December 3, 2012
Getting pregnant is easier said than done for at least 10% percent of women in the U.S. About 90% of women will conceive after one year of trying. If you’ve been trying to get pregnant without success, consider these reasons and possible solutions.
- You’re not having sex at the right time. The only way a woman can get pregnant is if the egg is fertilized by sperm but if there’s no egg, there’s no baby. If you don’t get your period every month, there’s a strong possibility that you’re not ovulating. What can you do? Buy an over-the-counter ovulation kit (many are sold at the dollar store) to determine if you’re ovulating.
- You might have scar tissue in your tubes or in your uterus. If you’ve had a history of a sexually transmitted infection or pelvic inflammatory disease (PID), your tubes might be blocked. A procedure called a hysterosalpingogram (HSG) inserts dye into the uterus and tubes to see if they’re open or closed.
- Your partner’s sperm count might be low. Male infertility accounts for 23% of reasons why women can’t get pregnant. If you’ve been trying unsuccessfully to get pregnant after a year, please see your healthcare provider.
- There might be something wrong with your uterus. “Congenital anomalies” means something was wrong with your uterus from birth. An HSG will make the diagnosis.
- You could have endometriosis which is tissue from the uterus on places such as the ovaries, rectum, abdomen or other unlikely places. Severe pain during the times of your period gives a clue about this possible condition.
- Your eggs might be too old. Your age plays a significant role in your ability to conceive. If you’re over 30 and can’t get pregnant, please see your health care provider. IVF (in vitro fertilization) is very successful for women in their 30’s.
- You’re having a lot of miscarriages. Two or more miscarriages could signify an autoimmune disorder and a good reason to see a infertility specialist.
- There might be something wrong with either your genes or your partner’s. Another reason to see an infertility specialist.
- You’re trying too hard. There have been studies that have proven that meditation and hypnosis has helped women get pregnant. You might be one of those success stories when all else has failed.
- You’re overweight. If you’re overweight and not getting your period, you’re not ovulating. I had a patient who had been trying to conceive unsuccessfully for years. She lost 10 pounds, became pregnant and the mother of a beautiful baby girl. Losing weight can help.
If you’ve been trying to get pregnant unsuccessfully for over a year, it’s time to move your feet and find out why.
June 6, 2012
In my 25 years of clinical experience as an ob-gyn physician, I have seen our specialty evolve, especially in the area of infertility. In Vitro Fertilization (aka IVF) has come a very long way since its first “test tube baby,” Louise Brown, back in 1978. When I was attempting to conceive (unsuccessfully), the price of IVF was exorbitant and it had a very low pregnancy success rate. 34 years later, the landscape has changed.
When women delay childbearing after age 32, they increase the risk of developing infertility and pregnancy complications significantly. It is now recommended that women over 35, who have not conceived after six months of having unprotected sex seek further evaluation as opposed to waiting a year. Women who are 40 or older and trying to conceive should be seen by a high risk specialist immediately. Women who are less than age 35 have a 41.7 % percent of conceiving as opposed to women over 42 who only have a 4.1% of conceiving.
If a woman over age 40 attempts to conceive through IVF, egg donors are her only option if the quality of her ovaries is poor or the number of eggs is reduced. However, the Center for Human Reproduction (CHR), a New York fertility center claims to have increased the pregnancy rate of women over age 44 to 10.3% through the use of a male hormone, DHEA. CHR takes pride in its reputation as being the fertility center of “last resort” and managing “aging” ovaries. According to its medical director, Norbet Gleicher, MD, the majority of their patients had failed IVF cycles somewhere else and were turned away by other fertility centers if the patients didn’t want to use donor eggs. Gleicher claims his fertility center succeeds where others have failed and allows older women to use their own eggs during the IVF cycle.
It would be helpful to see more medical studies done to prove whether adding a male hormone such as DHEA does in fact, increase pregnancy rates of women over 44. If these findings are true, it would take the treatment of older infertility patients to an entirely new level.
My hope is that all infertility patients will one day experience the joys of motherhood whether by IVF, or in my case, through the miracle of adoption.
