive thoughts, and expect miracles. It is a wonderful gift and resource for women no matter how you’re trying to conceive. Visit www.fertilehopeyoga.com for additional information.

Monthly Support Webinar We recognize that some of our clients are unable to make it to in-office support meetings. Luckily, we are able to offer an Interactive Fertility Support Webinar. This allows clients to listen in and ask questions from the comfort of their own homes. Additional information and calendar can be found on our website www. cnyfertility.com.

Private One-On-One Support If you are looking for a more private one-on-one support situation, CNY Fertility can recommend several counselors who have successfully worked with fertility clients in the past.

Whether you’re more comfortable in a group setting, one-on-one or as an observer, CNY Fertility has the support you need to reduce stress associated with infertility from a medical, emotional and financial perspective.

Circle of Hope Support Group The Circle of Hope Support Group meets monthly at each CNY Fertility Center/CNY Healing Arts Center location. The group is

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PATIENT SUPPORT AT CNY FERTILITY

The Fertile Spirit

The Fertile Spirit Membership As a member of The Fertile Spirit, you’ll receive daily inspiration and access to weekly groups led by a trained coach. This is an opportunity to truly envision and create a fertile life with the circle of support from our team of coaches, doulas, and others going through a fertility journey.

The Fertile Spirit’s growing team of fertility coaches and doulas is here to support you by providing a spectrum of care options to meet your unique needs. We work with you and your goals to bring insight, healing, growth, and transformation to your path.

Your monthly Fertile Spirit Membership includes:

We believe that caring for your total wellbeing—body, mind, and spirit—is essential to achieving a fertile life. Our expert team of care providers specializes in all stages of women's health, to guide, educate, and inspire you on your path towards wholeness, healing, fertility, pregnancy, birth, motherhood, and beyond.

A TRUSTED GUIDE

Doulas & Coaches

Weekly Facilitated Group Coaching Session

Weekly Support Circle

Guided Meditations

Journaling Prompts

Access to Private Events & Workshops

Access to Group Support Platform

Our patient support specialists are wellness professionals and trusted companions who support you in every part of your journey. They offer skillful and compassionate guidance. We offer help with: ✓

Understanding the Process

Client Advocacy

Creating a Plan

Stress Management

Resources & Education

Balancing Work, Life, and Fertility

Seeing the Bigger Picture to Achieve Goals

Setting and Meeting Nutrition Goals

Breaking through Obstacles to Greater Fulfillment

Danielle specializes in an in-depth approach to transformational growth and change. Weaving imaginal psychology, somatics, self-inquiry, creativity, and mindfulness, she helps individuals, couples, and groups connect to their most fertile spirit so they can live from a more realized, embodied, and authentic place. Her background in trauma and creativity brings a unique lens to her work with clients.

DANIELLE SARA

Danielle believes that our biggest obstacles reveal profound rewards when we orient to ourselves and our dreams with awareness, trust, and love. Danielle has a Masters in Counseling Psychology, is a Group Counseling Facilitator, a Somatic Mindfulness Practitioner, and an Expressive Arts Specialist.

Director of the Fertile Spirit

Contact us Fertility Treatments Coaching

Health & Wellness Support

Prenatal Support

(800) 738-4297 support@thefertilespirit.com www.thefertilespirit.com FOLLOW US! Postpartum Support

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Hope & Heal

Couples Coaching

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Fertile Hope Yoga YOUR PATH TO FERTILITY STARTS HERE But it’s more than just yoga . . What if releasing your emotions and sharing your fertility story meant you could go from 1 in 5 women to 1 in 2 women who become pregnant? Statistics from a Harvard research study show patients who participated in a mind-body program for a 10-week period (which included yoga and meditation) conceived 3 times more often. If you’ve been keeping your fertility journey private (outside of a few close friends), you’re in good company. Holding in your emotions and trying to avoid the pain by not being too optimistic may feel like a safe choice, but releasing your emotions and opening up to share your story is one of the best things you can do for your health.

Fertile Hope Yoga is a sacred space where mamas-tobe can expect miracles. Fertile Hope Yoga is the brainchild of CNY Fertility’s resident fertility Yogi, Erin McCollough. Born from her inperson yoga for fertility classes she has taught for over a decade in Rochester, New York. Fertile Hope Yoga is the first-of-its-kind online platform serving and supporting clients of CNY Fertility from around the globe. It is a comprehensive yoga fertility program for women experiencing IUI, IVF, ICSI, egg donor cycles, ovulation induction, frozen embryo transfer (FET), or any reproductive assistance or procedure during their fertility journey. CNY Fertility has partnered with Fertile Hope Yoga as another way to support our clients both near and far.

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Stop stressing and start loving your fertility journey! Fertile Hope Yoga includes comprehensive online yoga courses and private coaching for women who believe in a holistic approach to fertility wellness. It is a sacred space to share stories, focus on the power of positive thoughts, and expect miracles. It is a wonderful gift and resource for women no matter how you’re trying to conceive (natural cycle or receiving IUI/IVF or FET treatments with the help of a doctor), and an opportunity to build an unshakable foundation while supporting your unique fertility journey. You’ll hear from women who have been in your shoes and see how other women’s Fertile Hope stories have transformed their lives. We support women in all types of partnerships: single moms by choice, mom and mom couples, mom and dad couples, and couples experiencing secondary infertility.

The support you’ll experience will set you up for lifelong success as a mother, partner and woman. You’ll become so much bigger than your fertility story. Fertile Hope Yoga will help you learn about getting pregnant, how to reignite your hope, and everything else your doctor doesn’t discuss with you. Western medicine might be one part of your equation, but just as important is -Addressing and rewiring your underlying beliefs… Embracing who you are, where you are right now... Shoring up support, love, and a net of people to catch you…

Fertile Hope Yoga offers three program levels with access to the FHY app, live Zoom yoga classes

NURTURE

IGNITE

VIP

$27

$69

$297

NURTURE is for you no matter where you are at in your fertility journey. It is for you if you do not desire peer support or fertility coaching.

IGNITE is for you if you are experiencing known fertility challenges & desire a small, intimate support network + group fertility coaching.

VIP is for you if you desire 1-1 fertility coaching sessions in addition to everything in NURTURE + IGNITE.

/mon

/mon

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That’s how you overcome any obstacle, persist, and succeed in your fertility journey. Working hand in hand with a reproductive endocrinologist and fertility clinic, Erin is the only yoga teacher to develop a program that addresses all of this. Her methods are proven and safe. This is where your new Fertility Story begins. Let Erin and Fertile Hope Yoga show you the way.

“Go from hopeless to hopeful while boosting your fertility”

What You Get:

NURTURE

IGNITE

VIP

Ever Growing On-Demand Yoga for Fertility and Meditation Library On-Demand Yoga for Pregnancy Library Live Zoom Yoga for Fertility Classes Mobile App Downloadable Resources Member Only Facebook Community

Fertile Hope Yoga Founder Erin McCollough

Group Fertility Coaching

New Monthly ThemeBased Content Afinnity Peer Group Access All-Access Pass 24/7 Support from FHY team Wisdom Chat Fertility Coaching Oneon-One

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Here’s What Other are Saying About Fertile Hope Yoga "Ferile Hope Yoga is the best club I never wanted to join." Nobody wants to sign up for this, and I didn’t think I needed yoga. It’s the best club I never wanted to join. I was also really uncomfortable opening up to all of these women I didn’t know and uncertain with how I would feel about it. I was harboring so much grief that I couldn’t even effectively communicate with my own husband and family. I was angry. I honestly thought the first or second IUI would get me pregnant and little did I know it would be 4 failed IUI’s before turning to surgery, IVF and yoga to get our miracle baby. I was able to better connect with my center and find grounding. I consider myself a pretty balanced person, but my experience with infertility was crushing and debilitating. My self-worth was so low and I felt I was having trouble succeeding in other areas of life. I became overwhelmed with despair when friends and close family members announced pregnancies— and then experienced overpowering guilt for not being able to celebrate their happy news.

My own journey fractured my relationships with very close friends— and even my loving sister— because people had such trouble relating to my situation while they enjoyed their own paths to parenthood. The yoga group was always there, eternally patient and always encouraging— always understanding and never judgmental. The friendships and closeness grounded me and enabled me to make clear decisions to find my way to my wonderful son.

"I found my voice and have become more open with my emotions and words." The Fertile Hope Yoga program is transformative. It’s a safe space that not only allows you to realize that you are not alone, but also gives you the time and place to begin sharing your journey. It has given me the chance to find my voice. I’m not overly emotional or communicative by nature, so dealing with infertility and loss was difficult. Fertile Hope Yoga helped me find the words to talk about the plethora of emotions I was feeling. When I started the program, I was talking about my journey with only a select few and keeping mum. Now I talk to everyone about our fertility journey (when appropriate— not the cashier at the grocery store. That teen probably doesn’t really care.) I have become more open with my emotions and words. I loved hearing everyone’s stories.

Sasha Tulgan | New York, NY FET Success Story + Fertile Hope Yoga Graduate

“This was one of the best experiences of my life and I will be forever grateful to Erin and all of the women who supported us on our journey.” Katya Metidieri | Rochester, NY FET Success Story + Fertile Hope Yoga Graduate

FREE 14-DAY FERTILE HOPE YOGA MEMBER TRIAL Get off the emotional roller coaster of anxiety and develop a sustainable sense of inner strength and faith regardless of the many unknowns, imperfections and no guarantees. Try Fertile Hope Yoga for free. No risk and no credit card required. You’ll receive immediate access to the tools that will help you rewrite your fertility story.

To get started, simply visit: fertilehopeyoga.com/free-trial or scan this

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Virtual Fertility Support & Education The fertility journey can be overwhelming. There’s so much to learn: names of hormones, anatomy lessons, what to take when, and when to just wait. It’s confusing. Like a whole other language, and you’re already on an emotional roller coaster. Whether you’re currently a patient or just starting to tip your toe into the fertility pool, we’re here to help. No question is off limits or too absurd. Pull up your comfiest chair (and your phone or lap top) and join us in real time for some information, inspiration, and affirmation.

*Weekly schedule subject to change 88

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To guide CNY's world-renowned reproductive immunology program, CNY Fertility partners with PREGMUNE, a state of the art reproductive immunology testing company. The Pregmune PGM-1 Reproductive Immunology Assessment Report helps identify potential causes of your infertility, estimates your chances for successful live birth based on our customized artificial intelligence algorithm, and provides your CNY Clinical Care Team with expert guidance for follow-up treatment for improved chances of success. The Pregmune PGM-1 identifies often-overlooked immunological causes for reproductive failure — and provides expert guidance for individualized treatment with your own doctor.

Get Answers for Your Unexplained Infertility, Miscarriages and IVF Failures DISCOVER HOW PREGMUNE’S REPRODUCTIVE IMMUNOLOGY ASSESSMENT REPORT CAN HELP GUIDE YOUR FERTILITY TEAM & CLINICAL CARE CNY Fertility has been on the forefront of treatment innovation since its inception. When it comes to infertility, we refuse to accept a formulaic approach to IVF where protocols are one size fits all. Dr. Kiltz is one of the first reproductive specialists to study and apply the principles of reproductive immunology. The medical field of the immunology of pregnancy--reproductive immunology--has made great progress in recent years, and there are medical journals dedicated just to this topic.

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Implantation of a pregnancy is a complex immunological process. In order for a pregnancy to implant normally in the uterus, the body has to block the natural process of rejection of a foreign body (aka, the baby). So, when it comes to recurrent implantation failure or pregnancy loss or even infertility of long duration, it is imperative that women seek specialists who are familiar with these issues and who can help them.

Find out if any of these are a problem for you:

Parental Compatibility (HLA mismatches)

Natural Killer Cell Cytotoxic Activity

Because of Dr. Kiltz’s scientific collaborations with its founder, Dr. Andrea Vidali, Pregmune is offering its report to CNY Fertility clients at a significantly discounted cost. The report will help the CNY providers to better diagnose and guide your immune management. For a limited time, CNY Fertility patients receive this groundbreaking immunological testing for 90% off, only $200 compared to the open market price of $2,000.

Thrombophilia

Regulatory T-cell)

Systemic Inflammation

Autoimmunity

Scan the QR code below or head to www.pregmune.com/cnyfertility/ to schedule your complimentary consultation with Pregmune to learn how including their testing in your treatment can help you on your fertility journey.

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Some of these problems can be measured with antibody testing: looking at anti-thyroid antibodies, rheumatoid factors or C-reactive protein, and looking at many other cytokines and white cell dysfunction, such as elevated natural killer cells. We can also take an endometrial sample to look at the pathology of the endometrial tissue to determine if there is abundant evidence of inflammation.

The Reproductive Immunology Story While other fields of medicine have understood for some time that our immune system is a common cause of many diseases, Reproductive Endocrinologists are only in the very nascent stages of grasping how important the immune system is to unlocking the mysteries of unexplained infertility.Our immune system is what keeps us alive, but it is also the source of numerous problems. Reproductive Immunology is a field of medicine that studies the interactions between the immune system and the reproductive system. The current area of study in reproductive medicine is the role of the immune system in relation to recurrent pregnancy loss and repeated IVF failures. The immune system may react to an embryo as an “invader” and thus attempt to stop the growth of these cells. Many treatments are being utilized in the field of reproductive medicine to reduce inflammation and suppress the immune system to support successful pregnancy outcomes.

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For couples experiencing recurrent miscarriages, late pregnancy losses and repeated IVF failures, research and treatment in the area of immunology shows real promise, particularly in treating unexplained infertility. There are many different immunologic problems that can cause pregnancy loss, IVF failures and infertility. Immunologic dysfunction is just one of a wide variety of problems that may lead to infertility and pregnancy loss. Indeed, a large number of pregnancies fail because of chromosomal abnormalities resulting in fetal demise. While we believe that these defects account for a very substantial portion of pregnancy losses, the defects occur randomly and thus are unlikely to be significant causes of recurrent pregnancy losses and repeated IVF failure, especially in younger patients.

“It is our belief that diet is the number one source of chronic inflammation and fertility dysfunction.”

CNY Fertility offers the latest diagnostic testing and treatment options available for immunological conditions. Our oocyte enhancement and implantation enhancement protocols, in conjunction with our standard protocols, provide our clients with the very best opportunity for a successful pregnancy. Recently, we have achieved success treating inflammation pharmacologically with low-dose steroids like Prednisone, Humira, intravenous immunoglobulins and intralipids which are made up of egg protein and soy fat. The fat appears to be a successful method of reducing the inflammation in our bodies. However, since the source of inflammation is likely related to the food we eat, it only makes sense that making dietary changes can and will reduce inflammation. There is ample evidence that excessive amounts of carbohydrates, sugars, grains, fruits, fiber and vegetables along with milk products are very inflammatory to our bodies and increase the number of antigen/ antibody interactions. These white cells and cytokines that are enhanced in our bodies, in many cases, are not specific to a certain area. You might feel it in your joints, your skin, bowel, head, eyes, or you may not even feel it at all. But, you have a problem that results in repetitive pregnancy loss, failed implantation from IUI, IVF or natural cycles, or simply not conceiving.

FAT IS WHERE IT’S AT The mitochondria of our cells need saturated fat (beef fat, pork fat, butter fat, and coconut fat). These are areas of research we are only beginning to study because we’ve had such a societal fear of fat. We’ve believed that fat gets us fat, but it’s really fruit, fibers, vegetables, grains and milk that make us fat and chronically inflamed.

