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Trying to Conceive Community

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Susannah D Copland, MD, MS

Joined: 04/01/2011

Expert Profile:

Dr. Copland brings scientific understanding, sincerity, and empathy
to her medical practice in assisted reproduction.Dr. Copland pursued an undergraduate education in agricultural and biological engineering as a stepping-stone to medicine. She graduated from Cornell with honors and distinction eager to apply the problem-solving rigor of engineering training to medical education, receiving a full scholarship to the Mayo Clinic School of Medicine. She went on to complete her obstetrics and gynecology training at the Magee-Women's Hospital in Pittsburgh and her Reproductive Endocrinology fellowship at Emory University in Atlanta where she also completed a Master of Science in Clinical Research. Her ultimate career choices were influenced by her affinity for solving complex problems and a desire to develop long-term relationships with her patients. After fellowship, she was recruited to Duke University Division of Reproductive Endocrinology to oversee clinical research and to direct the fertility preservation and third party reproduction programs, which she did for five years. While enjoying academic practice, she partnered with David Walmer to found Atlantic Reproductive Medicine Specialists to provide personalized patient care in a welcoming independent practice.

Susannah learned the value of hard work, perseverance, and family early in life from her parents, who were the first generation to complete higher education and go on to accomplished careers in the humanities and sciences. When Susannah was six, the choirmaster at St. Andrew's in Cherry Hinton near Cambridge, England recommended that her parents support her education in music, recognizing that she had remarkable musical abilities. After years of musical training in vocal performance and cello, culminating in training with the principal cellists of both the Buffalo Philharmonic and the Cleveland Symphony Orchestra, she decided to make medical science her profession, while continuing her life-long passion for music as an amateur. That passion now includes duets at home with her children.

In addition to enjoyment and relaxation, music has provided Susannah with valuable lessons in communication. Working cooperatively to develop complex harmonies with other musicians and rapport with many audiences taught Susannah the art of connection in communication, an art that she now uses to interact with patients. After taking time to listen to each patient's individual circumstances, she provides detailed counseling on the possible causes of their delay to pregnancy and the full spectrum of treatment options. Susannah believes in patient autonomy, counseling her patients that they are the "Captains of their ship," making informed decisions guided by a better understanding of their fertility.

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Reply to message on FSH and phytoestrogens

Hello, I was not able to reply to the line of discussion, so I have...

Posted by Susannah D Copland, MD, MS

0 Replies | Reply | Watch This DiscussionReport This| Share this:Reply to message on FSH and phytoestrogens Hello, I was not able to reply to the line of discussion, so I have...

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Understanding Ovarian Reserve

Understanding your egg supply, both origins and ways in which egg number...

Posted by Susannah D Copland, MD, MS

Understanding your egg supply, both origins and ways in which egg number declines, can help you to decide your next steps on the pathway to parenthood.

Women have their lifetime supply of eggs when they are babies inside their mother. Eggs are a time-limited and time-released supply: time-limited because all women will someday go through menopause, and time-released because each month only a small group of eggs gain the ability to compete to ovulate. As egg number declines with aging, the group of eggs competing to ovulate each month gets smaller. With a smaller group of eggs competing each month, women tend to ovulate sooner and have fewer days between periods. Eventually there are periods of time where an egg is not available, and women will start skipping periods. Eventually there is not an egg available to ovulate, and a woman will no longer have periods.

Fertility testing includes tests for egg number and egg release. Test of egg number include FSH (follicle stimulating hormone) and AMH (antimullerian hormone). FSH is the hormone that pushes eggs to move toward ovulation. When egg supply is low, FSH goes up. FSH is high in menopause. AMH is made by eggs at an earlier stage in their journey toward ovulation. AMH is higher in women with more eggs and lower in women with fewer eggs. AMH is undetectable in menopause.

Tests of egg release include progesterone. Progesterone is a hormone that is made by the ovary after ovulation. If a woman has an elevated progesterone one week before her period, she is ovulating. If she does not, she needs to see her doctor to find out why she is not ovulating. The group of eggs that have the ability to ovulate will only compete if they receive the correct signals. A physician will test hormone levels and make the necessary adjustments to induce ovulation.

Egg number tests like AMH and FSH predict how well you will respond to fertility drugs, because they reflect the number of eggs competing to ovulate. If FSH is high and AMH is low, a woman does not have many "extra eggs" to respond to medication. If she has regular menstrual cycles with a progesterone proving ovulation, she is getting at least one egg out. If we try fertility medications and still get only one egg, fertility drugs are not helping to improve chances of pregnancy. As long as she continues to ovulate, she has a chance for pregnancy. If she wants to improve her chances after fertility drugs with her own eggs are not helping to increase the number of eggs released, she can consider using donated eggs.

