Question 22. Why are my menstrual cycles irregular?

We often have residents from the Ob Gyn residency program at Georgetown rotating through our office. When they sit in on my consultations they get very familiar with my little song and dance about the normal menstrual cycle. Let's face it....if you don't understand normal reproduction then how can you figure out how to order appropriate tests on your patients to determine the problem. Yet, sometimes in spite of our attempts at education, they still can't figure it out. So here is your chance, dear reader, to become smarter than an Ob Gyn resident!...

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Question 21. Will my insurance pay for my fertility treatments?

Obviously healthcare reform has been a hot topic here inside the beltway this past year. No doubt that trying to navigate the insurance coverage jungle is confusing to say the least. Most plans cover diagnostic testing for infertility. Some plans cover treatment for infertility. Some plans only cover certain treatments and dictate a specific order to those treatments. Some plans cover a certain dollar amount and couldn't care less what treatments you do....and on and on and on.Sometimes patients ask us to code visits using non-infertility codes....

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Question 20. How expensive are infertility treatments?

Children are not cheap. Unfortunately, those patients with infertility are having to invest in a bit more than dinner and a movie in order to have the privilege of spending thousands of dollars to house, feed and entertain the little monsters. But seriously, when contemplating the array of treatment options one must consider the economic aspects when making a plan. Unfortunately, the fertility treatments that work the best tend to be the most expensive and most invasive options. So let's look at the options available and a range of what these...

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Question 19. What are Natural Cycle fertility treatments and am I a candidate for them?

Given the interest in organic food, environmentally friendly energy and "green" buildings, I guess it was only a matter of time until Natural Cycle fertility treatments became more attractive to all of us. Remember those Promise margarine commercials that would end with "It's not nice to fool Mother Nature!" Well, sometimes Mother Nature may in fact know best and that is the idea behind Natural Cycle fertility treatments.I think that one has to be creative when considering the infertile couple and using Natural Cycles for fertility treatment may...

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Question 18. How will my reproductive endocrinologist determine a plan of therapy?

Here in Washington we are surrounded by planners. People are available to plan your party. People are available to plan your finances. People are available to plan for your kid applying to college (or secondary school or even kindergarten). People are available to plan your attempt to lose weight and get in shape (personally I am doing the Special K diet...gotta look good for my college reunion at the end of May). So it is not surprising that patients look to their RE to plan their fertility evaluation and treatment. I am not a "me doctor - you...

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Question 17. Can I choose the sex of my baby?

Years ago I saw a patient that had 3 girls and wanted a boy. Their solution was to take fertility shots and have timed intercourse with the logic that even if they had a multiple pregnancy, one should be a boy. I tried to explain that their logic was not very sound and that they could end up with a real surprise. They were not to be dissuaded and went to another clinic. They followed through with that plan and ended up with triplets....all girls. Six girls under 6 years of age is hard for me to contemplate. Wow. That is a lot of squealing under...

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Question 16. My friend keeps asking whether I had an endometrial biopsy or a postcoital test. Do I need these tests?

As we work our way through the 2nd Edition of 100 Q&A about Infertility, I suppose it is inevitable that some blog posts may end up getting recycled. When discussing the post coital test I always think of the story that I initially related in one of my first blog posts. It may not be the most politically correct story but here it goes....Here is a true RE urban legend. Many years ago a very trustworthy and honest infertility specialist (not yours truly although I would hope to be described in this fashion) arrived at the office for his usual...

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Question 15. After we have sex, I think that everything comes out. Is this why I am not getting pregnant?

A few years ago I had a high school student spend the day with me in the office since he was considering a career in medicine. He went with me to Fairfax Hospital where I gave a lecture to the medical students and residents. He went with me to Reston to see some consultations. He went with me back to Arlington to watch some procedures including an embryo transfer (he was in the lab not in the room with the patient). I thought that he would be impressed by the depth and breadth of what I do all day long.....At the end of the day I asked him what...

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Question 14. Can infertility be unexplained?

Well I am back from Spring Break in beautiful Quincy, Massachusetts where it rained constantly and there was flooding on a Biblical scale....The ride back was tough but all of us survived the New Jersey Turnpike without incident. To help pass the time, my wife and I listened to an audiobook while the kids watched DVD after DVD. We listened to "The Thirteenth Tale" which is really an amazingly good Gothic-type ghost story. Early on in the book the reclusive author Ms. Vida Winter is confronted by a young man who demands that she "tell him the truth."...

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