Advanced Reproductive Specialists

08/09/2025

Maverick Lee Townsend born May 14th 2025 (the day after Ronin’s transferday anniversary) Ronin was soo eagerly waiting for him to arrive !! We are always so thankful for Dr. Lipari and the whole team at ARS/JCRM 💙🍍 These boys bring so much joy to our lives and so many others who they cross paths with.

08/07/2025

Mediterranean Diet Associated With 23% Reduced Risk Of All-Cause Mortality Among Women, Study Finds

The Hill (5/31, Suter ) reported,
"The Mediterranean diet often consists of higher consumption of foods and ingredients like olive oil, fruits, fish, nuts, and vegetables, and lower consumption of red meat and sweets." Women who maintain this diet "live significantly longer, according to a new study" published in JAMA Network Open. In the study, researchers wrote, “In this cohort study of women followed up for 25 years, higher adherence to the Mediterranean diet was associated with a 23 percent reduced risk of all-cause mortality.”

If this approach lowers mortality by 23%, then the keto approach will lower it by over 100%! If there had been a category for the keto nutrition approach and enough women available for data collection, we would see this result. This is based on our assessments of patient improvements, looking at parameters of weight loss and improvements in blood sugar levels, cholesterol, and high blood pressure between the two approaches. Mortality is related to insulin exposure over a lifetime (as seen in insulin-requiring diabetes), and the Mediterranean diet, while somewhat better, does not lower insulin levels as much as the keto nutrition approach. Therefore, we would expect multiple times better success with the keto approach compared to the Mediterranean approach. Remember also that the Europeans who were initially studied for the Mediterranean diet walk everywhere and are not engaged in the exercise revolution behavior that women in America are engaged with. All these factors are important to overall health.

Michael D. Fox, MD
Advanced Reproductive Specialists �Jacksonville Center For�Reproductive Medicine�jcrm.org


https://thehill.com/policy/healthcare/4697185-women-mediterranean-diet-live-longer/

Women who are on a Mediterranean diet live significantly longer, according to a new study. The Mediterranean diet often consists of higher consumption of food and ingredients like olive oil, fruits…

08/04/2025

Virtual Family Reunion 💕💙

08/01/2025

07/28/2025

Experimental In Vitro Study Finds Insulin May Be Toxic To Placenta Early In Pregnancy.

More information supporting the toxicity of insulin now directed at pregnancy. Here it has shown that insulin stimulates toxicity to the placenta which will have widespread consequences to the unborn fetus. We know that in type II Diabetics (an insulin elevation disease) that high blood pressure and placental problems are common. Many patients though are walking around with dramatic elevations in insulin based on a high carb diet that often worsens in pregnancy, the diet that is. Therefore using the conclusions of this study, a great negative pressure is exerted on the placenta that is trying to deliver the lifeblood (oxygen and nutrients) to the fetus. This is hugely significant!

Importantly, based on the conclusions of this study, the logic pattern continues in the erroneous direction of "drugs fix all." In the physiology 101 textbook from medical school, it clearly states that the only significant stimulus for insulin release in humans is dietary carbohydrate. This doesn't seem to rise to the surface in these scientific studies and the primary fix is focused on drug treatment as in this study where metformin is proposed. No one seems to want to primarily focus on nutrition as a therapy. In my experience, metformin is maybe 10-15% of the beneficial effect, whereas with nutrition the disease improves 85 - 90%.

Michael D. Fox, MD
Advanced Reproductive Specialists�Jacksonville Center�Reproductive Medicine�jcrm.org

https://www.fertstert.org/article/S0015-0282(18)32227-1/fulltext

To study the effects of insulin and metformin on primary trophoblasts from early pregnancies.

07/26/2025

Dr. Lipari talking about embryonic testing. This is part one of a series. Stay tuned for more….

