Jacksonville Center for Reproductive Medicine

I was referred to Dr Lipari in 2012. A few years later we finally tried IVF and now my 8 year old is in third grade. So grateful for the team there!

So what is it about women that gives them a longer lifespan than men? A single word: Estrogen. Estrogen is cardio protective, despite the government and the WHI's attempt to discredit this idea. there is also very suggestive evidence that it reduces the incidence of Alzheimer’s disease. In our practice of reproductive medicine, we recognize that fertility problems also carry with them chronic health consequences. PCOS and insulin resistance cause a host of metabolic diseases including diabetes and heart disease. The newer soon to be more common, hypothalamic dysfunction or stress induced ovulation dysfunction also will be shown to result later in stress induced diseases that mimic those of PCOS but also will result in significant osteoporosis, bone and joint problems later in life. At JCRM, we are committed to educating women on these risks and offering changes and strategies that will improve long term outcomes. This study:
Women With Irregular Periods May Be More Likely To Die Before 70, Researchers Say highlights this problem.

https://www.hsph.harvard.edu/news/hsph-in-the-news/irregular-periods-premature-mortality/

In this study it was determined that if women had cycles that were long (our definition >30days) that their lifespan was significantly compromised. All of reproductive medicine should take a much more active role in helping women see these issues and provide valid strategies to avoid these negative outcomes.

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

Women with irregular menstrual cycles may have greater risk of death before age 70 Women who always have irregular menstrual cycles or cycles lasting more than 40 days may have a greater risk of dying before age 70 compared to women with very regular cycles.

On August 22, national rainbow baby day our 5x rainbow baby turned 2! 🌈🌈🌈🌈🌈She wouldn’t be here if it wasn’t for JCRM and Dr. Lipari doing my second endometriosis surgery (and true excision), Dr. Fox for my egg retrieval, and Dr. Lipari for our IVF transfer!

Congrats on 30 years!!! Thank you Dr. Lipari and Dr. Fox for this beautiful little blessing! He started kindergarten this year. Seems like just yesterday I was sitting in your office… 🥰🥰

Because of you, every day is great with this sweet little addition to our family ❤️ Thank you for never giving up on us! 🙏🏻

Congratulations on 30 years!!! Thank you Dr. Fox and the nursing staff for giving us these two miracles!! They're now 15 months old and are the best additions to our family ❤️❤️. We couldn't have done it without you! ☺️

Congrats on 30 years....forever grateful to Dr Lipari and the whole team for not only the greatest gifts we could hope for 12 years ago but also saving my life so I am around the see to them grow!

Congrats on 30 years!!! Thank you for the incredible work you all play a part in!!! The Rayburn family is forever grateful for my stage 4 Endo excision and our two IVF blessings 🥰

Thirty years ago when I started my practice as a young physician I had no idea what a charmed life I would live!! I have experienced immense joy with the creation of thousands of pregnancies and the family building that has accompanied these outcomes. In my specialization of endometriosis surgery and pelvic pain, the evolution from a 50 - 60% long term pain relief to now over 95% with new techniques I have developed, I have watched the complete transformation of patients from non-functional to functional and given thousands of patients "their life back." To hear this positive life changing report day after day is nothing short of remarkable. Similar dramatically positive outcomes in the hormonal treatment arena coupled with the above have provided me with constant professional satisfaction. Together with our distinguished team of 5 physicians and 8 Nurse Practitioners, we serve the North Florida and South Georgia area with the commitment to excellence in all areas of women's reproductive health. I love my job!!

I look forward to many more years of service to the community - Last weekend my wife Felicia and I moved our triplets into their dorms at FSU, giving us a life changing experience as we look to the children’s future accomplishments!! I hope everyone has as great a day today as I will have.