“At CNY Fertility, we’ve been increasingly focusing on diet as being therapeutic and as a way to improve fertility.” Increasing saturated fat intake and significantly reducing (or eliminating) carbs as part of a ketogenic food plan has yielded some eyeopening results. Our clients have many success stories to share. More than a few “keto-babies” have been born as a result of making these diet changes, many with no or limited reproductive assistance. 93


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hat we choose to put into our bodies can create inflammation and dysfunction, or it can be a source of wellness and healing. The Ketogenic Food Plan (yes, it is more than just a diet) is about eating to experience life, love, energy, and abundance. For years and years, most of us believed what we were being told by health professionals, nutritionist and dietitians. Fat is bad. Eat low-fat. Eat plenty of fruits and vegetables. But in treating infertility, we have discovered the opposite to be true.

The

Ketogenic Food Plan For anyone experiencing infertility, recurrent pregnancy loss, or repeated fertility treatment failure, we believe immunologic dysfunction is the root cause of many diseases and can contribute to infertility and recurrent pregnancy loss.One of the easiest ways to improve immunologic function is to reduce inflammation by eating fats, reducing carbs, and eating less frequently. 94

“FAT IS HEALING. FAT IS THE BUILDING BLOCK OF EVERY CELL IN OUR BODIES. FAT CAN REDUCE INFLAMMATION AND HELP OUR BODY TO REPAIR ITSELF.” The human body was built for survival, requiring fat and protein to provide the energy needed to bear the elements and go about the necessary functions of the day. The potential to eliminate our biggest health problems and concerns —including issues of fertility— has proven itself to be possible by going back to a basic diet, the one man first followed when he hunted the earth for sustenance. Increasing your saturated fat intake, limiting protein consumption, and significantly reducing (or eliminating) carbohydrates reduces inflammation throughout the body.

We use the term “ketogenic” to represent ketones. Ketones are supposedly built when the body converts to burning fat instead of sugar. Dr. Kiltz believes we never burn glucose as fuel. Rather, we must convert amino acids and simple sugars to fat in the liver via insulin for energy storage in the liver and adipose tissue. Fat provides fuel for the mitochondria and thus ATP. ATP is the chemical energy produced by the mitochondria to keep the cells alive. Therefore, we are always burning fat (acetyl Co-A that comes from fatty acids) 24/7/365 regardless of what we’re eating. Our bodies can either make fat by converting carbohydrates and amino acids in the liver via insulin, or use the animal fat we eat for fuel. Acetoacetate, beta-hydroxybutyrate, and acetone are ketone bodies that can be measured. People perceive the elevated level of ketone bodies in the blood to be evidence of our bodies replacing glucose as a fuel source, but the presence of ketone bodies is really just a reflection of lower glucose levels. Ketone levels appear to be higher when glucose levels are lower. It’s simply a matter of ratios. More fasting lowers glucose and ketones show up.

WHAT IS KETO? The ketogenic diet or “keto” is a low-to-no carbohydrate diet, that eaten intermittently 1-2 times per day, results in an overall reduction of glucose in the blood stream. It was first created back in the 1920s and 1930s as a treatment for epilepsy and diabetes. It was developed as an alternative to fasting, which had demonstrated success in controlling seizures. The later advancement of medications that could effectively control epilepsy saw the diet abandoned, but renewed interest in the mid-1990s sparked research into using it to treat other disorders, including heart disease, Parkinson’s, Alzheimer’s, ALS, diabetes, and a host of other medical conditions, including infertility.

EAT TO LIVE, NOT LIVE TO EAT. 95


Dr. Kiltz’s Keto Lifestyle Don’t trim the fat, eat it!

In the case of bacon, don’t render it. When Dr. Kiltz says “Eat bacon”, he’s not talking about crispy bacon where the fat has been completely liquified and tossed away. You need to eat the fat. Eating fat reduces inflammation. And save any bacon drippings you have for future use! It’s a great way to add fat and flavor to any meal. When you’re eating a rib eye, don’t trim away the delicious fat or feed it to your dog. If you do, you’re giving away the best part.

The B.E.B.B.I.S. Diet

T

he ketogenic diet or “keto” is a high-fat, adequate-protein, low-to no-carbohydrate diet that was first created back in the 1920s and 1930s as a treatment for epilepsy and diabetes. It was developed as an alternative to fasting, which had demonstrated success in controlling seizures. The later advancement of medications that could effectively control epilepsy saw the diet abandoned, but renewed interest in the mid-1990s sparked research into using it to treat other disorders, including heart disease, Parkinson’s, Alzheimer’s, ALS, diabetes, and a host of other medical conditions, including infertility. Dr. Kiltz’s Keto takes things a step further. It combines a high fat (preferably animal fat) / low protein diet with intermittent feasting. One meal per day at night is what I recommend. I often refer to it as the B.E.B.B.I.S. Diet (pronounced “babies”, because I am a fertility doctor after all) for its focus on bacon, eggs, butter, beef, full-fat ice cream and salt as its primary sources of nutrients. The idea that bacon, eggs, butter, beef, ice cream, and salt are good for us doesn’t make any sense to most of us, I know. We have been taught and repeatedly told that they are not good for us, but I’m betting a billion dollars the ivory tower “experts” are wrong. We use the term ketogenic to represent ketones. Ketones are supposedly built when the body burns fat instead of sugar, but I don’t believe we burn sugar and then convert to burning fat. I believe we are always

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20%

80% FAT PROTEIN & CARBOHYDRATES

burning fat (acetyl Co-A that comes from fatty acids) 24/7/365 regardless of what we’re eating. Our bodies make fat by converting carbohydrates and amino acids in the liver or use the animal fat we eat for fuel. Acetoacetate, beta-hydroxybutyrate, and acetone are ketone bodies that can be measured. People perceive the elevated level of ketone bodies in the blood to be evidence of our bodies replacing glucose as a fuel source, but the presence of ketone bodies is really just a reflection of lower glucose levels. I believe they appear to be higher when glucose levels are lower. It’s simply a matter of ratios. An el­evated level of ketone bodies in the blood, a state known as ketosis, leads to a reduction in inflammation throughout the entire body. Ketosis can make you feel less hungry, and it also helps you maintain muscle. Intermittent feasting or longer periods of fasting reduces glucose in the blood stream and reduces glycation. Glucose is the cause of most disease.

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Most of us eating the Standard American Diet are almost always hyperglycemic because we consume a low-fat, high carb, high protein diet. By eating carbohydrates 3-6+ times throughout the day and little to no fat, glucose is constantly being secreted into the bloodstream requiring insulin to make fat in the liver. Because glucose levels are never allowed to drop, we end up with a hyperglycemic environment that causes glycation. This leads to cellular damage throughout our bodies. What’s more, a high plantbased diet is putting a “compost heap” into the bucket that is your bowels, which ferments via the bacteria, yeast, and other microbes that love your bowels. What you get is simple: heat, gas, alcohol, and aldehydes, or the “ring of fire” as I refer to it. This causes further inflammation everywhere in our bodies. It’s simple. Inflammation then elicits an immune response which send our bodies into further turmoil. Immunologic dysfunction is the root cause of many diseases and can contribute to infertility and recur­ rent pregnancy loss. Eating fat and also eating less frequently are the easiest ways of reducing inflammation and improving immunologic function. Nutritionists frequently recommend complex carbs and foods with a low glycemic index. We are told

these foods are better for us because they take longer for the body to break down. This is exactly the reason they are so dangerous. They are slowly digested and absorbed, meaning we are always secreting glucose into the bloodstream and liver. Eating too often and too much fiber and complex carbs keeps our glucose elevated, stimulating insulin and leading to glycation and inflammation everywhere. The truth is we don’t need very much food. By eating a very narrow diet of bacon, eggs, butter, beef, and full-fat ice cream and eliminating carbs, which include all fruits, vegetables, seeds, nuts, and fiber, you get rid of the “compost heap” in the belly and significantly reduce the resulting damage caused by glycation. Vegans and vegetarians should simply cook carbs well, add fat, and eat 1-2 times per day.

The Cause of All Disease is the Incorrect Diet for the Human Lion!

Health Conditions That May Benefit from the Ketogenic Diet: • • • • • • • • • •

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Hypertension Diabetes Crohn’s Disease Irritable Bowel Syndrome Anxiety Depression Polycystic Ovarian Syndrome (PCOS) Colitis Asthma Migraine Headaches

• Dementia • Multiple Sclerosis (MS) • Epilepsy • Metabolic Syndrome • Some Cancers • Autism • Parkinson’s Disease • Alzheimer’s Disease • Nonalcoholic Fatty Liver Disease •

Infertility

The Simple Guide to Dr. Kiltz’s Fertile Lifestyle 1. Eat one meal & one snack per day 2. Higher fat, lower protein & carbs 3. Eat less frequently- reduce your bowel contents by fasting 18-23 hours 4. Cook carbs well – simplify your carbs to speed up absorption. Eat less complex carbs. This delivers sugar (glucose) to the liver to be converted to fat fast, reducing serum glucose levels. 99


How Do I Get Started?

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t’s helpful to “buddy up” when starting Keto. Adopting the Keto lifestyle with a partner or friend allows you to share, learn from and support each other. Many of our client couples go Keto together and find they are both happier and healthier. When it comes to fertility, both the man’s and woman’s health are important and play a role in conception. And you don’t have to go 100% Keto cold turkey. It’s okay to take baby-steps and gradually incorporate the Keto lifestyle into your everyday living. Start by decreasing your carb intake and cutting out sugar. Consider eliminating all processed foods from your diet. If it comes in a bag or a box, it’s processed. A good pantry and refrigerator clean-out can help reduce temptation. Donate unopened boxes and bags to your local food pantry. Then re-stock your refrigerator with real food, the way nature made it: fatty meats, poultry, and seafoods. Avoid foods with preservatives and coloring, both of which can be detrimental to our health. Buy organic when possible and grass-fed beef. Farmers markets are a great place to find locally grown/raised foods. And don’t expect to be perfect. None of us is. You will have days when you don’t stick to your goals and you make bad food choices— you have a glass of wine with a friend or eat a couple French fries. That’s okay. Just get back on track and stay focused.

The good news is that a keto diet is generally more fulfilling than one heavy in carbs and sugar. Fats are filling. Even though you are eating less, you will feel fuller faster and not get hungry as fast because your sugar levels aren’t on a roller coaster anymore.

GETTING STARTED ON DR. KILTZ’S KETO: 1. Get rid of all sugar— any type. 2. Get rid of all grains — wheat, corn, rice, oats. 3. Get rid of all hydrogenated or partially hydrogenated oils (e.g. vegetables oils)—canola oil, grapeseed oil, corn or sunflower oil, and most vegetable oils contain Polyunsaturated fatty acids (PUFAs) and are very inflammatory. These should be eliminated (or kept to a minimum like peanut or sesame oil). 4. Get rid of all fruits, vegetables, and fiber. 5. Practice intermittent feasting — (1-2 meals per day spaced out)

Keto Resources Making the decision to go keto can seem overwhelming at first. You wonder, “Where do I even begin?” Fortunately, there are lots of resources to reference: websites, articles, books, cookbooks, etc. At CNY Fertility, we are very fortunate to have Keto-experts Maria and Craig Emmerich as a CNY Fertility special consultants. Their books, website, blogs, and seminars are a priceless resource for anyone wishing to boost fertility and achieve countless other health benefits by going keto.

MARIA EMMERICH is a wellness

Maria’s Books

expert in nutrition and exercise physiology. She has a passion for helping others reach their goals of optimal health. She struggled with her own weight throughout childhood and decided enough was enough. She decided to study health and wellness so she could help herself and others stop wasting time feeling discouraged with their outward appearance and not feeling their best mentally. Maria is an international and best-selling author of several books and cookbooks. She understands the connection between food and how it makes us all feel on the inside and out and shares answers to lots of nutrition questions at her website www.mariamindbodyhealth.com. Other Resources: DoctorKiltz.com

AVAILABLE NOW!

Dietdoctor.com

What do you get when a leading fertility expert and a best-selling keto-expert/speaker get together to write a cookbook that will help improve your fertility? The Keto for Fertility Cookbook, that’s what. Dr. Robert Kiltz and Maria Emmerich share the why, what, how, and when of eating to reduce inflammation and promote fertility when trying to conceive.

Livinlavidalowcarb.com drberry.com Carnivoreaurelius.com Kevinstock.io Shawn-baker.com

Infertility can take an enormous toll on anybody struggling in its throes. But the secret to success may be as simple as changing your diet. Together they’ll show readers how a diet low in carbs, moderate in protein, and high in fat can boost your fertility, improving your overall health and odds of conception (with and without additional fertility assistance). Includes delicious, easy recipes and helpful tips to keep your pantry stocked with fertility-friendly ingredients. This HFLC (high-fat, low-carb) food plan has worked for patient after patient, even when modern fertility techniques failed. Together, Dr. Kiltz and Maria Emmerich hope to inspire a HFLC fertile lifestyle while guiding readers on the many ways it can improve how you feel, how you look, and ultimately your ability to conceive the child you’ve been longing for.

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Purchase Keto for Fertility Cookbook at https://ketoforfertility.co/.

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Keto Meals

Waffle Pizza Burger Prep: 10 minutes Cook: 15 minutes Yield: 4 servings

with Maria Emmerich

Nut Free

Al Capone Steak

INGREDIENTS

Prep: 10 minutes Cook: 14 minutes Yield: 2 servings Egg Free Nut Free

Waffles

INGREDIENTS 1 (10 ounce) ribeye steak, butterflied 1/4 cup crumbled feta 1/4 cup crumbled Gorgonzola cheese

INSTRUCTIONS

1/4 cup diced ham

1.

Preheat the grill to high heat.

2 teaspoons fine grain sea salt

2.

Using a sharp knife, Butterfly the ribeye so you can open the steak like a book.

3.

Place the cheeses and ham in a small bowl. Stir well to combine. Place the cheese mixture into the center of the steak. Close the steak and secure shut with toothpicks.

4. Season the steak well on all sides with salt. 5.

6.

Place on the grill and cook for 4 minutes, flip and cook for 7 minutes. Flip again and cook for 4 more minutes. Remove from the grill and allow to rest for 10 minutes before slicing. Best served fresh.

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Time Saving Tip: I make extra waffles to store in the freezer so all I have to do is fry a few burger patties and dinner is ready in no time! I recommend Rao's Pizza sauce which has no sugar and no harmful vegetable oils.

8

eggs

4

hard boiled eggs

4

tablespoon powdered Parmesan (or egg white protein powder if dairy free)

1

teaspoon onion powder

1

teaspoon baking powder

1/2

teaspoon fine grain sea salt

8

tablespoons ghee or coconut oil, melted

Burgers 1

pound Ground Beef Fine grain sea salt and fresh ground pepper

4

(½ ounce) slices mozzarella cheese

4

slices bacon (or pepperoni slices)

8

tablespoons Pizza Sauce (check zero sugar)

INSTRUCTIONS WAFFLES 1. Heat waffle iron to high heat. Place the raw eggs, hard boiled eggs, Parmesan, baking powder and salt in a blender or food processor and combine until smooth and thick. Add the ghee or coconut oil and combine well.

3. Store waffles in an airtight container in the fridge for up to 3 days or in the freezer for up to 1 month. To reheat, place in a toaster oven or oven at 375 degrees for 3 minutes or until warm to your desired liking. NOTE: Waffles can be made up to 3 days ahead and stored in airtight containers in the fridge, or up to a month in the freezer.

