Chainsaws and Other Stress Relievers

I took this photo the other day on my way to the office and I think it is one of the more inspired decals that I have ever seen on a car's back window. As a fertility doctor I celebrate in the successes of our patients but that also means that I also share in their pain and frustration when it doesn't work out.The holiday season can be tough on our patients. The daily mail brings holiday greetings from friends and family that report the happy news...

Read More

Christmas Lights and Other Frustrations.....

Last night I became inspired to get our Christmas lights hung up before the weather turned cold again when I would be risking frostbite to complete the job. So I got the bags of lights down from their perch in the unfinished part of my basement and began the job of sorting through which strings lit and which ones did not. Just as soon as one strand lit up it seemed that another winked out. Finally, I had enough to start the job and I managed to string...

Read More

Goodbye to Twinkies

No more Twinkies. How is this possible? Yesterdays announcement by Hostess that the company is shutting down its bakeries has me completely stunned. In the movie Zombieland, the character played by Woody Harrelson is obsessed with finding Twinkies in the post-zombie apocalypse ravaged world. Now we have a world without Twinkies and no zombie apocalypse....go figure. I am on a bit of a post-apocalyptic bender at the present time....I am watching The...

Read More

Happy Halloween!

Good riddence to Hurricane Sandy! We are all happy to see the end of you... At Dominion Fertility we appreciate the dedication of our staff who braved falling trees and high water to make it to the office on Tuesday.It is important to have an emergency back-up plan for your IVF lab and this past 6 months have been pretty rough here in the Mid-Atlantic. First we had the crazy July storm (Derecho - which means crazy thunderstorm that no weather forecaster...

Read More

Scare Tactics

My brother Steve loved to scare the daylights out of me when I was a kid. He hid under my bed, in my closet, in the boiler room in our basement, in the hall closet or in the garage just waiting for me to pass by before jumping out and trying to give me a heart attack. Just look at this picture of the two of us in the backyard of my house in Milton. Is there any way that I was not going to end up in therapy after being tormented incessantly? Actually,...

Read More

New Hope for Hyperstim...Curing the OHSS Woes (Part 2: GnRH-antagonist Rescue).

So we have been using the Lupron trigger protocol in more patients and these patients cannot have been on a traditional LTL (long luteal lupron) or MDL (microdose Lupron flare) protocol. That means that the only patient eligible are those who are on a GnRH-antagonist protocol (one that uses Antagon or Centrotide) to eliminate the LH surge. Well, interestingly enough it turns out that adding GnRH-antagonists in the middle of a LTL or MDL flare...

Read More

New Hope for Hyperstim...Curing the OHSS Woes (Part 1: Lupron Trigger).

I have been writing this blog for a couple of years now. Year in and year out the most popular post has been my discussion of OHSS (see the OHSS Woes). Hundreds of comments have been posted with some pretty scary stories of OHSS. Well, there will always be some risk of OHSS in patients who take fertility drugs but some recent advances may markedly reduce the risk. So here are some details about some new ways to manage OHSS that you may want to discuss with your RE....#1. Lupron triggerAll egg collections must be timed so that the egg within the...

Read More

Goodbye Summer...Hello Autumn!

Goodbye Summer…Growing up in New England you get used to summer lasting only a few weeks. Of course, here in DC it seems like summer lasts a lot longer as temperatures can be in the 90s in April…. However, in Boston the weather in Spring may not be very Spring-like as I remember a snowstorm one year in June!The end of summer is always sad to me. In June it seemed like there were an almost infinite number of possibilities for the coming season….then...

Read More

Free Advice is Worth What You Pay for It....

Recently my older brother Steven and I were having a discussion about the Internet and this Blog in particular. He wondered why I spent so much time and effort responding to posts from patients all over the country and the world whom I would never meet face to face. In addition, we discussed the fact that I often referenced Mom and Dad in my posts and shared my grief over her final illness and passing at the end of May.Honestly, the whole blog thing...

Read More

It only takes one...

Although we strive for multiple embryos in stimulated IVF, sometimes we loose track of the concept that it really takes just a single embryo to make a baby. I have a current patient who went through IVF with PGS (preimplantation genetic screening) and had multiple grade AAA blastocysts for embryo biopsy on day 5. Interestingly, only a single embryo of all these normal looking blasts was genetically normal. We transferred that single embryo and now...

Read More

Crazy Twin Stories #2

Here is another one that leaves you scratching your head....RL is a 32 year old fertility patient who had failed to conceive with less invasive therapies and elected to pursue stimulated IVF. At the time of egg collection we anticipated around 12 eggs but only got 4 eggs plus a couple of empty zona (egg shell only with no egg inside). From those 4 eggs we ended up with only a single embryo. However, it was a beautiful blastocyst and we had high hopes...

