Optimize Your Fertility
Bay IVF - Advanced Reproductive Care                                Palo Alto  650-322-0500

 

Lifestyle and Reproductive Health:
How to Optimize Your Fertility

Please carefully study the following information in its entirety. It represents a centerpiece of your participation in treatment at Bay IVF.

 

There is mounting scientific evidence that an outcome of In Vitro Fertilization and related reproductive treatments is determined before the treatment starts.

Your lifestyle, type of diet, the level of stress in your life, your physical activity, and exposure to egg/sperm damaging factors play a decisive role in your probability of success. This is particularly the case with advancing age (30 and older).

Advanced reproductive treatments require your active participation (both partners) in the process, starting as much in advance of the beginning of your treatment as possible.

The outcome of reproductive treatments depends almost solely on the health of your eggs and sperm that exists before the treatment begins. Reproductive treatment cannot improve the egg and sperm quality, but your close adherence to the following reproductive health requirements can result in an improved capacity of your eggs and sperm to result in a healthy baby.

It is essential that you start implementing these requirements as fully and as soon as possible, as it may take several weeks before there is an improvement in your reproductive health.

Reproductive health factors fall into two general categories:

Nutrition-related factors (Part I)
  1. Acid-alkaline balance
  2. Pesticides
  3. Omega-3 essential fatty acids
  4. Glycemic load
  5. Reproductive hormones imbalance
  6. Nutritional deficiencies
  7. Impact of CoQ10 on eggs and sperm
  8. Alcohol
  9. Caffeine
  10. Advanced glycation end-products
  11. Hydration
  12. Reproductive health promoting diet
Non-nutritional factors (Part II)
  1. Exercise
  2. Stress
  3. Sperm oxidative stress
  4. Volatile organic compounds
  5. Fire retardant chemicals
  6. Smoking
  7. Dental Hygiene
  8. Acupuncture
  9. Chinese Medicine

 

Part I
Dietary Habits and Reproductive Health

 

Following a health promoting diet and taking nutritional supplements are the most important steps in optimizing your reproductive health.

 

1. Optimize Your Body’s Acid-Alkaline Balance

 

The pH of our blood is slightly alkaline. The choices of foods that we eat affect the acid-alkaline balance of our bodies. The typical North American diet is highly acidic. If we eat acidic food, our bodies have to compensate to keep the blood in an alkaline state. This extra work stresses our body and our immune system and can result in a decrease of the fertility potential.

The best way we can maintain a proper blood pH balance is to avoid acid producing foods and increase consumption of alkaline foods. Be in control of what ingredients you eat; prepare your own food as much as possible, do not eat out.

For optimal acid-alkaline balance, follow these rules as closely as possible:

  1. Minimize or eliminate the intake of the following acidic foods:
    1. All grains and foods made out of flour: bread, pasta, pastry, cereal, dumplings, tortillas, chips, cupcakes, cakes, cookies, pancakes, puddings, muffins, crackers, tacos, pretzels, bagels, doughnuts, etc.

      This includes whole wheat, whole grain, multigrain, and bulgur flour products, as well as brown rice, oats, and barley.

      Corn and all corn products including high fructose corn syrup MUST be avoided altogether (see below). This can be very difficult as most processed (grocery store) foods contain corn products.

      It is OK to have up to two cups of cooked white rice a day. Substituting quinoa and buckwheat instead of grains is OK. Beans and legumes are OK (not canned), but diligent overnight soaking before cooking is necessary for the proper digestion and nutrient absorption of legumes.

    2. Dairy (especially hard cheese, i.e., Parmesan)
      Butter, buttermilk, kefir, and yogurt are OK.
      Alternatively, you can use unsweetened coconut, hazelnut, hemp, or flaxseed milk.

