Dr. Goldstein's Blog
July 7, 2010
We had a very interesting patient that recently went thru embryo adoption and had a beautiful girl. There were two remaining embryos left and she elected to have the transferred several weeks ago and is pregnant. NBC- Channel Five did a story last night on this couple which you can see if you go to the "In the News Section" of the web site. It really is an amazing story.
June 29, 2010
Tubal ligation is a very common form of contraception that makes a lot of sense often when presented with the option after having children. Unfortunately, it is for the most part a permanent form of contraception. I can't tell you how many women I have seen that have a lot of regret about this decision now in their lives. At the time, it makes sense. The surgery involves blocking the egg from the ovary from reaching the uterus. This is done either by cutting the fallopian tube, burning the tube or in some instances using a clip to block or occlude the tube. The use of cautery or burning the tube has the lowest chance of success and it really depends on how much of the tube is damaged.
Tubal reversal is a procedure that is a reasonable option for patients, as long as they understand the success rates associated with the procedure. It may not even be discussed because fewer physicians are trained in this procedure now as compared to ten years ago. The probability of success is based on the type of tubal ligation performed as well as the length of remaining tube following the tubal ligation. It is usually less expensive than in vitro fertilization which can vary between 9 to 13 thousand dollars depending on the center.
The decision to undergo a tubal reversal is based on several factors. For example, IVF requires the use of hormone injections daily for period of 2-3 weeks and if not successful, then you have to do this procedure over again. This assumes that you do not have embryos that are frozen or cryopreserved. Tubal reversal allows you the chance of getting pregnant every month without taking hormone injections. In short, there are a variety of factors that one needs to discuss prior on making a decision about doing either a tubal reversal or IVF. The decision is not an easy one. My suggestion is to have your records with you from your tubal ligation which will help the doctor in discussing realistic options for you regarding tubal reversal or IVF.
June 25, 2010
The hardest part of infertility treatment
Over the years of treating patient, I have found that it is important to understand and appreciate the emotional pain that our patients experience. I have thought about what it must feel like to come into a doctors office and seek advice and treatment for something that we expect ( having a baby) to happen on its own. I am sure it must be very frustrating. That is why when I see a couple for a new patient visit, I review there history, prior treatment, etc and we develop a plan. But I always talk about the physical and emotional aspects of infertility because I know it is important. The medical part of what we do is relatively straightforward, it is the emotional and physical part that is difficult to deal with. It takes the most out of you.
I have always found it very interesting how men and women perceive things differently and how men react differently to infertility issues than women. For example, even in cases when the fertility issues is directly related to the male, the female partner usually assumes the "burden" of the infertility. I have always been amazed by this statistics not because I don't believe it, but it is so insightful ( and quite frankly, embarrassing to me). It is not because husband's don't care, they just don't know how to express their feelings and as a result they say very little. The process of evaluation and treatment does not have to be lonely, and I believe that recognizing and addressing the emotional aspects of infertility is important. Hopefully.... we can make the process a little easier.
June 22, 2010
IVF and Acupuncture
I have attached an article I recently found that talks about the benefits of acupuncture and IVF. I see a lot of patients who ask, " Should I start acupuncture?.
My perspective is that trying to get pregnant and not being able to is stressfull. Looking at the available evidence regarding the role of acupuncture and infertility and specifically IVF, there are some studies that show it is helpful, and others that show no benefit. It certainly cannot hurt in my view and therefore I encourage the use of acupuncture. In my experience, patients have felt like they were less stressed while using acupuncture while undergoing treatment.
June 16, 2010
Father's Day this weekend
As Father's day approaches it is amazing to think about the advances that have been made in infertility treatment of males. There are certainly couples getting pregnant now that would not have been able to conceive prior to the development of ICSI which is used with IVF. Approximately 30 percent of patients that I see in the office have a "male factor" issue. There are specific issues that can affect a man's ability to produce viable sperm, some of which are mechanical such as an undescended testicle or other causes such as using "muscle building supplements" such as steroids. While the use of exogenous steroids is rare, it is not at all uncommon to have a couple come into the office and the male history, while limited is really not remarkable. We then start a basic fertility evaluation including blood work for the female, ultrasound, sometimes a HSG and a semen analysis for the male.
Several days later I get a report which shows very few sperm and I call the wife ( sometimes the husband if I can reach him) and discuss the results. Usually I then go back to the husband and ask, "are you sure you are not taking herbs, etc or anything that may affect sperm development." It seems like at that time, I sometimes get the story that well, I have actually been taking testosterone, etc we find out that this is having an effect on sperm. Nevertheless, I think it is important that men know that today in 2010, we have a lot of tools available to address a low sperm count in males and some, such as ICSI are very effective. We hope to develop a network of men who have been treated in our practice for male factor issues and would be willing to talk to other men about how they found the process of fertility treatment. By educating our patients about treatment options, we are able to help more couples celebrate Father's Day
June 12, 2010
Compensation for Egg Donors?
There has been much discussion about the cost associated with using an egg donor.Our center uses donor agencies that are local as well as from other cities. . I was listening to this interview on ABCNews about egg donation from Dr. Nicole Noyes from NYU and found it very interesting. We find ourselves in an environment where there is more and more regulation and our field, in particular is highly regulated. It is clear in countries where egg donors are not reinbursed, that the number of women willing be be egg donors drops significantly making it not a viable option. Watch the ABC video below for more details.