Read More

Crazy Twin Stories #1

Here at Dominion Fertility we are really doing our best to reduce the number of twin pregnancies. Seriously. No, I really mean it. Recently we were commended by the CDC for our exceptionally high rate of single embryos transfers.Usually we urge patients to pursue elective single embryo transfer (eSET) if it is their first cycle of stimulated IVF and they are < 35 years old and embryo quality is very good to excellent. However, as many patients/couples...

Read More

Thanks from Dr G

I really want to thank all of my patients, friends and associates who have extended their heartfelt condolences on my loss. Your kindness is much appreciated. I apologize to any of my patients who were inconvenienced in my absence and also to those who have been trying to schedule appointments and have been unable to get in as quickly as usual to see me. Please understand that I am doing my best to accommodate everyone's schedule.Thanks again,...

Read More

Claire Braverman Gordon (1923-2012)

My Mom passed away peacefully on Thursday May 31. She lived a full and wonderful life and will be missed by all of us who knew her.http://www.legacy.com/obituaries/bostonglobe/obituary.aspx?n=claire-braverman-gordon&pid=157872029&fhid=5...

Read More

Back to Boston....

Well I am on my way back to Boston to spend the day with my Mom. She is really going downhill fast and I really hope that she is awake enough to know that I am there with her. It is funny to think that back when I was born that a woman over than 35 years old was considered high-risk just because of her age. We are not talking about the risk of genetic issues...simply being pregnant at 35 was considered problematic! Now I consider a 35 year old to be pretty darn young considering my average patient is 38.5 years old.My Mother conceived me when she...

Read More

Having a Back Up Plan

Yesterday my son Seth (see photo of him with his Grandparents before my Mom's recent turn for the worse health-wise) experienced the Mac equivalent of the "blue screen of death." His MacBook Pro started behaving unpredictably and then refused to boot up at all. Earlier I had made an appointment at the Genius Bar but Seth had reassured me that all was well and I didn't need to bring his laptop over to the Clarendon Apple Store (25 min from our home)....

Read More

Question of the Day: Follicle Reduction

So as I was wasting precious time by goofing around on my blog I came across this post on another internet bulletin board. At the risk of getting flamed by posting on a patient board I have elected to reply here in the relative safety of my own blog/Facebook page! So here is the post..... I was diagnosed with PCOS and am prone to overstimulating. Two of my IUI cycles were canceled due to too many follicles. I was googling and found Dr. Gordon's facebook page on follicle reduction. Just cautious whether someone here been through a follicle...

Read More

Returning to Old Haunts

Over Spring Break I found myself back in Houston where I completed my first internship in Obstetrics and Gynecology at University of Texas Health Sciences Center, Houston at Hermann Hospital. As a medical student at Duke I had spent my 4th year doing electives that were not in Ob Gyn because the Chairman of Ob Gyn at Duke had encouraged me to rotate onto other specialties since I would be doing Ob Gyn for 4 full years....."But Dr Hammond," I inquired...

Read More

Question of the Day: Diminished Ovarian Reserve

Yesterday I gave Grand Rounds at Inova Fairfax Hospital in Falls Church, VA. Fairfax is a very large hospital routinely performing over 10,000 deliveries annually. There are over 100 Ob/Gyn physicians on staff and I have the title of Division Director of Reproductive Endocrinology and Infertility. As Division Director, I am responsible for ensuring educational content at the weekly departmental meetings that have an educational purpose. These meetings...

Read More

Looking and Not Seeing

For the past 12 years I have been giving lectures to the students and residents from The George Washington University (and more recently VCU). I usually give my lectures in a room that is located on the campus of Inova Fairfax Hospital and you can usually find me there every week at 7:15 am trying to keep the audience awake, entertained and educated. I usually hook up my MacBook Pro to the LCD projector that I keep in my car. After my lecture last week I noticed an LCD projector that was mounted on the ceiling of the room. Looking around I noted...

Read More

Revisiting the Past

I just returned from Boston where I helped my Dad celebrate his 89th birthday. My Mom is doing amazingly well considering what she has been through this past year in terms of her health.At the party, attended by many cousins that my kids never even knew that I had, my Dad relived his early years growing up in Charlestown, MA and how he went to Tufts and Tufts Medical School. He then was an Intern in Internal Medicine at Bellevue Hospital in NYC....

Read More

Question of the Day: Failed FETs, what to do next?

