Women's Health | Mount Sinai Today

I Am Thinking About Freezing My Eggs. How Does It Work?

Apr 9, 2024 | Featured, Women's Health, Your Health

Egg freezing is popular among women looking for options and balancing family planning with other important responsibilities. Thanks to significant scientific advancements in the laboratory, success rates are higher than ever.

In this Q&A, Alan Copperman, MD, Director of the Division of Reproductive Endocrinology and Infertility and Vice Chair of the Raquel and Jaime Gilinski Department of Obstetrics, Gynecology and Reproductive Science at the Mount Sinai Health System, explains the process of egg freezing and its benefits. Dr. Copperman is also Managing Director and Chief Executive Officer of RMA of New York.

“Fertility preservation has the potential not only to safeguard fertility, but also to empower women to choose parenthood on their terms, at their own pace, aligning with personal and professional aspirations,” says Dr. Copperman. “It enables informed decisions about future family planning.”

Why should I freeze my eggs?

Egg freezing halts the biological clock, which is crucial for women whose age may mean they are facing possible declines in egg quality and quantity. Preserving eggs at a younger age enhances the chances of future conception and reduces risks of chromosomal abnormalities in offspring. It safeguards a woman’s fertility timeline while optimizing her prospects of having biological children later in life.

When should I freeze eggs?

Freezing eggs at a younger age is advisable, ensuring eggs are preserved at their peak quality and minimizing age-related reproductive challenges.

How does the process work?

Over a two-week period, the ovaries are stimulated to release multiple mature eggs for retrieval. Patients self-administer fertility medications, attend monitoring appointments, and then undergo a brief egg retrieval procedure under light sedation. Eggs are frozen and securely stored for future use.

How many eggs are frozen?

The number of eggs to freeze varies based on a woman’s age and family-building goals. Some may require multiple rounds of egg freezing to collect an adequate number of eggs.

What happens next?

When you are ready to conceive, your frozen eggs are thawed and fertilized with sperm, leading to embryo transfer into the uterus to achieve pregnancy.

Contact RMA of New York at 212-756-5777 or email info@rmany.com to schedule a consultation.

Learn more about Reproductive Endocrinology and Infertility Services at Mount Sinai

Is Pregnancy Causing My Headaches?

Updated on Mar 10, 2023 | Pregnancy, Women's Health, Your Health

While pregnancy brings joy and excitement for many people, it can also cause quite a few headaches. Headaches are common during pregnancy, especially early on. However, there are ways to manage the pain. Most often, headaches are not serious and do not cause harm. But it is important for you and your physician to monitor your headaches, as headaches can be associated with pre-eclampsia, a condition that can become serious and lead to complications. In this Q&A, Mount Sinai obstetricians Bruno Caridi, MD, and Jian Jenny Tang, MD, explain the different types of headaches you may experience, how to ease and prevent headaches, and how to know if you should be concerned.

Bruno Caridi, MD

How common are headaches during pregnancy?
Headaches are a very common medical condition, especially among those who are pregnant. There are three different types of headaches: tension headaches, cluster headaches, and migraine headaches. Almost 26 percent of pregnant patients will experience tension headaches, a mild-to-moderate pain that is often described as having a tight band around the head. Pain may also be located toward the neck with tension headaches. Cluster headaches are characterized by intense pain, often concentrated around one eye or on one side of the head, and occurring frequently. Cluster headaches are very uncommon in women, occurring less than one percent of the time. A migraine headache is usually unilateral, which means it is concentrated on one side of the head. During pregnancy, about 10 percent of people will have experienced some type of migraine headache. With migraine headaches, an individual may be more sensitive to light, to certain types of noise, and to certain smells. Migraine headaches can also be accompanied by other symptoms, such as nausea. After 20 weeks of pregnancy, careful attention needs to be paid to headaches to ensure they are not a symptom of pre-eclampsia. Headaches associated with pre-eclampsia are usually global tension headaches, occurring all around the head.

