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I'm on vacation. When I walked out of the clinic on Tuesday many people commented "don't think about this place,"  "relax - we'll take care of your patients,"  "don't do work while you are away."  I never heed that advice.  When I am on vacation I find it is the perfect time to relax and flip through research journals, catch up on emails and think about work, a lot.  It's this break from the day-to-day concentration each patient sitting in front of you needs to getting to think bigger picture about practice, the future and how we can do better.

In IVF we create embryos by fertilizing eggs with sperm. Once you have an embryo, you can do one of three things with it:

I love getting on the latest bandwagon.  I'm a pretty early adopter of trendy stuff like when everyone started counting their steps I had a fitbit strapped on. I whitened my teeth the first time a Crest commercial told me I should, about 15 years ago. I took yoga classes in the 90s before there were even yoga clothes.  My latest trend? Low carb, high fat eating.

There is not a day that goes by when I don’t think about the security and safety of the embryos, sperm and eggs we have frozen in our cryopreservation or cryo tanks. I am on vacation this week and was out for a run and our tanks were on my mind. Our lab director would say an hour doesn’t go by when he doesn’t think about our tanks.

I wrote this blog a week ago.  My mom has since died, very peacefully.  I decided to post it today as I feel stronger today than when it was written. 

Nearly every patient I meet wants twins.  Of course, they want twins!  The idea of having two children at once when they have longed for children for years, makes perfect sense.  Many people want a sibling for the children, so instant siblings seems very efficient.

There are 3 main IVF protocols we use regularly: antagonist, agonist, MD Agonist Flare.  Sure, there are plenty of variations on these protocols, but essentially all protocols come from these 3, even minimal stimulation IVF, natural cycle IVF and others.    Study after study has shown that there is little difference between pregnancy outcomes with the different protocols.  What does seem to matter is what dose your physician picks for you, the timing of the different medications used during the protocol and the "extra" medications that are used based on the patients

Live with no regrets, dance like no one is watching, live every day like it is your last.  For me that is all nonsense. That kind of fridge-magnet and facebook-friendly advice just makes me feel badly about myself. I have regrets, I waste a lot of time, and why would i dance like no one is watching?   Anyway, for people like me who are pretty sure we aren't yet living our "best life" the new year is awesome.  It's this awesome time when you get a little reset.  You get to imagine being a better version of yourself in the future.

Merry Christmas!  Every time one of my patients does a pregnancy test I hold my breath a little bit, but at Christmastime I hold it a long time.

Nearly all of us are deficient in vitamin D. Ninety percent of our body’s vitamin D comes from the sun, meaning cholesterol in our skin is converted into vitamin D3 (cholecalciferol) by the action of UV rays from the sun. Vitamin D3 is then converted by the liver and kidneys into the active form of vitamin D. The other 10% of out body’s vitamin D3 comes from our diet. If you live in Canada you are probably vitamin D deficient. The rates are so high the BC government health plan no longer pays for testing - they want us to just assume we are deficient.

I remember writing my Royal College of Physicians exam to get certified as an obstetrician/gynecologist and thinking “please, please don’t ask me much about adenomyosis.”  Adenomyosis is a fairly uncommon disease of the uterus that is hard to diagnosis, hard to treat and causes a slew of terrible symptoms like pelvic pain, heavy periods and infertility.  In the past decade or so sinc

My blog went stale the past few weeks. I really didn't want that to happen. I haven't posted in a really long time... I think I got a bit busy, was feeling like I didn't have much interesting to say (research published in the last couple of months has been rather boring - either too esoteric or too silly), I started watching Game of Thrones and just kind of felt like I was in a funk.

I think sunscreen typifies the anxiety that has been bred by the internet and media.  Is it good or bad?  Fifty years ago we would assume it is good as our doctor would have told us to use it, teachers in school would remind us it is important and we'd have no or few resources to check whether they were right.  If the doctor and teachers were right this was a better time.  We would have been saved google searches that doubted the doctor.  I think there would be less anxiety.  Of course, the big assumption is that the doctor and teachers are right.