March 28, 2012
A recent article in the February issue of Ob-Gyn News described a medical study that claimed to have a great success rate of pregnancies for women who had previous infertility problems because of fibroids.
Fibroid tumors are noncancerous growths in the uterus that affects 77% of women. Most women are not even aware that they have them because they have no symptoms. However, a small percentage of women have complaints such as heavy periods, pain and pressure. Depending on their location, fibroids can affect the ability to have children in 1 to 2% of women, especially if they are located inside the womb where the baby would normally grow. Traditionally, fibroids are removed surgically if a woman wants to have children but the larger the fibroids, the more difficult they are to be removed without causing significant scar tissue.
In the study described, robotic surgery was used to surgically remove fibroids. A surgical robot is a computer-controlled device that is used during laparoscopy (belly button surgery) procedures. In this particular study, 108 women had fibroids surgically removed by robotic surgery that resulted in 127 pregnancies. 61% of women became pregnancy after the procedure without the use of infertility drugs and 39% became pregnancy using in-vitro fertilization (IVF). Unfortunately about 21% of these pregnancies ended with a miscarriage and there were two tubal pregnancies (ectopic) as well. Most of the women who became pregnant had an average of 4 fibroids that were no larger than 3 inches in size but was b locking the lining of the uterus which caused infertility. After the procedures, they delivered around 36.6 weeks, had babies weighing 7 pounds and the average age of the mother was 35.
If you are trying to conceive and have fibroids, should you have a robotic procedure? Probably not without getting a second opinion. Robotic surgery is more expensive than traditional laparoscopy procedures and has a longer operating time. The advantage of having robotic surgery is that the surgeon has a better image of the operating field in 3-dimensions (3-D) as opposed to 2-D and it has features that make it technical easier for the surgeon to perform the procedures.
Women with fibroids who are attempting to conceive should contact the National Institute of Health for further information at the following link http://www.nichd.nih.gov/health/topics/Uterine_Fibroids.cfm
Remember, a healthy pregnancy doesn’t just happen. It takes a smart mother who knows what to do.
December 21, 2011
When I think about Christmas, I instinctively think about the miracle of birth. Four million miracles (aka births) happen in our country each year and many more occur globally. On a hot summer night in the urban community of Harlem almost 30 years ago, I witnessed my first miracle as a volunteer and was never the same again. The mother was a young teen who had been pushing for approximately forty-five minutes. She suddenly let out a piercing scream and out popped the hairy head of baby who started to wail. The mother sat straight up and peered down at the baby whose body had yet to be delivered. The delivery nurse admonished her to lie back down so that the baby could be delivered properly. Oh what a humorous and miraculous sight. I was in complete awe.
The events leading up to the birth of a baby are amazing. It begins with fertilization. The male sperm cannot fertilize an egg until it undergoes specific changes. It has the task of finding the egg which lies outside of the uterus. Does it turn left or right to enter the fallopian tube? Only Nature knows for sure. In order to fertilize the sacred egg, the sperm must change its shape so that it can penetrate the egg’s protective barrier. Once fertilized, the egg must travel from the fallopian tube back into the uterus and implant into the uterine lining to begin its miraculous journey towards the human experience.
All paths to greatness begin with a journey. Sometimes that journey is simple. At other times it might be complex. Let us remember the journey of the three wise men that followed a star that led them to a special baby in Bethlehem. And may we also remember that each of our lives began in a most miraculous way.
I wish all of my readers a very Merry Christmas and happy holiday.
October 24, 2011
Infertility or the inability to have a baby can be devastating and affects approximately 10 percent of the female population. There are many conditions that prevent women from having children including and Mayer Rokitansky Kuster Hauser syndrome (or MKHS). MKHS is a rare disorder that affects a woman’s ability to conceive. At present, for every 10,000 women, only 1 to 2 will be affected. Both Sara Ottoson of Sweden and Melina Arnold of Australia have this condition. MKHS is characterized by the absence of a vagina and part of the cervix. Patients with this condition have normal breast development and functioning ovaries. Genetically, they also have female or double X-chromosomes and look like normal women. The problem comes to light during adolescence when a teen fails to have a period. The condition is also known as Vaginal Agenesis because they are born without a true vagina, a problem that can be corrected through surgical and non-surgical procedures. Unfortunately, they are unable to have children and usually adopt or use a surrogate mother. Those options, however, might soon change.