One percent of women will go through premature ovarian failure (before age 40). A reproductive endocrinologist will test to see why egg number declined early and test to see if other glands (thyroid, parathyroid, pancreas, adrenal) are showing signs of low hormone production. Women with POF have a 5-10% lifetime chance of pregnancy if an egg remaining in the ovary gains the ability to ovulate, ovulates, and meets with sperm. Currently there is no way to know when or if this post-ovarian failure ovulation will occur.

Hearing that egg number is low can be devastating. A second opinion can help increase comfort with the diagnosis. A reproductive psychologist can help to discuss the feelings that arise. Egg donation, embryo donation, and adoption can help women with ovarian failure to build their family.View Thread

Posted bySusannah D Copland, MD, MS

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Reply: Hello

Moauz, I hope that your IVF process is going well. In vitro...

Posted by Susannah D Copland, MD, MS

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Reply: Hello

April, Please see Dr.Walmer's post on PCOS. In general, women with PCOS...

Posted by Susannah D Copland, MD, MS

8 Replies | Reply | Watch This DiscussionReport This| Share this:Hello April, Please see Dr.Walmer's post on PCOS. In general, women with PCOS...

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Understanding your fertile window

Knowing when you are about to release your egg can help decrease stress...

Posted by Susannah D Copland, MD, MS

Knowing when you are about to release your egg can help decrease stress and increase the effectiveness of trying to conceive. While sperm can survive for up to 6 days in the female body, eggs survive twelve hours. Therefore, most pregnancies occur when sperm are waiting for the egg. While babies have been conceived with acts of intercourse up to 6 days prior to ovulation, the hightest chance of conception is within the two days prior to ovulation. Learning to interpret your body's signals can help you find your fertility.

Cervical mucus.
As the egg approaches ovulation, increasing amounts of estrogen are produced and cervical mucus becomes sticky, or stringy like egg whites. Consistency changes as the water content of the mucus increases, making penetration by sperm easier. Cervical mucus changes can be identified up to 6 days prior to ovulation. Timing intercourse when you notice your cervical mucus changing can be effective in helping you to conceive.

Ovulation Predictor Kits.
OPKs detect luteinizing hormone (LH) or both LH and estradiol. As the egg moves closer to ovulation, estradiol rises. While estradiol rises, LH is released in increasing quantities then drops creating the LH surge that precedes egg release by 24-48 hours. To use an OPK, you urinate on the wick daily and look at the test kit window. With most kits, one line means urine made it into the kit and two lines means LH is detected. Kits that detect both estradiol and LH, read low peak when estradiol only is detected, and high peak when both estradiol and LH is detected. If you are able to detect the surge on the kit, intercourse the day of the surge, and the day after the surge should provide sperm for the arriving egg.

Basal Body Tempteratures
Once the egg is released, progesterone is produced. Progesterone increases body temperature. Therefore, your temperature goes up after ovulation. The best time to take your temperature is before you get out of bed in the morning. If you chart your temperature daily, you should see at least an 0.3 degree rise in the baseline temperature the day after ovulation. Temperature should stay up until shortly before the period. If you have conceived, your temperature will stay up during pregnancy. Unlike cervical mucus changes, and ovulation predictor kits, basal body temperatures do not let you know that you are about to ovulate. Rather they tell you that you have. So if you want to use them to time intercourse, you need to chart for a month to see when you ovulated and then plan to have intercourse in the cycle days prior to the temperature rise during the next month. Since menstrual cycles can be different from month to month, this method can be frustrating to some. Once you have seen that there is a temperature rise and that your temperature stays up for approximately 2 weeks, you may wish to stop checking daily temperatures to decrease the stress of trying to conceive. If, however, you find the daily temperatures reassuring, feel free to continue.

Don't worry. Not all women can detect all of the signs of ovulation. Follow whichever of the signs works for you.

If you are unable to detect any of the changes discussed here, you may not be ovulating. See your physician to make the final determination with a blood test for progesterone timed one week after the surge on your OPK or rise in temperature, which should be one week before your period. If you are not ovulating, your physician can try to determine the cause and give you medications to help you release your egg.

If the thought of testing for ovulation is frustrating to you, intercourse two to three times a week should cover your fertile window.View Thread

Posted bySusannah D Copland, MD, MS

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Doctor's responses 3-19-2010

Hello, Several lines of discussions are interested in clomiphene. Here...

