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Adriana Wong, MD MPH

@adrianawongmd

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Your BFF fertility doc👩🏻‍⚕️
OB/GYN & fertility specialist in LA 🌴
Views mine, info not medical advice
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Ultrasound findings in early pregnancy 👶🏻

4-5 weeks: Tiny fluid-filled sac appears in the uterus called the gestational sac
5-6 weeks: Yolk sac shows up
6-7 weeks: Fetal pole (looks like a grain of rice at first) then cardiac motion can be seen
8 weeks: Tiny limb buds start to form!

#pregnancyjourney #pregnancyultrasound #pregnant #obgyn #fertility by @adrianawongmd

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2 years ago

longgggg post, but one that I worked really hard on so that you can go into IVF or egg freezing with a better idea of what the whole process may look like from start to finish! 🥚💉A lot of this covers information that I talk about with patients day in and day out. Of course, there is SO much more nuance to this than I could possibly fit into an IG carousel, and every person’s treatment plan will look a little different. If you have questions, drop them in the comments and I’ll try to go into more detail!

If you’re thinking about fertility treatment, egg freezing, or just want to better understand your fertility and options, you can schedule a consultation with me at the link in my bio. I’d love to help you figure out the best plan for you 🧡 by @adrianawongmd

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a month ago

Do any of these come as a surprise? #ttc #ttccommunity #fertility #infertility #ivf #ivfjourney taken in Los Angeles, California by @adrianawongmd

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2 years ago

Save this for your first fertility appointment! #ad

There’s a lot to think about before your first fertility appointment. Remembering every detail about your cycle shouldn’t be one more thing on your list.

If you track with the @naturalcycles app, you can export your Cycle Report before you go. It brings together data from your last six cycles, including cycle length, periods, detected ovulation, and logged symptoms, into one report you can share with your provider.

It’s a simple way to come prepared and give your doctor more context about your cycle as part of your overall fertility evaluation.

NC° is for 18+ and does not protect against STIs. Always read and follow the instructions for use. by @adrianawongmd

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2 days ago

If you’re considering fertility preservation, one of the decisions you may face is whether to freeze eggs vs. embryos. Both are great options, but there are some important differences to consider!

Egg freezing gives you more flexibility. You don’t have to decide on a sperm source right now, which can be especially helpful if you’re unsure about a future partner or donor. The tradeoff? We have less information about the reproductive potential of those eggs until they’re eventually thawed, fertilized, and grown into embryos.

Embryo freezing gives you more information upfront. We can see how many eggs successfully fertilize and develop into blastocysts, assess embryo quality, and potentially perform preimplantation genetic testing (PGT-A). This gives us more information about the likelihood of future success, although it still doesn’t guarantee a pregnancy.

There are also other factors to consider, including cost, thaw survival rates, and legal considerations surrounding embryo ownership and future use.

Ultimately, this is a very personal decision but I am always there for my patients to be a sounding board and help weigh the pros and cons of each! The right choice depends on your age, reproductive goals, relationship circumstances, and how much flexibility you want to preserve for the future. by @adrianawongmd

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Have you ever heard of taking baby aspirin in pregnancy to reduce the risk of preeclampsia? by @adrianawongmd

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7 days ago

What should you actually do to optimize your fertility? 🥒🍓🏃🏻‍♀️ I totallyyy understand being motivated and wanting to do whatever it takes to improve your chances of pregnancy, especially while going through fertility treatment. On the flip side, I’ve also seen people take lifestyle changes so far that they become stressful, expensive, restrictive, or centered around things that don’t necessarily have good evidence behind them.

These are the things I usually focus on:

- Keep underlying health conditions well-controlled. Things like thyroid disease, diabetes, hypertension, and other chronic conditions can affect fertility and pregnancy, so optimizing your general health matters.
- Track your cycle closely. Know your cycle length, when you are likely ovulating, and your fertile window so you can time intercourse appropriately.
- Stop smoking, including vaping and marijuana. Tobacco use is associated with worse fertility outcomes, and I recommend no nicotine and recreational drug use while trying to conceive.
- Minimize alcohol. You do not need to panic about every drink you have ever had, but keeping alcohol intake low while TTC is a reasonable goal. This is also good for your overall health...alcohol is a carcinogen.
- Focus on whole, fresh foods rich in fiber and nutrients. Think vegetables, fruits, whole grains, legumes, nuts, healthy fats, and good sources of protein. You don’t need to have a perfect diet all the time - you should be able to live and enjoy life too! Shoot for 80/20.
- Prioritize good sleep habits. Aim for consistent, adequate sleep and a schedule you can realistically maintain.
- Exercise regularly. Studies favor a combination of moderate-intensity cardio and resistance/weight training, adjusted for your baseline fitness and any medical conditions.
- Prioritize your mental health and stress management. Stress itself does not cause infertility, but TTC and fertility treatment can contribute to overall life stress.

