In This Issue
5 Reasons to Consider IVF as Your FIRST Infertility Treatment
Could Taking Painkillers Mess With Your Heart?
5 Surprising Benefits of Yoga
Answers to Embarrassing Questions About "Down There"
5 DIY Health Checks That Could Save Your Life

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We have 3 office locations to accommodate our patients in the Mercer and Bucks County areas:


123 Franklin Corner Rd.

Suite 214

Lawrenceville, NJ 08648

Phone: 609-896-1400 

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1401 Whitehorse-Mercerville Road

Suite 216

Hamilton, NJ 08619

Phone: 609-890-2412 

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909 Floral Vale Boulevard

Yardley, PA 19067

Phone: 215-504-9090 

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Our physicians and midwives deliver at

 Capital Health System's Hopewell Campus 

in Pennington, NJ

5 Reasons to Consider IVF
as Your First
Infertility TreatmentIVF
pregnant belly
By Dr. Art Castelbaum of Reproductive Medical Associates (RMA).

1) IVF is dramatically more successful than ovulation induction with intrauterine insemination. Although many couples initially choose Clomid or Femara with intrauterine insemination, pregnancy rates are generally less than twelve percent per cycle.   In our practice, women under age thirty five transferring a single embryo can expect an IVF implantation rate (seeing a sac in the uterus with ultrasound after embryo transfer) of fifty five percent. A recent important study (FORT-T) showed that in women aged thirty eight to forty two with good egg quality (ovarian reserve), initial treatment with in vitro fertilization is the most cost effective and successful approach.

2) For couples without insurance coverage for infertility treatment, early in vitro fertilization is very cost effective.   Ninety percent of women who conceive usng Clomid with intrauterine insemination become pregnant within 3 cycles. Among younger patients, we strongly encourage IVF after two or three unsuccessful cycles of Clomid with insemination.

3) In vitro fertilization decreases the incidence of twins. We routinely transfer only a single embryo for women under age thirty five with outstanding pregnancy rates. The ability to perform embryo biopsy with comprehensive chromosomal screening and transfer a single genetically normal embryo allows for a sixty-five percent implantation rate for women up to age forty-two.

4) Many women undergoing in vitro fertilization will have additional embryos available for freezing. In our experience, frozen embryos are just as likely to result in pregnancies compared to fresh embryos. Frozen embryos don't age. If a woman freezes embryos at age 33, they will always have the risk of miscarriage and Downs Syndrome of a 33-year old, even if thawed and transferred when the patient is much older.

5) RMA at Jefferson and RMA of Central PA at Pinnacle Health are proud of our world-class IVF program.   We offer many affordable options including a money-back IVF guarantee and first responder and military discounts to make IVF affordable for our many patients who do not have insurance coverage.
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heart2Could Taking Painkillers Mess With Your Heart?   Heart rhythm
It's a common habit: When you have a headache or bad period pains, you pop an OTC painkiller and then get on with your day.
But recent drug-safety communication from the Food and Drug Administration has some people rethinking the move.

In the notice, the FDA announced that it will adjust the labels for non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) to say the following: "The risk of heart attack or stroke can occur as early as the first weeks of using an NSAID. The risk may increase with longer use of the NSAID. The risk appears greater at higher doses."

The most common forms of over-the-counter NSAIDs are ibuprofen and naproxen, and they're usually taken for pain relief. But heart attack? Stroke? That's kind of terrifying.

Don't panic, says women's health expert Jennifer Wider, M.D.-just be smart about it. "People who are taking these meds should take the lowest effective dose possible for the shortest period of time," she says.
So if you take an ibuprofen here and there for pain, you're probably okay.

Wider points out that the labeling is essentially changing to say that there is a risk of heart attack or stroke, versus there "might" be an increased risk of heart attack or stroke (as the labels used to say). Since research has found a solid connection, the FDA decided it's time for an update.

People who need to be concerned are those with heart disease and stroke risk factors (like high cholesterol, diabetes, obesity, and a history of vascular disease), says Wider.
However, she points out that if you're taking NSAIDs in high doses for longer periods of time, you should keep these risks in mind.
While people who are older tend to be more likely to suffer from complications, Wider says "it's not really an age thing. It's more of a risk factor thing."

