Over the years certain patients really stick out in your memory. This week one of my favorite fertility veterans brought in a whole box of homemade cookies to the office. Needless to say, they were consumed within 45 minutes and I got one or two but almost lost my hand in the feeding frenzy that occurred. In any case, this young woman had really been through the ringer. Low responder, high FSH, pregnancy loss, antiphospholipid antibodies requiring Lovenox, male factor….and the list always seemed to keep growing. However, the low point was an ectopic...
jeudi 11 décembre 2008
mardi 9 décembre 2008
Again the weeks have just flown past with no additional blog entries by yours truly. I have no excuse really. Just too busy, too tired, too overextended…yadda, yadda, yadda. So beat me, slap me and call me dirt.The issue of blocked fallopian tubes is a very important one, even in patients undergoing IVF. Now on the surface this makes little sense because if IVF is used to bypass the fallopian tubes then who really cares if they are abnormal? A reasonable concern and one that for many years we agreed with as we entered patients into the IVF process....
lundi 24 novembre 2008
Well I must apologize for being very bad about blogging this past month. I was in San Francisco for the ASRM meeting and then up to Boston to check on Dad who has had some real health issues this summer.San Francisco was great to visit and I had not been back there since I left to join Long Island IVF in 1996. There is a pretty high freaky person quotient around the convention center and the weather was pretty cold and rainy but it was good to see old friends.Several topics were on my mind and I will address these in future posts. Today I want...
mercredi 29 octobre 2008
Several times a month I am asked about tubal reversal surgery. Performing a tubal reversal is actually something of a vanishing art among reproductive endocrinologists. Personally, it has been over 10 years since I last did one and if a patient really wants to pursue this option, then I refer them to Dr. Gary Berger in Chapel Hill, NC. Dr. Berger has a great set-up for doing tubal reversals and his price is hard to beat along with his level of experience. And I do not receive any kick-backs from Dr. Berger. In fact, I am sending business out...
vendredi 17 octobre 2008
As readers of this blog are aware…my family is not really sure that I am a “real” doctor since I am not a general surgeon. As IVF success rates have climbed, the number of reproductive surgeries perfomed has plummeted. When I was a Duke medical student I still remember the REs scheduled 5-10 laparoscopies every day that they were in the operating room! My how times have changed. The problem with most surgeries aimed to improve fertility is that they often don’t help very much. In addition, since infertility is a couple’s disease and half the problems...
jeudi 2 octobre 2008
The economic news lately has been sobering to say the least and certainly a drop in the economy usually forces patients to carefully assess their options when considering various treatment options. Fertility treatment can be very expensive and life would be so much easier if I had a crystal ball that allowed me to predict with 100% certainty when and through what means a couple (or individual) would achieve success. But life is not like that and so we are left to counsel patients using our best advice as to how to proceed.We have certainly seen...
lundi 29 septembre 2008
My older brother Steve always told me that I had a great face for radio.....maybe he was right but in any case Dr DiMattina and I will be back on the airwaves tomorrow morning at 9 am on WIHT-FM (Hot 99.5) here in Washington DC. You can listen via streaming audio on their website at the Kane Show website. So go ahead and light up the airwaves with all those great questions for your 2 favorite fertility physicians.Hey, if the Reproductive Endocrinology thing doesn't work out there is always stand-up comedy I suppose....In any case, pray that Dr.G...
vendredi 26 septembre 2008
I am a 3rd generation physician, which means that as a little kid I was given no choice as to what I was going to me when I grew up... "So, you are so smart little Johnny, I am sure that you want to be a doctor just like your father and grandfather and brother and uncle etc etc." You get the idea. My grandfather had his office in his house. He ate breakfast and then walked across the hall, opened the big sliding doors and Voila! he was in his office and its waiting room. What a great commute!My father had operated on so many citizens of Quincy,...