INSTRUCTIONS BURGERS 1. To make the burgers, divide and form beef into 4 hamburger patties. Season well with salt and pepper. 2. Place the bacon in a cast iron skillet and fry for 3 minutes per side or until crisp. Remove from the skillet and set aside. 3. Place the burger patties in the bacon grease and cook for 4 minutes then flip and place 1 piece of cheese onto each patty. Cook for an additional 4 minutes or until the burger is cooked to your liking. 4. Place the cooked hamburger on top of one waffle, top with bacon and top with another waffle and serve. Enjoy!

2. Grease the hot waffle iron. Place 2 1/2 tablespoons mixture into the center of the iron and close (they should be smaller waffles like the size of a hamburger bun). Cook for 3-4 minutes or until golden brown and crisp. 103


Carnivore McMuffin

Breakfast Protein Cookies

INSTRUCTIONS 1.

Heat the oil in a cast-iron skillet over medium heat.

2. Place 2 mason jar rings face down in the skillet. 3. Crack an egg into each ring to form a perfect circle for the “bun” of your sandwich.

Prep: 8 minutes Cook: 10 minutes per batch Yield: 12 patties (1 per serving) Difficulty Meter: Easy

4. Season the eggs with the salt.

Prep: 4 minutes Cook: 4 minutes Yield: 1 servings Difficulty Meter: Easy Note: I love to make this sandwich for an on-the-go breakfast. Simply wrap it in parchment paper and take it with you for an easy portable meal!

INGREDIENTS 1 2 ¼ 1 2 1

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teaspoon bacon fat large eggs teaspoon fine sea salt breakfast protein cookies (see below) ounces shaved ham (1 ounce) cheddar cheese

5. Use a fork to scramble the eggs a little and break up the yolks. Cover and cook until the eggs are cooked through, about 4 minutes. 6. Remove the eggs from skillet and place on a platter and place the patties in the skillet and cook for 4 minutes, flipping after 2 minutes. Cook until patties are cooked through. Add the ham to the skillet to heat through. Remove the eggs from the skillet. Place an egg on a plate. Top with the warm ham, and slice of cheese and sausage patty. Top with the other egg “bun.” minutes before slicing. Best served fresh.

Note: My boys love my breakfast patties so much that they called them Breakfast Protein Cookies! Skip the sugar filled cookies and make these delicious protein cookies filled with brain-building nutrients!

INSTRUCTIONS 1.

Place the ground pork, ground pork fat, salt, pepper, and sage in a large bowl. Mix well to evenly combine the ingredients. Using your hands, form the mixture into twelve 3-inch patties.

2.

Heat 1 tablespoon of lard or coconut oil in a large pan over medium heat. Sauté the patties in batches for 3 to 5 minutes per side, until cooked through. Add additional fat for the pan as needed.

INGREDIENTS 2½ pounds ground pork (or ground beef if pork free) ½

pound ground pork fat (or ground beef fat if pork free)

2

teaspoons fine sea salt

2

teaspoons fresh ground black pepper

½

teaspoon ground sage Lard or coconut oil, for the pan

1

(1 ounce) cheddar cheese

Ask your butcher to grind the pork fat for you. Or, if you are grinding it at home, first cut it into cubes and freeze it on a rimmed baking sheet for an hour. Then pulse it in batches in a food processor until finely ground. TIP: Make a double batch of this recipe and store the cooked patties in the fridge or freezer for easy breakfasts on the go. Cooked patties will keep in the fridge for 5 days or in the freezer for 6 months. Form the patties and store them in the fridge for up to 3 days, cooking the desired number of patties when ready to eat.

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Pan Seared Snapper with Browned Butter

Zero-Carb Dirty Rice with Chicken Livers INSTRUCTIONS

INSTRUCTIONS 1.

Heat a cast iron skillet to medium high heat. While the pan is heating, season fillets on all sides with salt and pepper.

2.

Once the skillet is hot, add the butter. Once the butter is melted and starting to have brown flecks, add the fillets and cook for 3 minutes per side or until fish flakes easily with a fork and no longer opaque inside. (timing will depend on how thick your fillets are).

3.

Prep: 5 minutes Cook: 6 minutes Yield: 4 servings Note: Brown butter is the most amazing sauce to serve on just about anything! It has a carmel-like flavor that makes your food extra delicious!

INGREDIENTS

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4

tablespoons butter

4

(6 ounce) snapper fillets

1

teaspoon fine sea salt

½

teaspoon fresh ground pepper

1.

Place the ground pork, ground pork fat, salt, pepper, and sage in a large bowl. Mix well to evenly combine the ingredients. Using your hands, form the mixture into twelve 3-inch patties.

2.

Heat 1 tablespoon of lard or coconut oil in a large pan over medium heat. Sauté the patties in batches for 3 to 5 minutes per side, until cooked through. Add additional fat for the pan as needed. Ask your butcher to grind the pork fat for you. Or, if you are grinding it at home, first cut it into cubes and freeze it on a rimmed baking sheet for an hour. Then pulse it in batches in a food processor until finely ground.

Remove from heat and serve with pan brown butter pan drippings.

4. Store extras in an airtight container in the refrigerator for up to 3 days. Reheat the fish in a lightly greased skillet over medium heat until warmed through.

Prep Time: 2 minutes Cook Time: 16 minutes Yield: 4 servings

TIP: Make a double batch of this recipe and store the cooked patties in the fridge or freezer for easy breakfasts on the go. Cooked patties will keep in the fridge for 5 days or in the freezer for 6 months. Form the patties and store them in the fridge for up to 3 days, cooking the desired number of patties when ready to eat.

INGREDIENTS 2 ½ 2 ½ 8 11/3 ½ ½

tablespoons bacon grease or butter pound ground beef teaspoons fine sea salt, divided cup chopped chicken livers large eggs cups heavy cream cup (1 stick) unsalted butter cup shredded sharp cheddar cheese (about 2 ounces)

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Glycation WHAT IT IS AND WHY YOU SHOULD BE CONCERNED Another way carbs and sugars damage our bodies is through glycation. Glycation is the process during which glucose molecules circulating in the bloodstream attach to proteins, damaging them and making them unusable. Once the proteins are damaged, they can't be easily removed from the body, and they start to accumulate. This accumulation is proven to cause disease and accelerated aging. Glycation also reduces the number of available proteins the body can use to create healthy cells, and it produces harmful molecules called advanced glycation end products (or AGEs). Ultimately, glycation causes inflammation that damages mitochondria, while mitochondrial dysfunction exacerbates glycation. This results in an age-accelerating cycle as glycated proteins accumulate in tissues throughout the body. The acronym AGE is entirely appropriate, considering these toxic protein reactions are a root cause of premature aging. Your skin is one of the first and most obvious places you see signs of aging in the form of wrinkles and sagging skin. Glycation is a normal and natural part of aging, but higher blood sugar levels can speed up the damage and mitochondrial dysfunction. This is one reason the tissues and organs in people with diabetes tend to age and

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degenerate faster than in a non-diabetic. It’s also why we begin to move and think more slowly as we age. The mitochondria are the power source for every cell in our bodies. As they become damaged, they produce less energy. It also takes longer and becomes more challenging for cells to repair themselves.

stroke. Another study demonstrated that one ketone body (beta-hydroxybutyrate) can slow down aging by triggering gene expression, which modifies factors associated with aging.

Low carb diets reduce triglycerides, which are fatty acids in the bloodstream. Elevated triglyceride levels are markers for increased risk of heart disease and inflammation.

A ketogenic diet reduces baseline blood sugar levels, which in turn reduce glycation rates and the formation of AGEs. A high-fat / low-carb diet controls blood sugar and reduces hunger as it mimics the effects of fasting. Several studies have shown that consuming fewer calories decreases oxidative damage within the body.

Following a keto diet reduces your blood sugar, which reduces blood insulin levels, AGEs, and inflammation. These three factors are closely linked to higher mortality rates from all sorts of diseases.

Ketosis improves mitochondrial function by increasing mitochondrial glutathione, an important antioxidant that works directly within the mitochondria. This is particularly important because antioxidants in our food don't easily make it into the mitochondria.

Remember, an often-overlooked source of sugar and carbs are plants, which may contain extra toxins that we don’t usually consider harmful, but they can be.

One study showed that fructose, or fruit sugar, which is found in honey, tree and vine fruits, flowers, berries, and most root vegetables, accelerates glycation within the body at a rate ten times faster than simple blood glucose. And worse, this study also showed that even a single episode of higher postprandial glucose levels (AKA after meal blood sugars) is associated with the formation of AGE precursors.

HOW DO YOU STOP GLYCATION? Good question. It's impossible to prevent glycation completely, but the good news is that a ketogenic diet can help reduce oxidative damage (think RUST) within the body. It also helps the body to produce potent antioxidants that help slow down the aging process. Ketones have also been found to provide relief from and even reverse several neurological disorders believed to be caused by oxidative stress at the cellular level. These include: Alzheimer's, ALS, traumatic brain injury, Parkinson's disease, and

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CREAM IS THE NEW ORANGE JUICE. Adding full-fat heavy cream to your coffee or tea is an easy way to add fat back in to your diet, and it tastes great too! Give up the non-dairy creamers, sugary flavored mixins, almond or soy milk. Go with full-fat heavy cream to fight inflammation.

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Find the FAT MAKE BACON, EGGS, BUTTER, BEEF, & ICE CREAM THE MAINSTAYS OF YOUR REGULAR DIET

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nyone who has spoken to me has heard me repeat these five foods like a mantra. They are the basis of Dr. Kiltz’s Keto Cure. They point back to this simple truth: Our bodies require fat for energy. If we can’t eat fat or make fat, we die. Unfortunately, the majority of fat we consume is industrial, man-made fat. What we really need to be eating is nature’s fat—that stuff that surrounds the animal or is intertwined and marbled in every nook and cranny of the meat. Stay away from lean meats and try to choose grassfed, all-natural meats. You want to consume fatty meats like a rib-eye steak, not lean, fat-free chicken breast. You need to eat the fat. By adding fat, cream, butter, and eggs, you reduce inflammation, you reduce your appetite, you reduce your glucose levels, and your energy is so much better. All of the bowel problems go away, the skin problems and the joint problems are gone. Minimize the variety and simplify your meals. Eliminate pasta, bread, yogurt, milk, seeds, and nuts. Plant oils which harden when exposed to oxygen likely contain a multitude of plant antigens, which are harmful. Eating fat in its purest form is the simplest energy source for our bodies. There are a lot of different food plans out there that focus on high fat / med-low protein / low carbs. They are pretty similar, but tend to differentiate themselves by their recommended fat and carb consumption. Paleo is about 20% protein, 70% fat, 10% carbs. Dr. Kiltz’s Keto is 80% fat, 20% protein, zero carbs. This is the key to health and wellness.Any combination of bacon, eggs, butter, and beef (or fatty meat) is crucial to reducing inflammation. We call this The Lion King Plan. To eat like the king of the jungle means eliminating all fruits and vegetables that produce sugar and phytochemicals, and focusing only on high quality, high fat foods. A nice, fatty rib-eye is a mainstay in Dr. Kiltz’s Keto.

THINGS TO AVOID: • • • • • • •

Sugar Carbohydrates Alcohol High-intensity exercise Probiotics Fiber Seeds & nuts

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Kiltz’s Keto Ice Cream In Dr. Kiltz’s Keto, even “treats” are full fat, that includes my guilt-free ice cream which can be enjoyed as a treat or actually as an entire meal. Yes, there’s a little bit of sugar in there, but that small amount of pure cane sugar in that much heavy cream isn’t a concern, even on the keto diet. This is the most delicious ice cream you can imagine and it’s packed with all of that healthy fat your body needs.

What you’ll need: •

1 Pint of High-Quality Heavy Cream (preferably grass-fed)

2 TBSP of granulated pure cane sugar

2 TBSP pure vanilla extract (can use vanilla bean scraped as well)

1 egg (organic preferred) (optional)

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Note: Recipe can be doubled depending on the capacity of your ice cream maker Directions: Shake cream and pour into a large bowl. Add sugar, eggs, and vanilla extract. Whisk until well combined and frothy. Pour into ice cream machine and follow manufacturer’s instructions.

“Eating fat in its purest form is the simplest energy source for our bodies.”

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Intermittent Feasting: “ Your best health comes from eating one meal a day in the evening and giving your body time to rest and digest.” TRUE FASTING: EAT ONCE PER DAY

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asting between meals gives your body time to rest and digest and allows the glucose levels in the bloodstream and throughout the body to go down. Some refer to this as “intermittent fasting”, but I find the term “intermittent feasting” to be more accurate. I believe your best health comes from eating one meal a day in the evening and giving the body time to rest and digest during sleep (allowing 12-24 hours between feedings). This is in line with how prehistoric man lived: going for days to weeks without eating, not knowing where or when his next meal was coming, feasting and then fasting, fasting, fasting while on the hunt for food. Our bodies were not designed to eat 3-5 meals a day with snacks in between like a grazing animal. Eating several meals a day fills the gut with fiber and carbs that ferment and feed the bacteria and yeast causing more disease. The more we eat, the more we fill “the bucket” that is our digestive system. We fuel the fire of inflammation; we fill our intestines, never allowing them to diminish their contents because of the continuous supply of food. Intermittent feasting allows time for digestion, reduces glucose and insulin levels in the bloodstream, thereby reducing the damage that causes foggy brain, digestive issues, and aches and pains throughout the body.

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Our bodies are well- designed to go without food, yet most of us consume more calories than we could ever burn through in a day. This adds fat to our bodies. Fat is meant to be there to help ensure our survival during times of famine and drought. Dr. Jason Fung has a lot of good information on incorporating intermittent fasting into your lifestyle. “Carbo-caine” When I talk to patients or friends about eating bacon, eggs, butter, and beef and removing carbohydrates and sugar from their diets, most worry they won’t be able to do it. Carbs and sugar have a real grip on most of us, you’re not imagining it. I actually call carbs “carbo-caine”. Like cocaine, they are addictive. Eating carbs affects the pleasure centers in the brain just like a drug. High carb consumption spikes insulin which allows tryptophan to enter the brain and make serotonin, the feel-good neurotransmitter. Eating carbs quite literally makes us happy, but only temporarily. A steady diet of high carbs and sugar will create a host of problems that affect your daily enjoyment of life and can shorten your lifespan.

WHAT TO DRINK:

HOW MUCH TO EAT:

Water, Coffee, Tea. Copious amounts of water are not required. Have a cup of coffee or tea (with added cream or butter, if you like) and a glass of water (still or bubbly with no added sugar) when you are thirsty. The whole 8 glasses of water a day mandate is overkill. Over-drinking of water likely robs our bodies of essential minerals that are inadvertently flushed out.

Frequency is more harmful than intermittent abundance. With intermittent feasting, your allowed to feast since you’re only eating one meal per day. But you will find that eating fatty meats or adding fat to your food is more filling than eating lean meats. You will likely feel full before you finish your meal.

Avoid alcohol in all forms. Alcohol is toxic to your body and fuels the fire of inflammation in the gut. While bone broth can be used as an ingredient in soups and sauces, many people drink it as part of their daily routine. It’s a great snack and a soothing way to start or end the day. Adding a bit of extra sea salt to your bone broth and drinking it in the early stages of transitioning to keto can help ward off the keto flu. When you stop eating processed foods, you take in a lot less sodium, some of which your body needs. This is one way to add it back.