    3. Cranberries (all other berries are OK)

    4. Processed meat (salami, sausages, hot dogs, canned meat) should be avoided.

    5. Consumption of carbonated beverages (soda) should be minimized or eliminated if possible.

  2. Increase intake of the following alkaline foods (organically grown if possible)*:

 
  • Apples
  • Cantaloupe
  • Green peas
  • Papaya
  • Apricots
  • Carrots
  • Grapefruit
  • Parsley
  • Artichoke
  • Cauliflower
  • Grapes
  • Peach
  • Asparagus
  • Celery
  • Kale
  • Pear
  • Avocado
  • Chard
  • Kiwi
  • Persimmon
  • Bananas
  • Coconut
  • Lemon
  • Pineapple
  • Berries
  • Cucumber
  • Lettuce
  • Raisins
  • Beets
  • Dates
  • Mango
  • Spinach
  • Bell peppers
  • Eggplant
  • Melons (all)
  • Salad mix
  • Bok Choy
  • Fennel
  • Nectarine
  • String beans
  • Broccoli
  • Figs
  • Olives
  • Sweet potato
  • Brussels spr.
  • Garlic
  • Onions
  • Tomatoes
  • Cabbage
  • Ginger
  • Orange
  • Zucchini
* Items in bold are especially helpful. Please note that all citrus fruits have an alkaline effect.

Consume an abundance of fresh green leafy vegetables (salads).

2. Avoiding Pesticides

 

People who eat organic produce eat fewer pesticides. The following table will help you decide which produce may be safe to buy conventional and which you should always purchase organic. (Click on the table to download a full-size pdf copy).

Pesticide Residue
(Lower numbers = More pesticides = Buy organic instead)

Pesticide Residue

 

It is paramount that you make fruits and vegetables the foundation of your reproductive health diet. The health benefits of a diet rich in fruits and vegetables even outweigh the risks of pesticide exposure. If you cannot buy organic, eating conventionally grown produce is better than skipping fruits and vegetables.

 

3. Reduce Your Omega-6 to Omega-3 Fatty Acid Ratio

 

Over the course of human history, there has been a dramatic change in the ratio of omega-6 and omega-3 fats consumed in the diet. This change, perhaps more than any other dietary factor, has contributed to the epidemic of modern disease. Elevated omega-6 intake is associated with a systemic inflammatory response in the body and an abnormal immunological response. This state of chronic "silent" inflammation can have a significant impact on reproductive health.

It is essential to decrease the omega-6 to the omega-3 ratio:

  1. Eliminate or minimize your intake of high omega-6 trans fatty acids (very important):

    1. Corn and corn products must be eliminated from your diet. Corn has the worst fatty acid profile (omega-6 to omega-3 ratio) of nearly all grains.

    2. All grains and foods made out of flour should be eliminated or minimized.

    3. In addition to eliminating corn oil from your diet, also avoid soybean, canola, sunflower, safflower, cottonseed, grapeseed, walnut, sesame, peanut, and vegetable oils. Americans get almost 20% of their calories from a single food source – soybean oil.

    4. Hydrogenated or partially hydrogenated fats (vegetable shortening, margarine)

    5. Fried foods

      If you must have occasional fried food, use only ghee (clarified butter), avocado oil, light olive oil (not extra virgin), and coconut oil (not extra virgin). It is OK to use extra virgin olive oil if not heated (salad dressings, etc).

    6. Junk food

  2. Consume an abundance of foods high in omega-3 essential fatty acids:

    1. Deep-sea fish from non-polluted sources: softivf.com/fish (pdf)

    2. Seaweed

    3. Flaxseed oil

    4. Flax, chia, sesame, and pumpkin seeds

    5. Broccoli, cauliflower, spinach, kale, collards, cabbage, Brussels sprouts, and squash

    6. Coconut oil, coconut milk, and coconut products although not an omega-3 or omega-6 fat, contain an extremely beneficial dietary fat. Coconut’s health benefits derive from its unique medium-chain fatty acids.

  3. Take high-quality Omega-3 supplements:

    Daily and consistent use of an omega-3 supplement (from fish oil products*) by both partners (if applicable) is critical for good reproductive health and is a part of your treatment at Bay IVF.

    Since high levels of omega-6 fatty acids interfere with absorption of omega-3 from the digestive system, it is not sufficient to only take omega-3 supplements; you must eliminate/minimize the intake of foods high in omega-6 as well.

    We recommend ProOmega®-D Xtra produced by Nordic Naturals as the highest quality omega-3 supplement. Nordic Naturals’ products surpass strict international standards for purity and freshness and have no fishy smell, taste, or aftertaste.

    You can use another omega-3 supplement of your choice, as long as it contains a minimum of 2,400 mg of EPA and DHA in approximately 2:1 ratio in a daily dose and has been certified by the International Fish Oil Standards Program (IFOS).

