When a couple is having difficulty conceiving, accurate information about all aspects of their fertility can actually help them conceive more quickly. That information can go beyond the usual medical information about the woman’s cycle, timing of intercourse and other issues related to maximizing their chance of conceiving. It can also include information to make them better consumers by knowing where to get the best care and what treatments make sense especially if they need assisted reproductive procedures such as IVF. Because “misconceptions” can lead to a “missed conception,” I wrote my latest book, “Conceptions & Misconceptions” (Hartley & Marks Publishers, Pt. Roberts, WA 2004). The top ten misconceptions about infertility treatment are:
1. . “Our goal is to become pregnant.” Actually the goal should be to have a healthy baby. A lot can happen between pregnancy and a healthy baby. Keep you eye on the real goal.
2. “Success is not everything; it’s the only thing.” The point is, when you are searching for a doctor or clinic to perform an assisted reproductive procedure, the success rate of that center is not the only factor to consider.
3. “Ethics, shmethics! All we want is a baby.” It might seem best to do anything you can to achieve your goal. However, following ethical principles may protect you from potential harm.
4. “More is better.” One might assume that if something is good, more of it would be better. This is a misconception when applied to assisted reproductive technology. Too much of a good thing can quickly get you into big trouble. The most critical example would be that placing too many embryos back into the uterus for one's age in in vitro fertilization can lead to a triplet (or more) pregnancy which may present potentially dangerous problems for mother and children.
5. “Don’t worry; this is a ‘simple’ procedure.” This is an easy misconception to explain because there is no such thing as a simple medical procedure.
6. "Don't put all your eggs in one basket." If you are going through assisted reproduction, you will want all your eggs "in one basket." Not only will you want them in one basket, you will want to make sure that it's your basket. That's a metaphor for making sure that there are no mistakes made with your eggs. Furthermore, you want to make sure that someone doesn't take them out of your basket and put them in someone else's without your knowledge or permission like happened in the U. C. Irvine fertility scandal.
7. “Let the doctor decide: he/she knows best.” There are many things about which the doctor knows best. But does this mean that you should leave all the decisions to the doctor without any input from you? Of course not.
8. “There is such a thing as a free lunch.” If it sounds too good to be true, it probably is. . Since the early days of assisted reproduction, the enthusiasm of some of its practitioners has led to a variety of advertising claims and marketing schemes. You need to be a careful consumer.
9. “Don’t worry. I’m sure our insurance covers this.” Wrong. Most people do not have infertility coverage.
10. “Trust me. I’m a doctor.” If you are considering the possibility of ART, you are going to need to put a great deal of trust in a team of physicians, scientists, and other medical personnel. We feel that the vast majority of teams doing this work are deserving of your trust. But unfortunately, you cannot rely on blind trust.
If you keep these misconceptions in mind when you seek fertility treatment you will be a better consumer, which will make you more likely to succeed.
Showing posts with label infertility treatment. Show all posts
Showing posts with label infertility treatment. Show all posts
Thursday, August 20, 2009
Tuesday, March 10, 2009
The Basic Infertility Evaluation
The basic elements of an infertility evaluation target ovarian function, tubal and uterine anatomy, ability of the sperm to reach the fallopian tube and male factor.
Improvements in diagnosis and treatment technology are changing the medical experience and chance of success for couples experiencing infertility. The efficiency and accuracy of the infertility work up is a key factor in developing the appropriate treatment plan to achieve the couple’s ultimate goal, a healthy baby. Since women are often starting their families at later ages, the initial infertility evaluation in the female has evolved to focus more on ovarian function as an indicator of fertility potential. However, assessments of all the other factors are still important parts of the evaluation.
Following a history and physical examination, the initial tests used to assess the major causes of infertility are:
• Day 2 or 3 FSH (Follicle Stimulating Hormone) and estradiol (estrogen)
• Hysterosalpinogram (tubal dye test) and/or Sonohysterogram (ultrasound)
• Ultrasound to document the time of ovulation
• Post coital test to see if sperm can penetrate the cervical mucus
• Mid-luteal phase progesterone level
• Semen analysis
In the majority of cases this information is enough to indicate the appropriate initial treatment plan. Today laparoscopy is not routinely indicated, because it has the risks of surgery and does not usually change the initial treatment plan. It may be recommended in specific cases if there is suspected endometriosis or tubal disease based on the history, physical findings, ultrasounds or if there are other specific gynecologic reasons to perform this procedure.