What is pre-eclampsia?
While the causes of pre-eclampsia are not understood, the condition may be related to placenta and maternal vascular dysfunction. However, high blood pressure and protein in the urine are the most common signs. In rare cases, the condition causes seizures. If you are experiencing frequent headaches, it is important to have your vitals checked by your physician to see if your blood pressure is elevated. Also, be aware of any headache that is different from what you’ve previously experienced. Changes in vision, such as spots or blurriness, or right upper quadrant abdominal pain or epigastric pain are all signs of pre-eclampsia.

Jian Jenny Tang, MD

What are the best over-the-counter and non-pharmacological treatments for alleviating pregnancy-related headaches?
The first line of treatment recommended is Tylenol^®. Patients may take three regular strength Tylenol (975 milligrams total), or two extra strength Tylenol (1000 milligrams total). Tylenol can be taken every six to eight hours, and must not exceed 3000 milligrams per day. This medication is an excellent initial line of over-the-counter treatment for headaches. We do not recommend migraine medicines that you may have been taking pre-pregnancy, such as sumatriptan. Besides Tylenol, caffeine is a great way to help alleviate headaches. Caffeine is fine to use in moderation, and should not exceed 200 milligrams per day. If the headache persists, then the patient should contact their physician. Other non-pharmacological treatments include drinking plenty of fluids to stay well hydrated, keeping your blood glucose levels up by snacking or eating light meals every few hours throughout the day, getting adequate rest, moving to a dark room to avoid light, or placing a damp washcloth over your forehead and relaxing. Other stress reduction or relaxation techniques, such as taking a shower to relax your muscles, listening to soothing music, and aromatherapy can help. Deep mindful breathing and light exercise, such as yoga, are other common non-pharmacological methods that help with headaches. Prevention is key.

How can I prevent pregnancy-related headaches?
Experiencing headaches during pregnancy does not mean you have pre-eclampsia. Other common causes can include dehydration, low blood glucose levels, lack of sleep, and anemia. As such, staying well hydrated and getting enough food and sleep are good ways to prevent headaches. Also, if you consume a lot of caffeinated beverages before pregnancy, abruptly scaling back on caffeine could trigger headaches related to withdrawal. If you plan to give up caffeine, easing yourself off of these beverages gradually can prevent headaches. Your pregnant body is going through a lot of changes, especially during the first trimester. Knowing how to adapt to these rapid changes will help put both your body and mind at ease, so you can focus on your baby.

What Are the Benefits of Using A Midwife?

Nov 18, 2021 | OB/GYN, Women's Health, Your Health

Midwives are health professionals who are best known for providing critical support and care for many expectant mothers, but their role is often little-known or understood. Patients may wonder if you can have a midwife and an OB/GYN, how their roles differs from a doula, and how to locate a reputable midwife.

In this Q&A, Rochelle Lipshutz, CNM, Clinical Director of Midwifery at The Mount Sinai Hospital, explains how midwives support patients before, during, and after childbirth and discusses how midwives work with consulting physicians at Mount Sinai to offer integrated care.

What is a midwife?

Midwives are licensed independent health care providers, meaning they provide care without the supervision of a physician. Certified nurse midwives are trained in both nursing and midwifery while certified midwives have graduated with a master’s-level degree in midwifery but do not have nursing training.

They offer a full range of reproductive and primary health care services for patients from adolescence through menopause. These services include independent provision of primary care, gynecological care, and family planning services; preconception, pregnancy, and postpartum care; and care of healthy, full-term infant for the first 28 days of life.

What is the difference between a midwife and a doula?

Both midwives and doulas are trained professionals. Midwives care for clients throughout the life cycle, especially during prenatal care, delivery, postpartum care, and gynecological care as well as primary care. Doulas provide non-medical physical, emotional, and informational support to a woman before, during, and shortly after the process of childbirth. A doula is an additional support during the birth process who—like a midwife—helps a woman achieve the healthiest, most satisfying experience possible.