We can all agree friends don't use the phone much any more. So, much so that if someone does phone me I assume something horrible has happened.  In my mind, if my phone rings it is either (1) the hospital calling about a patient (2) someone I don't know managed to get my number and wants to sell me something (3) someone I love has died,.

A friend of mine always hates her job.  Every job she has ever had has been "the worst."  She moves from job to job and inevitably after the 2 month mark in a new job complains how terrible it is.  I once bought her a greeting card that read "You hate your job?  Why didn't you say so?  There's a support group for that.  It's called 'everybody' and they meet at the bar."  She didn't laugh like I did. 

Ever notice when you get something in your head you start seeing that thing everywhere? I remember when I was a teenager I wanted a cordless telephone. I begged my parents for one with the claim that "everyone had one."  It did seem like they did: Carrie, my short, rebellous friend would walk around her house on one for hours, Monica down the street had one she'd hide from her brother, Radio Shack had them prominently on display. It felt like I was the only person without one and I had the 1980s version of FOMO.

Let's talk about IVF paradigms. In a nutshell, IVF involves stimulating the ovaries to produce multiple eggs all at once.  The egg are then removed, fertilized with sperm and embryos are created.  The embryo(s) are then put into a woman's uterus in hopes a pregnancy will occur.

#1in6 You've probably seen that hashtag and you probably don't believe it.  Last week was infertility awareness week in Canada and since 1 in 6 Canadian couples experience infertility we promoted that hashtag to raise awareness of how common infertility is.  

About 11  years ago I heard Jonathan Tilly speak at the American Society of Reproductive Medicine (ASRM) meeting.  His research suggested in mice new eggs could be made. This raised the question "what if our understanding that women are born with all the eggs they'll ever have, is wrong?"  What if we could make new eggs for women?  Huh.  A basic premise of human reproduction is that you can't.  All evidence so far has supported the idea that women are born with about a million eggs and rapidly lose them, running out at menopause.

I'll make this brief because it is 10pm on Friday night and Netflix is calling, but: please do not wait to try and get pregnant again after a miscarriage.  We've known for years that you are more fertile and less likely to have an adverse pregnancy outcome if you get pregnant soon (within 6 months ideally) of a miscarriage.  It's "old school" to tell women to wait a few months to get pregnant after a miscarriage, but this message is still being conveyed by some health care providers.

What about the guy?  As fertility doctors we focus a lot of our energy on investigating the woman and counselling couples about the success rate, risks and outcomes as they relate to the woman.  Partly this is because testing of the male is more straightforward and partly because the success rate is usually more dependant on female factors, but outcomes are different: the male matters more than we previously thought.

I didn't want my blog to become stale but lately I haven't been writing much.  I blame myself and Facebook and Instagram and Netflix and a few other life distractions. I am sure in the pre-social media years I got a lot more done. Then again, maybe I didn't and I am just glamourizing the olden days.  Anyway, I am on vacation this week so thought I'd put fingers to my keyboard. 

At least once a month I have a woman in my office crying because her IVF cycle didn’t work and she believes in her heart that she is to blame. Typically she will say she “did too much after the transfer.” Women are so hard on themselves.

Happy New Year’s Eve 2016!  Now that I have eaten my body weight in chocolate and chips, it’s time to make resolutions.  First, stop eating my body weight in chocolate and chips.  My other resolutions are pretty similar to previous years:

There are a few main infertlity journals I read: Human Reproduction, Fertility and Sterility (F&S)  and the Journal of Clinical Endocrinology & Metabolism.  It is in these journals the latest fertility research is published, useful topics are reviewed and in F&S they have a section called "Inkings."  This is the section I enjoy the most, honestly.  Inklings are short musings, generally by well respected fertility doctors and scientists.  They write about their "gut feelings" or their pet theories about disease or treatments.