Two is not better than one....at Dominion Fertility!

Two are not better than one.....Two weeks ago I was zipping back to the Arlington office from the Fair Oaks location when suddenly there was a Virginia State Trooper on my tail with lights flashing. Ugh. I pulled over to the side on I-66 and dutifully awaited the officer's arrival. Honestly, I really had no idea what I had done. I was certainly not speeding. I wasn't weaving (heck, I can't even knit....that was from Robin Williams). I was using my hands free wired ear buds (to avoid brain cancer from my iPhone). What on Earth had I done wrong?

The answer came as swift justice. It is illegal to drive in the Commonwealth of Virginia with both ear buds in place. One is OK, two not so much. Seemed logical and yet I honestly never knew that this was actually illegal. Neither did my insurance agent. Neither did my wife or kids or anyone at my office. Go figure. You would think that in this day and age where every item contains instructions that are beyond simplistic that my ear buds would have a big sticker on them that read: "Hey MORON, don't drive with both ear buds in your ears!"

The same is true when it comes to deciding to transfer 1 vs. 2 embryos. 1 is safer and makes more sense. True you can get away with 2 most of the time. Some patients will have twins but most will not. But some patients with twins deliver extremely premature babies that don't survive or who struggle with lifelong health issues. One is better. Just like when driving along I-66 with your ear buds in place!

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Thanks to Those Who Serve - Happy Veteran's Day

I want to offer a heartfelt thanks to the brave men and women who serve or have served in our armed forces. My late father actually managed to serve in both the Navy (pictured here) and the Army. Growing up with extremely limited means in Charlestown, MA the V-12 Program supported my father's aspirations to attend college and medical school. My Dad loved to tell me stories that they were so poor that he had to eat lettuce sandwiches since they were too poor to afford meat to put in the sandwich. However, my Dad later confessed that he actually traded the sandwich meat for chocolate cake or other dessert items once at school....

Following the end of World War 2 (he graduated from Tufts Medical School in '47) Dad wanted to go to Europe to serve but as member of the Navy he was told that he would likely be assigned to Portsmouth Navy Hospital here in the US. Fortunately one of the former residents at the University of Minnesota was head of medical procurement for the armed services so in 1948 he and my Mom drove to Washington DC from Minneapolis to find out where he would end up. Turns out there was a spot in Trieste Italy and so Dad was made Chief of Surgical Services and off they went to Europe. Along the way he was quickly transferred from the Navy to the Army! Service to his country was very important to Dad. His two brothers had served as members of the medical corps assigned to the Big Red One and fought all across North Africa.

Although his military career was not long-lived, my parents had a deep love of country and respect for those who serve. Dad finished his career as a surgeon in the VA medical system. In July, he was laid to rest with full military honors including an honor guard. God bless all of you who serve or have served our great country both in peacetime and in war.

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Vote Early....Vote Often for My Patient.

One of my favorite patients is a finalist in the Ferring Pharmaceutical Heart to Heart contest (https://hearttoheartcontest.com). Although Gena does not name me or Dominion Fertility, I have her permission to share her story and encourage all of you to vote for her by going to the Ferring Website https://hearttoheartcontest.com/.

Gena is an amazing individual. I diagnosed her as having Hypothalamic Amenorrhea and all stimulations were done with Menopur only. Patients with HA sometimes have suboptimal endometrial linings. This was the situation with Gena and we began discussing the use of gestational carrier following the disappointment that she describes in the video.

Ultimately they had a wonderful experience with their gestational carrier who ended up carrying twice for them. 

I am so happy for the entire Marino family. They are wonderful people and hung in there with me through thick and thin. I once asked Gena if she had ever thought about jumping ship and switching clinics. She gave me that look and said "no way Dr. Gordon. You were not going to get rid of us!" Glad she hung in there and hope they win the $15,000 scholarship.

Daily voting is allowed. Polls close this weekend! Vote early. Vote often.

