Ah, the end of summer. How sad that always made me as a little kid. It meant loading up our station wagon and driving back from Cape Cod after spending the whole summer in West Dennis. It meant no more mini-golf and no more trips to the beach and of course, the beginning of a new school year. Fall was not a favorite of mine as it meant classes and homework and the approach of winter. But times change and now I relish the change in the weather, especially here in DC where August is so hot and humid (pretty much like June and July!). And since I...
vendredi 31 août 2007
mercredi 29 août 2007
Patients can usually be divided into active and passive subtypes. Active patients read books (like this one), cruise the internet, pepper their RE with questions and engage in extensive discussions of the options available to them. Passive patients look across the desk at us and say “Doctor, you decide what is best.” Although at the end of the day, the active patients can certainly leave you feeling exhausted, I really enjoy these interactions and the challenge of making a treatment plan with them. I worry about the passive patients. Do they really...
mardi 28 août 2007
So yesterday we discussed blastocyst transfer in general and today we get down to brass tacks…You know, it amazes me that some of the Residents and Medical Students that I teach do not know some of these quaint little sayings like the one I just used. I have said to them “a watched pot never boils” and received just blank stares. Is this a sign of advancing age on my part or is it because they watched too much TV as kids? I have no idea. All I know is that it still really disturbs me that the 80s music that I listen to in the operating room was...
lundi 27 août 2007
“Going to blast” is different than “having a blast.” When your RE talks about going to blast he/she is referring to the stage of embryo development at the time of the embryo transfer. When I began practicing infertility in 1996 most embryo transfers were done on the second day after egg collection (egg collection is day zero). However, most clinics moved rapidly to day 3 ET to allow for better embryo selection. The move to day 5 ET was a bit more...
dimanche 26 août 2007
Clearly the million dollar question that all patients usually ask is "why is it not working?" The "it" can range from natural attempts at conception up to and including IVF. In some cases we really don't understand what the problem is and are faced with approaching fertility treatment with the "more eggs, more sperm...in the right place at the right time" approach. This logic is really the basis of most of our treatments. However, paradoxically we often recommend the most expensive and invasive treatment to those without an identifiable problem..why?...
vendredi 24 août 2007
In my last blog post I discussed the general concept of frozen embryos which is certainly a bit of a mind bending concept by itself. But I want to emphasize how important the option of having cryopreserved embryos can be to a patient’s overall chances for success. Many times over the years we have ended up with success by using the last frozen embryo that a patient had to work with after multiple failed cycles. Of course, the natural response would be that if we were really smart, then we should have known which embryo out of the whole bunch would...
mardi 21 août 2007
The previous post discussed egg freezing which is a much more difficult technique compared with embryo freezing which has a much longer, proven track-record. We will discuss egg freezing some other time. In general, if there are high quality embryos that are not going to be transferred it is always a good idea to consider freezing them for future use. However, the mere fact that these embryos exist has led to other concerns that are not only medical but social, philosophical, ethical, and moral. What obligations do a couple have to their frozen...
samedi 18 août 2007
A recent case in Canada raises some very interesting ethical questions. A women with a young daughter with Turner Syndrome wished to undergo IVF with cryopreservation of the unfertilized eggs so that her daughter could use them later in her life in order to conceive rather than rely on another egg donor to provide her this opportunity for parenting.http://www.associatedcontent.com/article/221699/medical_first_mother_to_daughter_egg.htmlNever a dull moment in the world of reproductive medicine! In the above situation the girl would give birth to...
vendredi 17 août 2007
Not a week goes by when a couple asks during a consultation "Why should we come here instead of clinic X." I know that many fertility books advise patients to ask this question but what response are they looking for....This question always takes me back to my college, medical school and internship/residency interviews and to tell the truth I usually interviewed badly. My Harvard undergrad interview was particularly memorably bad and I remember my high school guidance counselor shaking his head slowly and asking what happened. I blew it. In retrospect...
jeudi 16 août 2007
I know that the 5 people who read this blog have been wondering that for the past 2 weeks. Gee, he was so good about posting questions from that fantastic book and then...POOF..he disapparated. Well, the answer is that I have been here but too overwhelmed to post to the blog. Sorry but true. When returning from vacation you always get hit hard and this month was no exception. So my patients in cyberspace had to take a back seat to the real flesh and blood patients.And then last Friday night disaster struck...Upon returning from dropping off the...
mardi 7 août 2007
Well, I am back having spent a very relaxing vacation in Wyoming. If only there were more people in that beautiful state, then I would seriously consider relocating from the Metropolitan DC area. Returning back to DC was like entering a swamp and considering the current state of our elected officials there are more similarities than I really would care to admit...In any case, as sales of the book on Amazon.com place it only 599,997 book rankings...
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