Question of the Day:Hello Dr,I had egg retrieval in sept 2011 5 blastocyst and 6 third day embryo.I ended having OHSS and transfer was cancelled. I had my FET done with one five day embryo in october 2011 which did not work.I had one more FET done with two embryos from third day. Today is 12th day and I got -ve on HPT.I also gave my blood this morning will have results tomorrow.I am afraid that result may be -ve.At this I do not know what to do for IVF to work.I have followed all the instructions religiously.What would you suggest if I was your...

Read More

Question of the Day: Blocked Tubes and IVF

Question of the Day:My doctor said she will remove my left blocked tube to help IVF without mentioning whether I have a hydrosalpinx. Is it possible that my tube doesn't have this condition? Do they have to remove a blocked tube no matter whether it has a hydrosalpinx? I am frustrated because they don't tell you enough and I cannot ask suitable questions as obviously I don't know enough as a patient.DrG answers:So first of all we need to define "hydrosalpinx." This term literally means a water/fluid filled tube as "hydro" is latin for water and...

Read More

Natural Cycle IVF Success After Essure

This has been a busy month for patients with prior tubal ligations. Although some patients with a prior tubal ligation will opt for a surgery to reverse their tubal ligation, most will pursue IVF. The data seems to favor IVF over tubal reversal if the patient is over age 37. Of course, other factors also come into play when making this decision. The presence of male factor infertility, the ovarian reserve of the patient, the desire for additional...

Read More

DrG on NBC

This morning one of my favorite patients, Kaet Ruffner, joined me on the Midday Show on NBC channel 4 here in Washington, DC. The topic was the comments that Mr. Gingrich had made concerning oversight of IVF and specifically concern about extra embryos. Of course, there are no extra embryos in Natural Cycle IVF ....one egg, one embryo, one baby. So off we went to NBC to talk about NC-IVF.... View more videos at: http://nbcwashington.c...

Read More

Endometriosis and NC IVF

One thing is true in medicine and that is that you never want to be an interesting patient! Seriously. You should aim to have the condition that your doctor sees all the time and knows exactly what to do. As soon as you start getting a lot of "hmmms" and "wow, that is unusual'" then you may feel free to panic a little bit. Not a lot. Just a little. Because being an interesting patient doesn't preclude a happy outcome! It just means that when you are successful then the medical team feels like they deserve a victory lap. So here is a headline for...

Read More

Question 61. I had an allergic reaction to the progesterone in oil shots. Does this mean that I cannot do IVF?

We often have drug reps in the office at lunchtime. As there are only really 4 companies that make pharmaceuticals that are used in fertility we get to know the reps pretty well. This past week we were speaking with a couple of reps about vaginal progesterone in lieu of PIO. The data is very good regarding success with vaginal progesterone but honestly some patients just prefer the shots because the suppositories are so messy.Both Endometrin and Crinone may prove less annoying to patients who want a shot-free 2ww but these products are also more...

Read More

Can NC IVF work following a failed stimulated cycle IVF?

When a stimulated cycle IVF fails it is devastating to say the least....all that money, all those shots, all those morning visits, the bloating, the cramping, the PIO shots....yikes, it's a wonder we can convince anyone to try it again. Thank goodness the husbands don't have to go through all that or our business would fold overnight!So following a failed stimulated IVF it is typical to ask what other options do I have. In cases of poor responders who may have not even made it to retrieval the answer has been "not much." Some of these patients...

Read More

IUI vs IVF...The FASTT Trial

Frequently I am asked about IUI compared to IVF and specifically about NC IVF compared with IUI. Although IUI can be successful, there are clear limitations to an IUI. First of all, unless pregnancy occurs an IUI does little to explain why a couple has failed to conceive.Could the tube have failed to catch an egg(s)?Could the sperm have failed to find an egg(s)?Could the sperm have failed to fertilize an egg(s)?Could the fertilized egg(s) have failed to grow?Could the embryo(s) have failed to make it to the uterus and failed to implant?The answer...

Read More

Here comes 2012!!

Happy New Year! (belated)Good grief, somehow I have failed to post for nearly 6 weeks….How is this possible? Beats me but I am hoping to make up for it in 2012. This past year was full of ups and downs. I am hopeful that 2012 will be a little bit less of a roller coaster ride for the world economy. Last weekend I was camping (yes, in a tent) with the Boy Scouts at the USNA Jambo at Annapolis. It was pretty chilly at night and I may indeed be getting too old to sleep outside in a tent when all standing water freezes solid…Be that as it may, I was...

Read More