Embryonic genetic testing, also known as preimplantation genetic testing (PGT), involves screening embryos created through in vitro fertilization (IVF) for genetic abnormalities before implantation. This testing helps identify embryos with a higher chance of successful implantation, a healthy pregnancy, and a lower risk of genetic disorders in the child.

07/23/2025

https://www.facebook.com/share/r/1HsNoEHGgv/?mibextid=wwXIfr

07/20/2025

Understanding Uterine Fibroids: Symptoms, Treatment, and Support

Uterine fibroids are growths that can develop in or around the uterus. They're common, especially among women in their 30s and 40s. While many fibroids don't cause symptoms, some women experience:

- Heavy or painful periods
- Pelvic pressure or pain
- Bloating and discomfort
- Frequent urination

*Treatment Options:*

1. *Watchful waiting*: Monitoring symptoms and fibroid growth.
2. *Medications*: Hormonal therapies or pain management.
3. *Surgery*: Options like myomectomy or hysterectomy.
4. *Minimally invasive procedures*: Like uterine artery embolization.

*Support and Awareness:*

If you're experiencing symptoms or concerns, consult a healthcare provider. They can help determine the best course of action.

*Resources:*

- American College of Obstetricians and Gynecologists (ACOG)
- National Institute of Child Health and Human Development (NICHD)

July is uterine fibroids awareness month!

07/18/2025

Infertility Communication tips:

What To Say:
Let them know that you care. The best thing you can do is let your infertile friends know that you care.

Do your research. Read up about infertility, and possibly treatments or other family building options your friend is considering, so that you are informed when your friend needs to talk.

Act interested. Some people don’t want to talk about infertility, but some do. Let them know you’re available if they want to talk.

Ask them what they need. They may also appreciate if you ask them what the most helpful things to say are.

Provide extra outreach to your male friends. Infertility is not a woman’s-centric issue; your male friends are most likely grieving silently. Don’t push, but let them know you’re available.

When appropriate, encourage therapy. If you feel your friend could benefit from talking to a professional to handle his or her grief, suggest therapy gently. If you go to therapy regularly, or ever have, share your personal story.

Support their decision to stop treatment. No couple can endure infertility treatments forever. At some point, they will stop. This is an agonizing decision to make, and it involves even more grief.

Remember them on Mother’s and Father’s Day. With all of the activity on Mother’s Day and Father’s Day, people tend to forget about those who cannot become mothers and fathers. Remember your infertile friends on these days; they will appreciate knowing that you haven’t forgotten them.

Attend difficult appointments with them. You can offer to stay in the waiting room or come into the appointment with them. But the offer lets them know how committed you are to supporting them.

Watch their older kids. Attending appointments may be difficult if they have older kids at home.

Offer to be an exercise buddy. Sometimes losing weight is necessary to make treatments more effective. If you know they are trying to lose weight, you could offer to join them because it would help you achieve your personal fitness goals as well.

Let them know about your pregnancy. But deliver the news in a way that lets them handle their initial reaction privately – email is best.

Not To Say: follow the link below to keep reading.

Talking about infertility can be difficult for everyone including friends and family members. Learn communication tips for discussing this sensitive topic.

07/18/2025

Occult or hidden Inguinal hernia as a cause of pelvic pain in women

Currently in the U.S., there are fewer than 5 programs considering or offering treatment for inguinal hernias as a cause of pelvic pain in women. These hernias are called hidden because they are not appreciated on exam, xray or even visible initially on laparoscopy. This is a clinical syndrome that is diagnosed solely based on history, with some findings on exam that relate to the location of pain. The diagnosis is confirmed with a special search or dissection into the inguinal region at laparoscopy and the treatment is administered at that time in the same way a traditional hernia is repaired. To further define this, while typical hernias are visible immediately at laparoscopy because of the prolapse of the peritoneum through the inguinal ring, with occult hernias, there is no prolapse of peritoneum in most cases and therefore would be “missed” in a standard laparoscopy. This is a large part of the confusion with this diagnosis.