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Improving Implantation: The goal of SEET using PGS

The Holy Grail of IVF is having an IVF pregnancy rate that approaches 100% with a low rate of pregnancy loss...Now, I know that some clinics advertise pregnancy rates of 120% (just kidding....I hope) with a 100% money back guarantee and a free toaster in the color of your choice... All kidding aside, the goal is a laudable one and the Devil is in the details of how to achieve that goal.

Back in July I was in Santa Barbara for the Annual UCLA IVF meeting. This gathering of medical professionals is a truly excellent opportunity to interact with colleagues and learn about what constitutes the "State of the Art...in ART." A lot of programs are using stimulation protocols for IVF that rely upon Lupron (GnRH-agonist) to trigger for egg collection instead of HCG. We have been using this protocol for over a year now but quickly concluded that patients using this protocol may be best served by freezing all embryos and then performing an FET the following cycle. This protocol reduces the risk of OHSS to near zero but the benefit of that risk reduction also results in such a precipitous drop in hormone levels following egg collection that implantation rates also drop significantly. Hence the logic behind freezing all embryos after egg collection. Indeed, this year the theme at the meeting was almost uniformly "Freeze, baby, freeze."

However, the Holy Grail remains elusive. If we perform PGS on the blastocyst stage embryos then the implantation rates can be improved markedly and the miscarriage rate reduced as well. So if the implantation rate at age 38 is typically 12% and we can increase this to 65-70% with PGS.  So we are clearly making some real progress.

But why is the implantation rate not 100%? That is the $64,000 Question.... Data presented at the meeting indicated that performing the biopsy was not the culprit. Other possible explanations are single gene defects that are not currently detected, the embryo transfer procedure and the receptivity of the endometrium (hormonal or possibly immunologic).

So we are aggressively pursuing the concept of Single Euploid Embryo Transfer (SEET) which is a fancy way of describing the transfer of one genetically proven normal embryo.  Although an implantation rate of 65-70% isn't 100%, that may represent the best that we can do....but stay tuned.

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Edward T. Gordon MD, 1923-2013

Edward T. Gordon MD
1923-2013

Edward Theodore Gordon was born on March 4, 1923. He was one of four children of Mr. and Mrs. Samuel Gordon of Charlestown, Massachusetts. Edward was predeceased by his brothers, Nathan and David, and his sister, Celia. Edward graduated from Boston English High School. He attended Tufts College and Tufts University School of Medicine and graduated at the top of his class in 1944 and 1947 respectively. Following a rotating internship at Bellevue Hospital in New York City, Dr. Gordon pursued a residency in General Surgery at the University of Minnesota where he trained under Dr. Owen Wangensteen. In 1949, Dr. Gordon became the Chief of Surgical Services at the 7th Station Army Hospital in Trieste, Italy. Upon his return from Europe, Dr. Gordon completed his surgical training at the Beth Israel Hospital in Boston.

Dr. Gordon practiced at Quincy City Hospital and Milton Hospital for over three decades serving as Chief of Surgery and President of the Medical Staff. A lifelong supporter of Tufts University School of Medicine, he was active in the medical school alumni association founding the M Club dedicated to financial supporting his alma mater. Along with his wife, the late Claire Gordon, they supported several scholarships for deserving medical students.

Dr. Gordon met his wife, Claire Braverman of Quincy, when they were both in high school. They were married during Dr. Gordon's second year at Tufts University School of Medicine. During their nearly 67 years of marriage they lived in New York, Minnesota, and Trieste, Italy before returning to Quincy in 1950. The family ultimately moved to Milton in 1960 where they resided for the duration of their lives together.

Dr. Gordon's lifelong love of medicine influenced the career choices of his three sons, all of whom pursued careers in the medical field (clinical and administrative). He loved classical music and was an avid reader especially enjoying historical and political non-fiction books. He and Mrs. Gordon spent many happy summers at their vacation home in Chatham, Massachusetts where he enjoyed golf, tennis and boating.

Dr. Gordon was predeceased by his wife of nearly 67 years in May 2012. He is survived by his three sons, Dr. Michael Alan Gordon and wife Mary of Sanford, North Carolina, Steven Roger Gordon and wife Sharon of Brattleboro, Vermont, and Dr. John David Gordon and wife Dr. Allison Smith of Bethesda, Maryland. He is lovingly remembered by his nine grandchildren and celebrated the birth of his first great-grandchild last July.

