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.
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:
Every job has good days and bad days. Today was 90% good and 10% bad.
A couple brought their 6-month-old daughter from IVF by to meet us, a woman who has been trying to conceive for a few years brought us a gift to say "thanks for trying so hard" for her, a couple who has twins on the way sent a "thank you" note, and a box of chocolates came from another successful couple.
I hate popularity contests. I never entered the "Homecoming Queen" contest in high school. Along that line, I don't like sports that require the athlete to wear a costume or have their hair done and make-up on. Nope, I prefer quantifiable achievement-based performances. Who scored the most goals? Who swam the fastest? Who had the highest mark? Who won the chess game?
One of the first questions we ask the woman, when seeing couples with infertility, is "how often do you have your period?" We ask this question because if a woman has a "regular period," there's a 95% chance that she is ovulating. So you can learn a lot from this simple question. A menstrual cycle length is counted from the first day of bleeding to the next first day of bleeding, and a "regular period" means the woman has her period every 25-34 days throughout the year. Is there an ideal menstrual cycle length for fertility? Yes.
Sometimes we just don't know. Today I saw two couples with unexplained infertility; all the testing is normal. It's really frustrating for thse couples. They come to a fertility specialist who says "I don't know why you can't get pregnant." Not helpful... or is it?
Fertility doctors use ultrasound like accountants use a calculator or a teenager uses their cell phone -- often. Most patients have an ultrasound at their first or second visit with a fertility doctor and again during treatment. The first ultrasound is to assess, among other things:
1. the uterus: is it of normal shape and size? Does it have any fibroids?
2. the ovaries: are there cysts? How big are the ovaries? What is the estimate of the egg count? Are the ovaries in the expected position?
I am tired tonight. I am tired because I was up late last night at a party. By late, I mean 11pm, but still... Since I entered my 40s, 11pm is now officially late. When I go to sleep tonight, which is imminently, the pineal gland in my brain will produce melatonin to help me sleep. It's a lovely feature we have as humans. Melatonin will signal to the rest of my body that it's time to sleep. Some friends of mine have been giving melatonin to their sleepless children and several other friends have suggested it helps them get into a new time zone when travelling.
I am having a slow morning at work so decided I'd pull up the latest journals and start reading. I've read the latest work on using dopamine receptor 2 agonists (e.g. Dostinex) in preventing ovarian hyperstimulation syndrome (OHSS). Dostinex is often given to women we think will develop OHSS during IVF or superovulation treatment. A study of granulosa call, the cells that surround and support eggs, suggests one of the reasons dopamine receptor agonists work is by decreasing VEGF secretation by granulosa cells. VEGF is the main perpetrator of OHSS. This is new information supporting and better explaining what we see in our practice, which is always good.
Let's go back to the beginning. One of the oldest treatment in fertility care is insemination of sperm. Intrauterine insemination (IUI) has been around for decades. IUI involves taking a man's ejaculated semen, washing and concentrating it, and placing it into a woman's uterus on the day she is ovulating. It's cheaper and less invasive than IVF and we have hundreds of IUI babies in our practice. Who should do it and does it work?