Wicked Slippery

Author: John David Gordon MD

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!

Stepping out in Faith

Author: John David Gordon, MD

Anyone who has been in my office can readily guess that I am a dog person and not a cat person. If you are a cat person, then you have my sympathies…Dogs have families and cats have servants. Making the decision to move to Knoxville was clearly a case of stepping out in faith. I am someone who is loathe to change toothpaste brands and who, much to my wife’s chagrin, always orders the exact same menu items whenever and wherever we go out for Indian food. So the decision to move was not insignificant. But sometimes making a leap is the right call (like moving to Knoxville) and sometimes making a leap can end up with you getting a bit of a surprise…

A few summers ago we adopted a second four-legged friend from a high kill shelter in South Carolina. Lucky was heartworm positive and his life had taken a turn for the worse since he had been abandoned by his former owners. Fortunately, he responded very well to medical treatment and was declared healthy prior to making the journey up to join our family.

Although we think that he may be a Goldendoodle, we really have no idea about his doggie DNA. He has shown absolutely no interest in swimming and after getting a bath to get whatever that black deer musk is off of him he now refuses to go anywhere near a bathroom!

But one thing that he absolutely loves is riding in the car. He sometimes sits in the minivan while it is in the garage in hopes that one of us will decide to take him for a spin. Since a boat is kind of like a car with no roof he quickly decided that tooling around on our boat was pretty awesome.

One summer day we were out on the lake and pulled up to the dock at the market to grab a snack. Lucky was happy to get back on land for a few moments to use the doggie facilities (nearest tree). Suddenly he realized that just 20 yards away there were a bunch of Canadian Geese. However, they were not on land. They were happily gliding around the end of the docks seemingly oblivious to Lucky. As we walked back to the boat he decided to check out the geese from a different vantage point. I walked with him to the end of the dock and we stood for a few moments watching the geese mill around about 10-15 yards away from us.

Then Lucky launched himself into the air and off the end of the dock. I have no idea what he was thinking… He hit the cold water and immediately turned back toward the dock…all hope of catching a goose quickly forgotten. As I helped him clamber up on the dock he seemed a bit embarrassed by the whole affair. However, his happy personality soon returned and he dried out quickly in the heat of the day.  He now clearly regards swimming as a near-death experience.

So what does this shaggy dog tale have to do with infertility? Well, on some level pursuing fertility treatment is a leap of faith. Our patients are making the assumption that there is a good egg, a good sperm and a uterus capable of carrying a pregnancy. We really wish that we had definitive tests to figure out if these assumptions are correct, but we do not.

AMH, FSH/estradiol and antral follicle count will predict responsiveness to fertility medications for stimulated IUI or stimulated IVF cycles. However, these tests will not predict who will conceive either with or without treatment.

Recently I had this discussion with a patient who was over 40 years old but with poor ovarian reserve as evidenced by her AMH, antral follicle count, FSH levels and previous response to fertility medications. I explained that the further use of medications was unlikely to improve her odds of success and that NC IVF probably made the most sense in her situation unless she was interested in Embryo Adoption or traditional adoption. I explained that NC IVF pregnancy rates per embryo transfer depend upon her age (which I cannot change) and are NOT dependent upon ovarian reserve.

Making that leap of faith is difficult. Sometimes you come up short…just like Lucky in his attempt to secure a tasty lunch of Canadian Goose….BUT sometimes the leap is successful. The only way to find out is to take a deep breath and take the plunge.