Funeral services were held at Stanetsky Memorial Chapel, 475 Washington Street, Canton, on Friday, August 2 at 2:00pm.

Interment followed at Sharon Memorial Park, Sharon, MA.

In lieu of flowers, charitable contributions in Edward's memory may be made to the Dr. Edward T. and Claire Gordon Family Scholarship Fund, Tufts University School of Medicine, 136 Harrison Avenue, Boston, MA 02111.

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And the winner is....Aauuuuugggghhh.....

Well, since the NHL season just ended 5 minutes ago with a crushing defeat for my hometown Boston Bruins I guess that winter is now officially over.....

So I guess I can still share my recent award from the folks at HealthTap. It is an interesting site and I have tried to provide balanced informative answers to questions all within a 400 character limit...kinda like Twitter but longer.

I am constantly amazed by some of the posts that patients put online. If I were in terrible pain or freaking out because of some other health issue, I doubt that I would rush to my computer and start typing....I would call my doctor.....

However, this behavior is not new as is clearly evident from this scene from one of Western Civilizations finest films....Monty Python and the Holy Grail.

ARTHUR:  There!  Look!
LAUNCELOT:  What does it say?
GALAHAD:  What language is that?
ARTHUR:  Brother Maynard!  You are a scholar.
MAYNARD:  It's Aramaic!
GALAHAD:  Of course!  Joseph of Arimathea!
LAUNCELOT:  'Course!
ARTHUR:  What does it say?
MAYNARD:  It reads, 'Here may be found the last words of Joseph of Arimathea.
    He who is valiant and pure of spirit may find the Holy Grail in the Castle
    of uuggggggh'.
ARTHUR:  What?
MAYNARD: '... the Castle of uuggggggh'.
BEDEVERE:  What is that?
MAYNARD:  He must have died while carving it.
LAUNCELOT:  Oh, come on!
MAYNARD:  Well, that's what it says.
ARTHUR:  Look, if he was dying, he wouldn't bother to carve 'aaggggh'.  He'd
    just say it!
MAYNARD:  Well, that's what's carved in the rock!
GALAHAD:  Perhaps he was dictating.
ARTHUR:  Oh, shut up.  Well, does it say anything else?
MAYNARD:  No.  Just, 'uuggggggh'.
LAUNCELOT:  Aauuggghhh.
ARTHUR:  Aaauggh.
BEDEVERE:  Do you suppose he meant the Camaaaaaargue?
GALAHAD:  Where's that?
BEDEVERE:  France, I think.
LAUNCELOT:  Isn't there a Saint Aauuuves in Cornwall?
ARTHUR:  No, that's Saint Ives.
LAUNCELOT:  Oh, yes.  Saint Iiiives.
KNIGHTS:  Iiiiives.
BEDEVERE:  Oooohoohohooo!
LAUNCELOT:  No, no.  'Aauuuuugh', at the back of the throat.  Aauuugh.
BEDEVERE:  N-- no.  No, no, no, no.  'Oooooooh', in surprise and alarm.
LAUNCELOT:  Oh, you mean sort of a 'aaaah'!
BEDEVERE:  Yes, but I-- aaaaaah!
ARTHUR:  Oooh!
GALAHAD:  My God!
    [dramatic chord]
    [roar]
MAYNARD:  It's the legendary Black Beast of Aaauugh!
    [Black Beast of Aaauugh eats BROTHER MAYNARD]
BEDEVERE:  That's it!  That's it!
ARTHUR:  Run away!
KNIGHTS:  Run away!
    [roar]
    Run away!  Run awaaay!  Run awaaaaay!
    [roar]
    Keep running!
    [boom]
    [roar]
    Shh!  Shh!  Shh!  Shh!  Shh!  Shh!  Shh!  Shh!...
BEDEVERE:  We've lost him.
    [roar]
KNIGHTS:  Aagh!

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Learning to Swim - Natural Cycle IVF and Stimulated Cycle IVF

I love summer. I really do. In fact, I love June most of all because summer has just begun and there seems almost limitless possibilities for fun in the sun....at least there were when I was a kid.