Little research has been done or exists on this topic but the buzz words for the syndrome are “sports hernia” or “runner’s hernia.” Even so, less than 15 articles exist on this topic. Dr. Debra Metzger, a reproductive endocrinologist, was instrumental in developing this diagnosis and treatment approach back in the 1980’s and 90’s. She treated hundreds of patients with great success and promoted the procedure. Diagnosis and treatment of hernias, however, is done by general surgeons as an integral part of their specialty. The vast majority of General surgeons on a philisophical basis do not operate solely for pain without diagnostic findings. This certainly would be a prudent approach for traditional hernias where a bulge is usually appreciated. This approach though would exclude 90+ percent of the occult hernias that we see and treat. Gynecologists on the other hand have been operating for pain for over 100 years to diagnose and treat endometriosis. The idea of operating on pain without specific findings is therefore not at all foreign to us.
At ARS/JCRM, we have established a working relationship with some general surgeons who are open minded enough initially to work with us and now see the dramatic results in their patients. Other surgeons have been critical of the approach and universally would tell our patients that they do not have a hernia if the patient was evaluated by these physicians. This is not a criticism of them as surgeons, this is simply a very obscure description and we wouldn’t expect any physician to understand this without specific education. This syndrome is very common in association with endometriosis and about 30-40% of our pain surgeries include attention to this problem.

The History: Patients may report the following:
Lateral low quadrant pain (often, “my ovaries”) that is sharp and intermittent or constant

Radiates: Down the front of the leg / inner thigh / groin
Through or around to the back
Less commonly to the hip or up towards ribs
Pain is worse with in*******se, periods and with exercise or standing for a long time
The pain can be relieved by recumbent position
Often relieved some by pressing on the area
Generally worsens over time but may come and go.
A prior laparoscopy seems to be able to relieve this pain for 3-12months.
A common history is a patient who has had several laparoscopies for endometriosis followed by losing one o***y (the bad pain side) followed by hysterectomy only to continue with the same pain localized to the groin.
The Physical Exam:
Pain just above the crease of the leg to palpation.
Valsalva or straining can make the pain increase in some.
Pain on vaginal exam when directed toward the inguinal ring.
The exam findings are not subtle in the vast majority of cases.
*Few patients exhibit all of these symptoms. Most patients have several of these key elements.
Xrays: CT would almost never find this. MRI might see it in a minority of cases.

Dr. Michael Fox, MD
Advanced Reproductive Specialists
Jacksonville Center for Reproductive Medicine
www.JCRM.org

https://jcrm.org/occult-or-hidden-inguinal-hernia-as-a-cause-of-pelvic-pain-in-women/

Currently, in the U.S., there are fewer than five programs considering or offering treatment for inguinal hernias as a cause of pelvic pain in women. These hernias are called hidden because they are not appreciated on an exam, X-ray, or even visible initially on laparoscopy. This

07/14/2025

July is Fibroids Awareness Month

​Uterine fibroids (also known as leiomyomas) are extremely common muscle tumors (or growths) that develop from a single muscle cell within the womb. It is stated in the literature that up to 75% of women develop a fibroid prior to menopause (1). That being said, not all women require intervention. The questions that need to be answered include: Do I really need this fibroid removed? If it needs to be removed, how can that be accomplished?

​Recommendations for fibroid removal or myomectomy hinge on size, location, symptoms and the desire for future fertility. Fibroids may be located anywhere in the uterus. Tumors located within or close to the uterine cavity may impact bleeding and cramping even if they are small. Some women may suffer from anemia or low blood counts. Larger fibroids can cause pressure symptoms and discomfort. Decisions regarding management in these cases are fairly straightforward since surgery should be able to resolve or significantly improve these symptoms. The big question is a woman with no symptoms that is attempting to conceive.