Bottom line: You shouldn't freak out and throw away all of your ibuprofen. But if you experience any heart-related side effects while taking an NSAID, call your doctor immediately.

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September 2015 

September is National Yoga Month!
Now that the summer season has past, this is the perfect time to start anew and rejuvenate yourself for the fall. September is National Yoga Month, which was designed to educate about the health benefits of yoga and to inspire a healthy lifestyle. With a regular practice, individuals often notice a stronger, slimmer and more flexible body, in addition to a mentally sharper, more patient and relaxed sense of self.  Still not convinced? Check out these 5 Surprising Benefits to Yoga that will have you saying, "Namaste!" in no time!

Millions of women have a "down there" dilemma. Yes, millions. Unfortunately - though perhaps understandably - many of them keep these problems to themselves. As much as women share with each other about personal issues, they still may consider pelvic disorders to be too taboo to talk about with their friends, their sisters, even their doctors. Whether you're having painful periods or zero interest in sex, there's a lot going on "down there" that you probably don't feel comfortable chatting about.   So, we've decided to get the conversation started! Be sure to check out our article, Answers to Embarrassing Questions About "Down There."

You may have heard about a new study released last month that links drugs like ibuprofen to a higher risk of heart attack and stroke. So, does this mean you have forgo taking Advil after a particularly grueling workout or to get rid of a bad headache? Not necessarily. But it begs the question, Could Taking Painkillers Mess with Your Heart? Find out how worried you really need to be about the notice the FDA just issued.

If you're conscientious about your health, you probably see your doctor for an annual physical...or perhaps even more often if you have a chronic condition or get sick. But if you'd like to keep tabs on your health between your doctor visits, there are some easy, do-it-yourself tests that can give you valuable information about your body. These tests can sometimes tip you off that you may have a serious medical condition even though you don't have any symptoms. Here are 5 DIY Health Checks that Could Save Your Life that you should never be too busy to do.

Have you heard the news? We're thrilled to have Reproductive Medicine Associates (RMA) of Philadelphia and Central Pennsylvania on our team. Our patients benefit from having world-class infertility specialists right in our Yardley location on the second Friday of every month. If you've been struggling to conceive and are not sure where to start, be sure to read Dr. Castlebaum's 5 Reasons to Consider In Vitro Fertilization (IVF) as Your First Infertility Treatment.

With warm regards,
The Practitioners and Staff of Lawrence OB/GYN 
5 Surprising Benefits of Yogayoga 
yoga-studio.jpg Yoga increases flexibility and reduces stress, but the practice can do more than help you twist your body into pretzel shapes and find inner peace. These hidden benefits will help you in the kitchen, office and bedroom -- and will give you five new reasons to show off your yoga skills (plus recommended poses for each one!).

1. Boost Immunity
A recent Norwegian study found that yoga practice results in changes in gene expression that boost immunity at a cellular level. And it doesn't take long: The researchers believe the changes occurred while participants were still on the mat, and they were significantly greater than a control group who went on a nature hike while listening to soothing music. Yoga also helps to boost immunity by simply increasing overall health, says Mitchel Bleier, a yoga teacher of 18 years and owner of Yogapata in Connecticut. "As you breathe better, move better and circulate better, all the other organs function better."

Strike A Pose: Sun Salutation (Surya Namaskar)
This sequence of eight poses performed in a row can be found in almost any yoga class. It creates great circulation and tone, plus sweat, says Bleier.

2. Ease Migraines
Research shows that migraine sufferers have fewer and less painful migraines after three months of yoga practice. The cause of migraines isn't fully understood, but Bleier says it could be a combination of mental stressors and physical misalignment that create migraines and other issues. Hunching over a computer or cell phone with your shoulders up and head forward causes overlifting of your trapezius and tightening of the neck. This pulls the head forward and creates muscle imbalances that can contribute to headaches and migraines.

Strike A Pose: Bridge Pose (Setu Bandha Sarvangasana)
Lie on your back with your knees bent and your feet hip-distance apart on the floor. With your hands resting on the floor, begin to press down into your legs and draw your hips toward the sky. The key, Bleier says, is to keep your shoulders in line with the base of your neck, moving the back of the shoulders together so the shoulder blades are close. Lift your chest towards your chin and your chin away from your chest, so the upper trapezius muscles flow away from the head.