Both Ottoson and Arnold plan to have biological children using those mothers’ transplanted wombs next year. The wombs that these women resided in prior to their birth will potentially be used to nurture their unborn babies. Ottoson and Arnold will be making history in the same manner as Louise Brown did in 1978 when she became the first successful “test tube” or In Vitro Fertilization (IVF) baby. Has a womb transplant been attempted before? Yes, about 10 years ago in Saudi Arabia but it was an unsuccessful procedure. After four months, the 25-year-old patient’s body rejected the transplanted uterus of a 46-year old woman. Ottoson will receive the uterus of her 56 year old mother but will not be able to conceive through IVF until she has waited a full year to make certain that her body will not reject the donated organ.
If womb transplant becomes successful, it will also be a powder keg regarding ethical and legal issues. It would also provide an option to women who are cancer survivors and desire fertility. All eyes will be on Ottoson and Arnold next year. It will be history in the making.
October 5, 2011
It’s a sad commentary when human beings have to be reminded how to act like human beings, especially when they’re in the helping profession. Loni Hildebrandt was a 29 year old certified nursing assistant who was pregnant with her first baby. Make that two babies because she was pregnant with twins. Hildebrandt considered her pregnancy miraculous because she had infertility and was a diabetic since the age of one. Together, she and her boyfriend saved their money and obtained fertility treatments. Her mother, Jo Novtny, a nurse of 30 years was ecstatic when she saw the ultrasound of her two grandbabies but her happiness was short-lived. One day after the procedure, Hildebrandt began to bleed so they went to Sarasota Memorial Hospital in Florida.
Sarasota Memorial Hospital has an excellent maternal fetal medicine (aka high-risk obstetrics) department but Hildebrandt never made it there. She got as far as the hospital’s emergency room where she was attended to by one of its physicians. Despite repeated requests to have her blood sugar checked, Hidebrandt had to wait six hours before it was done. An ultrasound at the hospital revealed a blood clot that was causing the contractions and the ER doctor told her that he could probably save one by “suctioning the clot so the labor would stop.” According to The Herald Tribune, the physician suctioned the clot and one of the twins as well. Hildebrandt allegedly began bleeding more, passing bright red blood clots. They called for help but no one came. According to the newspaper report, a nurse put the afterbirth in a bedpan and left it near Hildebrandt’s head where she was lying. Her mother moved it and placed it under her daughter’s bed. Novtny ultimately delivered the second twin because no one else was around. The ER doctor returned to the room saw the fetus in Novotny’s hand took it from her and put it in a bucket.
Novtny states her daughter did not receive proper treatment until her personal physician arrived and remained in a pool of blood for over 10 hours. Hildebrandt’s iron count was dangerously low because of the bleeding. Her mother’s request to speak with the hospital administrator was met with no response so she wrote a letter to the governor instead. An investigation was done, gross negligence was found, the ER doctor resigned and Hildenbrandt’s nurse was cited for “lack of critical thinking skills.” The hospital will now have unannounced federal inspections in order to keep their Medicare payments. The hospital administrator issued a public apology.
Perhaps one day hospitals will do the right thing, even when no one is watching. Hopefully, Hildebrandt will become pregnant again and have a better outcome.
September 12, 2011
There are some patients that keep you humbled. Barbara Tate was one of those patients. With a shopping list of chronic conditions a mile long, she was told she could never carry a baby because she had miscarried two during her early 20’s. She suffered the hammer blows of diabetes, high blood pressure, congestive heart failure and asthma. And it doesn’t stop there. Tate also had a history of two slipped disks, a cellulitis infection and a non-cancerous tumor on her adrenal gland. In fact she was scheduled to have surgery until she discovered she was pregnant at the age of 43. She was strongly encouraged to terminate the pregnancy because of her multiple medical conditions but she didn’t. Tate viewed her pregnancy as a miracle and for all intent purposes, it was. After age 37, there is a rapid decline in the ability to conceive although not impossible.