    It is important to start taking the omega-3 supplements as much in advance of your treatment as possible. Both partners are encouraged to begin the regimen right away.

    There are several ways to obtain ProOmega®-D Xtra:

    1. You can purchase it locally, sold as Ultimate Omega® Xtra:

      • Visit: nordicnaturals.com

      • Select: Natural Health Retailers

      • Select: Find A Store (at the top)

    2. You can buy ProOmega®-D Xtra online:

      • Visit: nordicnaturals.com

      • Select: Patients Referred By Practitioners

      • Select: Nordic Naturals Patient Fulfillment

      • Select: Patients Referred By Practitioners

      • Enter: Practitioner’s ID 85453

      You will receive 15% off every order with free shipping and no minimum purchase.

    3. You can pick up ProOmega®-D Xtra at Bay IVF in person once you have made an appointment even if you have not been seen at our clinic yet. You will receive ProOmega®-D Xtra at our cost.

    Please note that each partner should start taking FOUR soft gels of ProOmega®-D Xtra a day (in a single dose or divided into two doses a day) as soon as possible. It is important to be on this supplement even if you are already taking fish oil.

    *There is a non-fish based, a vegetarian omega-3 alternative to ProOmega®-D Xtra. It is not as effective as ProOmega®-D Xtra and should not be used as a first choice omega-3 supplement. Please call us for additional information.

 

4. Reduce Your Dietary Glycemic Load

 

Glucose, a form of sugar, is a primary source of energy for body cells. Carbohydrates in food are a major source of glucose. After we eat or drink something with carbohydrates, our body breaks down the carbohydrates, converting them into sugar. The sugar then enters our bloodstream. The hormone insulin moves sugar from the bloodstream into individual cells throughout our body to provide energy. Extra sugar is stored in our liver and muscles in a form called glycogen. Excessive sugar is stored as fat.

Our ancestors consumed, on average, about 80 grams of carbohydrate a day compared to the 350-600 grams a day in the typical American diet today.

The glycemic index ranks foods and beverages based on how they affect our blood sugar level. Our body rapidly digests foods and beverages with high glycemic index scores. This causes a spike in our blood sugar and insulin levels, which may then be followed by a rapid decline in blood sugar, creating wide fluctuations in our blood sugar level. The body has trouble responding, and over time, this contributes to insulin resistance.

Insulin resistance is associated with a host of health problems including suboptimal fertility. Our shared genetic susceptibility to insulin resistance, inflammation, cardiovascular disease, and obesity shows that any kind of refined sugar or grain is detrimental to our health.

In contrast, items with low glycemic index rankings (most fruits and vegetables) are digested more slowly, raising blood sugar in a more controlled and gradual way.

Research shows that, like cholesterol, there are good sugars and bad sugars. High-fructose corn syrup and crystalline fructose are the worst. Today, 55% of sweeteners used in food and beverage manufacturing are made from corn.

  1. Examples of high glycemic index foods:

    • High-fructose corn syrup must be avoided.

    • Consumption of all grains and foods made out of flour should be minimized or avoided.

    • Minimize consumption of potatoes and potato products.

  2. Examples of low glycemic index foods:

    • Fruits and vegetables
      Make fresh vegetables the base of your food pyramid.

    • Legumes

    • Seeds

    • Nuts

    • Seafood and meats

    • Eggs

    • Dairy products

If you want to use a sweetener occasionally:

  • Use the herb Stevia.

  • Use organic cane sugar in strict moderation.

  • Use organic raw honey in moderation.

 

5. Reproductive Hormones Imbalance

 

One of the primary environmental causes of hormone imbalance for both men and women is dietary.

  1. Low nutritional value diet:

    Diet that is high in sugar, flour, caffeine, nicotine, alcohol, and processed food can have a significantly negative impact on our endocrine system. It is imperative to avoid, or at least minimize, the consumption of these foods.

  2. Soy products:

    Soy is not part of the original human diet. Only very recently has soy been eaten the way we typically eat it: consuming significant amounts in an unfermented and often highly processed form. Soy, soy flour, and soy products are in almost every packaged food today. Americans now get nearly 20% of their calories from a single food source: soybean oil.

    Traditionally, Asians eat only small amounts of fermented soy products (miso, tempeh, or soy sauce) as a condiment, and the Japanese typically combine it with fish broth and seaweed that naturally contains iodine, helping offset the thyroid-suppressing effects of soy.