When I was about 6 years old my parents decided to send me off to Day Camp somewhere south of Boston. I am not sure exactly where this camp was located but my Mom assured me in later years that it was an outstanding camp. I don't remember a lot about that camp but I do remember two very specific aspects of being a camper there.....First of all, we ate a lot of hot dogs. I can still remember the smell of those burned cylinders of artificial fillings and how the odor mingled with the smell of all the fresh pine needles at the camp. Secondly, I remember the pool....

Now I was not afraid of water. In fact, I spend hours and hours in my backyard swimming in a little plastic kiddie pool that we bought at Child World. The best thing about the pool was that it was warm and shallow. I loved making a whirlpool by swimming around and around the edge of pool and then rolling over on my back and letting the moving water continue pushing me along. Boy, life was sure easy...

But then I was sent to Day Camp and I found myself way outside of my comfort zone. First of all, the pool was 25 feet deep. Not really but it seemed that way. Secondly, the water was ice cold. How cold was it? Well every morning the cooks broke off chunks of ice from the shallow end to add to the Kool-Aid to keep the drinks cool all day. Finally, the method of choice to encourage us to become comfortable in the pool was to have us hold hands and play "Ring Around the Rosie." Of course, I always ended up holding hands with a kid whose lung capacity allowed him to remain submerged for half the morning. That meant that every game represented a "near-drowning" opportunity. Needless to say, I didn't swim a lot that summer. To my Mother's credit she silently noted every day that my bathing suit was completely dry and never ridiculed me for my pool phobia.

The following summer we rented a house in West Dennis on Cape Cod and an amazing thing happened...I learned how to swim on my own. The gently sloping beach allowed me to gradually overcome my fear of deeper water and by the end of that summer I was a real little fish. Years later I served as the Assistant Waterfront Director at Storer Scout Reservation...a far cry from the scared 6 year old who wouldn't go swimming.

So what does this little vignette have to do with IVF? Well, sometimes you have to wade before you can swim. Natural Cycle IVF offers some patients a much less threatening introduction to ART than stimulated cycle IVF. Although some physicians roll their eyes and basically tell patients to just get over their fears and jump into the deep end of the fertility treatment pool, not everyone is comfortable with that approach. Patients who fail to succeed with NC IVF will often consider stimulated IVF following this less imposing introduction.....sometimes surprising themselves in the process. So when patients come in and tell me that they are not mentally and emotionally ready for stimulated cycle IVF, I remember how I felt sitting on the edge of that pool in 90 degree weather watching those kids dodge icebergs and laughing with joy and am really glad that I can offer them a chance to get their feet wet gradually...

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Improving Implantation: The Endometrial Tickle

Sometimes you learn things about your friends, co-workers and mentors that you really would prefer not to know. Years ago when I was a Stanford Ob Gyn resident we were sitting around the lounge on Labor and Delivery and chatting about my decision to specialize in Reproductive Endocrinology. The discussion turned to the subject of the endometrium and implantation (yup, we were a totally out of control group of docs...just like on Gray's Anatomy..). One of the faculty members volunteered that she had conceived with an "endometrial tickle." I did a double take. What in the world was an "endometrial tickle" and did I seriously want to find out. Clearly we were traveling into the TMI zone here....

But how could I not ask? Well turns out that the endometrial tickle was not as disturbing a concept as I feared. On the day of an LH surge she had popped into the clinic where an RE doc had basically done a mock IUI/cervical check/mock ET with an empty catheter. In mice you can apparently generate a false pregnancy by doing something similar and the thought was that by scratching the endometrium the odds of implantation following a bit of romance would be enhanced even though she was not a rodent. Yikes. Talk about learning a bit too much about friends and faculty.