If you are interested in working with a doula, Mount Sinai has partnered with Oula, a modern maternity care center that provides similar care.

Do midwives only provide services for child birthing?

Midwives are best known for attending childbirth. But that is not all they do. About 76 percent of midwives provide reproductive care and about 46 percent offer primary care. Reproductive care can include annual gynecological exams, Pap smears, and prescriptions including contraceptive methods, patient education, and reproductive health visits.

Midwives also treat the partners of patients in cases of sexually transmitted infections. They can also diagnose and offer initial and ongoing comprehensive care for many common health care problems as well as admit, manage, and discharge patients from hospitals. When appropriate, midwives prescribe use of medical devices, such as breast pumps. Midwives also promote health education, disease prevention, and personal wellness programs to patients and their families. They work in a variety of settings, including ambulatory care centers, hospitals, community and public health care arenas, and homes and birth centers.

What benefits do midwives offer?

Midwives are experts in ‘normal.’ For the most part, they respect and enjoy observing the natural birth process. Midwives encourage women to use their inner strength to cooperate with this process. If a woman in labor requests pain relief, midwives support her decision-making skills. In fact, the relationship between the midwife and patient focuses on shared decision making. If medical intervention is necessary, midwives will discuss the risks, benefits, and any alternatives. Together, midwives and patients reach a decision that will guide the care in a safe and comfortable manner. And, if necessary, the midwife will work closely with doctors and nurses to ensure safety throughout the birthing experience.

How do doctors and midwives work together?

Midwives participate in hospital births as well as home births and those at birth centers. In general, the midwife will focus on basic care, however, if complications develop, the midwife will work with the physician to ensure a comfortable, rewarding, and safe experience.

How do I find a midwife?

Midwifery services are available at The Mount Sinai Hospital and Mount Sinai West. Additionally, the Mount Sinai Health System partners with several well-established local midwifery groups including Central Park Midwifery, Community Midwifery Care, and Nettle Wellness.

You can also check with the American College of Nurse-Midwives to find a local midwife. This national organization lists midwifery practices and private groups in most communities. Many patients go by word of mouth. In addition, many websites that focus on local reproductive care provide information about midwives.

Learn more about Midwifery Services at Mount Sinai

Your Guide to Some of the Most Common Questions About Breast Cancer Diagnosis and Treatment

Oct 8, 2021 | Breast Cancer, Women's Health, Your Health

There have been many significant advances in the treatment of breast cancer that have helped patients to diagnose cancer earlier and to provide a range of treatment options. But patients still have many questions about what’s best for them.

In this Q&A, Michael Zeidman, MD, Assistant Professor of Surgery at the Icahn School of Medicine at Mount Sinai and a breast surgeon at Mount Sinai Brooklyn, answers some of the most common questions he gets from patients, including why it is critical to get regular mammograms, how doctors determine the stage of disease, and, if you are looking for a second opinion, the importance of visiting a leading medical center such as Mount Sinai.

Michael Zeidman, MD

How do mammograms help patients and doctors?

Mammograms are the only imaging method that’s been proven to save lives. If we go back to the early 1970s, before screening mammograms were widely implemented, the only way that a patient could discover that she had breast cancer is if she felt it. Now that we have the capability to diagnose breast cancer before it becomes symptomatic, we’re catching it much sooner. So it’s not surprising that survival rates have dramatically improved, while at the same time, we’ve been able to significantly cut back on the amount of treatment needed, which results in a better quality of life after breast cancer.

Why is it important not to delay a mammogram because of concerns about COVID-19?

We are only now starting to see the effects of the public’s general hesitancy of getting mammograms during the pandemic. It’s unfortunately increasingly common for patients who were normally very regular about getting their screening mammograms to skip getting one last year, and now they’re presenting to me with breast cancer that’s likely at a later stage than it would have been if it were discovered a year earlier. If there’s one message I want to get across is, come in, get your screening. The sooner we catch this, the sooner we can deal with it, the less treatment you need, and the better your prognosis will be.