Her baby was born three months early and it appears that she was unaware of the classic signs of premature labor. On the day of her child’s birth, she had been complaining about back pain but attributed it her adrenal tumor. She rested and then got up to use the bathroom thinking that she had an “accident” when most likely it was probably a case of ruptured membranes (or her water “breaking.”) At that point, the baby’s feet were emerging and Tate called for help. Luckily, the baby delivered spontaneously and did not require assistance perhaps because it only weighed 2-pounds-7 ounces. By the time the Emergency Medical Support team arrived, the only thing left to do was cut the umbilical cord. Both mother and baby were whisked to the local hospital initially but then the baby was transferred to a regional hospital 79 miles away in critical condition. Tate was discharged home the next day and the baby’s condition has improved.
Tate’s case is yet another example of a near-miss pregnancy and delivery disaster and she would certainly have benefited from someone performing a
- measurement of her cervical length by ultrasound during the early second trimester to determine her risk factors for preterm labor
- a referral to a maternal fetal medicine specialist given her complex medical history
- a referral to a Healthy Start Program to obtain social service support
Tate’s car is not in the best condition so friends have volunteered to drive her 160-miles in order to visit her baby and donation jars for gas money has been left in strategic locations. Her determination is commendable. Although the baby had a stormy beginning, hopefully it will continue to thrive. Miracles do happen. Hopefully Tate’s story will inspire infertility patients to please, keep the faith.
August 17, 2011
Twins. Oh how we adore them. They represent approximately 3.3% of all births in the U.S. and are associated with both joy and complications such as prematurity. When I saw the headlines of the August 14th edition of the Sunday New York Times, I paused to reflect. Have we gone too far?
The article, Unnatural Selection, Ruth Padawer reviews a growing trend among U.S. women who, when pregnant with twins requests that the twins be reduced to one pregnancy. We have grown accustomed to multiple births in our country based upon the increase in the use of fertility drugs. Indeed, 1% of all births and 16% of twin births are associated with the use of fertility drugs. Very few people complain when there is a request to reduce quadruplets (four babies) or quintuplets (five babies) to twins. And who doesn’t remember Nadya Suleman, the controversial “Octomom” who gave birth to 8 babies that were conceived with fertility drugs.
Padawer describes a woman who was pregnant with twins and sought a physician to reduce her pregnancy to one baby. She initially encountered difficulty because most physicians will not reduce a twin pregnancy unless they have a medical indication and feel that the mother is in jeopardy. The word “reduction” is a polite term for termination and very few physicians will terminate one-half of a twin pregnancy based solely upon maternal request. However since a termination of pregnancy is legal, some physicians will reduce a twin pregnancy to a single pregnancy based upon a mother’s request. According to Dr. Richard Berkowitz, a high-risk specialist at Columbia University Medical Center in New York City, “The overwhelming majority of women carrying twins are going to be able to deliver two healthy babies.” As a mother of two sons who are eleven months apart, I can understand the concerns one may have regarding raising twins. However, despite all of the perceived obstacles of raising two children who were born so close together, somehow my sons managed to thrive and their parents have maintained their sanity.
Should twin pregnancies be reduced to one? It’s an individual decision, so please — make it wisely.
June 6, 2011
Life is about self-discovery. A few days ago, I discovered what it’s like to be the parent of an athlete. The sacrifice and joy of seeing your children excel in a gift you weren’t certain that they had until it manifests right before your astonished eyes.
Checking into a hotel with children is an absolute joy. The excitement of going to a new place. The excitement of sleeping in a new bed (after Mommy checked for bedbugs). They giggled so much and were so excited that I thought I was going to have to give them Valium.
We got up the next day and their coach wanted them at the stadium immediately. They hadn’t eaten breakfast so we gave them a banana and then off we went at 8:15 a.m. in the morning. Parking was crazy but we found a spot. We were not prepared. The sun in Florida is brutal. The UV rays could kill you if you’re caught without protection. I asked their father to please get the umbrellas from his car. I was only in the bleaches 20 minutes and my clothes were soaked and my feet were baked. He returned with huge umbrellas that provided some relief but next time I’ll be prepared. I will buy a tent and make sure it’s “user friendly.” My children WILL have breakfast. I will have a cooler with ice, cold fruit, water, juice and any other amenities that can keep us hydrated and cool.