When you eat lean meats, your body must convert them to amino acids which are then converted to sugar in the liver and finally into fat. CUT OUT THE MIDDLE MAN! Choosing to eat natural animal fats allows your body to send fat right to the lymphatics. NARROW AS AN ARROW: Variety, spices, and sides are deadly. Stick to bacon, eggs, butter, beef, and Kiltz’s ice cream. Skip the spices and the sides dishes.

SIMPLE BONE BROTH RECIPE INGREDIENTS •

2–3 pounds of beef bones.

4 liters (1 gallon) of water.

2 tablespoons apple cider vinegar.

1 onion (optional).

4 garlic cloves (optional).

1 teaspoon of salt and/or pepper (optional).

DIRECTIONS Put bones and vegetables in a big, stainless steel pot*. Pour cold water into the pot so it covers the contents. Add the vinegar, and then raise the temperature to bring to a boil. Reduce heat, add salt and pepper, and then let simmer for 4–24 hours (the longer it simmers, the tastier and more nutrient-dense it will be).

Allow the broth to cool, and then strain the solids out. Now it’s ready. You can also add other meat, veggies or spices to your broth. Popular additions include parsley, bay leaves, carrots, celery, ginger, lemon rinds and liver, but they are not required. Broth may be stored in an airtight container in the refrigerator for up to 5 days, or in the freezer for up to 3 months. For those who prefer to multi-task (cook and sleep), you may also want to use a pressure cooker, slow cooker or Crock-Pot. You can use a Crock-Pot to make bone broth overnight. *For extra flavor, roast the bones before adding to pot. Preheat oven to 450°. Roast bones on a parchmentlined rimmed baking sheet for 30 minutes. 115


Fatty, Flavorful, and Filling WHY RIB-EYE STEAK IS THE PERFECT KETO MEAL

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consider a rib-eye steak to be the perfect keto meal, and it’s one I eat quite often. Here’s why: A rib-eye steak is cut from the rib section of beef cattle. Known for their tenderness, rib-eyes also have a high fat content. Generally, the higher the grade of meat, the more fat it contains. It’s half fat and half protein in a delicious package and contains no carbohydrates, sugar, or fiber. All that beautiful marbling in a rib eye means fat— great for flavor and your body.

Fat Fat comprises the other half of rib eye steak’s calories. About 40 percent of that fat comes from saturated fat. The body needs dietary fat for energy and for the essential fatty acids it contains that the body can’t produce. These fatty acids reduce inflammation, control blood clotting and aid in brain function. Fat also allows the body to absorb vitamins A, D, E and K.

“Fat is the fuel for cells in the muscles. Muscles always need energy.”

Vitamins General Nutrition A 242-gram serving, or about 8.5 ounces, of grilled, boneless, choice rib eye steak with its fat trimmed contains 520 calories, 133 percent of the recommended daily intake of protein, 44 percent of the fat and 6 percent of the sodium. I recommend you don’t trim the fat and eat it instead. Protein Protein makes up about half of the calories in rib eye steak. Your body breaks proteins down into amino acids. Amino acids are essential to the creation, repair and maintenance of cells. There are three types of amino acids: nonessential, conditional, essential. Your body can produce nonessential amino acids and conditional amino acids, but may need supplemental sources in times of illness or stress. Your body cannot make essential amino acids, which come only from the food you eat. Rib eye steak offers both conditional and essential amino acids.

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A serving of rib eye steak offers 239% of the recommended daily intake of vitamin B12 for an adult male. Vitamin B12 helps red blood cell formation, neurological health, DNA synthesis, and may play a role in reducing the risks of dementia and age-related cognitive decline. A rib eye also provides 84% of daily recommended intake of niacin, which helps in red blood cell formation, neurological function and maintaining healthy digestion, skin and nerves. Minerals An 8.5-ounce serving of rib eye supplies 153% of the daily need for zinc. Zinc is integral to energy production, protein and nucleic acid synthesis, healthy immune function and cell division. The same serving of rib eye has 145% of the daily requirement for selenium. Selenium combines with proteins to form antioxidant selenoproteins that help prevent cellular damage from free radicals, which may help lower cancer and heart disease risks. Selenium may also play a role in alleviating arthritis.

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Can I Go Keto If I’m . . .

Tips for Vegetarians/Vegans Who Want to Eat Keto

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an vegans and vegetarians still reap the benefits of keto? They can, but it takes a little more work when you’re not eating animal proteins and fat. Because of this, there is a tendency to feel hungry more often and there’s the potential for deficiencies in some essential fats, vitamins, and minerals. The more restrictive your diet, the better the chances of deficiencies.

Watch Your Carbs: Vegans or vegetarians who

Eat Enough Protein: While fruits and vegetables

want to eat keto still need to be cognizant of their carb intake or they’ll never get into ketosis. Make sure the fruits and vegetables you choose to eat are low in carbs. We suggest including: spinach, zucchini, avocado, Brussels sprouts, and cauliflower, all of which have lower carbs.

provide some protein, it usually isn’t enough. You’ll need to make sure you consume higher sources of protein, which include eggs, Greek yogurt, hemp seeds, cottage cheese, parmesan or romano cheeses, other hard and soft cheeses (Swiss, feta, blue, brie, cheddar), peanut or almond butter.

Use Healthy Fats & Oils: Stay away from highly

VEGAN/VEGETARIAN?

PESCATARIAN?

Yes, but I recommend cooking the vegetables down to reduce the effects of phytochemicals and add the fat. The key is to simplify the carbs and cook the vegetables down with some avocado oil, hemp seed oil, or coconut oil. Don’t consume them in the raw form. Raw fruits and vegetables contain lots of bacteria, yeast, and plant antigens which are dangerous. Vegetarians will have an easier time doing this if they’re still consuming eggs, butter, and cream. Vegan is a little harder. Look to add more fat. Ideally butter fat and cream are best, but avocado oil and coconut oil can work. Really separate out the meals to one every 12-24 hours. We’re not a grazing animal. Limit the greens, fruits, and vegetables, and keep variety to a minimum.

Focus on fatty fish like salmon, mackerel, and herring that are high in omega-3s, known to be antiinflammatory. Be careful about eating too many varieties with high mercury levels (swordfish and Ahi tuna). Salmon, anchovies, and sardines canned in oil are a great source of fat, tasty right from the can, and provide on-the-go protein.

Make sure you’re getting enough protein from eggs (if vegetarian) or soy/beans or vegan-friendly protein powder (if vegan). You might need to consider supplements for vitamins you’re not getting from meat.

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DIABETIC? Before starting a keto diet, it’s best to have a conversation with your doctor and continue to maintain your diabetes management plan prior to making any dietary changes. The keto diet can be very helpful for people with are prediabetic or have type 1 or 2 diabetes by decreasing the body’s demand for insulin and helping to keep blood glucose levels at a low yet healthy level. Many diabetics who switched to a keto diet found they were able to reduce their medications because they were consuming far less sugar and carbohydrates.

processed oils such as sunflower and canola. Stick to butter, ghee, coconut oil, olive oil, and avocado oil for meal prep and at the table.

NUTRIENT-DENSE VEGETARIAN OPTIONS Nuts and Seeds

Vegetables

Almonds Chia Seeds Flax Seeds Hemp Seeds Pumpkin Seeds Walnuts 100% Dark Chocolate Unsweetened Cocoa

Artichokes Broccoli Brussels Sprouts Kale Mushrooms Spinach Swiss Chard

Fruits

Dairy

Avocado Olives

Plain Greek Yoghurt Cheese

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Success Stories LEIA & JOHN'S STORY: year of negative pregnancy tests I started to get worried. We didn’t waste any time and met with a fertility specialist. We both got a work up done (bloodwork and HSG) and there were zero issues found so I was given the dreaded “unexplained infertility” diagnosis. Little did I know then that the most difficult time in our lives was about to begin.

My husband and I had known each other since high school, went our separate ways for college and ended up running into each other again in our mid-twenties when we were both back in the Buffalo/ Rochester area in 2011. It was love at first sight and we got married in January of 2014. We wanted to enjoy married life and travel before we started trying to have children and said we would wait a bit. In the fall of 2016, we began to try. I was 29 at the time. After almost a

My doctor at the time suggested IUIs first. I always had a good egg or two during these treatments but my lining wasn’t the greatest. We did four of them with no luck, and given no answers really on why - they suggested we move to IVF. I remember just being shocked and terrified. I was young, healthy...and nothing was showing up as wrong with me. Why is this happening? Our first egg retrieval came quickly. I responded very good to the meds - they retrieved 32 eggs. Of those 19 fertilized and we ended up with five day five embryos that were all great quality. We did a fresh embryo

transfer with two embryos. Then the two-week wait commenced. About 8 days later I started bleeding heavily. I was crushed - I was out before I could even get my beta test. They brought me in anyway and then I got a call - I was actually pregnant. My HCG levels were a bit low they told me but bleeding sometimes happens and as long as they doubled, we were fine. I couldn’t believe it. We were so excited! Our first IVF had worked and the nightmare was over. We were so wrong. Two days later my beta came back barely doubled and my progesterone level had tanked. Two days after that my beta had lowered and they told us I was losing the pregnancy. We were devastated but quickly picked ourselves back up because we had three embryos waiting and one of them had to be our baby. We did a FET a few months later... which didn’t work at all. After that, I needed some time. We enjoyed the end of summer and early fall, and planned to put our last two embryos in before Thanksgiving. Before that we had a consultation with the doctor and I was basically told to just keep trying. I demanded they do a laparoscopic surgery to

IN HER OWN WORDS:

"We will never forget what CNY did for us when no one else could. We owe them everything." -Leia 120

see if there was anything causing my issues - it was the only thing we hadn’t tried. They did the surgery and found endometriosis. We were excited and optimistic again - that had to have been the problem and now we’re going to be okay! So now the last transfer of our last two embryos was approaching and this time I did all the little things you read about on the infertility boards -pomegranate juice, pineapple core, McDonald’s fries. I was desperate. We got the call two weeks later that I was pregnant again - but my beta was low and to be cautiously optimistic. Two days later my beta had dropped and we were losing another pregnancy. We were gutted. This time it felt like we wouldn’t recover emotionally. Two years, four IUIs, five embryos, two chemical pregnancies, a mountain of debt...and all we had to show for it was heartache and loss. We took a serious break. During that time I heard about CNY and made an appointment for a consultation while we tried to heal. Then the big day arrived and we headed in to meet Dr. Kiltz. He was the most inspiring doctor I’d ever met. He explained they correlation between unexplained infertility and inflammation. He put me on a keto diet and a bunch of immune medications. He recommended a FET and a bunch of other procedures (intralipids, PRP, HCG wash). He had all of these answers, all of these new things that could help me and I felt invigorated and excited again about this journey. He taught me about positivity - he told me to read the book The Secret. Which I did and completely changed my outlook. I was ready for it this time. After that I met Nurse Kris Ziegler who was my rock. I just felt

in the best hands - I truly believed that Kris and Dr. Kiltz were going to get me pregnant even after all I’d been through and how unlikely it may have seemed before. With the medications and diet I needed to be on, it took months to prep for my IVF and embryo transfer. I did intralipids once a week, I was on a strict keto diet - during my egg retrieval I got 15 eggs, 14 fertilized and we ended up with six beautiful, perfect embryos. With the FET approaching I pushed

out any feelings of nervousness or negativity. I listened to positive pregnancy affirmations every single night. I was given five different shots a day and was on countless pills, vitamins and supplements. But I was ready. I remember Kris telling me that I was going to get pregnant this time, that everyone in the office had a feeling. My FET day came and we headed back to Syracuse. I did acupuncture before (and after) and Dr. Kiltz performed the procedure.

coworkers knew my struggle so when I answered we all just sat together. The nurse told me, Leia... you’re pregnant. And your HCG level is outstanding at 257. I burst into tears. Like - was sobbing. I knew this was it...my miracle baby. I immediately left work to go surprise John. It was midday and he’s a coffee junkie so I went to Starbucks and instead of his name had them write 257 on the coffee cup. When he saw my face he could tell I’d been crying and assumed the worst of

course. But then I gave him the cup and he saw the number on it. He fell back in his chair stunned and we just hugged and cried together. Our miracle baby Eleanor James was born on January 9, 2020. We will never forget what CNY did for us when no one else could. We owe them everything. Thank you for listening to your patients, not giving up on them, and being so supportive and incredible every step of the way through the hardest battle a couple can face.

I remember exactly where I was when I got the call ten days later at work, so distracted and actually shaking when the phone rang. My

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Success Stories SAMANTHA & KYLE'S STORY: meds and an IUI. We had our first IUI in June of 2018, and it was unsuccessful. Trying again the next month, and once again, it was unsuccessful.

My husband and I wed in October 2016 and immediately started trying for a family. After a year and a half of trying with no success, I knew something had to be wrong. I made an appointment with CNY fertility for a consultation and it was wonderful. I felt completely at ease and filled with hope after my meeting with Meg. After that, we prepped for our first round of

Feeling a bit defeated and knowing the percentages for success from the IUI versus IVF, we decided to jump ahead to the IVF. The meds were no joke for the IVF procedure and the egg retrieval was a little intimidating, but none the less, I was completely on board. I had my retrieval in August 2018. When everything was said and done, we had 2 great embryos, and we were so excited and hopeful! We had our fresh transfer that cycle, and then the dreaded 2 week wait began! We had a trip to Seattle scheduled for the beginning of September, and I started experiencing a few symptoms of pregnancy and I couldn’t wait any longer. I tested

while we were gone because I missed the date for testing due to our trip. 2 pink lines! I was ecstatic, and I went and jumped on my husband in the hotel bed and he gave me a high five when I told him (he’s not a morning person). I was pregnant, and I couldn’t believe I was lucky enough for it to happen on the first IVF transfer! Week after week, everything looked great, until our 7 week appointment. They didn’t see the fetal pole, but they said that could happen, and they would try again at the 8 week appointment. Then that appointment came, and it was one of the worst moments of my life...bad news from the NP and then from the Doctor. We had lost the baby, he stopped growing at 6 weeks. Feeling so devastated and defeated, I went in for the D&C. I needed closure and I needed to know why. We had testing done

IN HER OWN WORDS:

"I never knew I could experience this much love, and I have CNY to thank for that! You made my dreams come true of being a Mom!"" -Samantha 122

after the D&C and it was confirmed that there was something wrong with the baby, but they also told me it was a boy. It was the closure I needed, because I had to understand why, but was so sad to put a gender to that baby we lost. I knew I needed some time to heal (both psychically and mentally) and of course all my levels needed to drop before we could try again. After a few months my levels were back down to normal, and I was ready to try again. I had the next transfer in January 2019 with the frozen embryo that we had, and it was unsuccessful. I was starting to get depressed, felt like there was something wrong with me and that I would never be a mom, but still I drove through it.

let us know the devastating news. All of our embryos had died, and he had no idea why.

again, the 2 week wait. I of course tested early because I couldn’t stand it any longer.

This time I wasn’t taking any chances, so we went 100% in with keto, metformin, thyroid medication, acupuncture, anything and everything that the doctor recommended to make sure we had a successful retrieval and good eggs.

This time, I just was so overwhelmed that when we got home I just cried uncontrollably. I had given up, lost all hope and was completely done. I was angry, and a horrible person. I couldn’t be happy for anyone else, even close friends and family with wonderful news themselves, I couldn’t share joy because I had nothing left inside me to give.