How do you determine what stage breast cancer a patient has?

A very common question that I get from patients with a new diagnosis of breast cancer is “What’s my stage?” I explain that I can’t tell you your stage until after surgery. Determining the stage is made up of a three items: the size of the tumor, whether or not the cancer has spread to the lymph nodes under the armpit, and whether or not the cancer has spread to a distant part of the body. The pre-operative imaging does a fairly good job of estimating the size. But we won’t know the precise size of the tumor until it’s been removed. In fact, unfortunately sometimes the imaging can significantly overestimate or underestimate the true size of the tumor. The only way to tell whether or not the cancer has spread to the lymph nodes is to actually sample a few of them during the operation. We do that with a technique called a sentinel lymph node biopsy. In the operating room, we are able to determine if cancer were to spread to the lymph nodes, what are the few lymph nodes that would be the first to receive that cancer. So we identify and remove those nodes. And if the pathologist tells us that there’s no cancer in those nodes, we can safely assume that there’s no cancer in the rest of your nodes.

What do I need to know about the different stages of breast cancer?

Stage one breast cancer means that the tumor is two centimeters or less, and there’s no spread to the lymph nodes. Our goal is to catch breast cancer at this stage, because the five-year breast cancer specific survival from stage one breast cancer approaches 100 percent, which means that nearly all of those treated are alive five years after diagnosis. Also, the amount of treatment that a patient would need with stage one is much less than for later stages. It may result in smaller surgery, and patients at this stage are unlikely to need chemotherapy.
Stage two and stage three breast cancer means that the tumor is larger and it has spread to the lymph nodes. If this is the case, patients need more surgery and are more likely to need chemotherapy. Their five-year breast cancer specific survival is between 80 to 90 percent. This highlights the importance of coming in to get your screening mammogram because even though you may survive your breast cancer with a later stage, you’re going to need a lot more treatment to do so.
Stage four breast cancer is if the cancer has spread to another part of the body, other than the lymph nodes. At this stage, I tell patients that I can no longer cure them of breast cancer. The five-year survival rates drop to less than 30 percent. We can certainly treat it and, depending on how aggressive the cancer is, we can keep the cancer at bay for many years. But this is what we are trying to avoid.

I just had a COVID-19 vaccine. Should I delay getting my mammogram?

You do not have to delay your mammogram if you are receiving the vaccine, but you should make your radiologist aware which arm got the shot. There has been a lot of talk in the news about how the vaccine can mimic breast cancer. This is not entirely true. The purpose of the vaccine is to activate your immune system to produce antibodies that fight the virus. The cells that make these antibodies are located in small organs throughout your body called lymph nodes. The closest group of lymph nodes to where the vaccine is administered is in the armpit. These are called the axillary lymph nodes, and they are the first group of lymph nodes where breast cancer will typically spread. After receiving the vaccine and activating the cells in the axillary lymph nodes, they will grow in size. This may result in the radiologist wanting a closer look at the lymph nodes with an ultrasound to better delineate if these nodes are large due to the vaccine or if they are concerning for cancer.

What is the difference between a biopsy and surgery?

When we talk about a biopsy, we’re mainly talking about a core needle biopsy. This is where we get a small snippet of tissue in the area of concern, as discovered by the imaging. It’s usually done under the guidance of imaging, such as an ultrasound guided biopsy or something called a stereotactic biopsy, which is done under mammographic guidance. Usually the needle biopsy is done before we do the surgery because it helps us guide what type of surgery the patient needs and because it allows us to determine if chemotherapy is the first step, rather than surgery. For surgery, you are actually coming to the operating room and we remove a large area of tissue around the cancer. If we already know that it’s a very large cancer, we may perform mastectomy to remove the entire breast.