Posted by Susannah D Copland, MD, MS

Hello,

Several lines of discussions are interested in clomiphene. Here are some thoughts and responses to questions:

Clomiphene is structurally similar to estrogen. When taken early in a menstrual cycle, it tricks the the hypothalamus (a part of the brain that controls the menstrual cycle) into behaving as if estrogen were low. The hypothalamus pushes the pituitary gland to put out more follicle stimulating hormone, and the ovary gets a bigger push toward ovulation.

80% of women who do not ovulate will respond to clomiphene and ovulate.

If the ovary is responding, most will see a LH surge on ovulation predictor kit between 5 and 12 days after the last clomiphene pill.

Because the ovary can respond with more than one follicle/egg, clomiphene has an 8% risk of twins.

Because 3/4 of women who do not ovulate will be pregnant by 6-9 cycles of clomiphene, most doctors will start looking into different treatment options if a patient has completed 6 cycles without getting pregnant.

In women who do ovulate, clomiphene can be used to increase the number of eggs released. Many times intrauterine insemination is used to maximize pregnancy rates. Clomiphene has a lower success rate per cycle in women who are already ovulating. In women who do not ovulate, clomiphene has a 15-20% chance of pregnancy per cycle. In women who do ovulate, clomid with insemination has a 8-10% chance of pregnancy per cycle (2-3 x the pregnancy rate of women with infertility who do not use clomiphene with insemination).

Now to the specific posts:

Ovulating

ladyjane1025 Because clomiphene can cause your ovary to release more than one egg, you may perceive ovulation more. Pelvic discomfort is perceived is reported by some women using clomiphene. The smiley on your kit is a positive LH surge. The egg is released 24-48 hours later, so intercourse on the day of the surge and the day after will get sperm there before the egg is released.

Follicle growth

Anon_6592
If a woman is using hCG shots to trigger ovulation, we will usually give the shot when the follicle is 18-22 mm in diameter, however we see pregnancies with smaller and larger follicles too.

Have a great week!View Thread

Posted bySusannah D Copland, MD, MS

0 Replies | Reply | Watch This DiscussionReport This| Share this:Doctor's responses 3-19-2010 Hello, Several lines of discussions are interested in clomiphene. Here...

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Doctor's responses 3-8-2010

Below are some thoughts and suggestions regarding your discussions: ...

Posted by Susannah D Copland, MD, MS

Below are some thoughts and suggestions regarding your discussions:

Last dose of provera:
The period usually occurs 2-7 days after the last dose of Provera. Women are usually given Provera when they are not ovulating. Women who do ovulate get a cyst of ovulation (corpus luteum) that makes progesterone for two weeks. If they are not pregnant, the cyst goes away, progesterone falls, the period arrives. Women who are not ovulating take Provera to have a period and keep their uterus healthy. If the period does not arrive by two weeks after the provera, she should check a pregnancy test and call her doctor. Sometimes a woman may have been in the process of ovulating on her own, so the period does not come until her own cyst of ovulation goes away. Sometimes a woman may not bleed after Provera because her estrogen is low. In either case, failing to bleed after Provera is a reason to call your doctor.

C/s and fertility
While any surgery can cause infection, bleeding, and scarring, an uncomplicated cesarean usually does not harm a woman's chance of pregnancy in the future. Check with your doctor to see if anything about your cesareans may cause concern.

Ovulation/BD and CM:
Ovulation predictor kits and cervical mucus are two great ways to target intercourse for fertility. As the egg moves toward ovulation, cervical mucus water content increases. Target intercourse when you notice a change in your mucus to wet, slippery or smooth feeling and/or transparent, stretchy/elastic, watery, liquid or reddish in the days prior to ovulation. After ovulation, intercourse is recreational and cervical mucus changes may be related to other factors.

Ovulation predictor kits detect the mid cycle LH surge that preceeds egg release. A positive kit predicts ovulation within the following 24-48 hours. The interval of greatest fertility is the day of the surge and the following two days. The best single day is the day after the first positive kit. Remember that sperm can survive in the fallopian tube. While most babies are conceived with intercourse in the two days prior to ovulation, pregnancies have been reported with intercourse up to 6 days prior to ovulation. So having intercourse every other day in the fertile window should be fine. For those woman using donor sperm who only have one chance at sperm exposure, we try to plan insemination for the day following the first positive test.

Have a good week.View Thread

Posted bySusannah D Copland, MD, MS

1 Reply | Reply | Watch This DiscussionReport This| Share this:Doctor's responses 3-8-2010 Below are some thoughts and suggestions regarding your discussions: ...

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Hello

Hello to all Exchange users! I am happy to join the WebMD community. Dr....

Posted by Susannah Copland, MD, MS

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