I had my next retrieval in February 2019, and it seemed that everything we had been doing worked! We had 14 beautiful embryos, and I was so excited with how many chances we would have with that retrieval. We went in for the transfer full of hope again, and when we got to the point where we were waiting for the doctor to come in for the procedure, Dr. Kiltz came in and

We took a much needed vacation to unwind and reset, I so needed that! We got back and I felt refreshed and after seeing a therapist for a few months, we decided to try one more time. I had my last retrieval in April 2019, and we had 3 embryos survive to day 6. Given our past experience, we decided to transfer 2 for increased odds. We had our transfer that same cycle and

2 pink lines!! I was pregnant again, and this time felt different. I prayed and prayed that this would be it, and that this baby would be healthy and make it to term. I was a nervous wreck those first 12 weeks, every week praying for good news at my ultrasounds. Week after week, everything was great, and I made it out of the first trimester. We did a gender kit, and we were having a little girl. Things felt real this time, and we were so excited! Fast forward to today, I have a beautiful little girl who is 5 weeks old and the cutest thing I’ve ever laid my eyes on! I never knew I could experience this much love, and I have CNY to thank for that! You made my dreams come true of being a Mom!

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Success Stories

TESS & KIM: STORY: We quickly contacted CNY for a consult. After learning more about options on how we could successfully build our family we chose to do Reciprocal IVF. We found our sperm donor at California Cryo and Kim had a very successful egg retrieval in June of 2019. We ended up with 11 frozen embryos. In July of 2019 we had our first FET which was unsuccessful.

CAMILLE & TYLER'S STORY: went for it! We retrieved 3 eggs, 2 fertilized, and we transferred both day 5 embryos that did not implant. After grieving this next hurdle in our journey, we decided to give it another try with the standard IVF protocol. This cycle also yielded 3 eggs, 2 fertilized, and only 1 made it to transfer as a day 5 morula. Unfortunately, this embryo did not implant either.

Our infertility journey began in 2017 when we decided it was time to start a family of our own. I had 3 older children from a previous relationships, and Tyler had no children of his own. I went for a tubal reversal in December where we were devastated to discover that the surgery was unsuccessful as the doctor delivered the news that my tubes were destroyed. Our only option was IVF. Our first cycle was through an IVF study that was researching an investigational FSH drug. We quickly decided that the benefits far outweighed the risks, so we

We were out of money, and I felt like I was running out of time due to my age (I was 42 at the time), so I joined some support groups on Facebook. This is when I discovered CNY, and it was exactly what we needed! We did a cycle with CNY in which we retrieved 8 eggs and had a total of 5 viable day 3 embryos. We transferred 2 but they did not implant. We immediately began prepping for an FET the following cycle where we transferred our last 3 embryos. Sadly, none of these implanted either. We took some time away from the ttc roller coaster and I began researching the best ways to prime my body

in order to find success in IVF. I began the BEBBI diet in March 2020 and decided I would give myself 3 months of that prior to starting another cycle. In June of 2020 we were ready. Our 4th IVF cycle gave us 14 beautiful eggs, and our final viable embryo count came to 7! My levels were a bit off for a fresh transfer, so we opted to do an FET on my following cycle. In July 2020, we transferred 2 blastocycts and on July 31st we got the news that we were pregnant! What an amazing feeling! During our follow-up ultrasound, we discovered that both embryos had implanted and appeared to be doing well. We welcomed our beautiful daughters, Saoirse and Xiomara in March. Words cannot describe the range of emotions throughout this entire process, but getting to bring these perfect little babies home with us has been the most amazing experience! We could not have done it without CNY, so thank you, thank you, thank you!

CNY through my OB doctor. After getting a consultation we decided to do IVF.

"Words cannot describe the range of emotions throughout this home with us has been the most amazing experience! 124

-Camille

-Tess

JAIMILYN & CAMERON:

IN HER OWN WORDS:

entire process, but getting to bring these perfect little babies

We knew we didn’t want to wait long in between transfers. We tried again in August 2019 and we had a successful transfer done by Dr. Kiltz. Our daughter Poppy Rae was born on April 28, 2020! A huge shoutout to Katie Miller at the Syracuse office! We can’t thank CNY Fertility enough for the family-building options for LGBTQ+ families!

Kim and I met in the summer of 2013 and got married on September 29, 2017. For the longest time we didn’t think we wanted to have a family but after a couple years of being married we knew that starting a family is something we wanted to do. Being locals in Syracuse we knew exactly where to go to start this process of making our family.

"We can't thank CNY Fertility enough for the family building options for LBGTQ+ families!"

We started trying to get pregnant in October 2015. After a year of trying I had testing done, and my husband had testing done. We found out it was male factor infertility, heard about

Over the course of 3 years, our first round of IVF ended in a miscarriage, doing our second round of IVF only months later and it didn’t take. We then did the third round of IVF with our last embryo almost a year later, in September of 2020. We are truly blessed to have welcomed our baby boy in April of 2021. Thank you CNY for helping us with our rainbow baby!

"Thank you CNY for helping us with our rainbow baby! " -Jaimilyn

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Success Stories LESLIE & GIGI'S STORY: hated losing out on our special day, so simultaneously we hired a photographer, put on our wedding attire, ordered a cake, and recited our vows to each other at Red River Gorge in Kentucky.

My wife and I are both Active Duty military, we found each other about four years ago while stationed in Puerto Rico. She came to me as the most attentive and patient partner, on top of everything she accepted and raised my 3-year-old without any hesitation. Three years later, she took me to New York where she proposed during a beautiful sunset sail. Right away we began planning our intimate destination wedding perfectly timing the seasons for crystal clear turquoise waters amongst the Canadian Rocky Mountains. Unfortunately, the pandemic erupted just six months prior to our wedding with about 90

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percent of the wedding planning completed and deposits made. We were devastated when the borders were closed and our plans crumbled, we wanted our wedding immediately followed by IVF to begin expanding our family. We optimistically waited and planned another destination wedding for December 2020 this time to Puerto Rico only to find out they too were forced to enforce a mandatory curfew after a spike in positive cases in September. After discussing it extensively we decided to begin IVF, we had heard through a military friend that CNY was the most affordable and effective LGBTQ-friendly team and began the process. We

IVF is overwhelming and has so many steps, thank god for the travel team. They guide you day by day and are available at all hours for emergencies. The progesterone shots were tough, they were emotionally draining and my hormones were all over the place for what seemed like forever. It became more difficult for my wife to watch me become a wreck after every shot day after day. Recovery from the retrieval process was a little more painful than I anticipated, they harvested 32 eggs! We contacted the Sperm bank and CNY took care of fertilizing the eggs with a total of 16 viable embryos! Transfer day finally came and we were so excited, travel during a pandemic, COVID testing, and quarantine upon arrival was another hurdle but that wasn't going to get in our way. Two days before Thanksgiving we got the call...our HCG numbers were through the roof, we were pregnant!!!

The next two weeks were a struggle to keep my progesterone levels high enough for my body to recognize I was carrying a child. I was put on three different forms of progesterone in order to keep my levels stable. On December 4th I woke up cramping and in a puddle of blood, I tried to stay calm but I couldn't hold back the silent tears as I headed to the Emergency Room. I explained to the doctors the tissue I passed and they began to prepare for a cervical exam to make sure no tissue was left behind that would cause infection. Something wasn't right, I demanded an ultrasound before we went any further. To our surprise, there was still another baby in there with a very faint and low heartbeat!! My ER

doctors reached out directly to Dr. Kiltz and he was so supportive, he gave them instructions on medications that could possibly help. The doctors there quickly warned me not to get excited because the heart rate was so low and I was still bleeding so I was possibly still in the process of miscarriage. They said it was a big probability that I was carrying twins but because I hadn't had an ultrasound before that one, they couldn't confirm. Days passed and the bleeding would stop and begin again, I rushed to the Emergency Room three more times, and eventually, they asked me to stop and told me not to return unless I had a fever which was a sign of infection. I was directed to wait until my first OB visit, my

first four months of pregnancy were devastating...I bled every other day for four months but my baby was still hanging on. It finally stopped around week 25 and during our first anatomy scan we were told our baby had a single vessel umbilical cord which put the baby at high risk for developmental issues, birth defects in the heart, kidneys, or spine and possibly early delivery. I am now almost 33 weeks along and Baby Sophie is measuring 2 lbs. larger than she should. What a blessing, we are humbled and excited to shower our daughter with love. One day we will tell her this story and remind her that she's a fighter and she is so loved.

IN HER OWN WORDS:

"We had heard through a military friend that CNY was the most affordable and effective LGBTQ-friendly team and began the process."

-Leslie

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Medicines for Treating Inflammation “Inflammation is the cause of all of our diseases.” Inflammation is the cause of all of our diseases. Infertility is just another list of diseases caused by acute and chronic inflammation. Whether it’s a bug—a microorganism—or it’s due to glucose and glycation or other phytochemicals or plant antigens that actually damage and create an inflammatory response from our own body, we don’t yet know. Exactly why it happens in the uterus, tubes, ovaries or in the male reproductive organs, we’re not completely sure, but it likely has to do with blood flow that deposits these microorganisms or plant phytochemicals and antigens in those areas. Plus, it’s secondary to the excessive heat in the G.I. tract—the colon and small intestines. As the fermentation of these particles (fruits, fibers, vegetables) occurs, it creates an exothermic reaction which heats the local organs and damages all of them. Inflammation is the body’s reaction to these insults.

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We’re constantly looking for ways to reduce inflammation. Reducing the quantity of plant molecules you put into your body as food and reducing the heat in your body by slowing it down can help. Recently, we have achieved success treating inflammation pharmacologically with low-dose steroids like Prednisone, Humira, and intravenous immunoglobulins and intralipids, which are made up of egg protein and soy fat. The fat appears to be a successful method of reducing the inflammation in our bodies. We also use aspirin, NSAIDs, steroids, and antibiotics. Using low dose naltrexone and CBD oil or Cannabidiol in conjunction with acupuncture, massage, meditation, light therapy, and visualization is beneficial as well.

LOW DOSE NALTREXONE (LDN) Because infertility may be due to the immune system’s overreaction to one’s own hormones, we may try prescribing low dose naltrexone (LDN). LDN is a therapy that has shown promise in a variety of health issues including infertility. Although originally developed decades ago for the treatment of heroin/opioid addiction because of its ability to bind with opioid receptors in the brain thereby blocking the effects of the drugs, it was discovered that in very low doses, naltrexone was helpful in treating autoimmune disorders, HIV/AIDS, cancer, and central nervous system disorders. Because it can balance and regulate the immune system without over-stimulating it, any condition that involves immune dysregulation may benefit from LDN. Since auto-immunity is a potential cause of infertility, LDN therapy is a useful treatment option. In lower doses, naltrexone still causes a very mild blockage of endorphin receptors throughout the body. The body’s response to this binding is to compensate by increasing production of endorphins and enkephalins (our natural opioids). The brief blockage every night appears to be enough to effect a prolonged change in many aspects of the immune system and increases the body’s ability to heal itself. In addition to treating Lyme disease, fibromyalgia, chronic fatigue syndrome, multiple sclerosis, Parkinson’s, Hashimoto’s thyroiditis, Crohn’s disease, autism, and rheumatoid arthritis, LDN can also be helpful for depression because of its endorphin-boosting effect.

infertility in general. In the treatment of infertility, the goal is to stop any process in the body where the immune system is attacking its own tissues, which could hinder the fertility process, thereby improving one’s ability to get (and stay) pregnant.

TAKING LDN Patients who are prescribed LDN typically begin taking 1.5 mg – 4.5 mg by mouth once daily at bedtime. Although LDN is noted for being side-effect free because it stimulates the body’s own mechanisms, there are clients for whom it is not well-suited, especially those being treated for addictions. LDN should not be used if you are taking Methotrexate or any narcotics. Some people do report vivid dreams, sleep disturbances, nausea (usually for the first 2 weeks), dizziness, headache and mild dry mouth, but sleep issues typically resolve themselves spontaneously. It is recommended that patients take LDN prior to beginning a cycle and continue, when recommended, throughout pregnancy. It will be temporarily stopped 4 days before oocyte retrieval and resumed the following day.

LDN boosts the immune system, the mechanism for which we do not entirely understand. LDN makes the immune system begin working at optimum levels again which includes the correction of the many imbalances which plague our body. Studies have also helped to uncover some relationships between the immune system, the hormonal imbalance of the body and the problems experienced by women with PCOS and 129


OTHER MEDICINES FOR TREATING INFLAMMATION The following medications enhance implantation and reduce inflammation in conjunction with our standard protocols.

Prednisone: This low dose steroid is taken orally. There is evidence that empiric treatment with low dose steroids may be beneficial in repeated pregnancy loss, even when the autoimmune testing has been negative. Side effects generally are minimal and mild when given in low dose, short term use. Lovenox: A blood thinner, has been successfully used in promoting embryo development and preventing small blood clots from forming at the site of embryo implantation. It is administered by injection and has been an effective form of treatment for recurrent pregnancy loss. Although recommended for clients with known blood clotting disorders, Lovenox has been widely used empirically with infertility treatments to prevent miscarriage and for those with repeated unsuccessful fertility treatments. HCG: Low dose HCG injections or HCG uterine wash. The corpus luteum provides the main source of progesterone support. The corpus luteum maintains its activity for 14 days. If an embryo fails to implant and HCG is not secreted, the activity of the corpus luteum will decline. The normal development of pregnancy depends on proper corpus luteum activity. Providing HCG, along with Progesterone, supports the luteal phase in infertility treatments.

Neupogen: Given either by injection or uterine wash, causes the body to generate neutrophils, a type of white blood cell which plays an important role in the immune system. You may benefit from Neupogen if you have experienced recurrent miscarriages or failed IVF treatments.

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IVIG: Intravenous Immunoglobulin has been established as one of the most effective treatmentsfor multiple miscarriages. IVIG helps protect the embryo from the mother’s immune system by suppressing many of the immune responses which commonly attack the embryo. It is administered via IV in our office. Intralipids: Intralipids are a liquid emulsion of fat. They are mainly composed of soybean oil and egg fats. It is similar in effectiveness to IVIG, but significantly more affordable for couples who are seeking success after multiple miscarriages. Researchers believe it acts to suppress the body’s natural killer cells and prevent embryo rejection. This is an IV infusion that is performed in our office and generally takes approximately 20-30 minutes. The recommendation is to infuse intralipids before IUI/Egg Retrieval/Embryo Transfer and weekly thereafter to 12-14 weeks gestation. Prograf (Tacrolimus): Prograf is an

and triggers the production of more insulin than your body actually needs. Higher insulin levels seem to lead to higher levels of androgens, which lead to PCOS symptoms and problems with ovulation. Metformin lower excess levels of insulin in the body, which may then help regulate the reproductive hormones and restart ovulation. Research shows that menstrual cycles become more regular and ovulation returns with the use of metformin.

Humira: Originally developed to treat rheumatoid arthritis, Humira is now frequently prescribed to treat many autoimmune disorders, inflammation, and to decrease the number of natural killer cells. Humira is an injectable medication used for clients who have not been able to achieve a successful pregnancy with other treatments by reducing the risk of immune system reactions that may cause embryo rejection. Plaquenil: Plaquenil is also used most commonly for the treatment of rheumatoid arthritis. We have introduced this medication to our clients in order to enhance implantation and

prevent embryo rejection. Plaquenil inhibits the stimulation of cells that induce inflammatory responses in the body. Minimizing inflammatory responses in turn minimizes embryo rejection. Plaquenil is an oral medication taken twice daily.

