Lenore Tietjens-Grillo, MD

Director of the Fertility Wellness Center

As the newest addition to the RAD family, I am excited to lead the new Fertility Wellness Center. I have practiced medicine in Women’s Health for over 18 years and have a strong interest in the impact lifestyle has on reproductive health. I enjoy the challenge of discovering the root of a patient’s problem. My treatment plans frequently include recommendations for changes in diet, exercise and other habits. The new fertility wellness center has given me the opportunity to practice this philosophy of care. Our program will work with women who may or may not have health problems, but do have concerns related to their ability to conceive in the near or distant future. The goal is to help patients improve their current health, so they may avoid future fertility issues. If it is determined that further fertility treatment is needed, the Wellness Center will aid patients in maintaining their reproductive health until they are ready to actively pursue treatment. In addition to lifestyle programs, our center will offer counseling for genetic disorders and future family planning. I have a strong personal interest in genetic testing, especially as it relates to cancer prevention, because of my own mother’s battle with Ovarian Cancer. As I start my new journey at Reproductive Associates, I am excited to be a part of a team that shares my enthusiasm for women’s health. I look forward to educating women about the full spectrum of wellness issues that impact their current and future health and fertility!

• Board Certified: Obstetrics and Gynecology, by the American Board of Obstetrics and Gynecology
• Residency: Obstetrics and Gynecology, Christiana Care Health System, Newark, DE
• MD: Jefferson Medical College, Philadelphia, PA
• MA: Chemistry, University of Virginia, Charlottesville, VA
• BS: Chemistry, The Pennsylvania State University, University Park, PA

Lifestyle and Wellness Consultations

The journey to a healthy pregnancy begins with a healthy lifestyle, good nutrition, and proper control of any chronic medical conditions. For many patients these goals are often hard to reach alone. Whether patients suffer from persistent medical issues, or struggle with unhealthy lifestyles, the Fertility Wellness Program guides patients on their journey to better reproductive health. Through diet, exercise, and lifestyle counseling, the program is designed to enhance fertility, weight loss, metabolic function, aerobic capacity, flexibility, strength, and stamina. By boosting overall wellness, patients can improve future fertility and pregnancy outcomes.

How Weight and Metabolic Issues Impact Fertility

For women who suffer from weight and metabolic challenges, diet and nutrition can play a huge role in determining the health of a potential pregnancy. The effects of obesity can contribute to menstrual cycle disturbances, prolonged infertility treatments, pregnancy loss, and adverse pregnancy outcomes. Not only does added weight make it difficult to become pregnant, but women with a BMI greater than forty are at increased risk for preeclampsia, gestational diabetes, large gestational age infants, and hypertension during pregnancy. By targeting these modifiable risk factors that may impact fertility and pregnancy outcomes, we can enhance success rates and promote healthy pregnancies.

Fertility Wellness Plan

At your initial visit you will meet with Dr. Lenore Tietjens-Grillo, Director of the Fertility Wellness Program. Together, you will thoroughly review your medical history, family history, and current medications. She will also discuss your plans for future family building. After reviewing all of the information, Dr. Tietjens will develop a plan of care for your unique needs. This will develop into the Fertility Wellness plan. The Fertility Wellness plan will include nutrition, exercise, and treatment recommendations, and will serve as your road map to better reproductive health.

To schedule an appointment with the Fertility Wellness Center, call (302) 602-8822.

What is Endometriosis?

Endometriosis is a gynecological condition in which cells from the lining of the uterus (endometrial tissue) grow outside the uterine cavity in areas such as the ovaries, fallopian tubes and abdominal cavity.  Because of the excess tissue growth, irritation and pain can occur in the affected organs.  This irritation can develop into adhesions and/or scar tissue that can make it difficult for women with endometriosis to get pregnant.  Symptoms of endometriosis can vary depending on the stage and severity.

Common symptoms/indicators include:

• Pelvic/abdominal pain
• Painful periods
• Menstrual abnormalities
• Pain during intercourse
• Infertility
• Bowel symptoms such as bloating, diarrhea or constipation
• Urinary frequency or urgency

Often when a woman seeks treatment, it is because she is having difficulty getting pregnant.  30% to 50% of women who experience infertility are diagnosed with endometriosis.[1] Whether you are seeking treatment because of medical or fertility reasons, at RAD we provide a full spectrum of care for all stages of endometriosis.

How is endometriosis diagnosed?

Patients with suspected endometriosis will undergo a complete health history and assessment. Although symptoms are often key indicators of endometriosis, some women have no symptoms at all and the only way to conclusively diagnosis it is through a surgical procedure called a laparoscopy.  Laparoscopic surgery is a minimally invasive outpatient procedure, performed by making small incisions in or around the abdomen and utilizing a small camera instrument called a laparoscope to see in and around the reproductive organs.  This allows our two physician surgical team to determine if there is a presence of endometriosis and/or other conditions.

How is it treated?
During the laparoscopy, if endometriosis and/or adhesions are found, our physicians will remove as much of the endometriosis and scar tissue as possible.  Removal of the tissue should help alleviate pelvic pain, as well as improve the chances for achieving pregnancy naturally or with fertility treatments.  It also allows the physicians to stage your endometriosis to help determine your best course of action to achieve a pregnancy or stay pain free.  Further, Because of the minimally invasive surgical techniques used, the healing process is very quick, and patients are able to return to work and usual activities in about a week.