3. Boost Sexual Performance
Studies have found that 12 weeks of yoga can improve sexual desire, arousal, performance, confidence, orgasm and satisfaction for both men and women. How? Physically, yoga increases blood flow into the genital area, which is important for arousal and erections, says Bleier, and strengthens the "moola bandha," or pelvic floor muscles. Mentally, the breathing and mind control involved with the practice can also improve performance.

Strike A Pose: Bound Angle Pose (Baddha Konasana)
Sit with your feet together and your knees bent and reaching toward the floor. Slowly fold over your feet while trying to bring your knees closer to the ground while moving the groin back and engaging the pelvic floor muscles. "It's a great hip opener, plus the pelvic floor engagement tones the muscles for orgasm," says Bleier.

4. Sleep Better
Researchers from Harvard found that eight weeks of daily yoga significantly improved sleep quality for people with insomnia. And another study found that twice-weekly yoga sessions helped cancer survivors sleep better and feel less fatigued. This can be attributed to yoga's ability to help people deal with stress, says Bleier. "Sleep issues are like anxiety. Your head can't stop spinning, you don't know how to relax," he says. "Breathing and mental exercises allow the mind to slow down, so you're going to start to see yourself sleep better."

Strike A Pose: Corpse Pose (Savasana) With Diaphragmatic Breathing
Savasana is the final pose in a yoga class and is meant to restore the body. Lay on your back with your legs slightly apart and your arms extended at your side and your hands on your belly. Inhale and exhale through your nose, follow the breath and feel the belly rise and fall under your hands. The breath, muscles and mind should be completely relaxed.

5. Fight Food Cravings
Researchers from the University of Washington found that regular yoga practice is associated with mindful eating, an awareness of physical and emotional sensations associated with eating. By causing breath awareness, regular yoga practice strengthens the mind-body connection, Bleier says. The awareness can help you tune in to emotions involved with certain cravings, and yoga breathing exercises can help you slow down and make better choices when cravings strike.

Strike A Pose: Meditation
Sit or lay in any comfortable position and bring attention to the natural breath moving in and out through your nose. Next, bring attention to the triangular area around the tip of your nose and upper lip, paying attention to your breath hitting this space as you exhale, the temperature of your breath, and which nostril you're breathing through. Try this for two minutes, working up to five or more. "The key is to try and be still and focus just on the breath," Bleier says. "No moving, no reacting, just stay present."

Answers to Embarrassing Questions about
"Down There"embarrassing 

woman embarrassed Surely, you must have questions about "down there" that you're afraid to ask. But believe us when we say we've heard it all before. You'll be relieved to get it out in the open and know that you could be heading off a potentially serious health issue. So, don't be shy... read on for three of the most embarrassing health questions (and possible solutions).

Vaginal discharge - is it normal?
How to tell: In the first half of your menstrual cycle, discharge is thick and sticky and its color is white, clear, or yellow. A few days before ovulation, the amount increases and it becomes more watery, clear, and elastic (what docs refer to as "egg-white discharge"). After ovulation, discharge decreases until the next menstrual cycle begins. You probably won't notice any odor (although you might), especially anything that's bad.

What causes it: Normal discharge is just skin cells; fluid from glands in the vulva, vagina, and cervix; and even bacteria and yeast.

What to do: Nothing! Avoid the impulse to clean what's already clean with perfumed soaps and douches; they increase the risk for developing an infection.

Is it a yeast infection?
How to tell: The discharge is thick and white, and it resembles cottage cheese but has no odor. Sometimes it's too thick to drip into your underwear, so you may not see it-but you're certain to notice an itch inside your vagina that won't quit.

What causes it: An imbalance of good bacteria and yeast. The bacteria usually keep the yeast, a fungus, in check. But yeast thrives in moist places, so sitting around in a wet bathing suit or sweaty underwear can trigger the infection by allowing yeast cells to multiply. Other culprits: taking antibiotics or birth control pills, douching, or wearing panty liners. (The latter actually trap moisture in the vagina.)

