Infertility Evaluations and Treatments

Thank you all for reading my blog. Writing this is really rewarding for me. I feel like I am doing something that really needs to be done. And I don't think anybody else writes a blog like this. I believe that it needs to be done. Thank you all for reading. Please don't hesitate to say a few words in the comments. Criticism or praise is welcome. And linking would be great. I hope to get higher on the google ranks if people like my blog.

I am a little bit late posting my blog today. I have been at The Valley Hospital in Ridgewood New Jersey with a number of full term patients having babies. Everybody is doing well. Today was a bit busy. I've delivered 2 boys and a girl today and it's now time to take a bit of a break. All of these babies are beautiful miracles. In fact, all babies are beautiful miracles. I am so lucky to be a part of all of these lives. I think that I have the best job in the world. The hours are long, the work is busy, but I like my job and that makes this all very easy. I like what I do and I never regret the long hours. I think my patients can see that I like my job. My patients can see that I am having fun and they can truly appreciate it. I wind up with thousands of baby pictures on my wall, and it's great. Please come by and see them if you are close by.

But, I promised to write about a significant problem that some couples have. There are plenty of women in the world who would love to be in the delivery room today, in labor, who are not. I see these patients in my office every day. Frequently I will see these couples in my office for a checkup. Many times, after some delicate back and forth discussions trying to find out what the couples goals are, I find out that there has been no contraception for some time. In other words, they want to be pregnant and are not. Most of the time, these women are becoming more and more stressed as the months go on. It seems to them that all of their friends are having babies and they are not. Each time the menstrual period starts, they become more and more stressed. Many times there is tears, every month there is more.

About 20 percent of couples that want to have a baby cannot get pregnant.

The old textbooks used to say that there was not a problem with fertility unless the couple has tried for Two Years and there is still no pregnancy. I can tell you all right now that after two years of wanting to be pregnant, most women would be out of their minds with anxiety. Many of my patients have deferred pregnancy into the mid or late thirties, or even later. This means that the "Biological Clock" is ticking very loudly. They simply cannot stand waiting any more. They know that if they wait,  they may completely lose their chance to have a baby. That is a damn shame.

I think the new standard of care should be SixMonths. If there is no contraception for six months, then they deserve a consultation about what to do.

When a patient presents to me with this problem, my job is to help them figure out what is wrong. This is not hard at all. Sometimes, the problem is really easy to diagnose. And many times, the problem is really easy to overcome. I have done it many times.

Also, there are times when a couple needs help but the diagnosis presents itself with the patient. Very little workup is required. For instance, there are gay couples. Women that are married, or consider themselves married, to another woman, that want to have a baby, are infertile. It is not rocket science to know that there is a lack of sperm. Helping them is really easy, and unbelievably rewarding. I have helped these women out. I have helped these couples form entire families. It is so easy to do. Any properly trained gynecologist can do these things. Many times a sperm bank is the answer. Some women have other solutions in mind.

But the usual infertile couple is a man and a women who have been having "unprotected intercourse" for 6 to 24 months. If they are not pregnant, then then are in my office for that problem.

After doing a complete checkup and making sure that nothing obvious is wrong, I will sit down with the patient and discuss several things. First, I will explain what the common "factors" of infertility are. These are, in anatomical/biological order:

-Male Factor
-Timing Factor
-Cervical Mucous Factor
-Uterine Factor
-Obstructed Fallopian Tubes, or Tubal Factor
-Weak or absent ovulation, or Ovulatory Factor, or Luteal Factor
-Peritoneal irritations, or Peritoneal Factor, most likely endometriosis
-Defective Embryo's, or "old ovaries and eggs".
-Unexplained Infertility 

This discussion can be tailored to the specific couple. It usually takes only a few minutes. Many times I will write these things down on a small legal pad that I keep handy.

But this discussion of "factors" is not what usually catches their undivided attention. It is the next step that really catches their attention. This is really important.

I start with making of plan of action for the couple to figure out what is wrong. I will almost always write this plan on my small legal pad. I try to make this plan very specific.

Here is my usual workup, or plan, for the usual patient:

-Basal body temperature charting. Easiest to chart on www.fertilityfriend.com, but paper charting is OK.
-day 2 to 5 basic Gyn hormone levels, including thyroids, prolactin, LH, FSH, AntiMullerianHormone.
-Ovulation predictor test kits, or OPK's,  from days 10 until the 3 day surge of LH is over, about day 19.
-Post coital test on day 13 or so, or the day prior to ovulation
-Luteal day 7 progesterone blood test to evaluate the Corpus Leuteum, and evaluate the ovulation.
-Semen Analysis
-Hysterosalpingogram, or HSG, in the early second or third good cycle.

Usually, after these tests are done, after a month or so, we have an idea of what is wrong.

About 50 percent of the time there is a mild male factor. About 40 percent of the time, the women is not ovulating very well. Many times, the cervical mucous is "hostile" to the sperm, and will not let sperm swim in to the uterus. About 10 percent of the time, there is endometriosis, and this is "hostile" to the embryo before it implants into the uterine wall. If the woman is near menopause, then there is likely either a weak ovulation, or defective embryos.

I can easily test for most of these things in my office.

And then overcoming these problems is mostly straightforward. Most of the technology is easy to do in the office.

But, for some factors, such as a serious tubal occlusion, a very very low sperm count, anovulation resistant to oral medications, or a bad case of unexplained infertility, the patient will need to be referred to an IVF clinic. This is a sad development. IVF is very expensive, and it is highly interventional. The good news is, is that IVF is highly effective. The latest IVF success rates are about 50 plus percent. 50 percent of the IVF cyles will lead to a confirmed pregnancy. This is very welcome news indeed to a couple who has been trying to get pregnant for a very long time.

There are two kinds of reactions that women might have to this kind of infertility technology. The most common is intense relief that we are finally doing something that may help. But some women are very over-stressed by all of this scientific analysis. The stress is just too overwhelming. Sometimes they just give up.

I think that supportive care givers can help quite a bit.

I've done this many times .

I find that it is really rewarding to help women and couples through these problems. The reward is in their smiles when the baby finally comes. Like I said before, every baby is a miracle and a gift from God.

Thanks for reading. Please comment and let me know if you have any constructive criticism.

This blog is really rewarding for me and I am having a great time doing it. I don't think any other Gyne is doing exactly this kind of a blog.

Thank you, Sincerely,

Dr John W Marcus MD FACOG
89 North Maple Ave
Ridgewood, NJ, 07450
201-447-0077

website is www.doctorjohnmarcus.com
blog is doctorjohnmarcus.blogspot.com