If I am looking for a second opinion, why is it important to go a leading medical center like Mount Sinai?

The treatment of breast cancer has become increasingly complex, as we’ve learned more about it, and so it’s now more important than ever to have a team that works in a collaborative way to tailor a specific treatment program for you. The Dubin Breast Center at Mount Sinai is a true multidisciplinary Cancer Center with specialists concentrating on one problem, breast cancer. The facility is beautiful, and that produces a sense of calmness that translates to patient care and to the patients themselves. While I generally recommend that patients go for a second opinion, because of how complex breast cancer treatment is, I think it’s imperative to go to a center where that’s the primary focus, where that’s all they do.

Learn more about the Dubin Breast Center at Mount Sinai

Learn more about the Center of Excellence for Breast Cancer at Mount Sinai

Vaccine Facts: COVID-19 Vaccines Are Safe—and Essential—for Pregnant Women

Sep 23, 2021 | COVID-19, Featured, OB/GYN, Vaccines, Women's Health, Your Health

For those who are pregnant or considering getting pregnant, there are so many health questions, from “Is caffeine okay?” to “Can I still exercise?” But during the COVID-19 pandemic, some are also wondering if the COVID-19 vaccines are safe to take.

In this Q&A, Joanne Stone, MD, MS, Director of Maternal Fetal Medicine at the Mount Sinai Health System, explains the dangerous risks of COVID-19 during pregnancy, shares the facts on why you should get the vaccine, and offers reassurance for those who may be worried.

New Guidance on COVID-19 Vaccines: In April 2023, the Food and Drug Administration and the Centers for Disease Control and Prevention announced some major changes for COVID-19 vaccines. Click here to read more about what you need to know.

Update: The Centers for Disease Control and Prevention on September 29, 2021, strongly recommended COVID-19 vaccination either before or during pregnancy because the benefits of vaccination outweigh known or potential risks. Read more from the CDC

If someone is pregnant, or trying to get pregnant, should they get vaccinated?

Yes, if you’re pregnant, or thinking of getting pregnant, or even if you’re breastfeeding, this is absolutely the time to get the vaccine. I would not wait one extra day. I would get it today because there’s a lot of data that shows the vaccine is very safe and it’s not associated with miscarriage or infertility. Also, it’s the most important way to prevent COVID-19 infection.

Joanne Stone, MD, MS

Are pregnant people especially at risk for COVID-19?

Pregnant women who get COVID-19 infection are at a much higher risk for adverse outcomes, such as severe disease and even maternal death. There’s also higher risk for complications, including preeclampsia, which is high blood pressure in pregnancy, as well as increased risk for the baby, including preterm delivery. For all these reasons, the risks of COVID-19 infection are much higher for both mom and baby. So it’s extremely important to prevent this disease during pregnancy through vaccination plus other measures like mask wearing and social distancing.

What else should patients know about the vaccines and pregnancy?

Patients should understand there are a lot of myths out there that have not proven to be true. For example, there’s no increased risk of infertility if you get the vaccine prior to getting pregnant. Pregnant people should also know that there are complications associated with COVID-19 in pregnancy, and these complications that can be prevented by getting the vaccine. Also, the vaccine has been studied extensively. All the major organizations involved with women’s health care—including the Society for Maternal-Fetal Medicine and the Centers for Disease Control and Prevention—are strongly advocating that people who are pregnant get the vaccine.

Is It Safe to Eat That? — Debunking Pregnancy Dietary Myths

Updated on Jun 30, 2022 | Diet and Nutrition, OB/GYN, Women's Health, Your Health

Cropped side view portrait of pregnant African-American woman buying groceries while shopping in supermarket

Old wives’ tales about pregnancy have been around for centuries. While some myths vary from the lighthearted—carrying high? You’re having a girl—to those of a serious nature—spicy foods causes blindness in babies. Not true!—, we wanted to debunk some of those rumors.