What to do: Try an over-the-counter treatment. If the symptoms don't fade within three days, see a doctor. She may prescribe a different antifungal treatment like Diflucan-or discover that it's not a yeast infection. Keep in mind: Women often misdiagnose themselves with yeast infections, according to a recent study. There's no harm in trying the nonprescription medicine, even if you don't have a yeast infection. If you want an answer right away, though, try a do-it-yourself test like the Vagisil Screening Kit. If yeast is present but the acidity level is normal, you likely have a yeast infection. If acidity is high, call your doctor as you may have a different type of infection.

Is it a bacterial infection?
How to tell: The discharge is white or gray, and thin, with a strong and unpleasant fishy odor; it isn't quite as irritating or itchy as a yeast infection.

What causes it: Bacterial vaginosis (BV), which is more common than yeast infections, occurs when the pH balance (or acidity level) in your vagina is out of whack, allowing bacteria to grow and upset the usual bacterial balance. Doctors aren't sure why this happens, but risks are thought to rise if you have a new sexual partner or multiple partners, or if you douche, which can change the pH balance.

What to do: See a doctor for antibiotics that will get rid of the infection. Pregnant women need to treat BV as early as possible, because the infection increases the likelihood of a premature birth and low birth weight. Also, Pap smears sometimes can pick up BV.


5 DIY Health Checks That Could Save Your Lifecheck
There are a few things that you can do to keep track of your own health.  Staying in tune with your body is hugely important - no one can know it better than you. Read below for more about DIY health checks and then make them part of your monthly self-check routine.

Test #1: Your urine
Your first trip to the toilet in the morning can detect a lot more than pregnancy or a urinary tract infection. More than 70 markers in your urine can determine how your entire body is functioning and are key to preventing degenerative diseases, unknown gluten intolerance, low antioxidant levels that make you vulnerable to oxidative stress, and more, says Nancy Guberti, certified nutritionist and healthy lifestyle coach.

For instance, "accumulation of specific organic acids in urine often signals a metabolic inhibition or block," Guberti says. The abnormality could mean that you're vitamin deficient.

Test #2: Your weight
Unexplained weight gain and weight loss can also signal a major issue with your health, says Dr. Julie Chen, an integrative physician and health expert. Don't ignore them. If you unexpectedly gain a lot of weight, this can signify hypothyroidism, adrenal disorders like Cushing's syndrome, fluid retention as in congestive heart failure or renal disease, and pregnancy.

If you unexpectedly lose a lot of weight, this can signify cancer, hyperthyroidism, autoimmune diseases, chronic diseases, and depression.

Test #3: Your teeth
Many people don't realize the importance of a dental checkup. Dr. Lucy Slutsky, a general dentist based in West Orange, NJ, points out, "Oral hygiene and checkups are vital because dental problems can often be a sign of other health-related problems tied to the heart, lungs, digestive system, or other parts of the body."

Dental checkups can also give dentists the opportunity to check for early signs of oral cancer.

Test #4: Your skin
You should be in the habit of checking your skin at least once a month to look for changing moles or non-healing lesions, says Dr. Tim Abou-Sayed, board-certified plastic surgeon. "Remember that the only 'good tan' is one you are born with that comes naturally; when you get that tan from sunning yourself at the beach, you are actually damaging your skin with the sun's radiation," Abou-Sayed adds.

"A melanoma, which can be fatal, may begin as something so seemingly innocent as a slightly darkened mole, so a simple self-exam of the skin can alert you that you need to go to a dermatologist for a full screening."

Dr. Glenn Kolansky, board-certified dermatologist in Red Bank, NJ, suggests you use a mirror for the back or hard to reach places, or have a significant other assist you. "It is also important to realize that a skin exam is only good on the date it is performed. Growths can change a day, a week, or a month later," he says.

Test #5: Your home
Don't forget to also check your surroundings-it indicate health issues and even save your life. "To live a healthier lifestyle, it is extremely important to maintain a 'healthy home' and be aware of toxins and other irritants that can exist in your living space and make you feel unhealthy," says Caroline Blazovsky, national healthy home expert and certified mold remediator.

"If you notice headaches, congestion, respiratory irritation, asthma, or allergies, you should have your home tested for mold, allergens, and chemicals. Molds, for example, can produce spores, mycotoxins, and MVOCs (chemicals produced by mold), which can give you an array of symptoms and cause you to feel unwell."

Blazovsky suggests monitoring such conditions every few years to every year to see if your home is within safe limits.

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