What if I am still having trouble getting pregnant post surgery?
For patients who continue to have fertility issues after surgery, we often suggest looking into other fertility treatment options, such as Intrauterine Insemination (IUI) or In Vitro Fertilization (IVF).  (Link to IVF page).  Patients who do not wish to get pregnant after surgery will be put on medication to suppress their menstrual cycle, such as birth control pills, Lupron or Zoladex.  This is done because as long as a woman produces hormones and menstruates, endometriosis and pain may return over time.

Polycystic Ovarian Syndrome (PCOS)

What is PCOS?

Polycystic ovarian syndrome affects 5% of women and is one of the leading causes of infertility, as well as menstrual irregularity, and excessive hair growth (hirsutism).  The condition occurs when the ovaries produce excessive amounts of androgens, (male hormones, such as testosterone.)   Signs and symptoms of PCOS include:

• Irregular menstrual periods
• Infertility
• Excessive hair growth (face, abdomen, chest)
• Thinning hair
• Acne
• Ovarian cysts
• Weight gain
• Obesity

Changes in diet and exercise that result in weight loss can greatly improve the patient’s chance for pregnancy.  Obesity is common with PCOS; over 80% of women with PCOS are obese. Healthy lifestyle changes can improve the frequency of ovulation, lower diabetic risk and lower androgen levels.

Diagnosis

In order to properly diagnose PCOS, our physicians will request our clinical staff perform a physical examination.  A full physical evaluation is crucial because hormonal fluctuations can greatly influence the body in many ways.  Height, weight, blood pressure, heart rate, size of the thyroid glands, (an important metabolism regulator), exam of the heart, lungs, breasts and abdomen, and a survey of the skin are all taken into consideration.  Pelvic exams and ultrasounds can also provide insights into the causes of menstrual irregularities and/or fertility issues.

Treatment

Patients with suspected PCOS will undergo a complete health history and assessment. Depending on each individual patient the treatment plan can vary greatly.  Factors to consider are whether or not the patient would like to get pregnant, weight, other health problems, etc.  For patients struggling with weight, we offer weight loss and lifestyle support to help patients increase their chance of pregnancy.
 
For patients seeking fertility care:
Ovulation may be induced with fertility medication such as clomiphene or gonadotropin.

 
If a pregnancy is not desired at the given time:
Birth control pills can aid in regulating menstrual periods, reducing hirsutism and acne, preventing endometrial cancer and preventing pregnancy.

For more information on PCOS:

Dr. Feinberg’s Book “Healing Syndrome O,” A Strategic Guide to Fertility, Polycystic Ovaries and Insulin Imbalance” (Purchase “Healing Syndrome O”)

Contact us here to schedule an appointment, or call us at (302) 602-8822

What causes pelvic pain?

There are a variety of issues that can cause pelvic pain, ranging from gynecological problems to bladder, bowel and pelvic concerns. Upon your initial appointments, our clinical staff performs a physical examination and health history assessment to determine if there are any visible signs of a problem. If non-gynecological problems are ruled out, some of the most common reasons for pelvic pain include:

• Endometriosis
• Adhesions
• Uterine Polyps
• Uterine Fibroids
• Ovarian Cysts
• Pelvic Inflammatory Disease

To determine the root of your pain, a typical work up includes a physical exam and blood work. Because many issues related to pelvic pain are not visible through imaging tests, minimally invasive surgery is often the next step in determining a conclusive diagnosis.

What is Genetic Counseling?

Genetic Counseling is a very important part of both pre-conception and pre-natal care. The role of a genetic counselor is to assess genetic risks for a couple and provide education and support for couples considering genetic testing. Counseling sessions typically involve reviewing a couple’s complete family medical history and discussing genetic testing options. Understanding a couple’s risk for passing on genetic diseases can greatly enhance patient outcomes. For patients seeking fertility care, genetic screening tests can provide insight into the possible risks couples may have to pass on a genetic disease, or for their pregnancy to be affected with chromosome abnormalities. For couples pursuing IVF, pre-implantation genetic testing can significantly improve pregnancy rates, by identifying those embryos that are genetically and chromosomally normal. The goal of genetic counseling is to guide patients through the decision-making process by explaining complicated genetic concepts in a way that is easily understood. These decisions can greatly impact a couple’s future family planning and health. Our Board Certified Genetic Counselor, Tracy Gardner MS, CGC, comes with 25 years experience, and is passionate about helping families understand the complexities of their genetic make up.

Good Candidates for Genetic Counseling:

All RAD patients are offered carrier screening for common genetic diseases. However patients with the following histories may consider further genetic counseling:

• History of multiple miscarriages
• Family history of genetic diseases
• Patient or partner is a carrier for a genetic disease
• Advanced Maternal Age (35 years and older) for a singleton pregnancy or Advanced Paternal age (40 years or older)

Genetic Testing Offered at RAD:

Genetic Carrier Screenings are available for all patients considering starting a family. This testing screens patients for a variety of the most commonly diagnosed genetic diseases, such as Cystic Fibrosis, Fragile X and SMA.

Pre-Implantation Genetic Testing

Patients undergoing IVF treatment may consider utilizing Pre-Implantation Genetic Testing. Pre-Implantation Genetic Screening and Diagnosis determine the genetic and chromosomal health of an embryo. This testing can greatly enhance pregnancy rates, as embryologists can identify the healthiest embryos for transfer. To learn more about PGD and PGS, click here.