mardi 23 septembre 2008
In two previous posts (Jan 9, 2008 and Jan 10, 2008) I discussed the use of unstimulated (Natural Cycle) IVF. Since 2007 we have been offering this option to our patients with the understanding that it is not going to be as successful as stimulated IVF for the majority of patients. Our prediction was that we could generate acceptable pregnancy rates in those patients with the best prognosis (younger, regular cycles, well-defined cause of infertility) and our data suggests that we have been successful.However, our discussions with the leadership...
mardi 16 septembre 2008
Sometimes you just want to pack it in and head for the islands... There is nothing quite as stressful as a tricky embryo transfer. Here you are in a darkened room with a patient who is not very comfortable as a result of having a full bladder and enlarged ovaries. There may be a concerned spouse/partner sitting at the head of the bed watching you like a hawk and the whole time you are trying to push a wet spaghetti noodle through a pinhole. Well...
mardi 9 septembre 2008
Some nights you just have to roll with life's little surprises. Last night we had a delivery at 9 pm and the delivery man accidentally rolled his handcart over my dog's front leg. Poor Indy ran off yelping at the top of her lungs and when I finally found her she was huddled up against the kitchen sliding door. As I am not a veterinarian I bundled her off to the Animal Emergency Clinic in Rockville where we spent the next couple of hours. Ultimately, the xray showed the leg was not broken and they dosed her up with doggie morphine and doggie super-Motrin....
mercredi 3 septembre 2008
Wow, I knew that I was behind in my blogging but missing a whole month is pretty bad! In my defense, I was on vacation for part of the month and DrD was on vacation for several weeks as well so it was a pretty crazy time here at DFE.The end of summer is always very bittersweet. It brings back memories of driving back home from a summer on Cape Cod with the station wagon absolutely heaving from all the junk plus a wet dog and usually a container of Sea Monkeys. The return to school was usually not a high point for me...hard to imagine considering...
jeudi 24 juillet 2008
As part of the routine fertility evaluation we usually obtain cervical cultures including a test for mycoplasma and ureaplasma. These are bacteria that have essentially no symptoms but may decrease fertility and may also influence the chance of pregnancy loss and even preterm labor and delivery. However, the data is not particularly good and thus, many clinics do not routinely perform these cultures.Years ago when I was in practice in Long Island I was doing an examination and sonogram on a new patient. I carefully explained each step and while...
vendredi 27 juin 2008
I admit it…sometimes I do watch “real life” medical shows on television. Last year I was watching “Medical Mysteries” on Discovery (I think) and the show presented a young woman who wanted to conceive but had not resumed menstruating after stopping oral contraceptives. She noted that her doctor prescribed “pills” to induce ovulation but when she failed to bleed the doctor ordered additional tests to evaluate if she could be in “early menopause.” Although not exactly correct the story seemed appropriate thus far. Then the doctor called her and gave...
mercredi 11 juin 2008
As the son and brother of general surgeons I am often put in the position of defending the low volume of surgery that I perform as a reproductive endocrinologist. In years past, fertility physicians were often in the operating room spending hours repairing damaged fallopian tubes in an attempt to improve a patient’s fertility. However, as IVF technology has improved the need for laparoscopy has dwindled. I explain it to patients in this fashion: If I do a laparoscopy and find significant adhesions (scar tissue) and endomteriosis then IVF is your...
mercredi 28 mai 2008
When I was an Intern in Ob Gyn at Stanford, my friend and Senior Resident Jan Rydfors shared with me a helpful saying: “Like treats like.” He was referring to patients with polycystic ovarian syndrome (PCOS) and how to induce them to ovulate. He explained to me that since PCOS was a hormonal problem, its treatment should be with hormones (not surgery).Surgery for patients with PCOS was popular for many years and prior to the introduction of clomiphene, one could indeed help women with PCOS by performing bilateral ovarian wedge resection. My father,...
mardi 20 mai 2008
My brother Mike is a real doctor. I mean it. He is a general surgeon in a small town in North Carolina and has not had a full night’s sleep in about 27 years. He is always being called out to the ER to help save someone’s life (or at least remove their appendix) in the middle of the night. The life of a fertility doctor is very different.Some weeks are more reproductive psychiatry than reproductive endocrinology and emergencies are rare. We have an occasional patient with OHSS in the hospital and once in a while we have an ectopic pregnancy that...