K+M didn’t run until 1:00 p.m. It was the 1500 meter or 1 mile race. By that time they were hot, hungry and miserable. Mamush placed 5th for his age group and we’re still waiting for the official word about Kayamo because the computer didn’t record his time and they had to review the video . . . . Talk about frustration.
After being fed and hydrated, we waited for the next race . . . the 800 meter or 1/2 mile that occurred some three hours later. The coach admonished Mamush during the one mile race for not having a “killer instinct” to “close the race” at the end. I wish you could have witnessed it; at least 100 kids running in the 800 meter race. Kayamo won first place in his division. And then came the second race. Mamush was leading and then another young man sprinted ahead. His coach advised him to sprint when he reached the 200 meter mark. I was down from the stands as close to the 200 meter mark as possible yelling “Sprint, Mamush!! Sprint!!” His dad and coach were at the other end of the stadium saying the same thing. The runners turned the corner and Mamush picked up speed and flew past the young man. The crowd roared. Oh, what a sight to see. What a sight to see.
When Mamush returned to us, sweating, panting, I asked the coach “Is that enough killer instinct for you, Coach?” He just smiled and said, “Yeah, mommy it is.”
My sons are both now, one step away from getting to the Junior Olympics. We return to Jacksonville in 2 weeks for the State Qualifying race. And if they win, it’s on to New Orleans. It’s almost surreal to go from being childless to having two magnificent sons who represent more than I could ever imagine. I’m going to continue to enjoy the journey I’m having with K+M. And in doing so, I’m falling more and more in love with Life as well.
February 23, 2011
On any given day, 15 percent of U.S. couples will discover that they are not able to conceive. As a former infertility patient, I can personally attest to the earth-shattering emotions that many patients experience. But all is not lost. Motherhood can be attained through the gift of adoption or Gestational Carrier Pregnancy (aka Surrogate Pregnancy).
Gestational carrier pregnancy (GCP) is an arrangement where a woman (a gestational carrier) agrees to carry a pregnancy on behalf of another person or couple (the intended parent). Depending on the arrangement, the intended mother may or may not have a genetic connection with the unborn fetus. In one scenario, the intended mother provides the egg and the intended father provides the sperm. In Vitro Fertilization (IVF) is used to transfer the fertilized egg into the gestational carrier who has no genetic connection with the newly formed embryo. In another scenario, the gestational carrier provides the egg and the intended father provides the sperm. Artificial insemination is used for fertilization in this case. Many celebrities have used gestational carriers including: Sarah Jessica Parker, Nicole Kidman, Angela Basset and the late Michael Jackson.
Women who may have need of a gestational carrier include those who do not have a uterus; have unexplained infertility; have medical conditions that would make pregnancy life-threatening and those with a poor obstetrical history. The life birth rate of GCP is as high as and ever higher than IVF making it a viable option for intentional parents.
The selection of a gestational carrier (GC) is extremely important. The gestational carrier should have a medical, psychological and fertility screening. Many physicians will use a GC who has had at least one uncomplicated pregnancy and no chronic medical conditions. A young maternal age is desired because there is less chance that the GC will have uterine conditions such as fibroids or previous surgical procedures. Mental health counseling should be provided to both the GC and intentional parents before pregnancy. The psychological status of a GC is extremely important because she must be mentally prepared to give the newborn to the intentional parents after the delivery. In most cases this happens however, in some heart-wrenching cases it doesn’t. It is equally important for the intentional parents to have psychological counseling in the event the baby has a disability and is not “perfect.”
GCP usually involves substantial compensation for the GC. What is your state’s public policy? Is it legally permissible? In the event of a dispute between the gestational carrier and intentional parents, what does your state’s law state and who will it protect?
The use of gestational carriers to achieve parenthood involves ethics, trust and cooperation. If all three of those essential ingredients are present, a satisfactory outcome can be anticipated by all.