    Soy Phytoestrogens are plant-based estrogens that act like hormones. There are enough of them in soy to disrupt endocrine function and have the potential to impair reproductive health.

    Unfermented soy products should be avoided.

  3. Toxic plastics additives:

    Phthalates (PBA) are chemicals used in many plastics to make them soft or flexible. They are widely used in plastic products in the food industry and a vast array of everyday products. Since phthalates are not chemically bound to the plastic, they can easily migrate out especially with increased temperature (cooking).

    Studies have shown that most Americans have phthalates in their urine, and that all of us are exposed to phthalates from such ubiquitous sources as air, water, soil, and food.

    Phthalates are estrogenic/anti-androgenic compounds and can have a significant negative impact on reproductive health. They can affect sperm quality, lower the rate of embryo implantation, and increase the risk of miscarriage.

    Avoid the following:

    1. Microwaving foods in plastic containers

    2. Consuming ready-made meals in plastic trays or trays covered with plastic film

    3. Consuming boil-in-bag foods

    4. Bottled water in plastic containers
      Drink only filtered water or water sold in glass or metal containers. For instance, levels of BPA increase by about 1000-fold in the water of a bottle that has been sitting in the sun.

    5. Canned foods
      Cans (including soda) are lined with a plastic lacquer containing BPA.

    6. Putting very hot or boiling liquid in plastic containers if you plan to consume the liquid

    7. Wrapping food in stretch wrap

    8. Cooking with Teflon cookware

    9. Handling cash register receipts which are often coated with resins that contain BPA

    10. Exposure to phthalates released from plastic car interiors, i.e., "new car" smell

 

6. Nutritional Deficiencies

 

Scientific evidence shows that taking high potency multivitamins can significantly increase reproductive health in both men and women and, at the same time, reduce the probability of birth defects in offspring.

Daily and consistent use of high quality, high potency multivitamins by both partners (if applicable) is critical for good reproductive health and is a part of your treatment at Bay IVF.

Supplements are not intended to be a substitute for a well-balanced diet because they cannot replicate all the nutrients and benefits of whole foods, such as fruits and vegetables.

We recommend Alive!® Women’s Multi Max Potency and Alive!® Men’s Multi Max Potency multivitamins produced by Nature’s Way, three tablets daily.

You can use another high potency multivitamin supplement of your choice, as long as it contains a minimum of 800 mcg of folic acid a day for women and at least 30 mg of zinc a day for men.

It is important to start taking the multivitamin supplements as much in advance of your treatment as possible. Both partners are encouraged to begin the regimen as soon as possible.

There are several ways to obtain Alive!® Women’s Multi Max Potency and Alive!® Men’s Multi Max Potency multivitamins:

  1. You can purchase them locally:

    • Visit: naturesway.com

    • Enter your zip code in Store locator.

  2. You can buy them online:

    • Search for Alive!® Women’s Multi Max Potency and Alive!® Men’s Multi Max Potency.

  3. You can pick up Alive!® Women’s Multi Max Potency and Alive!® Men’s Multi Max Potency multivitamins at Bay IVF in person once you have made an appointment even if you have not been seen at our clinic yet. You will receive them at our cost.

Please note that each partner should start taking three tablets a day of the multivitamins as soon as possible.

 

7. Impact of CoQ10 on Eggs and Sperm

 

Coenzyme Q10 (CoQ10) is critical to energy production in the reproductive cells.

As eggs within the ovaries age, their mitochondria produce diminishing amounts of coenzyme Q10 resulting in decreased metabolic activity, a reduced probability of fertilization, and an increased frequency of embryonic chromosomal abnormalities.

Low levels of CoQ10 in the seminal fluid have been associated with low sperm count, decreased sperm motility, and male infertility.

It may be possible to reverse the effects of low CoQ10 levels on eggs and sperm by supplementation with CoQ10.

Your treatment at Bay IVF includes daily intake of 600 mg of CoQ10 by both partners (if applicable). We recommend Vitaline® CoQ10 (without vitamin E) produced by Integrative Therapeutics.

It is important to start taking the CoQ10 supplements as much in advance of your treatment as possible.

CoQ10 may increase the effect of medications used to lower blood pressure. Please consult your physician before starting CoQ10 if you take high blood pressure medications.