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

Wow! 30 years! I can't say l've been here for 30 but l can say it has been 18+ years since I joined Dr. Michael Fox here at JCRM. I knew from the moment I met with him that he had an intense dedication to patient care and that our philosophies aligned. He started something very special. I interviewed for the position back in 2006 and witnessed firsthand the fundamental principles upon which this practice was established. I have come to learn over the years how very blessed we have been. We are grateful that the people of Northeast Florida and beyond that have entrusted us with their care. It is so exciting assisting people in building their families! This feeling has and will not change from the first patient I saw in Jacksonville to the one I will see tomorrow. We enjoy watching ARS/JCRM babies grow and accomplish great things! Here's to the past 30 years! I look forward to the future and will continue to enjoy being part of something so great and witnessing firsthand the impact that JCRM has had on our community. Sincerely, Dr. Lipari

Celebrating 30 years of changing lives!

How many of you remember this picture?

Stress: My overwhelming observation amongst my patients both with endometriosis and Diminished Ovarian Reserve (DOR) and patients with other stress based causes of lower estrogen levels exhibit far more PMS symptoms at younger ages to include mood changes, anxiety, depression, migraine headaches, bloating, sleep disturbance and many more. These are all typical low estrogen symptoms. The referenced study underscores this through a look at living conditions:
Women Who Live Around More Green Space Less Likely To Experience PMS Symptoms, Study Indicates

Many years ago, studies with female primate monkeys in cages, where they were studied in separate rooms, then closer and closer together in the same room, showed increasing ovulatory and reproductive problems caused by stress at the brain level. This would explain why fertility rates are better in people who live in the country compared to those in cities where the dwelling proximity is much closer. This study further lends support to this hypothesis. We would all describe the countryside and more natural beauty as stress relieving. Our current world with its increased technology, buzing and beeping constantly and more apartment and condominium type living is contributing to more stress, less estrogen and therefore, an explosion in the symptoms referenced in this study. I don't know what it will take to reverse these trends but until we figure out significant stress reduction, fertility in our population will continue to decline as it has over the 30 years of my practice.

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

https://www.healio.com/news/womens-health-ob-gyn/20211214/living-near-green-spaces-improves-premenstrual-syndrome-symptoms

Living near green spaces improves premenstrual syndrome symptoms Women who live around more green space throughout their lives are less likely to experience PMS symptoms than women living in areas that are less green, according to a study published in Environment International. Up to 20% of women of reproductive age experience clinically relevant physical and psy...

Physicians and patients are becoming more aware of the chronic disease endometriosis. What is getting ignored now is a disease that often accompanies endometriosis called Adenomyosis.

Adenomyosis: Endometrial cells located in the muscle wall of the uterus. All patients with endometriosis probably have some degree of adenomyosis. The pain with endometriosis is probably most often characterized as pain with periods in the teen years. As the lesions begin to burn out in the 20’s, many patients report cycles becoming less painful. By the mid 30’s, many patients are again having increased pain with periods. This however, is most likely due to the slowly progressive problem of adenomyosis. Therefore, after excision of endometriosis, if pain with periods recurs it is likely adenomyosis. Adenomyosis is not visible at or treated by surgery except through hysterectomy. It is most commonly suspected when the uterus is enlarged on ultrasound. Continuous birth control suppression can slow the progression of this process.

Dr. Michael Fox, MD
Dr. Christopher Lipari, MD
Advanced Reproductive Specialists
Jacksonville Center for Reproductive Medicine

We ask every patient if their period pain was worse than their peers in the teen years. The vast majority say they don't know because it was not discussed. Because so many times, endometriosis is hereditary, the mothers of younger patients with severe periods had the same themselves therefore they feel it is normal. The mothers and grandmothers of today’s reproductive age women rarely had endometriosis diagnosed and therefore don't know this is not a normal situation. So many patients with endometriosis have heavy prolonged periods. In today’s a environment, the vast majority of women are subjected to extreme physiologic stress from aerobic exercise, underweight, eating disorders etc, all of which result in low estrogen levels. Low estrogen causes cycles to be prolonged and often can be heavier due to more days of bleeding. Teenagers with significant cycle pain should be evaluated and treated early for endometriosis. This condition can be cured and the period pain can be normalized. Medications may relieve symptoms but do not treat the disease that goes on to cause infertility, hormone problems and early menopause. At least 15% of teenagers have this disease and results of histories taken from these patients tell us that they lose decades of their lives in a less than normal functional state. Most patients have severe symptoms 5-7 days each month decreasing their functional lives by 25%!! This is a huge problem and deserves more attention in the lay press.