Fast forward to 2013. Amazingly enough this concept of the endometrial tickle has resurfaced in the form of enhancing implantation in IVF cycles by performing an endometrial biopsy in the cycle prior to an IVF attempt. The mechanism by which doing an endometrial biopsy weeks prior to embryo transfer and with an intervening menstrual cycle is elusive to say the least. We don't know the ideal timing, the mechanism, the duration of the effect or the degree of improvement in implantation. But besides that, we totally believe that it works.... Actually, I really don't know how to interpret the studies that have looked at this issue. So in general, if one of my patients fails to conceive after one or two ETs with good embryos then I usually suggest we consider performing an endometrial biopsy. Anyone who as had an endometrial biopsy knows that I would risk being beaten to death by my patients if I dared to call that procedure an "endometrial tickle" but still makes me wonder if the concept is similar....

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A Face for Radio

 My brother Steve used to tell me that I had a good face for radio....nice. Well, I guess that is what big brothers are for...torturing their younger siblings.

This week both DrD and yours truly were out testing out our radio faces in honor of National Infertility Awareness Week.

First of all, we were both delighted to meet Jack Diamond and spent some time getting to know him. The interview is available on our Fertile Grounds website and does address typical concerns of our patients.

Next I was able to visit the "glass-enclosed nerve center" of WTOP. And believe it or not...there actually is a "glass-enclosed nerve center" at the studio. And they say that the media is not truthful....

I was incredibly impressed by the team at WTOP and was amazed at how they don't miss a beat from spot to spot as they go about their business. Always a pleasure to see true professionals in action! Here is the link to that interview (look for 12:20 pm) or you can also listen on Fertile Grounds.

Hope that you enjoy these spots and apologies as usual for the delay in getting back to the blog....sometimes life interrupts.

Next topic: Implantation: the Endometrial Tickle.

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Improving Implantation: Embryo Transfer

There are few outcomes more frustrating than calling a patient who has failed to conceive in spite of the transfer of top quality embryos. I usually break down the factors into: 1) transfer technique, 2) endometrial receptivity and 3) embryo issues.

Embryo Transfer:
The goal of all transfers is to perform the transfer in an atraumatic fashion and to get out of the room without the patient peeing on you. In 16 years I have yet to have a patient urinate on me during an embryo transfer, but this is not to say that some of them did not fantasize about getting some payback.

We perform all embryo transfers under ultrasound guidance. For 16 years I have performed all embryo transfers to the accompaniment of Sam Cooke's classic ballad "You Send Me."

The reason for this choice is a story for another time but I am reminded of the line that John Candy uttered in the 1984 movie hit "Splash": "Hey, when something works, I stick with it..."

However, I have had some patients who have rarely requested a different soundtrack to their procedure and so I guess that I need to come up with a backup plan. Recently, I was presented with a request to go with the antithesis of Sam Cooke. I sat there and pondered for a moment while I scrolled through my iPhone 4. Another Sam Cooke ballad would be too similar.

I needed something appropriate to reproductive medicine...and with a driving beat and preferably a song from the 70s or 80s....So I chose.... "Love Shack" by the B-52s. Although we argued about the actual lyrics in this MTV favorite, it ultimately seemed like a good choice since the patient did conceive. For the record, I thought that the lyric in question was not "Tin roof....rusted," since I was sure that I had seen an interview with the band stating that the original lyric was total gibberish and made up on the spot without any consideration given to making it fit the song. Perhaps, I am totally confused on this point.

So ultimately the key is to play music that has the embryos best interest at heart. These two songs work for me. If you are not having any luck, then consider asking your RE to play one of these songs at ET...just don't tell him/her it was my idea....

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Seeking but not finding...

