eating while pregnant

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lundi 28 février 2011

Question 42. Can we have sex during a treatment cycle?

Posted on 10:02 by Unknown
Sometimes medical advice makes sense and sometimes it doesn't. Historically, fertility patients have been told to contracept during the month that they plan to start luteal lupron in order to avoid conceiving while on lupron. Actually, the registry of patients that have, in fact, conceived on lupron suggest no risk of birth defects in the children born after this little oops. Years ago in Long Island I had a patient that had 8 years of infertility. She and her husband finally got up the nerve to do IVF and boom, she conceived on lupron. Then 2 years later she wanted to have another baby and voila, she conceived on lupron again! Go figure.

So this recommendation against sex during a luteal lupron cycle has morphed into no sex during any treatment cycle which makes little sense except in a few cases as detailed below. Now if a woman is really bloated and unconfortable while on fertility drugs then that is a totally different issue. In that case we send the partner off to take care of business on his own or encourage then to pursue other ways to avoid delaying ejaculation for weeks before an IUI or IVF procedure.


42. Can we have sex during a treatment cycle?


In general, the answer is yes. Many experts, however, recommend no coitus for 2 to 3 days prior to an anticipated IUI to “build up” the male partner’s sperm count and volume. Also, some men may experience difficulty producing a specimen if they have recently had coitus. For men who have a low sperm count or motility, it is recommended that they abstain from sexual relations for 3 to 5 days prior to a planned IUI. In patients who are at risk for hyperstimulation syndrome, it may be wise to refrain from sex until the ovarian response has been assessed. In patients with an excessive response to fertility drugs the cycle may be abandoned and yet ovulation could still occur. Since the sperm can survive up to 5-7 days after intercourse, a pregnancy could occur even in the setting of a cancelled IUI or IVF cycle.
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mercredi 16 février 2011

Question 41. I read on the Internet that two inseminations are better than one. Is this true?

Posted on 11:29 by Unknown
The internet is quite an amazing place. You get anything you need at 2 am and research obscure medical disorders to your heart's content. But that can be a danger as well. I have been a bit under the weather recently and let me tell you that you do not want to type any ailment into that Google search box unless you are prepared to totally freak out. Seriously. Of course, medical professionals make the worst patients because we know too much about too little and often end up feeding into our own worst fears. It's never just a mole...it's melanoma. It's never just a superficial skin infection...it's flesh eating staph. It's never just a headache...it's a brain tumor. How does this relate to today's Question of the Day? I can' t remember because of my headache.

Oh, now I remember. Two IUIs vs. one......Well, here is the answer.

41. I read on the Internet that two inseminations are better than one. Is this true?

In general, one well-timed IUI is as good as two, and no advantage is obtained by performing a second IUI (providing ovulation was well monitored using blood hormone determinations and follicle ultrasound measurements). However, in patients who are undergoing IUI with less intense monitoring of ovulation, such as urine LH testing, or for those women who chose not to monitor their ovulation at all, two inseminations may be a better option.

Using basal body temperatures as the basis for an IUI’s timing is not recommended, because this method cannot prospectively pinpoint the optimal timing of ovulation for an IUI treatment. The rise in basal body temperature occurs after ovulation, so identifying this temperature increase would not help in scheduling an IUI procedure.
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lundi 14 février 2011

Question 40. How many office visits are required during a typical cycle using fertility drugs and IUI?

Posted on 12:24 by Unknown
TANSTAAFL. This acronym is well known to some. Back in my ill-spent youth I spent a lot of time reading science fiction. One of my favorite authors is Larry Niven (Ringworld, Ringworld Engineers, Children of Ringworld, Fertility Doctors Who Wish They Could Visit Ringworld, etc). He is very fond of acronyms and his protagonists often use these a great deal. TANSTAAFL is an oldie but goodie and means There Ain't No Such Thing As A Free Lunch. In other words, you get what you pay for....In fertility treatment that also can apply. In general, treatments that are more expensive and more invasive cost more than those that are not.

In using fertility drugs and IUI, the number of office visits relates to the goal of therapy and the desire to avoid unwanted complications (Jon and Kate plus 8, OctoMom). So in considering this approach of fertility drugs and IUI we want a couple of follicles but not too many. We also want to catch them before they release the egg so we can time the IUI with an hCG trigger shot. So how many visits does that mean? Or here in DC, how many trips in the HOV lane with an inflatable companion in my passenger seat? Well, that is the Question of the Day from 100 Questions and Answers about Infertility, 2nd Edition....


40. How many office visits are required during a typical cycle using fertility drugs and IUI?


For treatments using Clomid and IUI, only a couple of office visits per month are required. Clomid is usually prescribed at doses of 50-100 mg daily taken on cycle days 5-9. We typically have patients begin monitoring on cycle day 12. At a typical office visit for monitoring, the patient has her blood drawn for hormone analysis, and a pelvic ultrasound is performed to measure the size of the follicles and the thickness of the endometrial lining. The doctor uses this information to determine the optimal timing of the HCG trigger shot and the subsequent IUI. Most patients receive the hCG trigger injection once the follicle size is >20-22 mm mean diameter. This trigger shot will induce ovulation around 36-40 hours later so the IUI is scheduled accordingly or the couple is informed of the best timing for intercourse. Occasionally a patient will demonstrate an LH surge on her own and the timing of the IUI or coitus should take this into account.

For treatment using gonadotropins and IUI, closer monitoring is necessary, perhaps requiring 4 to 6 office visits per treatment cycle. Patients in our practice undergo a baseline sonogram on CD 2-3 to rule out any persistent ovarian cysts from the preceding treatment cycle. If the sonogram is normal, then patients begin the daily injections and usually return to the office after 3-4 days of medication to assess the response to the drugs. Adjustments in the dose of the medications may allow for the optimal treatment response and most patients require 10-12 days of shots before the follicles reach the ideal size. Once again the hCG trigger shot is used to induce ovulation at the appropriate time and the IUI is scheduled accordingly. The actual IUI takes only minutes to perform and is usually painless. We routinely ask our patients to lie on their backs for about 10 to 15 minutes following the IUI procedure. The woman may then return to her normal activities. A pregnancy test is performed usually 14 days following an IUI or 16 days following hCG in couples pursuing timed intercourse.
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