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

I underwent endo surgery in April 2023 by you and I want to share my experience. I've thought about writing to you many times and always stopped myself thinking you must get so many notes like this. Well in case you don't, I'd like you to know you changed my life. I say that with absolutely zero exaggeration. Let me explain what my period was like prior to my excision and presacral neurectomy. I was completely debilatated taking 1000mg of Tylenol and 800mg of ibuprofen every 4 hours. I would alternate so they didn't wear off at the same time, setting alarms for every 2 hours (including throughout the night). I was still in pain and bedbound with a heating pad. I would take the fabric cover off my heating pads to make it hotter and as a result, burnt myself many times over the years seeking relief. At 12 years old I was given Vicoden and when that didn't help, Percocet for the pain. It made me very sick and I always puked it up. I think I am very lucky in hindsite that I had this reaction because that certainly could've been a slippery slope. Over the years I was given Tramadol, Gabapentin, Celebrex, and more. I was told to just hurry up and have children young and just get a hysterectomy. I had an ablation procedure. I had my first pap at 12 years old and got put on continuous birth control. It didn't work. I spent family vacations in the bathtub. I lived in fear of my period each month for 15 years (ages 12-27).

I am one year post op and now, for the first day of my cycle I take 2 Aleve. THAT'S IT. Aleve never worked for me before. Since it lasts 12 hours I do not have to set alarms every 2 hours throughout the night. I would describe my cramps as very mild and I don't take any medicine beyond the Aleve on day 1. I can leave the house. I function as a normal person during those 3-4 days. I can't thank you enough. My liver and kidneys are probably very grateful too. 🙂
McKenzie

Hormones and endometriosis are integrally related. This is not discussed anywhere in the literature, textbooks and certainly not taught to upcoming OB/GYN residents currently in training. This is also true of Minimally Invasive Surgery Fellowships. As Reproductive Endocrinologists, we are innately attuned to Hormonal complaints from our patients. Observing through years of taking care of endometriosis patients, it is evident that estrogen levels begin to fall on average around age 35 producing intense symptoms to include a characteristic PMS syndrome of mood changes, bloating and cyclic headaches. In addition, all of the more typical symptoms of menopause can be evident as well. These symptoms include hot flashes, night sweats, night time urination, frequent urination urgency, vaginal dryness, Brain fog, anxiety, depression, memory loss, attention deficit disorder, bone pain and sleep disturbances just to name a few. Many women are all too familiar with these symptoms. In women without endometriosis, these symptoms would be common starting in the 43-45 age range and would be recognized by some doctors as pre-menopausal. At 30 or 35 however, nobody is thinking about menopause or estrogen, Sadly, most of these patients are placed on Anxiety, Depression, ADD, and Headache medicines and many are on all 4 when we see them. Most are so devastated by these symptoms and the relief provided by the drugs, that they can't conceive of coming off even after estrogen has resolved their symptoms. The low estrogen is caused by premature aging of the ovaries due to endometriosis induced chronic pelvic inflammation. If you know anyone with these symptoms, they need to be carefully evaluated for diminished ovarian reserve and treated appropriately. Remember, many women with endometriosis have little or no pain and are shocked when we suggest the diagnosis. There are other reasons for low estrogen as well and our world today brings estrogen down in many women who thrive via estrogen supplementation.

Michael D. Fox, MD
Advanced Reproductive Specialists
Jacksonville Center for Reproductive Medicine

Hormones and Endometriosis - Jacksonville Center For Reproductive Medicine Hormones and endometriosis are integrally related. This is not discussed anywhere in the literature, textbooks, and certainly not taught to upcoming OB/GYN residents currently in training. This is also true of Minimally Invasive Surgery Fellowships. As Reproductive Endocrinologists, we are innately....