Gordon men are known to lose all sense of perspective when it comes to our dogs. I am not sure why this is true. My Dad is so attached to his miniature Schnauzer that he actually called the kennel to check on the dog while he was being boarded a few weeks ago. Chester was unable to take the call as he was too busy playing with the other dogs at the time. Since we are all products of our environment then it should come as little surprise that I became a man on a mission when looking for a comfy dog bed for my two 4 legged friends. I had found a great bed at a Walmart several months ago but only bought one bed at the time. Since that purchase I looked and looked for a similar bed at all the local Walmarts and Lowes and Petsmart and Petco.....No luck. Amazingly enough I found one at a local small pet boutique in Arlington. I was totally psyched! Finally, my search was at an end. I bought that item and then went online to buy another one on Amazon. These beds are washable and that made all the difference to me since I have been known to leave the beds outside in bad weather. I was happy that my search was at an end. I brought home my trophy and placed Indy, my miniature goldendoodle, on the bed. Indy was also very excited. Really excited. So unbelievably excited that she promptly peed on the bed! Great. So now after 5 min it was time to wash the bed. I went on Amazon and to my dismay review after review said something like this: "Great bed. Dog loved it. I washed it once and then the thing totally fell apart"....or "Washed this bed and all the stuffing clumped together and I threw it out." Needless to say, I was not a happy consumer. But as an Eagle Scout I followed the Boy Scout motto and I was prepared. I washed the bed and then dried it with a couple of tennis balls (a trick I learned when drying sleeping bags after rainy campouts). Miracle of miracles the bed came out good as new...which it was since I had used it for only 5 min!

So does this have anything to do with fertility treatment? I guess I would consider the distressing information that I found on the internet prior to washing the dog bed insightful. Clearly these people were posting their experiences with the dog bed in an attempt to be helpful. However, it totally freaked me out that the washable bed was not really washable in a meaningful way. Same is true for patients who post information about clinics and treatments online. I have no doubt that these individuals are accurately describing their own experiences. But one size does not fill all in this case. Make sure that you don't become overwhelmed by the internet "experts." Your RE should be your best source of information. By all means, ask questions. Just remember that not all questions can be answered when it comes to infertility. We know a lot but some of it remains a mystery to all of us.

So here's the post script to my little dog bed search. Last week I was in Giant getting groceries and some dog bones. I look up and there on the top shelf in the pet care aisle are 4 of my sought after dog beds....at a better price than on Amazon. I almost sat down and cried. 

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Working With What You Have

I was actually able to get away this past weekend and made it on the slopes to ski for a day. The weather was spectacular and the snow pretty darn good for the Mid-Atlantic. I am not an aggressive skier which is mainly the result of breaking my collarbone on a ski trip back in college.

That tumble was on the first day on the slopes and apparently my fall was pretty impressive. As I lay on the ground stunned from my fall a well-meaning fellow skier rushed over and said "Man, that was an amazing wipe-out!" "I can't move my arm," was my reply. "That's OK, Dude. It's probably just dislocated. Wanna have me pop it back in?" I declined his offer and skied down to the first aid station. I ended up with an x-ray from a machine that looked like surplus from Dr. Frankenstein's laboratory. I survived the trip from Vermont back to Boston in an 8 seated prop plane and eventually healed up by the time Spring Break rolled around. Not sure how I ended up on that tangent but could be part of the aging process I suppose. In any case, the point I wanted to make has to do with the lovely self-portrait seen here. If you look closely you may notice that I am wearing a fetching pair of turtle shell sunglasses that my wife purchased from Brighton.

To say that this choice of eye-wear was embarrassing to my children would perhaps be an understatement. However, since I had given my sunglasses to one of my kids to protect from the blinding sun on the snow I was forced into sporting the Dame Edna look. Ultimately, the day was a success and the comments that I received on my sunglasses were minimal...at least to my face. But the lesson here is that you work with what you have. In terms of IVF that means not giving up and remaining hopeful in the face of odds that sometimes seem overwhelming.

Time and time again I have seem success with the final embryo that remained in the cryo tank. Over and over patients turn up pregnant when treatments have failed. If you have high FSH, low AMH and diminished ovarian reserve then all we can truly say is that you a one egg a month person. Other than that we really can't know if you have that one good egg left....until you walk in with your baby and then the answer is definitively "YES!"

So if you are a one egg a month person don't despair...there are options. Plus, be happy that your significant other wears more appropriate eye-wear out in public! 

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Wicked Slippery

Another Friday afternoon in the center of the known universe (Washington, DC) and the town is shutting down under threat of snow. Yes, that is correct....threat of snow. No snow has actually fallen from the sky but all local school systems have shut down and all after-school events are cancelled. The only thing missing from today's Snowpocolypse is.....("wait for it")...snow.