Valerie D. Lewis-Morris, MD, Assistant Professor of the Department of Obstetrics, Gynecology and Reproductive Science at the Icahn School of Medicine at Mount Sinai, gives us the facts on what to eat and what to avoid to ensure a healthy pregnancy.

If I didn’t eat a healthy diet before becoming pregnant, is it too late to start while I’m pregnant?

It’s never too late to change your dietary habits. And once you find out that you are pregnant, it’s really important to begin eating nutritious food for the health of you and your baby. If you need help with healthy meal planning, Mount Sinai nutritionists are available to answer your questions.

Can I drink coffee while I am pregnant?

Yes, but pregnant women should not consume more than 200 milligrams of caffeine each day—that’s about two, eight ounce cups of brewed coffee. Caffeine can increase your blood pressure and can cause unusual heart rhythms, so energy drinks, energy boosters, and too much coffee should be avoided.

Is alcohol okay to drink on special occasions while I am pregnant?

Not drinking alcohol is the safest choice. However, a glass of wine—which means a six to eight ounce glass—, a beer, or a toast of champagne a couple of times during pregnancy should not harm your baby, especially if you’re not in the first trimester.

If you are in your first trimester, then abstaining from alcohol is the best, safest choice and you should avoid hard liquor.

Can eating nuts during pregnancy prevent my baby from developing a peanut allergy?

This is an old wives’ tale with absolutely no truth to it. Nuts are a nutritious snack and an excellent source of protein, but consuming them while you’re pregnant will not have an impact on whether your baby will have allergies in the future.

Is it true that you should avoid cheese while pregnant?

Not exactly. The goal here is not to avoid all cheese and dairy, but you should not consume raw cheese or unpasteurized milk as these foods may contain bacteria that is harmful to your baby. All of the dairy you consume should have been pasteurized.

Avoid raw goat cheese, or cheese that has been mold ripened such as gorgonzola, or Roquefort. Hard cheeses, such as cheddar cheese or Swiss, are a safer option. And make sure that you read your food labels to make sure that all of your dairy has been pasteurized.

In addition to dairy, make sure that eggs are completely cooked before you eat them. So, save the runny yolks for after pregnancy.

Is it safe to eat fish?

Yes, as long as it is not raw or high in mercury.

Fish is an excellent food that is low in fat and contains high-quality proteins in omega three fatty acids, which are very important for your baby’s brain development. You want to avoid fish that are high in mercury as it can interfere with your baby’s brain and spinal cord development. These are fish such as shark, swordfish, towel fish, and king mackerel. However, fish that are low in mercury are safe to consume and those are fish like salmon, tilapia, and flounder. Enjoy those as much as you want a couple of times a week.

Should I be eating for two?

Eating for two is a very common myth, but the reality is that you should not be consuming double the portions of every meal and snack. You only need about an additional 350 calories per day and that can be easily achieved by adding two or three small healthy snacks like: a banana with a couple of tablespoons of peanut butter or three to five wheat crackers with about an ounce and a half of cheddar cheese cubes. You don’t have to eat a lot of extra food while you’re pregnant; don’t feel that you have to splurge.

Is it safe to exercise?

If you’re healthy and you have a low risk pregnancy, then the risk of moderate intensity exercise is safe. Consistent exercise during pregnancy can minimize constipation as well as decrease the risk of gestational diabetes and depression. If you incorporate aerobic exercises, such as brisk walking two to three times a week for 20 to 30 minutes or flexibility and strength workouts like yoga, that is all you need.

If you have a high-risk pregnancy, you should discuss adding exercise or continuing the exercises you are doing with your provider to make sure it is safe for you and your baby.

Finally, ignore the old wives’ tales and the misinformation that’s out there. When you’re in doubt, reach out to your obstetrician or midwife to get the most accurate and up-to-date information about your pregnancy and nutritional needs.

Make an appointment with Dr. Lewis-Morris

Learn more about OB/GYN Services at Mount Sinai

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