There are several ways to obtain Integrative Therapeutics’ Vitaline® CoQ10 supplements:

  1. You may be able to purchase them locally from a health food store.

  2. You can buy them online:

  3. You can pick up Integrative Therapeutics Vitaline® CoQ10 300 mg supplements at Bay IVF in person once you have made an appointment even if you have not been seen at our clinic yet. You will receive them at our cost.

Please note that each partner should start taking a total of 600 mg CoQ10 daily as soon as possible.

8. Alcohol

 

Alcohol intake by both partners reduces IVF success and increases miscarriage probability. Couples need to abstain before and during treatment.

 

9. Caffeine

 

Caffeine consumption (coffee, caffeinated tea, soda) by both partners should be eliminated prior to and during your treatment. Caffeine may decrease the IVF success, and it has been shown to almost double the risk of a miscarriage. Male pre-conception consumption of caffeinated beverages has been as strongly associated with pregnancy loss as female caffeine intake.

 

10. Advanced Glycation End-Products

 

Advanced glycation end-products (AGEs) are toxic end-products of foods cooked at high heat (grilling, barbecuing, broiling, and frying). Elevated levels of AGEs in serum and follicular fluid have been associated with a reduced ovarian response and a reduced chance of pregnancy.

Charred food also contains cancer-causing chemicals. Boiling, microwaving, and poaching are ideal ways to avoid overheating of foods.

 

11. Hydration

 

The body is over 70% water. Staying well hydrated is a prerequisite of good reproductive health. Adequate hydration is essential for transporting nutrients throughout our body and flushing toxic waste out of our body.

As a general rule of thumb, divide your weight in pounds by 2, and this is the minimum amount of fluids (water) in ounces you should consume every day. Thirst is not a good indicator of our hydration level. By the time we experience thirst, we are already dehydrated.

The color of urine is a reliable barometer of hydration. When we are sufficiently hydrated, our urine is clear or very pale. As you take vitamin and mineral supplements, your urine will be darker. Despite supplementation, your urine should be close to colorless at least once each day. If your urine is persistently clear, you are consuming too much fluids. This can lead to a potentially dangerous mineral imbalance.

  1. Hydrate with:

    1. Filtered water

    2. Water sold in glass or metal containers

  2. Avoid the following:

    1. Water/beverages sold in plastic containers

    2. Sports drinks (most of them contain corn syrup or too much sucrose)

    3. Caffeinated beverages (diuretic effect)

    4. Carbonated beverages (acidic effect)

    5. Apple juice (diuretic effect)

    6. Alcoholic beverages (cause dehydration)

 

12. Reproductive Health-Promoting Diet

 

In summary, your diet should mostly consist of some or all of the following:

  1. Fresh fruits and vegetables, especially large salads

  2. Cooked vegetables

  3. Less red meat and saturated fat

  4. Fish from non-polluted sources (softivf.com/fish)

  5. No fried food

  6. Beans and legumes (not canned) soaked overnight before cooking

  7. White rice in moderation

  8. Quinoa and buckwheat

  9. Sweet potatoes

  10. Eggs in moderation

  11. Butter, buttermilk, kefir, and yogurt

  12. Ghee, avocado oil, olive oil, and coconut oil for cooking

  13. Coconut products

  14. Honey

  15. Antioxidants (very important):
    1. Decaf green tea (1-3 cups a day, no sugar, honey is OK)
    2. Berries
    3. One oz. of dark (75% and higher) chocolate a day
    4. Spices especially turmeric, cumin, ginger, and oregano
  16. Water

 

Part II
Non-nutritional Factors

 

1. Exercise

 

Exercise has a significant impact on improving insulin sensitivity (decreasing insulin resistance).

Frequent and consistent exercise by both partners (if applicable) is critical for good reproductive health and is a part of your treatment at Bay IVF.

Exercise by both the male and the female partners is associated with improved egg and sperm function and IVF outcomes. In one study, exercise increased the pregnancy rate more than threefold.

Resistance training (i.e., "pumping iron") is as effective as aerobic activity ("cardio"), but a mix of the two is the best.

If you do not exercise regularly (several times a week), start brisk walks outdoors for a minimum of 30 minutes most days of the week.