When to Test for Infertility
Evaluation of infertility is warranted for a couple when the female partner is older than 35 and has been trying to conceive for 6 months without success. It is also indicated if the female partner is 35 years of age or less after the couple has been trying to conceive for one year. Immediate evaluation and treatment of infertility is warranted in cases of known problems such as anovulation, tubal occlusion, or severe male factor infertility. We also must be aggressive in evaluating and treat women 40 years and greater because of the increased potential for significant loss of ovarian reserve in this age group.
Day 2 or 3 FSH and Estradiol
These hormone levels are drawn on the second or third day of full menstrual flow. The purpose is to evaluate ovarian reserve. Diminished ovarian reserve may be suspected by elevation in either the FSH or the estradiol. An antral (early) follicle count can be used to further clarify the patient’s ovarian reserve. The ovarian reserve essentially tells us whether it is worthwhile to offer treatment to the patient using her own eggs.
The FSH levels will vary somewhat by the endocrine lab and the assay used. Unfortunately the prognosis is based on the highest, but not necessarily the most recent, FSH level. It is advisable to obtain an opinion and possible further testing from an infertility specialist for those patients with abnormal levels, especially those under age 38.
Day 3 FSH Level in relation to Ovarian Reserve*
Ovarian Reserve FSH Levels
Good < 10
Mild Decrease 10-12
Moderate Decrease 12-15
Severe Decrease > 15
*assumes simultaneous D-3 estradiol is <80pg/ml
Hysterosalpingogram & Sonohysterogram
The hysterosalpingogram (HSG) is still the best and least invasive method of evaluating the inside of uterine cavity and patency of the fallopian tubes. In addition, a sonohysterogram (ultrasound after saline is placed in the uterus through a catheter) is a relatively non-invasive way of evaluating the uterine cavity alone if intrauterine pathology is suspected, but does not give you any information about tubal patency. Both tests can uncover uterine abnormalities such as intracavitary adhesions, fibroids or polyps. But, only the HSG can evaluate tubal abnormalities such as occlustions or hydrosalpinges. Abnormalities on an HSG or sonohysterogram may warrant further evaluation with laparoscopy and or hysteroscopy.
Ultrasound
The proper development of the follicle, which contains the egg, and the timing of its release are critical to the evaluation of infertility. Ultrasound is a safe, painless and non-invasive way of evaluating this factor and timing subsequent tests.
Post coital test
Once the timing of ovulation is determined accurately, the next step is to asscess if the sperm can penetrate the cervical mucus. When ultrasound and the urine LH kit pinpoint the timing, the couple is instructed to have intercourse and come in the next morning, at which time a microscopic examination of the cervical mucus will show if there is dequate penetration of the sperm.
Midluteal Progesterone
Menstrual cycle regularity and premenstrual symptoms are reliable medical history indicating the probability of ovulation. However, some women ovulate but fail to produce adequate quantities of progesterone (luteal phase deficiency) following ovulation. The clinical tests for ovulation (e.g. temperature chart, positive ovulation predictor kit) are not sufficient to diagnose luteal phase deficiency. We recommend obtaining a progesterone level approximately 8 days after detection of the LH surge.
Semen Analysis
It is important to perform this test early in the infertility evaluation since in at least 40% of couples experiencing infertility the sperm quality will be a factor. The test will identify a potential male factor by checking the semen volume, sperm concentration, motility and morphology (appearance) in a semen sample.
With this streamlined work up, which can be completed within one menstrual cycle, a couple can be efficiently evaluated, specific major causes of infertility identified, and treatment options considered. As with all medical testing, an infertility evaluation must be tailored to each patient’s situation.
Credits –
This information is provided by Arthur L. Wisot, M.D., F.A.C.O.G., one of the team of outstanding fertility doctors at the Southern California fertility center, Reproductive Partners Medical Group. For more information on IVF and the many available fertility treatments please visit www.reproductivepartners.com.
Improvements in diagnosis and treatment technology are changing the medical experience and chance of success for couples experiencing infertility. The efficiency and accuracy of the infertility work up is a key factor in developing the appropriate treatment plan to achieve the couple’s ultimate goal, a healthy baby. Since women are often starting their families at later ages, the initial infertility evaluation in the female has evolved to focus more on ovarian function as an indicator of fertility potential. However, assessments of all the other factors are still important parts of the evaluation.