vendredi 9 mai 2008
If you spend any time surfing the websites and bulletin boards concerning infertility, then you will certainly notice that stimulation protocols are discussed by patients all over the web. Some patients complain that their heads are spinning as some of the women posting in cyberspace seem to have physiology PhDs and know all of their estradiol levels and follicle sizes…yadda, yadda, yadda.I think that informed patients are always the best patients but at some point I also think that you need to trust your RE to make sound decisions. There are many...
vendredi 4 avril 2008
Sorry for the large gap between posts but I actually took some vacation and have been paying for it ever since. Usually it takes at least a week to catch up and handle all the questions that have been raised over the previous week. This torture explains why my vacation schedule is pretty sparse!Once back here at Dominion I was interested in the Grand Rounds lecture given at Inova Fairfax Hospital this past Monday. The topic was the surgical treatment of endometriosis and infertility. Specifically the question of removal of endometriomas was raised...
mercredi 12 mars 2008
Before I jump into today’s topic I wanted to put a plug in for a local patient information seminar sponsored by RESOLVE. The volunteers at RESOLVE do an outstanding job and this conference (April 12, 2008, 8 am til 5pm at the Bethesda, MD Hyatt Hotel) provides a real resource for patients especially in regards to adoption information. http://www.resolve.org.Now back to our issue at hand…Every week it seems that I discuss fibroids with my patients…and...
vendredi 29 février 2008
Many of the questions that I answer on the INCIID bulletin board revolve around issues of stimulation. High responders, low responders, unusual responders…you name it. Of course, making pronouncements on cycles that I have never seen, from clinics that I have never heard of and with REs that I personally have never met represents a difficult proposition.IVF is really an art on some level and we need to carefully pick stimulation protocols and make...
vendredi 15 février 2008
Trust is at the heart of the doctor-patient relationship. You, the patient, put your trust in me to make the correct treatment recommendations, and I, the doctor, trust that you are being honest with me regarding your history, symptoms, insurance issues etc.Patients will sometimes ask me to use non-fertility codes during their care in order to get their insurance to cover a particular visit or procedure. This request is known as insurance fraud and...
mardi 22 janvier 2008
Clearly one of the biggest issues facing our patients is advancing age. We cannot turn back the biologic clock and it is not fair that Strom Thurman can become a father at age 84 and for women after age 35 fertility really starts to drop. If only we had a way to determine the number of health eggs remaining in a woman, then we could give accurate assessments of the chances for success. Unfortunately, there is no test for egg quality that is definitive.So...
jeudi 17 janvier 2008
Many of the questions that I answer on the INCIID (www.INCIID.org) bulletin board revolve around medication protocols especially the use of oral contraceptives. Personally, I have had poor results with the use of oral contraceptives except in known high responding patients. I know that many clinics use pills in protocols without any problems but my own experience has not been very positive.So here is today’s “Question of the Day” from the book that...
jeudi 10 janvier 2008
Yesterday we discussed two major issues facing patients and their doctors: How do we completely avoid the temptation to transfer more than one embryo and also avoid the risk of OHSS completely? One answer was to use Natural Cycle IVF.Why then would all clinics not offer Natural Cycle IVF? The procedure is already proven and familiar. We all do egg collections. We can use ICSI to ensure fertilization occurs if there is any concern. We all culture embryos. So where’s the problem?Here’s the situation as I see it. According to the Wyden Law every...
mercredi 9 janvier 2008
Happy New Year to all those wonderful people out in cyberspace who read this blog. Mom, check your mail for the family calendar that I sent you and tell Dad to stop shoveling the snow himself unless he wants to keel over from a heart attack this winter.January is the time for New Year’s Resolutions and one of mine is to resume this blog with the regularity that I was able to maintain prior to Tatiana’s sudden death (see last post). Part of healing is moving forward without losing your connection to the past and it is in this spirit that I am taking...
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