Several years ago Dish Network ran an entire advertising campaign featuring Boston as a Second Language. It was wicked funny. Trying to learn another language can be challenging….whether that language is Boston or Fertility.
The language of fertility revolves around so many acronyms and medical terms that it can be overwhelming. So overwhelming that I think that it deserves its very own series of Facebook Live video spots to help explain some of the terms that get used by those of us in the fertility world everyday.
Please join me on Fridays at 12:30 PM for your chance to learn Fertility as a Second Language. It should be wicked helpful as you try to navigate the fertility diagnosis and treatment maze!
As many (? most…? all?) of my patients may realize, I grew up in Boston. My parents were lifelong Bostonians and both of them (especially my Mom) did have Boston accents. So where is mine? Dunno… Maybe just like Chris Evans (Captain America) and John Krasinski (Jim from the Office), all it took was moving “fahr awey from Hahvahd Yahd” to lose my accent…But as you can see from the amazingly funny Hyundai commercial that is currently on the air, you can take the boy out of Boston, but you may never really be able to take the Boston out of the boy…
Wicked is not an adjective that I hear very frequently here in Knoxville. Truth be told, I never heard it very often in Washington, DC either! But that is not the case in Boston, as is evident from the Hyundai ad and from the MassPort electronic bulletin board alerting drivers to the fact that the “Roads are wicked slippery!”
Wicked slippery is how I describe the fertility treatment process to some of my patients. You start out with a few months of infertility and then it becomes a few years. Then you see your Ob Gyn and then maybe you do some clomid. Then you end up in the office of the fertility specialist and before you know it you are shooting yourself up with Gonal-F in the bathroom at Longhorn Steakhouse… Once you start down the slippery slope it is hard to know how to stop….Should you do multiple stimulations? Should you fertilize as many eggs as you can? Should you do PGT-A (Preimplantation Genetic Testing) on all the embryos? And more and more until you find yourself at the bottom of that slippery slope looking up and wondering how did I get down here?
In my 23 years of fertility practice I have seen it over and over again. I think that there is a way to put some brakes on the rapid descent down that slope. I believe that IVF is an appropriate treatment option for our patients, but there needs to be consideration given to where the process can lead before ending up where you never wanted to be….especially finding yourself stuck with too many embryos on the one hand and a family that feels complete to you on the other.
The options of Natural Cycle IVF or Mini Stim IVF or Stim IVF with careful consideration of how many eggs to fertilize can all serve to mitigate the headlong plunge down the slippery slope. In particular, I love Natural Cycle IVF. One egg…one embryo…one baby. No fuss. No muss. Here at Southeastern Fertility, our Natural Cycle IVF is up and running. What can I say…I think that it’s wicked smaht!
One of the questions that patients often ask us in the office here at Southeastern Fertility is whether or not to use an HCG trigger shot for the timing of an intrauterine insemination (IUI). So is it better to use a trigger shot than to use an at-home ovulation predictor kit? The answer is (drum roll please): There isn’t one correct answer.
We aim to do an IUI at the optimal time in a treatment cycle. The optimal timing of an IUI is at the time ovulation occurs; therefore, it is important to be able to accurately predict that time frame. Ovulation is triggered by a surge in luteinizing hormone (LH), which is released by the pituitary gland, when the ovarian follicle or follicles become mature. The egg is released from the follicle about 36 hours after the LH surge.
When we plan to use an HCG trigger shot, the patient is monitored via transvaginal ultrasound and hormone blood tests at intervals until the ovarian follicle or follicles are determined to be mature. Once we estimate that the follicle is ready (usually when it measures 18-22 mm in average diameter), an injection of HCG is administered. HCG is very similar to LH and thus the trigger shot serves as the LH surge, and IUI is scheduled accordingly anticipating that the egg(s) will be released about 36-42 hours following the HCG injection.
How does this compare to using an at-home ovulation predictor kit (OPK)? Well, in most patients the LH surge will be detectable in the urine after the surge is noted in a blood test. Usually the egg is released the day following a positive OPK. So, an IUI is ideally performed the morning after a positive OPK. Patients will typically begin testing on cycle day 12 and test every day until the test is positive.
indicates no significant difference in either clinical pregnancy rates or live
birth rates when comparing home monitoring of ovulation with OPKs to ultrasound
monitoring and HCG triggering. Therefore, the choice is patient specific.
If your schedule doesn’t allow the time commitment for multiple ultrasound visits and lab draws, and you are confident in your ability to do in-home monitoring, then OPKs may be the best option for you. However, if you have had difficulty interpreting OPK results in past cycles, or you’re simply afraid that you might miss the positive result, then ultrasound monitoring and HCG trigger shot may reduce your anxiety and uncertainty. Using a trigger shot also takes some of the guesswork out of the timing of an IUI, and may be beneficial if there are potential scheduling conflicts near ovulation (such as you or your spouse leaving town on a business trip).
The bottom line is that there is no right or wrong answer, and you should talk to your doctor about what is going to be most beneficial for you.
It is with mixed feelings that I ended my nearly 20 years at Dominion Fertility a little over 6 months ago. I am so proud of the wonderful staff at Dominion and so thankful to the patients who trusted me to be their fertility specialist. I rejoiced in their successful pregnancies and mourned along with them in the failed treatments.
When I arrived here in Knoxville back in July, it was like coming home without realizing that I had ever been away…The amazing staff at Southeastern Fertility and the wonderful people who make up the National Embryo Donation Center have been so welcoming to me….a Bostonian by birth no less! We have quickly found a wonderful church and have begun making friends.
It is a real pleasure to work alongside Dr. Jeffrey Keenan, and with our combined 50 years of fertility practice, we have had some very interesting discussions about the care and treatment of the infertile couple.
Slowly I am learning how to pronounce the names of local towns without the staff bursting into laughter, and I have been introduced to all sorts of new cuisine, including Petro’s Chili and Chips…
Over the coming days, weeks and months I will be blogging here on the brand new Southeastern Fertility website and covering a wide range of medical questions. This blog will also keep everyone updated on practice events including our Trying 2 Conceive Tuesday (T2-CT)…[It’s not my fault… I’m a Star Wars fan and if we can have R2-D2, C-3PO and BB-8, then why not T2-CT?]. Well, if anyone has a better name for our upcoming in-office information sessions then feel free to email me…