 

2. Stress

 

"The majority of the research thus far does support the theory that the more distressed one is before an IVF cycle, the less likely one is to conceive."
— Alice Domar, Ph.D., Assistant Professor of Obstetrics, Gynecology, and Reproductive Biology, Harvard Medical School

For a woman, the stress of infertility has been compared to having a diagnosis of cancer or HIV. Full-time employment, hostile mood, depression, and higher anxiety have been shown to correlate with retrieval of fewer eggs and IVF failure.

Stress shifts blood supply to the heart, brain, and muscles from “non-essential” organs, such as the ovary. Stress increases the levels of circulating stress hormones cortisol and norepinephrine (noradrenalin) resulting in vasoconstriction also reducing blood flow to the ovary.

A Mind/Body Program for Infertility (FertilityWithin.com/Course) that includes relaxation training, stress management strategies, lifestyle recommendation, and group support resulted in a pregnancy rate of 52% compared with 20% for couples who did not participate.

There are many stress-reducing techniques. Some of the more popular methods that have been shown to be associated with increased pregnancy rates are (in alphabetical order):

  • Acupuncture
  • Exercise
  • Guided imagery
  • Journaling
  • Listening to music
  • Massage therapy
  • Meditation
  • Mind-body groups
  • Practicing relaxation
  • Psychotherapy
  • Self-help books
  • Support/educational groups
  • Taking on fewer tasks
  • Taking time off from work
  • Visualization
  • Walking/hiking
  • Yoga

If you do not have a counselor, please visit bayivf.com/counseling for a list of therapists that specialize in infertility, and most of whom have previously worked with Bay IVF patients.

You may decide to take time off from work starting with the ovarian stimulation until the pregnancy test. If your employer requires it, we will provide you with a medical absence letter.

3. Sperm Oxidative Stress

 

Sperm loses most of its antioxidant defenses during maturation by shedding its cytoplasm, making it acutely sensitive to oxidative stress. Sperm are primarily affected by oxidative stress during passage through the male collecting system. Infrequent ejaculation, therefore, worsens exposure to oxidative stress.

From the beginning of your treatment, the male partner should ejaculate by intercourse or masturbation at least every 2-4 days. The last ejaculation prior to IVF egg retrieval must be 1 to 2 days before the retrieval, and must be only by masturbation if done the day before the egg retrieval.

 

4. Volatile Organic Compounds (VOCs)

 

Many everyday products release VOCs. It is very important to minimize your exposure (both partners) to VOCs:

  1. Consider sleeping with your bedroom windows wide open year round.

  2. Petroleum products: Avoid car exhaust fumes and solvents, use disposable gloves when filling up your car.

  3. The release of VOCs from plastics and building materials:

    • Do not drive a new car when trying to conceive.

    • Do not remodel your home or buy a newly constructed house.

    • Do not stay in the proximity of artificial turf sports fields.

  4. No exposure to cigarette smoke (both partners).

  5. Eliminate or minimize the use of perfumes and colognes (unscented deodorant is OK).

  6. Do not dry-clean your clothes.

  7. Eliminate air fresheners at home and in your car(s).

 

5. Fire Retardant Chemicals

 

There is evidence that flame retardants, polybrominated diphenyl ethers (PDBEs), can reduce fertility. Nearly all Americans tested have at least trace levels of flame retardants in their body. Try to minimize your exposure to flame retardants by using bedding and pajamas that are fire retardant free.

 

6. Smoking

 

You must not smoke. Cigarette smoking, including passive, second-hand cigarette smoke exposure, has been shown to have a dramatic adverse effect on oocyte (egg) quality and can also decrease the male fertility potential. Smoking appears to accelerate the loss of eggs and reproductive function and may advance the time of menopause by several years. There is an increased risk of miscarriage and genetic abnormalities in offspring among smokers.

7. Dental Hygiene

 

Periodontal disease has been linked to infertility, increase the likelihood of miscarriages, and poor sperm quality. Both partners should floss and water pick daily, and have regular dental checkups.

8. Acupuncture

 

It is OK to have acupuncture. For a list of acupuncturists, please see bayivf.com/acupuncturists.

9. Chinese Medicine

 

It is OK to use Chinese herbs as long as they are for strengthening your health only and do not have any male or female hormone-like effect.

 

Please use the following links for information about the Soft-IVF procedure and to request a consultation.

 

Request Information
or a Consultation
with Dr. Polansky

 

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We will contact you as soon as possible.