HCG Booster Injections: HCG booster injections may be prescribed for use immediately following IUI or Embryo Transfer to help sustain a possible pregnancy. An HCG booster signals the corpus luteum to keep secreting progesterone, which in turn keeps progesterone levels up to help maintain the endometrium and help with implantation. Clients are prescribed daily injections of HCG to support a pregnancy.

immunosuppressant that was studied in woman with elevated Th1/Th2 cells. Prograf was studied and shown to improve reproductive outcome of women with repeated implantation failure. Prograf is taken orally twice daily beginning 2 days before embryo transfer and stops with pregnancy test. Patients with a history of skin cancer or any type of cancer should not take Prograf.

Metformin: Metformin is an insulinsensitizing drug primarily used to treat Type 2 diabetes, but it is also used for fertility. Women with PCOS may benefit from taking metformin alone, along with letrozole, or during IVF treatment. Exactly how metformin improves fertility is unclear. Many women with PCOS have insulin resistance, where the body’s cells stop reacting to normal levels of insulin. As a result, the body thinks that there is not enough insulin

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CBD OIL WHAT EXACTLY IS CBD? CBD, or cannabidiol, is a chemical compound found in hemp and marijuana (cannabis) plants. The cannabis plant contains around 100 different chemical compounds called cannabinoids. THC, or tetrahydrocannabinol, is the most well-known as the one that gets you high. The second best known extract is CBD, which by itself, will not get you high. The same species that is used for THC and marijuana has also been used for thousands of years to make clothing, rope, plastics, fuel, and medicinals.

REDUCE INFLAMMATION Beyond diet, which is the easiest change to make, we’re always looking for ways to reduce inflammation. We use aspirin, NSAIDs, steroids, antibiotics, and more recently, I’ve been recommending CBD oil, or Cannabidiol. Cannabidiol has recently been touted as the “go to” herbal medicine for reducing inflammation and you can find it in a wide range of products from lip balms and lotions to cocktails and coffee.

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HOW DOES IT WORK?

WHAT YOU NEED TO KNOW

There is evidence that it may reduce the reactions of the white blood cells and other inflammatory markers on a local and systemic level. CBD works with the body’s endocannabinoid system, or EC, which is a network of receptors that power the immune system and regulate hormones and a variety of brain functions, like recognizing and responding to pain. CBD binds to various ECS receptors and activates them, thereby producing a therapeutic effect, like lowering anxiety and decreasing inflammation. CBD can also “unlock” certain chemicals and block others to create a calming effect.

CBD products labeled “full spectrum” can include less than 0.3 percent levels of THC (not enough to get you high, but enough to have an effect) while products noted “broad-spectrum” do not contain any THC at all. Be prepared to experiment and be patient! The single use of a CBD salve on your painful neck may not alleviate the pain overnight, or it might. You may need to try the combination of taking CBD orally and topically to achieve the desired results. Be prepared for some trial and error before you find the formula that works best for you.

THE BENEFITS OF CBD CBD may help with aches, pains, skin issues, and digestion. It has also been found to help with depression, anxiety, and epilepsy, and may even help with certain metabolic disorders, like diabetes. From a fertility perspective, CBD is thought to improve sperm and egg quality. But be mindful of the fact that everyone responds differently to CBD depending on the specific product they are using and their own unique body chemistry. And CBD is not known to be addictive. The World Health Organization reports that “CBD exhibits no effects indicative of any abuse or dependence potential.”

Your decision to use CBD must be based on some of your own research.

WHERE TO BUY: We recommend you find a reputable supplier where you can buy the highest quality pure CBD oils derived from non-GMO industrial hemp. We suggest CB Distillery: SCAN NOW TO LEARN MORE

Whether you take it as a vapor, an oil under the tongue, rubbed on the skin, in tablet form, or baked in something, the choices seem unending. 15 mg of CBD 1-2 times per day is a good starting point for many, although the exact dose has not been determined and can vary from person to person. Different varieties have been mixed with MCT oil, olive oil, or hemp seed oil in order to dilute the concentration of the CBD oil. The intent here is not to create a high or a buzz. There may be side effects, so everyone must be cautious in deciding whether to use it. Certainly, if you are pregnant, we currently recommend against using CBD. 133


Molecular Fertility

MALE FERTILITY Sperm provide half the genetic makeup of the any baby, so it’s no wonder experts agree that male factors contribute to approximately one third to one half of all cases of infertility. • Key nutrients found in the Molecular Fertility male fertility supplements are designed to improve the morphology (shape), count, motility, and DNA of sperm.* CNY Fertility similarly recommends that men ideally take Molecular Fertility’s entire male line for 90 days prior to trying naturally or the start of fertility treatment.

TRUSTED CNY FERTILITY-DEVELOPED SUPPLEMENTS Nutrition has a big impact on both male and female fertility. Even when eating right and making healthy choices, there can still be room for improvement when it comes to boosting your overall wellness and ability to conceive. The road to optimum pre-conception health starts up to 3 months before conception. This is because egg and sperm development begin as far as 90 days prior (around 74 days for sperm), so changes you make today can help boost your fertility 30-90 days from now by improving sperm and egg quality.

FEMALE FERTILITY The Molecular Fertility female line is designed to provide the fertile ground to grow and nourish life from preconception to post-natal recovery.

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They are designed to support everything from egg quality and ovarian response, to fetal development, and new mother and baby health.

We recommend the following Molecular Fertility supplements for Males: • Male Preconception (for all males if no diagnosed male factor) • Male Preconception+ (if male factor or if attempting IUI) • Fish Oil (all males) • Fertile Guard (for extra inflammatory support)

WHERE SHOULD I BUY MY SUPPLEMENTS? CNY Fertility searched for the very best supplements for our clients. When we didn’t find exactly what we were looking for, we decided to create our own line of fertility supplements. Thus, MOLECULAR FERTILITY™ was born. This comprehensive line of nutritional supplements was created using premium ingredients and backed by science. Many of Molecular Fertility’s formulas include patented/trademarked nutrients that have been clinically studied and shown to have superior absorption than generic vitamins and minerals. To order supplements from MOLECULAR FERTILITY, please go to MolecularFertility.com. or scan the code below. *These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

MOLECULAR FERTILITY TM Fueling Your Fertility One Molecule at a Time.

CNY Fertility’s board-certified reproductive endocrinologists and OBGYNs recommend that women take Molecular Fertility’s entire female line for 30, but ideally 90 days prior to trying to conceive naturally or the start of fertility treatment. We recommend the following Molecular Fertility supplements for Females: • Peak Prenatal • Fish Oil • Ovarian Bloom • Fertile Guard • Inositol (if PCOS)

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CNY Healing Arts EAST MEETS WEST It’s easy to believe that fertility treatment is strictly a modern day science made possible solely through the advances of high-tech medicine. But as good as modern science is, many couples trying to get pregnant find the results they are after with the assistance of ancient medical treatments such as acupuncture and massage. Sometimes acupuncture and massage are that something extra that help ensure the success of a fertility treatment over and above what typical western protocols alone can accomplish. At CNY Fertility, we’ve found that the best and most effective fertility treatment plans are created by incorporating both eastern and western medicine ideas. Dr. Kiltz was so impressed with the results achieved through massage, acupuncture and yoga, that he created CNY Healing Arts so that these services could be provided under the same roof to CNY Fertility clients.

OUR PHILOSOPHY The Fertile Secret is within each of us. By finding our place of peace and balance amidst the demands of life and the stress of infertility, we renew our lifegiving potential. Dr. Kiltz sees this potential in all of his clients. Recognizing the toll that infertility was taking on their lives, he felt a deep desire to offer a more balanced approach to treating infertility. By reconnecting his patients with the power of positive thinking, he sees men and women improve the quality of their lives on their journey to conception.

OUR TREATMENTS With inner peace comes deep healing. Our holistic approach is designed to support the physical, emotional and spiritual aspects of

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your fertility. Acupuncture, massage, nutritional counseling, yoga and specialized workshops, alongside assisted reproductive technology, returns your body to a place of balance from which conception can occur.

THE FERTILITY BENEFITS OF MASSAGE CNY Healing Arts offers traditional massage techniques as well as techniques focused specifically on the treatment of infertility.

Fertility Massage The Fertile Secret Massage is a relaxing and enjoyable way to increase blood flow to the reproductive organs, properly position the uterus, remove blockages and open the pelvic and hip region. Our fertility massage combines the principles of Maya Abdominal Massage, acupressure and breath work to balance the hormonal system and support conception. The Fertility Massage combines deep therapeutic touch with soothing abdominal massage. Your practitioner will customize your bodywork according to the stage of your menstrual cycle, using deeper abdominal work during the follicular phase (before ovulation) and focusing on relaxation during the luteal phase (after ovulation). In women, the pelvic region and reproductive organs tend to hold a lot of emotions. Expect your massage to be cleansing and detoxifying, physically and emotionally, leaving you with a deep sense of mental peace. Physical touch encourages the body to release oxytocin, contributing to increased pleasure. This Fertility Massage is perfect for anyone desiring to conceive and can also be customized for pregnancy and postpartum care.

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BENEFITS OF FERTILITY MASSAGE For Women : •

Increases blood flow to the reproductive organs

Nourishes follicles with fresh blood supply (oxygen and other nutrients)

Helps break down scar tissue and adhesions

Re-aligns the uterus

Helps cysts dissolve and resolves blockages in fallopian tubes

Relieves stress and anxiety

Improves digestion and absorption of nutrients

Helps regulate the menstrual cycle (addressing cramps, heavy bleeding, irregular cycles, reduced clotting)

Reduces inflammation due to PCOS, cysts, and fibroids

Helps prepare the body to prepare to carry for pregnancy

Many couples trying to get pregnant find the results they are after with assistance of ancient medical treatments such as acupunture and massage.

For Men :

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Increases blood flow to the reproductive organs

Regulates enlarged prostates

Improves sperm count motility and morphology

Improves digestion

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Prenatal Massage Prenatal massage can help moms-to-be find relief from the aches, pains and stresses of pregnancy. Regular massage sessions can help maintain health, reduce swollen ankles by increasing circulation throughout the body, as well as relieve lower back pain and sciatica. Our experienced therapists will use special positioning and cushioning for comfort and safety. The massage is done in a side-lying position with a pillow gently supporting the back and stomach.

Massage

Dry Brushing Massage

Customized Massage

Hot Poultice Massage

Allow our highly skilled therapist to create the appropriate session to fulfill your needs. This massage is designed to aide with any of the following conditions: Stress reduction, improve relaxation, increase circulation, relieve pain and discomfort from injuries, headaches, back pain, whiplash, carpal tunnel/thoracic outlet syndromes, plantar fasciitis, fibromyalgia and multiple sclerosis.

The poultice we use combines organic green tea and lavender, herbs that are specific for relaxing and relieving tight, sore muscles. The herbs are wrapped in traditional Thai fashion, creating a wonderful massage tool that is steamed and applied to the body using specific, purposeful massage techniques (techniques which are mostly compressive, broaden the muscles, inducing them to relax more readily). Massage with the hot, moist herbal ball softens tense muscles, decreases inflammation, calms the nervous system, and improves circulation. The combination of the heat, herbal properties and massage technique make the tissue more receptive, while inducing a more profound relaxation. The aroma of the steamed herbs has a relaxing effect as well.

Hot Stone Massage Heated basalt lava stones are massaged into the muscles, warming the tissue while melting tension away. Our oil is applied with long flowing strokes throughout the body incorporating the warmed stones for deep ease and warmth. Emerge feeling renewed, relaxed and rejuvenated.

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This is a 90-minute service that includes 30 minutes of dry brushing followed by a 1-hour full body massage. One benefit for fertility is improved circulation. Circulation helps the blood flow go to the reproductive body areas. This service should be performed around ovulation. Other benefits include the clearing of toxins and lymphoid. What's even better, after your massage, you get to bring the brush home with detailed instructions on how to perform dry brushing on your own to continue the benefits long after your treatment! Not recommended

if you have sensitive skin, body acne/rosacea or eczema, or have a recent tattoo. We suggest you select a regular, custom massage instead to not cause further irritation.

Reiki Treatments Reiki is a gentle hands-on healing technique to reduce stress, relieve pain, and facilitate healing. Your therapist will energize various body systems on levels that promote healing, clarity, and focus.

Foot Reflexology Bring strength and balance to your body through foot reflexology and gentle massage. Foot reflexology restores balance within your system. The treatment starts with a warm foot soak to promote circulation and blood flow to your pelvic organs. Next, we examine the feet to look for clues regarding what might be happening in the rest of your body. Finally, experience a relaxing foot massage aimed at the areas of your body on which you want to focus. This treatment can stand alone, or be added to any other treatment selection.

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Acupuncture EMBRACE THE RESTORATIVE POWER OF ACUPUNCTURE Acupuncture is one part of a complete system of healing known as Traditional Chinese Medicine, or TCM, that has its roots in China dating back several thousands of years. TCM also includes dietary therapy, herbal medicine, body work and other adjunctive techniques. Acupuncture uses small, almost hair-thin, surgically sterilized and disposable needles that are placed in certain points on the body. These points are located on energetic channels. In TCM terms, it is the strategic use of these points that regulates and balances the flow of energy and blood in the body, thus allowing for symptom relief. Laboratory and clinical studies have shown Acupuncture to have an effect on the central and peripheral nervous systems. It causes the brain to release opioids, the body’s natural pain killers, as well as other endorphins that moderate the stress response and help to balance hormone levels in the body. Acupuncturists at CNY Healing Arts are extensively trained in assisting those attempting to achieve pregnancy naturally and those who are undergoing fertility treatments. Each day, they work together with the staff at CNY Fertility Center to assist couples in achieving their dream of pregnancy. And, they continue to work with women, once pregnant, to moderate symptoms and help to prepare a woman’s body for labor and delivery.

BENEFITS OF ACUPUNCTURE FOR INFERTILITY • • • • • • •

Regulate menstrual cycle Improve sperm count and motility Reduce stress and anxiety associated with infertility Normalize hormone and endocrine systems Improve blood flow in the uterus Decrease chance of miscarriage Increase the chance of pregnancy for women undergoing in vitro fertilization (IVF)

Research has revealed that women doing invitrofertilization treatments were 65% more likely to conceive when they used acupuncture in conjunction with their western medical treatment.(1) Additional studies support the significance of acupuncture for the outcome of assisted reproductive medicine,(2) and that acupuncture administered on the day of embryo transfer significantly improves the reproductive outcome of IVF/ICSI.(3) Acupuncture is also associated with higher clinical pregnancy rates and live birth rates.(5)

1. Manheimer, Eric, Grant Zhang, Laurence Udoff, Aviad Haramati, Patricia Langenberg, Brian M. Berman, and Lex M. Bouter. “Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis.” British Medical Journal (2008). BMJ medical publications of the year. 7 Feb. 2008. 9 Apr. 2009 <http://www.bmj.com/cgi/content/full/ bmj.39471.430451.BEv1>. 2. Dieterle, Stefan, Gao Ying, Wolfgang Hatzmann, and Andreas Neuer. “Effect of acupuncture on the outcome of in vitro fertilization and intracytoplasmic sperm injection: a randomized, prospective, controlled clinical study.” 7 Apr. 2006. 9 Apr. 2009 <http://www.ncbi.nlm.nih. gov/pubmed/16616748/>. 3. Westergaard, Lars G. M.D., Ph.D, Mao, Qunhui M.D, Krogslund, Marianne, Sadrini, Steen, Lenz, Suzan M.D., Ph.D, Grinsted, Jorgen M.D., Ph.D. Acupuncture Improves pregnancy rates in IVF treatments. 2006 4. Udoff, L.C., G. Zhang, S. Patwardhan, Z. Wei, and H.D. McClamrock. “The effect of acupuncture on outcomes in in-vitro fertilization (IVF).” 20 Apr. 2006. 9 Apr. 2009 <http://clinicaltrials.gov/ct2/show/NCT00317317>. 5. http://www.ncbi.nlm.nih.gov/pubmed/21297382

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“Research has revealed that women doing in-vitro fertilization treatments were 65% more likely to conceive when they use acupuncture in conjuction with their western medical treatments" 143


Collagen is an essential protein used to repair damaged tissue and to replace old tissue. It is the most common protein found in the body and is the substance that holds cells together. LED Light Therapy can stimulate the production of collagen. By increasing collagen production, less scar tissue is formed. There are studies that prove collagen is an essential nutrient for the ligaments that support your uterus. If you have any prolapse concerns, collagen induction may help you reverse this pattern.