The sign in the photo is actually from a state which does get winter weather and miraculously enough continues to function in a near normal fashion in spite of the cold, white stuff.

I have taken it upon myself to catch up on many comments that I failed to respond to since November. For this lack of responsiveness I am very sorry. However, I fully understand the desire of patients to receive prompt and accurate answers to pressing questions. So I have attached the Health Tap widget to this blog. I have been responding to posts on the Health Tap website for a couple of months. Seems like a pretty interesting concept. Doctors respond to patient questions but both are limited in the character counts..kinda like Twitter but with a medical slant. The answers are provided by physicians who have passed some sort of screening process ("Convicted? No, never convicted.") and other physicians can agree or disagree with your answers. An interesting concept by itself.

In any case, please feel free to head over to Health Tap (www.healthtap.com) and don't forget to do your best to support your favorite RE physician...but if he/she is not on Health Tap then feel free to throw a little love my way so my DocScore increases...not that it's a competition or anything. Plus, you can check out all my witty and pithy answers to the questions I have chosen to answer on the site.

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Happy New Year!

Happy New Year to all! Well 2012 is in the can and 2013 is full of promise. In looking back over nearly 6 years of blog posts I notice that I have rarely posted on January 1 so here's hoping that I can keep up the pace so that the 17 individuals who read this blog will not be disappointed with a paucity of posts by yours truly.

It is important to be careful what you wish for....Last week I was on vacation and laying in bed listening as freezing rain lashed the windows. We were on vacation with our expended family and my brother-in-law's sons had rarely had the opportunity to play in the snow. I was so disappointed that they were only getting freezing rain instead of snow. Ice storms they can get in North Carolina but snow would be something different entirely.

Suddenly quiet descended and I looked out the window and saw absolutely nothing....complete whiteout! The snow fell and fell and fell. By the end of the week I was pretty sick of shoveling the fluffy white stuff but the boys had a great time sledding and having snowball fights. I guess the lesson to remember here is: Be careful what you wish for...you may get that wish after all. I am constantly sharing this advice with patients who request twins. Twins can be a lot more overwhelming than shoveling snow 5 times a day...and this comes from a man who doesn't personally have twins!

So let me now put on my Jean Dixon hat and make some predictions for 2013!

Prediction #1: DrG will be starving
DrG will follow the Special K diet for about 4 months. Seriously. I tend to do this every year as a means to overcome the chocolate overload associated with the holidays. For months on end I defy the odds as drug reps tempt me with delicious lunches from Lebanese Traverna and California Tortilla Factory among others. Eventually, I cave and start cheating. But my waistline usually improves a bit.

Prediction #2: Natural Cycle IVF
More patients will continue to pursue Natural Cycle IVF. Given the state of the economy and increased visibility of those patients successful with NC IVF, I predict that this approach will continue to appeal to a wide range of patients.

Prediction #3: Increased Use of PGS
The use of Preimplantation Genetic Screening (PGS) will increase exponentially. For many patients the ability to transfer only genetically normal embryos will represent the most efficient way to achieve an ongoing pregnancy. Given that the cost of PGS is about the same as the cost of a Frozen Embryo Transfer (FET) it will make sound economic sense to screen embryos and thus reduce the rate of implantation failure and pregnancy loss. Remember that PGS will not improve the cumulative pregnancy rate but its use will reduce the number of embryos needed to be transferred in order to establish and ongoing pregnancy.

Prediction #4: Reduced Rate of Twins and Triplets
The increased use of NC IVF and PGS will assist us in maintaining our extremely low rate of IVF twins. Although some twin pregnancies are unavoidable (identical twins from single embryo transfer), the rate of non-identical multiples will continue to drop. Currently, Dominion Fertility has one of the lowest rates of embryos per transfer in the nation and therefore one of the lowest twin rates. Single embryo transfer is better for everyone.

Prediction #5: DrG Will Lose More Hair
Shocking but true. I will continue to be increasingly follicularily challenged. I wont dwell on this sad point but there is always Hair Club for Men....

So there you have them. My 5 predictions for 2013. I would post another 5 but I need to go eat a bowl of Special K...with Red Berries. Happy New Year!

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