There is an adage in medicine that “like treats like.” So if you have a hormonal problem, then treat with hormones. If it is an anatomic problem, then treat with surgery…etc. In the case of PCOS, if this is an insulin related problem, then treat with a medication that addresses insulin issues. At Dominion, our preference has been for all patients with PCOS to take metformin. The majority of the patients tolerate the medicine and many resume normal cycles and conceive. For those patients in whom metformin alone is not sufficient, then we can induce...
lundi 23 juillet 2007
vendredi 20 juillet 2007
Years ago the field of Gynecology was actually a subspecialty within Surgery and many surgeons were trained in Gynecology since it was not a separate medical specialty. My father was one such surgeon and he still loves to tell me how he was better at hysterectomies than any Gyn physician. Since I never do hysterectomies as a fertility physician, I never took this comment as an insult. In any case, one day we were discussing fertility problems and I mentioned PCOS. I was surprised to hear from my Dad that he was quite familiar with PCOS and had...
jeudi 19 juillet 2007
Certain reproductive problems are more common than others and PCOS is one of the most common fertility problems that we deal with in clinical practice. When lecturing the medical students and residents I spend a lot of time talking about PCOS because this is a problem that all Ob Gyn physicians should understand and manage. That being said, it sometimes seems to me that the patients understand a lot more about PCOS than their doctor.Before I go any further let me set the record straight – polycystic ovaries are not like polycystic kidneys. In PCOS...
lundi 16 juillet 2007
Well the blessed moment has arrived as Jennifer, our office manager and I, unloaded 44 boxes of books at the local Storage USA facility here in Arlington. It is always exciting to tear open that first carton and see the books sitting there...kinda like Christmas morning.The road to this point was tough going at times. DrD and I had to balance the usual responsibilities at the office and at home, but we believed in the project and the folks at Jones...
mardi 10 juillet 2007
Several years ago I attended a conference about legal issues in reproduction. It was a great meeting and a lot of very interesting topics were addressed. At that meeting the following cartoon was presented.Clearly, there are different ways to screen your donors. However, the FDA has now become involved in egg donation to ensure that no diseases are transmitted through the process. Fortunately, even before the FDA became involved there had never been...
dimanche 8 juillet 2007
When the media is not foaming at the mouth over a sextuplet pregnancy, the next most likely sensationalistic topic is egg donation. The focus is usually on the compensation paid to the donors with $50 thousand to $100 thousand for Ivy League eggs often reported. As a Princeton grad, I can tell you that my wife, for one, would never pay that much for Ivy League gametes (eggs or sperm). In fact, after meeting my college buddies for the first time in 1985 she probably immediately had 2nd thoughts about my suitability as a future spouse. Fortunately,...
samedi 7 juillet 2007
It helps to read the instructions…carefully. This afternoon I was helping my son, Aaron, assemble a new baseball pitchback that he received as a birthday present. We read the instructions and quickly assembled the aluminum frame with the little shock cords that would hold the net in place. Suddenly we stood back and noticed that we had completely goobered the thing up and had to pull it apart and start over. The problem was that we were too anxious to get the pitchback pulled together and had not really read the instructions carefully. Couples...
vendredi 6 juillet 2007
Although I am a bit introverted and so is my wife, we occasionally venture out to parties and when people hear that I am a fertility doctor they often ask about the latest 63 year old or 67 year old who got pregnant. However, they all seem shocked to learn that the pregnancy was obtained with donor eggs. Human reproduction is very dependent upon the age of the female partner. This burden is not fair. It is not fair that Senator Thurman can father a child in his 80s but there you have it. Occasionally women in their late 40s will conceive and deliver...
jeudi 5 juillet 2007
As fertility providers we have become victims of our own success with the rate of twin pregnancies rising to very high levels as IVF laboratory techniques improve. I view twins as an OK outcome but honestly, if I was never responsible for another twin pregnancy I would be ecstatic. The problem with twins is that the rate of preterm labor, preterm delivery and pregnancy related problems are not insignificant. Not all twins end up as cute little Santas on the family’s Christmas card. Some twin pregnancies end in the mid trimester or in the early...
mercredi 4 juillet 2007
As I worked my way to downtown D.C. for the 4th of July Parade on Constitution Avenue, I consulted several maps in both the Metro stations and on the train itself. Once at the Federal Triangle stop there were several very helpful Metro employees directing pedestrian traffic and answering questions. The combination of the maps and the personalized attention made my trip less stressful and more efficient as I made the trip from my office (after 1 IVF retrieval and 3 embryo transfers) in much less time than I anticipated.The journey that patients...
mardi 3 juillet 2007
One of the most satisfying parts of being an RE is the fact that I can usually predict exactly where a patient is in her menstrual cycle with a blood test and a sonogram. Obstetrics is not nearly this precise. Some women deliver vaginally who you predict would have needed a Cesarean section and others need a Cesarean when you would have predicted a vaginal birth without any help at all. There is no way to predict what will happen in labor, it is all too crazy for me.During my Fellowship at UCSF I used to moonlight once in a while at the Palo Alto...
lundi 2 juillet 2007
Few issues in reproductive medicine are as controversial as gender selection. As the father of children of both genders I can certainly understand the desire for family balancing. However, few concepts are as disturbing as abortions performed on the basis of fetal gender alone. After my two sons were born, we figured that we would probably only have boys if we continued to add to our family. Then came pregnancy #3 and after a bunch of ultrasounds performed by yours truly, I was pretty sure that there was a change in the wind and we were having...
dimanche 1 juillet 2007
Sometimes it seems incredible to me that any humans ever conceive given the complexity of reproduction and the multitude of factors that can prevent conception. As fertility physicians we always need to keep in mind how the normal system works in order to evaluate for problems and suggest therapeutic interventions. Personally, I have always felt very privileged to work with patients seeking fertility. The rewards are great but the emotional costs can be high for both patient and caregiver. The news is sometimes not good and the treatments can...
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