Feel the Light LED LIGHT THERAPY Over the past ten years, CNY Fertility has been very successful at improving outcomes for our clients by incorporating eastern medicine with hightech western protocols. A new therapy we are recommending is LED Light Therapy, which has myriad benefits for our fertility patients, but also helps improve overall wellness in anyone. LED Light Therapy is a useful tool for improving circulation throughout the body by increasing the formation of new capillaries, stimulating the production of collagen, and stimulating the release of adenosine triphosphate (ATP) which is the major carrier of energy to all cells.

How Light Therapy Can Enhance Your Fertility: LED Light Therapy (or Light Emitting Diode Therapy) is a very effective, non-abrasive, noninvasive, and restorative treatment. Our skin has the ability to absorb and utilize light which

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creates a therapeutic response. Light therapy uses specific color wavelengths to penetrate different levels of the skin, providing a wide range of benefits. Light may be able to enhance your fertility by returning you to balance. By working directly over your eyes, we can affect your entire endocrine system by sending light frequencies to your hypothalamus. By elevating nitric oxide levels in the body and increasing the formation of new capillaries that replace damaged ones, Light Therapy increases vascularity (circulation). New capillaries accelerate the healing process by carrying more oxygen and more nutrients required for healing. They are also able to carry away more waste products. This can be an essential component in preparing your body for pregnancy, especially if you have endometrial lining issues.

ATP, or adenosine triphosphate, is the major carrier of energy to all cells throughout the body. Increases in ATP allow cells to accept nutrients faster and get rid of waste products more quickly by increasing the energy level in the cell. All food turns into ATP before cells utilize it. ATP provides the chemical energy that drives the chemical reaction of the cell. Light Therapy is able to stimulate the release of ATP. Increased ATP helps support your fertility by giving you the cellular energy you need to maintain a healthy pregnancy. A lack of energy can be a contributing factor to recurring miscarriage and may be an underlying cause of chronic inflammation and immune disorders. Edema, the swelling or natural splinting process of the body, has two basic components: liquid and protein. Research has shown that the lymph vessel diameter and the flow of the lymph system can be doubled with the use of Light Therapy. The venous diameter and the arterial diameters can also be increased. This means that both parts of edema (liquid and protein) can be evacuated at a much faster rate to relieve swelling. A well-functioning lymphatic system is an essential part of your overall fertility. A sluggish lymphatic system can contribute to chronic inflammation and immune disorders.

Light Therapy Pre-and Post Embryo Transfer: New capillaries can increase blood flow which assists in a more rapid and greater healing response. An IVF transfer can be considered an “invasive” procedure and improved healing may help ensure implantation. Photons of light energy enter the body as negative ions. This requires the body to emit positive ions, like calcium among others, to go to the area being treated. These ions assist in firing the nerves, thereby relieving pain and reducing the excitability of nervous tissue. This may assist your fertility especially after embryo transfer when you want a calm, assimilating environment for implantation.

LED light therapy is a useful tool for improving circulation throughout the body by increasing the formation of new capillaries, stimulating the production of collagen and stimulating the release of adenosine triphosphate (ATP) which is the major carrier of energy to all cells.

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Mind Body Smile WITH DR. ROB 15 Things You Should Do Every Day to Feel More Connected to Your Mind, Body, Spirit and the Universe as a Whole: 1. COUNT YOUR BLESSINGS Start the day by counting your blessings and saying THANK YOU to God for this day. As they say, if you want to find happiness, find gratitude.

7 . PRACTICE MEDITATION, DEEP BREATHING, AND/OR YOGA You will find yourself more connected to yourself as a result.

2. CONNECT WITH NATURE

8. READ OR LISTEN TO A BOOK

This can be as easy as sipping your coffee outdoors on your deck in the quiet morning, breathing in the fresh air and listening to the birds. Or, try taking a walk in the woods.

Whether it’s in your car to and from work or in a quiet corner during lunch, make sure you are reading and continuing to learn every day. There are so many wonderful authors to learn from.

3. UNPLUG

9. SHARE AN ACT OF KINDNESS

Don’t forget to turn off your computer, phone, tablet, and TV. Detach yourself from these distractions so that you can relax and tune into what’s happening on the inside.

It can be as simple as holding a door, giving blood, or buying a coffee for the guy behind you in the line at Starbucks.

4. MOVE Go for a walk, a swim, take an easy bike ride, paddle your kayak. It’s best if it’s not too strenuous.

5. SLOW I T DOWN Your body doesn’t need to work so hard. Stay off the elliptical. You don’t need to churn out 10 miles on the treadmill or on the roads. Less is more. Strenuous exercise causes inflammation, but don’t just sit still.

6. FLEX YOUR ARTISTIC MUSCLES Whether this involves writing a poem or short story, or just recording your thoughts in a journal, painting a picture, making pottery, playing an instrument, or dancing. Tap into your creative side every day.

12. BE MINDFUL & PRESENT Being mindful means being aware of one’s present moment and all of the senses, functions, and delights associated with that moment. It may sound simple, but it is not something that comes easily to most of us. Use your senses to describe each moment that you are experiencing. Repeat to yourself what you are doing “I am sitting on my couch under a warm blanket.” Don’t allow your mind to take you to the past or the future.

13. BE FORGIVING The act of forgiveness is one of the most noble and loving things we can do. Forgiveness is a choice, and it is very much an internal decision. When we forgive, we are choosing peace and emotional wellness over anger, resentment and emotional immaturity. When we deny forgiveness, we are holding ourselves hostage to negativity. Choosing forgiveness allows us to move out of pain and into peace. It will add balance to our lives and create deeper relationships with others.

14. LEARN TO LET GO Attachment to desire is one of the primary

reasons for human suffering. We easily attach ourselves to ideas, fantasies, expectations, and hopes. When we let go of attachments, we close the door on suffering. Letting go doesn’t mean throwing away or giving up. It simply means that we are happy with who we are and what we have at this very moment, and that we do not put all of our happiness into an external desire. Letting go enables us to tap into our inner strength and healing.

15. DANCE WITH LIFE Learning to seek out joy in life is the goal here. Trust that the river of life will provide you with a magical dance. Let your feelings be your guide. It may seem impossible if you are in a place where external events are having a negative effect on your energy and vibration, but when you change the way you view the negative events, the events themselves will change in response to your renewed way of thinking. One way to start experiencing joy right now is to try to hold your smile for as long as you can. Think about things that make you smile. Don’t let negative thoughts creep into your mind. If they do, simply envision yourself pushing them back out and maintaining your position of joy.

10. KEEP A JOURNAL and spend time writing in it every day. Record your thoughts and feelings. Your entries don’t have to be long.

11. LISTEN TO YOUR INNER GUIDE To do this, sit quietly and comfortably. Close your eyes, breathe in deeply, and exhale. Focus your attention on your breathing. Let thoughts come and go. Allowing yourself to live in the moment will reduce anxiety and stress, and you will have the wisdom to listen to your inner guide. You will suddenly find that things in your life have a beautiful flow and you feel you are exactly where you should be at each moment in time.

If you’re interested in reading more encouraging thoughts and ideas from Dr. Kiltz, pick up copies of his latest books: Daily Inspirations and The Fertile Feast. In Daily Inspirations, Dr. Kiltz shares the inspirational quotes and contemplations that lifted his spirit and guided his personal reflection. He shares his lessons for learning to slow down, breathe deeply, and look inward for the strength and inner guidance you need to feel connected with the universe, achieve your goals, and live the life of your dreams. Since learning the simple, yet radical truth that our bodies and brains run most optimally on high-quality fats, Dr. Kiltz successfully recommended Kiltz’s Keto Lifestyle to countless patients who had previously been unable to conceive. He has witnessed the power of keto to bring new life into the world and to transform the lives of his patients, friends, and colleagues. The Fertile Feast weaves accessible and lively explanations of keto’s healing power.

Daily Inspirations H OW TO C R E AT E A P O S I T I V E C H A N G E I N P E R S P E C T I V E , AT T I T U D E , A N D O U T LO O K . By Dr. Robert Kiltz, M.D.

The Fertile Feast D R . K I LT Z ’ S E S S E N T I A L G U I D E T O A K E T O WAY O F L I F E

Both books are available at Amazon.com. For more from Dr. Kiltz, please visit DoctorKiltz.com 146

By Dr. Robert Kiltz, MD.


Air Quality & Fertility • Ultrafine particles can be especially dangerous for pregnant women. Ultrafine particles can penetrate into the lungs and extra-pulmonary organs which can transfer toxic compounds to the fetus and placenta. • Women exposed to air pollution while pregnant have a higher risk of developing cardiometabolic diseases later in life, such as heart disease, diabetes, and stroke due to increases in oxidative stress, inflammation and endothelial dysfunction. • Exposure to high levels of pollution can result in sperm DNA damage, leading to male-mediated infertility, miscarriage, and other adverse reproductive outcomes. • Emerging studies suggest air pollution is also closely related to various birth complications, low birth weight, and increased risk of still birth.

What are You Breathing? PROTECTING YOUR HOME’S AIR QUALITY: A recent global study on the effects of air pollution concludes that toxic air may be damaging every organ and virtually every cell in the human body, causing harm from head to toe, including dementia, heart and lung disease, fertility problems, and reduced intelligence. In fact, there are more than 70,000 scientific papers demonstrating that air pollution is affecting our health. Perhaps the most disturbing impact of air pollution is the damage to reproduction and children. Fertility is reduced and miscarriages increased by exposure to air pollution. How does it happen? Ultrafine particles pass through the lungs, are readily picked up by cells, and carried via the bloodstream exposing virtually every cell in the body. The main reason for the far-reaching damage from air pollution is systemic inflammation. Immune cells think pollution particles are bacteria, so they go after it and try to kill

it by releasing enzymes and acids. These inflammatory proteins spread into the body, affecting the brain, the kidneys, the pancreas and every organ system. From an evolutionary perspective, our bodies have evolved to defend against infections, but not pollution.

Infants & Air Quality • A fetus exposed to air pollution during pregnancy has an increased risk of cancers, such as leukemia and Hodgkin lymphoma, respiratory diseases, allergic disorders and anemia as an infant • Children exposed to air pollution early on in life can also develop structural and volumetric abnormalities in the brain, as well as auditory, vestibular, and cognitive deficits. • According to the World Health Organization, more than 50% of premature deaths due to pneumonia among children under 5 are caused by the particulate matter (soot) inhaled from household air pollution

The Environmental Protection Agency Recommends: • Eliminate the source of pollution • Use chemical-free cleaning products • Clean the air with a high efficiency, portable air cleaner

There is also evidence that poor sleep can be a consequence of breathing toxic air, which has its own lasting effects on day to day living.

The Intellipure Difference • Effectively eliminates >99% of all particles

And while the possibility of controlling the air we breathe 24/7 boggles the mind, we can control the air we breathe in our homes and while we sleep. Intellipure has an air purification system that can provide the highest level of air cleaning performance while eliminating more than 99% of particles in the air. CNY Fertility is proud to have partnered with Intellipure to offer the same air purification systems we use in our offices to our clients for use in their homes. Please visit www.intellipure. com for more information, and don’t forget to use the code CNYFERTILITY to save 20% on your Intellipure home air purifier.

• Reduces mold, bacteria, virus, fungi, heavy gases and odors • Each unit is individually tested and certified to provide the highest level of air cleaning performance

D F S T E C H N O LO GY : T E S T E D TO U G H Laboratory test research shows that DFS system significantly reduces airborne bioburden in clean-rooms. It trapped and inhibited bacteria, and also improved the filtration performance of a­­­­­­­­ filter media by two to three orders of magnitude. (Control and Monitoring of Bioburden in Biotech / Pharmaceutical Cleanrooms Jaisinghani, et al) Exposure of bacteria on the surface of the internal filters in the DFS Air Cleaner can significantly reduce their survival rate. (Effect of the DFS Air Cleaner on the Survival of Microorganisms Fannin) The DFS system units can remove all particles passing through the system with near-zero count at the exhaust side of the DFS system of all particles larger than 0.007 micron. (Supporting case study by University of Buffalo IUCB, Baier, Ciriano, et al)

Bring healthy air to your home with the world’s best air purifier. CNY Fertility has partnered with Intellipure to offer a 20% discount to our clients. Use code: CNYFERTILITY

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SYRACUSE

ALBANY

CNY Fertility Center – Syracuse 195 Intrepid Lane Syracuse, New York 13205 315-469-8700

BY CAR

Our Syracuse office is just a short drive from the heart of the city. In your free time, catch an SU game or spend a couple hours at Destiny USA, New York’s largest shopping, dining, and entertainment center.

Our offices are located just off of Rts. 81 and 481, easily accessible from points east and west on the New York State Thruway. Take exit 1 (Brighton Ave.), toward Nedrow. Then turn left onto East Brighton Ave. Take a left onto Intrepid Lane. Our building is up on your left.

Before or after your appointment, relax at our Healing Arts Wellness Center & Spa located just upstairs from our CNY Fertility offices. Enjoy a massage, take a yoga class, have an acupuncture session, or a nutrition consultation while you’re here. Grab a healthy drink at our Fertile Grounds Café and take a moment for yourself in our comfortable surroundings.

BY AIR Nearby Syracuse International Airport offers convenient flights from all major cities and airlines.

BY TRAIN Amtrak’s Empire Service offers frequent daily trains between NYC and Syracuse, departing 150

from Penn Station and arriving at Syracuse Regional Transportation Center.

WHERE TO STAY Maplewood Suites Extended Stay 315-451-1511 400 7th North Street Liverpool, NY 13088 5 miles to office (offers airport shuttle, discounted rate when you mention CNY Fertility, free breakfast)

CNY Fertility Center – Albany 38A Old Sparrowbush Road Latham, New York 12110 518-690-0700 Our Albany office is conveniently located near major cities like Boston and NYC, just a few hours drive away and even closer by plane or train. With comfortable and reasonably priced lodging options, affordable fertility care at CNY Fertility is easily accessible to patients on the east coast. While you are in the area, be sure to schedule a treatment at our Healing Arts Center located upstairs from our CNY Fertility office. You can enjoy a relaxing massage, take a yoga class, or have an acupuncture session. Our offices are not far from world-class shopping and many fine dining options.