We are currently recruiting compassionate women who are willing to help infertile couples achieve their dreams of parenthood. Women interested in donating their eggs must pass our screening process, which includes drug, fertility, genetic, psychological, and STD testing.

Egg Donor Requirements:
* Women between the ages of 20 and 29
* Weight appropriate for their height (a BMI score >19 or

Become an Egg Donor Today Become an Egg Donor Today We are currently recruiting compassionate women who are willing to help infertile couples achieve their dreams of parenthood. Women interested in donating their eggs must pass our screening process, which includes drug, fertility, genetic, psychological, and STD testing. Eg...

Hi JCRM team! Wanted to send a picture of our new bundle of joy!

Joe “(Joey)” Williams III

Created with love: 10/24/2023
Frozen in time: 10/29/2023
Transferred with hope: 12/14/2023
Born: 8/2/2024

Definitely worth every shot! We are so thankful for JCRM in giving us our miracle baby boy.

Our practice made the decision to add a strong emphasis on the metabolic and nutritional aspects of PCOS and insulin resistance as it applied to ovulation and fertility.

Since that time we have refined our approach to cover all potential treatment options for this most misunderstood disease. Our pregnancy rates have more than doubled with this approach, and patients overall have a much better quality of life.

We treat PCOS. Call to schedule an appointment.

PCOS & Nutrition - Jacksonville Center For Reproductive Medicine PCOS & Nutrition Our practice made the decision to add a strong emphasis on the metabolic and nutritional aspects of PCOS and insulin resistance as it applied to ovulation and fertility. Since that time we have refined our approach to cover all potential treatment options for this

Meila Rose Rosenshein

Created with Love 7/24/21
Frozen in Time 7/29/21
Transferred w/ Hope 7/19/23
Born Easter 🐣 3/31/24

Worth Every Shot 💉

Thank you JCRM!!! 💕

Pregnant Women Who Consume Coffee May Be More Likely To Have Children With Behavioral Issues Later In Life, Study Indicates

About 3 or 4 years ago ACOG (Am College OB/GYN) made the landmark statement after 100 years of the opposite precedent that 200mg of caffeine per day in pregnancy was "OK." As many may know, I have been very outspoken in my belief that caffeine, like amphetamine (both stimulants) are very damaging to our metabolic systems. Even my most ardent Low Carb advocate friends are not really on board with this concept, yet the data is in the literature that caffeine essentially doubles cortisol levels indicating a 100% increase in body stress. This can't be good and must have profound negative effects for us in the long run in regards to weight gain and metabolic diseases such as diabetes and heart disease and certainly pregnancy.

Recent ideas in pregnancy and metabolic disease have supported the concept that some signal from the mother to the fetus "turns on the metabolic dysfunction gene or Insulin resistance" that is responsible for all the metabolic disease that we know of. The idea is called epigenetics. For highly conserved (same) genes like metabolic function the idea is that we all have the same genetic code but based on outside influences we may express those gene sequences differently. Therefore if a signal from the mother to the fetus said for example, there is not enough food in the environment, then the fetus would turn on Insulin Resistance and store fat to survive the lack of food. This would affect the individual's entire life. All of these ideas must be considered in cave man terms and not modern ones because our brains are wired from this origin. It would make sense then that if a pregnant cave woman was not getting enough food that the signal for this event would be stress. With Insulin resistance physiology already present in the mother, high insulin levels result in frequent hypoglycemia which is a very powerful starvation stress and likely causes this insulin resistance activation in the fetus. This train of thought has been used to explain the observed generational increases in obesity and metabolic disease in our population.

Pregnant Women Who Consume Coffee May Be More Likely To Have Children With Behavioral Issues Later In Life, Study Indicates - Jacksonville Center For Reproductive Medicine About 3 or 4 years ago American College of Obstetricians and Gynecologists (ACOG) made the landmark statement after 100 years of the opposite precedent that 200mg of caffeine per day in pregnancy was "OK." As many may know, I have

Hello August!