The goal should be to build habits that support your overall health and are realistic enough to maintain while you are trying to conceive or going through fertility treatment. by @adrianawongmd

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5 days ago

What does IVF look like if you’re planning to use donor sperm? There are generally two pathways: using a sperm-bank donor or using a known donor, such as a friend or someone you know personally.

With a sperm-bank donor, you can usually review information like physical characteristics, education, interests, personal and family medical history, and sometimes childhood photos, adult photos, or audio interviews. Donors also undergo screening, which includes infectious disease testing and genetic carrier screening.

A known donor may also be an option, but the process is usually more involved. Infectious disease testing, genetic screening, counseling, and legal agreements will all need to be done before the sperm can be used. Depending on the situation, the sperm may also need to be collected, frozen, and quarantined before treatment.

From there, donor sperm can be used for either IUI or IVF.

Beyond the medical process, there are also important questions around donor identity, future contact, disclosure to your child, genetics, and legal parentage that are worth thinking through before treatment starts.

This process might seem daunting but your doctor or your clinic can walk you through it step by step!! 🫂 by @adrianawongmd

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8 days ago

Vitamins and supplements are a huge industry, and when you’re trying to conceive it can feel like there is always one more thing you’re “supposed” to be taking.

One important thing to know: supplements are not regulated the same way as medications. They are not required to prove safety or effectiveness before being sold, and they are not regulated by the FDA in the same way medications are. That means a product can be marketed for “fertility” even when there is very limited evidence that it actually improves fertility outcomes.

So what actually has good evidence behind it?

Folic acid is the big one. ACOG, SMFM, and ASRM recommend at least 400 mcg of folic acid daily for those who are trying to conceive. Ideally, this starts at least 1 month before pregnancy because the neural tube develops very early, often before someone even knows they’re pregnant. Folic acid supplementation reduces the risk of neural tube defects.

For other vitamins, the goal is generally to make sure you are meeting your nutritional needs and to correct deficiencies when they are present. Vitamin D is one example, and deficiency can be checked with a simple blood test.

CoQ10 gets a lot of attention because of its role in mitochondrial function. Some studies in women with diminished ovarian reserve suggest it may improve ovarian response and certain embryology outcomes, but the evidence is still limited and it is not routinely recommended for everyone.

Myo-inositol is most often discussed in patients with PMOS. It may have some benefit for insulin sensitivity and metabolic measures, although the evidence for improving fertility outcomes is still limited. Metformin has stronger evidence for certain metabolic and reproductive indications in PMOS.

#ttc #fertility #infertility #vitamins #supplements by @adrianawongmd

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11 days ago

Does a low AMH mean you have low quality eggs? No, not necessarily and here’s why: AMH (anti-Mullerian hormone) is primarily a marker of ovarian reserve, meaning it helps us estimate the number of eggs remaining and, in fertility treatment, how many eggs we might expect the ovaries to recruit with stimulation. It is pretty good at helping us predict egg quantity and ovarian response to IVF medications. What it is much less useful for is predicting whether those eggs are chromosomally normal or whether someone will ultimately become pregnant.

When we talk about “egg quality,” one of the most important factors we are usually referring to is the likelihood that an egg will ultimately create a euploid embryo, meaning an embryo with the expected number of chromosomes. For that, age is much more informative than AMH.

A large F&S study (PMID 24355045) looked at 15,169 blastocyst biopsies and found that the lowest rates of aneuploidy were seen around ages 26-30. Aneuploidy then increased progressively with age. Roughly 20-30% of embryos were aneuploid around ages 26-31, compared with more than 70% in women over 40. The study also found that the chance of having no euploid embryos at all in a cohort was only about 2-6% from ages 26-37, but increased to 33% at age 42 and 53% at age 44.

This is why two patients can have the exact same AMH and very different expected outcomes depending on their age. The opposite is also true: someone can have a low AMH but still make chromosomally normal embryos. They may just have fewer eggs, and therefore fewer opportunities to find one.

Usually when I counsel patients, I think about these as two different pieces of information:
1. AMH helps tell us about quantity
2. Age tells us much more about expected quality taken in Los Angeles, California by @adrianawongmd

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11 days ago

finally posting Paris pics - back when we were croissant maxxing 🥐🥖🇫🇷 taken in Paris, France by @adrianawongmd

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15 days ago

Can you still conceive with only one fallopian tube? One of the coolest parts of our anatomy is that the fallopian tube is not directly attached to the ovary. Instead, the finger-like projections at the end of the tube, called fimbriae, help capture the egg after ovulation.

A healthy remaining tube can even pick up an egg released from the opposite ovary. In fact, one study of 707 women with a history of unilateral salpingectomy found that about one-third of unassisted pregnancies resulted from the remaining tube picking up an egg from the opposite side 🤯😯🫨

Still, it is very important to make sure the remaining tube is healthy and open. For example, after an ectopic pregnancy, there may be underlying risk factors that caused tubal damage or scarring, and sometimes both tubes can be affected.

The bottom line is that it is still possible to conceive with one healthy fallopian tube! by @adrianawongmd

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16 days ago