​It is well known that any fibroid that distorts or disrupts the uterine cavity has a negative impact on one’s ability to conceive both naturally and with in vitro fertilization (IVF) (2). In addition, pregnancy complications may be increased including miscarriage, preterm labor/delivery, postpartum bleeding, C-section risk and malpresentation (where the baby is positioned differently in the uterus). Some controversy exists regarding fibroids that are “close to” but not within the uterine cavity. According to multiple studies, there is some evidence that fibroids that exist in close proximity to the cavity (where the baby will be developing) do pose a negative impact on success. A recent study published in March of this year found that fibroids located close to the uterine cavity were associated with reductions in live birth rates in women undergoing IVF (3). How then do fibroids impact fertility?

​Fibroids that impact the uterine cavity have an obvious mechanical impact but what about fibroids not immediately within the cavity. What other mechanisms have been proposed? Impacts on blood flow have been proposed as well as the potential for fibroids to produce substances that may have a significant impact on the receptive nature of the nearby endometrium or uterine lining (4). Other theories have focused on the impact on the fallopian tube and the possible deleterious effect on the tubal transport of the s***m, egg or embryo. It is our belief that fibroids causing cavity distortion or larger fibroids in close proximity to the cavity should be removed.

​Since fibroid size and location are the most important characteristics that dictate how we counsel our patients, we recommend uterine imaging to assist us in our ability to recommend the best course of action. Saline ultrasound offers excellent visualization of uterine fibroids and furthermore, allows the physician to determine distance from the cavity as well as the best surgical approach for smaller fibroids that may not be directly visible from the outside when performing minimally invasive surgery.

​The technique of myomectomy may be performed in several different ways, depending on fibroid size, number and patient characteristics. Smaller fibroids located within the uterine cavity may be approached with a hysteroscope (an instrument placed through the cervix) while the patient is under anesthesia. This technique does not require incisions and most patients return to normal activity the following day. Larger fibroids or fibroids where all or the majority of the tumor is located outside the cavity are treated either with laparoscopy (small incisions) with approximately 5-7 days out of work or with laparotomy which requires longer recovery times. By far, the majority of cases can be handled in a minimally invasive way without a hospital stay. Laparoscopic management requires advanced laparoscopic skills and has been shown to be associated with reductions in post-operative complications and blood loss. Our experience has been that patients undergoing laparoscopic myomectomy recover faster and return to work sooner with minimal scars.

​Although fibroids are very common, the first step is to determine whether an intervention is necessary. This is based on symptoms and fertility desires. Furthermore, your physician, through very basic testing, can determine whether the fibroid(s) are hindering your ability to conceive and carry a child. If one desires to proceed with myomectomy, most can be accomplished in a minimally invasive way. We would encourage anyone with symptoms of painful periods, cramping, pelvic pressure or infertility to seek an evaluation for anatomic causes. There are multiple options available and outcomes after myomectomy are excellent.

Christopher W. Lipari, M.D.
Board Certified Reproductive Endocrinologist and Infertility Specialist
Jacksonville Center for Reproductive Medicine



1. Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 2003; 188: 100-7.
2. Farhi J, Ashkenazi J, Feldberg D, Dicker D, Orvieto R, Ben Rafael Z. Effect of uterine leiomyomata on the results of in-vitro fertilisation treatment. Hum Reprod 1995; 10: 2576-8.
3. Yan L, Yuq Zang Y, Guo Z, Lee Z, Niu J, Ma J. Effect of type 3 intramural fibroids on endometrial fertilization – intracytoplasmic s***m injection outcomes as: a retrospective cohort study. Fertil Steril 2018; 109: 817-22.
4. Rackow B, Taylor HS. Submucosal uterine leiomyomas have a global effect on molecular determinates of endometrial receptivity. Fertil Steril 2010; 93: 2027-34.

​Uterine fibroids (also known as leiomyomas) are extremely common muscle tumors (or growths) that develop from a single muscle cell within the womb. It is stated in the literature that up to 75% of women develop a fibroid prior to menopause (1). That being said, not all women require intervention....