What’s your favorite thing about the month of August?

For those faced with hysterectomy for period and uterine pain, but are still considering pregnancy in the future, adenomyomectomy can be a valuable alternative. I recently interviewed a patient who lost her uterus at age 25 with no prior pregnancies who was told that she had no other options.

Please go to the link below to continue reading.....

Hysterectomy for Period and Uterine Pain - Jacksonville Center For Reproductive Medicine For those faced with hysterectomy for period and uterine pain, but are still considering pregnancy in the future, adenomyomectomy can be a valuable alternative. I recently interviewed a patient who lost her uterus at age 25 with no prior pregnancies who was

Here’s the most common question we get from an infertility patient who is not experiencing pain, but who we believe may have endometriosis:
I’ve never had any of the symptoms, so how can I have endometriosis?
After 30 years of intense study and treatment of patients with endometriosis, I would say the most common symptom of endometriosis is infertility. We now believe that roughly 80% of women who seek our infertility services have endometriosis. The other issue we see at epidemic proportions is hypothalamic dysfunction, or what I call “stress physiology.”

Click the article below to continue reading.

Can Endometriosis Have No Symptoms? Here's the most common question we get from an infertility patient who is not experiencing pain, but who we believe may have endometriosis: I’ve never had any of the symptoms,

A message to our patients and to friends and family around them.

Miscarriage is one of the most underappreciated negative events in a woman’s and or couples’ life. It is clear, psychologically, that a pregnancy loss at any time during the pregnancy is like a death in the family. If you add infertility to the equation, it only gets much worse. As soon as the female partner has been notified of a positive test an enormous amount of bonding happens with the pregnancy.

To those around the couple, in early pregnancy loss, there is never any outward evidence of pregnancy that allows those people to “bond“ with the pregnancy. In many cases, the couple may not have even made a public declaration of pregnancy by the time the loss occurs. Therefore, when there is a loss, friends and family do not tend to appreciate the overall significance and often things are said which can be very hurtful like “you can just try again.“ Even husbands who may not have a similar bond to the pregnancy as the female partner had may underestimate the significance of this event and say things that can create significant grief for the female partner. Our experience has been over the years that patients need to grieve these losses as they would the loss of a child. Communication needs to remain open between the couple and their friends and family. Remember be very supportive but don’t offer solutions as they will come across uncaring. These are life changing events for these couples.

Michael D. Fox, MD
Advanced Reproductive Specialists
Jacksonville Center for Reproductive Medicine

Dr. Lipari says, “Infertility is based on the time of conception. If people are attempting to conceive and they’re having regular unprotected intercourse for a year without conceiving, that basically is a diagnosis of infertility.”

What Causes Infertility and How is it Evaluated? What is infertility? How is infertility diagnosed? What causes infertility? How is infertility treated? For many people, the dream of starting a family begins with a desire to have

Dr. Paschall joined the staff of Jacksonville Center for Reproductive Medicine in September 2011 in order to focus on advanced minimally invasive laparoscopic surgery and work side-by-side with her mentors, Dr. Fox and Dr. Lipari in the reproductive field. In addition to laparoscopic surgery, Dr. Paschall’s clinical interests also include the evaluation and management of PCOS as well as working with subfertile patients. In addition, she has taken a strong personal interest in familial cancer screening that focuses primarily in the area of breast, ovarian, endometrial and colon cancers. She is instrumental in offering the latest testing for those who are at high risk for genetic cancer syndromes.
Dr. Paschall is a member of numerous professional organizations including the American Society for Reproductive Medicine, the American Congress of Obstetricians and Gynecologists, the Society of Laparoendoscopic Surgeons, the Florida OB/GYN Society and the Duval County Medical Society.

Getting to Know Dr. Sarah Paschall | Jacksonville Center for Reproductive Medicine Meet Sarah Paschall, M.D., a board-certified obstetrician and gynecologist at Jacksonville Center for Reproductive Medicine. Dr. Paschall is skilled in advan...