BY CAR Our offices are located just off of the New York State Thruway / Rt. 87. Take 87N toward Albany International Airport / Montreal. Take Exit 7 and merge onto NY-7E toward Troy / Cohoes. Take exit onto US-9 toward NY-9R. Continue onto Sparrowbush Road, then turn right onto Old Sparrowbush Road. Our building is up on your right.

WHERE TO STAY Holiday Inn Express 518-783-6161 400 Old Loudon Rd Latham, NY 12110 less than 1 mile (offers airport shuttle)

BY AIR Nearby Albany International Airport offers convenient flights from all major cities and airlines.

BY TRAIN Amtrak’s Empire Service offers frequent daily trains between NYC and Albany, departing from Penn Station and arriving in the AlbanyRensselaer train station. 151


BUFFALO

ROCHESTER

CNY Fertility Center – Rochester 2244 East Avenue Rochester, NY 14610 585-244-1280 Located in the heart of the Finger Lakes Region, our Rochester office is within an hour of several nearby Finger Lakes—Canandaigua (45 min.), Conesus (40 min.), and Keuka (1 hour). Depending on the season, there is always something to see and do. And don’t miss a chance to schedule a treatment at our Healing Arts Wellness Center & Spa located upstairs from our CNY Fertility office. You can enjoy a relaxing massage, take a yoga for fertility class, or have an acupuncture session. Grab a healthy smoothie, pressed juice, or cup of coffer or tea at the Fertile Grounds Café while you visit. Spend a few minutes relaxing in our comfortable atmosphere between spa treatments or just catch your breath.

BY AIR Nearby Greater Rochester International Airport offersconvenient flights from all major cities and airlines.

BY TRAIN Amtrak’s Empire Service offers frequent daily trains between NYC and Rochester, departing 152

from Penn Station and arriving in the Rochester station.

BY CAR Our offices are located just off of the New York State Thruway. Take Exit 45 and merge on I-490 toward Rochester. Take Exit 25 toward Fairport/ East Rochester and merge onto NY-31F. Turn left onto Fairport Road/NY-31F. NY-31F become East Ave/NY-96. Our offices are approximately 2 miles ahead on the right.

WHERE TO STAY Rochester Plaza 585-546-3450 70 State Street Rochester, NY 14614 3.8 miles from our office

CNY Fertility Center – Buffalo 835 Hopkins Road Buffalo, NY 14221 716-688-5131 Our Buffalo office is conveniently located near major international cities like Toronto, Ontario, and all points in Western New York. Enjoy some of Buffalo’s world-famous foods or take in a game or two with one of Buffalo’s professional sports teams. Beautiful Niagara Falls is just a short ride away.

Sheridan Drive) toward Harlem Rd/NY-240 and merge onto NY-324. Turn right onto Sheridan Drive/NY-324. Turn left onto Hopkins Road/87. CNY Fertility’s offices are approximately 2 miles ahead on the right.

WHERE TO STAY Residence Inn by Marriott Buffalo Amherst 716-632-6622 100 Maple Road Amherst, NY 14221 3 miles from our office

BY AIR Nearby Buffalo Niagara International Airport offers convenient flights from all major cities and airlines.

BY TRAIN Amtrak’s Empire Service offers frequent daily trains between NYC and Buffalo, departing from Penn Station and arriving in the Depew station.

BY CAR Our offices are located just off of the New York State Thruway. Take Exit 25A and merge on I-290 toward Niagara Falls. Take Exit 6 (NY-324/

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MONTRÉAL

ATLANTA

CNY Fertility Center – Atlanta 924 West Spring Street Monroe, Georgia 30655 770-266-0933 Our newest office location and first outside of New York State is in suburban Atlanta, 35 minutes east of downtown Atlanta and 45 minutes from Hartsfield Jackson International Airport. Before or after your appointment, be sure to enjoy an organic coffee or tea and a local artisan treat at our wellness center/coffee shop where you can learn from a certified herbalist or discover the power of essential oils and aromatherapy. There’s lots to see and do while visiting Atlanta: visit the Georgia Aquarium, Centennial Olympic Park, tour the Jimmy Carter Presidential Library & Museum, or grab a bite at the Krog Street Market.

BY CAR Our offices are located just off of GA-138. Turn right onto West Spring Street/US78 Bypass East/ GA-10 Business. Our Offices are ahead on the left.

WHERE TO STAY Please call our office for lodging suggestions.

CNY Fertility Center – Montréal 6363 Transcanadienne, Ste. 105 Montréal (QC) CANADA H4T 1S3 514-508-1114

BY AIR

CNY Fertility’s first international location in historic Montréal is just 15 minutes from Pierre Elliott Trudeau International Airport. Take advantage of the full range of women’s health services, including counseling, to help put you completely at ease as you begin your fertile journey.

WHERE TO STAY

Nearby Pierre Elliott Trudeau International Airport offers convenient flights from all major cities and airlines.

Please call our office for lodging suggestions.

There’s lots to see and do while visiting Montréal: tour Old Montreal, visit the Montréal Museum of Fine Arts, Mont-Royal, Biodome, and the Basilica of Notre Dame. And don’t forget to treat yourself to some poutine.

BY AIR Nearby Hartsfield Jackson International Airport offers Convenient flights from all major cities and airlines.

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COLORADO SPRINGS

PHILADELPHIA

CNY Fertility Center – Colorado Springs 265 S. Parkside Drive Colorado Springs, CO 80910 877-475-BABY

CNY Fertility Center – Philadelphia 520 Bustleton Pike Feasterville, PA 19053

There’s no shortage of things to do—indoors and out—when visiting our Colorado Springs office. With more than 300 days of sunshine per year and over 30 natural attractions, including the famous Pikes Peak, Garden of the Gods Park, Seven Falls, and Cave of the Winds, you’ll have difficulty narrowing down your list. Hiking, walking, or just relaxing, there are lots of beautiful vistas to enjoy.

BY AIR

CNY Fertility Philadelphia is a monitoring-only office for those traveling to other CNY Fertility locations for IUI, IVF, Donor Egg IVF and more. The City of Brotherly love is the birthplace of life, liberty and the pursuit of happiness. You can begin your family journey here as well. Thousands travel to CNY every year for fertility treatment. Every member of our staff is passionate about treating the whole person and supporting you in every way possible.

Nearby Colorado Springs Airport and Denver International Airport (about 75 min away with 20 shuttles per day to Colorado Springs) offer convenient flights from most major cities and airlines.

If you don’t live near one of our full-service office locations, but do live a short drive from Philadelphia, scheduling your cycle monitoring appointments in Philadelphia can save you time and money.

WHERE TO STAY

Have your ultrasounds and bloodwork performed closer to home. Your CNY provider will review the results and call you with updates, next steps, and tell you when to schedule your next monitoring appointment.

Hotel Eleganté Conference & Event Center (719) 576-5900 2886 S Circle Dr, Colorado Springs, CO 80906

CNY Philadelphia plans to offer additional fertility services in the future. 156

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SARASOTA

CNY Fertility – Sarasota 5922 Cattlemen Lane Sarasota, FL 34232 CNY Fertility Sarasota is a satellite/ monitoring facility performing ultrasounds and bloodwork for those traveling to other CNY Fertility locations for IUI, IVF, Donor Egg IVF, and other services. We offer intralipids, IVIG, hCG and Neupogen Washes, and Saline Sonohysterograms, and plan to offer IUI, Semen Analysis, Sperm Freezing, and PRP in the near future. Please check with your provider. Soak up the sun (and boost your vitamin D) along Sarasota’s white-sand beaches. Just an hour south of Tampa, CNY Sarasota is CNY Fertility’s southern-most office serving the fertility needs of patients along Florida’s Gulf Coast. As the nation’s most affordable fertility clinic and the only to offer in-house payment plans, CNY makes top-quality care possible for all.

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Let CNY Fertility be part of your journey.


The single best way to reduce inflammation throughout the body is to adopt a high fat, low protein, near zero carbohydrate diet, such as Dr. Kiltz’s B.E.B.B.I.S. Plan.

What is the B.E.B.B.I.S. Plan? Pronounced “BABIES”, the B.E.B.B.I.S. Plan is a high fat (80%), medium protein (20%), zero carbohydrate food plan that focuses on bacon, eggs, butter, beef (or other fatty meat), ice cream, and salt. It’s also referred to as The Lion King Plan or the Carnivore Plan, because you’re eating like the king of the jungle—high fat, a small amount of protein, and no carbohydrates. This means eliminating all fruits and vegetables as well, as they are carbs and contain sugar and phytochemicals. In combination with intermittent feasting, the B.E.B.B.I.S. Plan has been shown to help boost fertility in both men and women by naturally reducing inflammation throughout the body.

Why B.E.B.B.I.S.? Diet is the number one source of chronic inflammation and fertility dysfunction. Making changes to what, when, and how frequently you eat can heal your body and reduce inflammation. The excessive and repeated consumption of carbohydrates, sugars, grains, fruits, fiber and vegetables is very inflammatory to our bodies. Constant sugar in the bloodstream, along with plant phytochemicals and antigens cause an immunologic response. White cells and cytokines are enhanced. You might feel it in your joints, your skin, bowels, head, eyes, or you may not even feel it at all. Heat in the gut and bowels carries over to the reproductive organs in both men and women damaging the uterus, tubes, and testes. Untreated, chronic inflammation can result in repetitive pregnancy loss, failed implantation during IUI, IVF or natural cycle, or simply not conceiving.

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Fat is Essential... Sugar & Carbs are NOT! Contrary to what we’ve been told and what many of us believe, fat is healing. Fat is the building block of every cell in our bodies. Fat can reduce inflammation and help our body repair itself. It’s really fruits, fibers, vegetables, grains and the constant ingestion of carbs that make us fat and chronically inflamed. Our bodies require fat for energy. If we can’t eat fat or make fat, we die. The mitochondria of our cells need saturated fat (beef fat, pork fat, butter fat). Unfortunately, the majority of fat we consume is industrial, man-made fat. What we really need to be eating is nature’s fat—that stuff that surrounds the animal or is intertwined and marbled in every nook and cranny of the meat. Excessive sugar leads to inflammation. All carbohydrates and all plant material (that’s fruits, veggies, and fiber) convert to sugar and then to fat in the liver. Carbohydrates and sugar are non-essential nutrients. Our bodies require zero carbs and zero sugar. Eating fat in its purest form is the simplest energy source for our bodies.

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Dr. Kiltz B.E.B.B.I.S. Plan

Bacon

Eggs

Butter

Beef

Ice Cream

Intermittent Feasting

Bacon, Eggs, Butter, Beef, Ice Cream, Salt Salt

WHAT TO EAT

WHEN TO EAT

Beyond bacon, eggs, butter, beef, and Kiltz’s Keto ice cream, I recommend that you stay very narrow in your selection of foods. Minimize the variety and simplify your meals. Eliminate pasta, bread, yogurt, milk, seeds, and nuts. Stay away from lean meats and try to choose grass-fed, all-natural meats. B.E.B.B.I.S. is about streamlining and simplifying.

Once per day is best. Intermittent fasting (or intermittent

You want to consume fatty meats like a rib-eye steak, not lean, fat-free chicken breast. You need to eat the fat. By adding fat, cream, butter, and eggs, you reduce inflammation; you reduce your appetite; you reduce your glucose levels; your energy is so much better; and your body begins to heal itself. Fat in its best and purest, most natural form comes from animals (lard, tallow, butter, ghee, duck fat). Secondarily, there are several fruits and vegetables that are high in fat, like coconut oil, cocoa butter, and hemp seed oil. Stay away from vegetable oils like soybean, canola, vegetable, sunflower, and corn oil. Be sure to include enough salt in your diet. Your body needs salt to help regulate fluid balances. As you’re eating fewer processed foods and your body begins to shed electrolytes and fluids while in ketosis, your body also loses salt. Even Good Meal Choices: transitioning from regular • Rib Eye Steak or other keto to the B.E.B.B.I.S. Plan, cut with good marbling you will lose extra water • Pork Belly from inflammation. Brain fog, • Liver/organ meats muscle cramps, headaches, • Pork/Lamb Shoulder, dizziness, and similar Chops, Ribs, Brisket • Skin-on Chicken symptoms are all likely signs thighs and wings fried you need more salt. in own fat

“feasting” as I refer to it) is highly recommended with the B.E.B.B.I.S. Plan. This involves eating just one meal a day and allowing 12-24 hours between feedings. We’re not meant to eat 3-6 meals a day with snacks in between, constantly filling the gut with fiber and carbs that ferment and feed the bacteria and yeast in our gastrointestinal tract causing more disease. Our bodies are well-designed to go without food, yet most of us consume excessive calories that add fat to our bodies. It’s best to eat just before bedtime, giving your body time to rest and digest while you sleep.

Getting Started on the B.E.B.B.I.S. Plan

WHAT TO DRINK: Water, Coffee, Tea, Bone Broth

it. Avoid alcohol in all forms. Alcohol is toxic to your body.

GET RID OF ALL GRAINS —(Wheat, corn, rice, oats)

2 TBSP of granulated pure cane sugar

GET RID OF ALL HYDROGENATED OILS (AKA VEGETABLE OILS)—Most vegetable oils contain

2 TBSP pure vanilla extract

inflammatory

• •

Purchased or homemade bone broth is another great addition.

GET RID OF ALL FRUITS, VEGETABLES, AND FIBER.

NOTE: Recipe can be doubled depending on the capacity of your ice cream maker

Add sugar, egg, and vanilla extract.

PRACTICE INTERMITTENT FEASTING —

Whisk until well combined and frothy. Pour into ice cream machine and follow manufacturer’s instructions.

stream and reduce glycation.

Helpful Resources: DoctorKiltz.com Dietdoctor.com Livinlavidalowcarb.com Kendberrymd.com

What you eat is far more important than how much you

down. That doesn’t mean stop moving, but be cognizant that

Carnivoreaurelius.com

eat. You will find that fatty meats are more filling than lean

strenuous exercise heats up the body and takes the blood

Kevinstock.io

meats, and you will likely feel full before you finish your meal.

flow away from your core where it’s needed.

Shawn-baker.com

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1 egg (organic preferred) (optional)

the fat, eat it!

We are meant to walk, take in the sites, not run or churn away

are great for your mind, body, and soul. I urge clients to slow it

DIRECTIONS:

additional friction, heat, trauma, and damage in the body.

movements accompanied by mediation and quiet thinking

(can use vanilla bean scraped as well)

Shake cream and pour into a large bowl.

longer periods of fasting reduce glucose in the blood

Activities like high intensity running or spin class create

(preferably grass-fed)

Eat rib-eye steak, fatty bacon, eggs, and butter. Don’t trim

(1-2 meals per day spaced out) Intermittent feasting or

Intentional movement is key, but avoid excessive exercise.

1 Pint of High-Quality Heavy Cream

ADD THE FAT! Add full-fat heavy cream to your coffee.

It’s a great snack and a soothing way to start or end the day.

EXERCISE

INGREDIENTS:

GET RID OF ALL SUGAR

Have a cup of coffee or tea with cream or butter and a glass of water (still or bubbly with no added sugar) when you need

Kiltz’s Keto Ice Cream

Polyunsaturated Fatty Acids (PUFAs) and are very

on the elliptical. Yoga and Tai Chi are ideal options. Slow

HOW MUCH TO EAT

Eating a meat-based or carnivorous diet provides all of the essential nutrients your body needs. A vegetarian diet—even with “super foods” and their antioxidants—cannot deliver some of these essential vitamins and minerals. This is why most vegetarians must take supplements.

Mariamindbodyhealth.com

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