Following a history and physical examination, the initial tests used to assess the major causes of infertility are:
• Day 2 or 3 FSH (Follicle Stimulating Hormone) and estradiol (estrogen)
• Hysterosalpinogram (tubal dye test) and/or Sonohysterogram (ultrasound)
• Ultrasound to document the time of ovulation
• Post coital test to see if sperm can penetrate the cervical mucus
• Mid-luteal phase progesterone level
• Semen analysis
In the majority of cases this information is enough to indicate the appropriate initial treatment plan. Today laparoscopy is not routinely indicated, because it has the risks of surgery and does not usually change the initial treatment plan. It may be recommended in specific cases if there is suspected endometriosis or tubal disease based on the history, physical findings, ultrasounds or if there are other specific gynecologic reasons to perform this procedure.
When to Test for Infertility
Evaluation of infertility is warranted for a couple when the female partner is older than 35 and has been trying to conceive for 6 months without success. It is also indicated if the female partner is 35 years of age or less after the couple has been trying to conceive for one year. Immediate evaluation and treatment of infertility is warranted in cases of known problems such as anovulation, tubal occlusion, or severe male factor infertility. We also must be aggressive in evaluating and treat women 40 years and greater because of the increased potential for significant loss of ovarian reserve in this age group.
Day 2 or 3 FSH and Estradiol
These hormone levels are drawn on the second or third day of full menstrual flow. The purpose is to evaluate ovarian reserve. Diminished ovarian reserve may be suspected by elevation in either the FSH or the estradiol. An antral (early) follicle count can be used to further clarify the patient’s ovarian reserve. The ovarian reserve essentially tells us whether it is worthwhile to offer treatment to the patient using her own eggs.
The FSH levels will vary somewhat by the endocrine lab and the assay used. Unfortunately the prognosis is based on the highest, but not necessarily the most recent, FSH level. It is advisable to obtain an opinion and possible further testing from an infertility specialist for those patients with abnormal levels, especially those under age 38.
Day 3 FSH Level in relation to Ovarian Reserve*
Ovarian Reserve FSH Levels
Good < 10
Mild Decrease 10-12
Moderate Decrease 12-15
Severe Decrease > 15
*assumes simultaneous D-3 estradiol is <80pg/ml
Hysterosalpingogram & Sonohysterogram
The hysterosalpingogram (HSG) is still the best and least invasive method of evaluating the inside of uterine cavity and patency of the fallopian tubes. In addition, a sonohysterogram (ultrasound after saline is placed in the uterus through a catheter) is a relatively non-invasive way of evaluating the uterine cavity alone if intrauterine pathology is suspected, but does not give you any information about tubal patency. Both tests can uncover uterine abnormalities such as intracavitary adhesions, fibroids or polyps. But, only the HSG can evaluate tubal abnormalities such as occlustions or hydrosalpinges. Abnormalities on an HSG or sonohysterogram may warrant further evaluation with laparoscopy and or hysteroscopy.
Ultrasound
The proper development of the follicle, which contains the egg, and the timing of its release are critical to the evaluation of infertility. Ultrasound is a safe, painless and non-invasive way of evaluating this factor and timing subsequent tests.
Post coital test
Once the timing of ovulation is determined accurately, the next step is to asscess if the sperm can penetrate the cervical mucus. When ultrasound and the urine LH kit pinpoint the timing, the couple is instructed to have intercourse and come in the next morning, at which time a microscopic examination of the cervical mucus will show if there is dequate penetration of the sperm.
Midluteal Progesterone
Menstrual cycle regularity and premenstrual symptoms are reliable medical history indicating the probability of ovulation. However, some women ovulate but fail to produce adequate quantities of progesterone (luteal phase deficiency) following ovulation. The clinical tests for ovulation (e.g. temperature chart, positive ovulation predictor kit) are not sufficient to diagnose luteal phase deficiency. We recommend obtaining a progesterone level approximately 8 days after detection of the LH surge.
Semen Analysis
It is important to perform this test early in the infertility evaluation since in at least 40% of couples experiencing infertility the sperm quality will be a factor. The test will identify a potential male factor by checking the semen volume, sperm concentration, motility and morphology (appearance) in a semen sample.
With this streamlined work up, which can be completed within one menstrual cycle, a couple can be efficiently evaluated, specific major causes of infertility identified, and treatment options considered. As with all medical testing, an infertility evaluation must be tailored to each patient’s situation.
Credits –
This information is provided by Arthur L. Wisot, M.D., F.A.C.O.G., one of the team of outstanding fertility doctors at the Southern California fertility center, Reproductive Partners Medical Group. For more information on IVF and the many available fertility treatments please visit www.reproductivepartners.com.
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