Posts

11
Sep

Reproductive Dysfunction

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Hi this is Dr. Rob talking about reproductive dysfunction, infertility, the inability to conceive and recurrent pregnancy loss. All these things affect our ability to conceive and deliver a healthy baby.

A 20% delivery rate per month is normal. After one year it may drop down to the 5-10% per month range and after two years it may drop to 1-5% per month range, but it doesn’t drop to zero! Keeping at it, I’m finding, is the key to all of this and I believe that stress, anxiety and fear are some of the major causes of reproductive dysfunction.

I believe in treating the patient as a whole entity, not just treating their reproductive organs. The mind, body and spirit play a huge role in each person’s day to day wellness and quality of life. Incorporating things like yoga, meditation, acupuncture, and maya abdominal massage are some steps from eastern treatments which work toward healing and normal reproductive function. Certainly it’s also important to look at western medical treatments for things such ovulation failure, pelvic adhesions, endometriosis, tubal factors, uterine factors such as uterine fibroids or intrauterine adhesions and diminished ovarian reserve from age factor infertility. All these can all affect egg function and implantation.

Let us not forget the male and sperm factors. There are two important halves to healthy reproductive function, and sexual dysfunction for many of us, can begin with the very basic inability to come together at the right time. There may be an inability to deposit sperm in the right place. There is also the question that if the sperm is properly placed, is the semen of normal count, motility and function?

In reality it all comes down to function, even though everything looks normal, regular cycles every 28 days, a normal hysterosalpingogram that documents that the fallopian tubes are open and the uterus is normal. A semen analysis that documents that there are at least 20 million sperm with 50% motility and the morphology is fantastic and normal. It’s all about the function of our organs (including the brain!), and the gametes. With unexplained factor (idiopathic) infertility there are unknown components preventing conception. It could be a genetic or chromosomal issue, a immunologic factor or a hormonal issue. We can treat these all with eastern and western treatments. We should start with the mind in all of these. With visualizing exactly what we want, we want – a baby, a family. There is an instinctual natural drive for these things. We do harbor fear, anxiety, worry, regret, guilt and judgment. Through yoga, meditation, acupuncture, massage, herbs, support group, connecting positively with other women and sharing stories, often sharing our pain, we can let it go.

I believe that journaling each and every day, a simple five minute journal entry, is helpful. Just write down how you are feeling. Then continue with working on the positive mantras of the day with meditation, which is really important. It can help. Studies by Ali Domar, of the mind body institute at Boston IVF have shown an increased success for patients who included a mind-body-spirit regimen with fertility treatments. Randine Lewis has shown with eastern treatments, significant improvements in outcomes that often do not require shots or pills or surgeries, both for the male and the female.

The fertility evaluation should start with sharing your story with your practitioner, whether it’s a Reproductive Endocrinologist, an OBGYN, family doctor or a Traditional Chinese practitioner. Share your story, or even if it’s with your partner or friend, share your story. There is guidance, there is assistance there.

Some blood work may be important for both the male and female. Patients may benefit from testing hormone levels, looking at immunologic factors, karyotyping and chromosomal factors. Performing a hysterosalpingogram to look at the fallopian tubes and uterine patency can add to the diagnostic picture. A pelvic ultrasound can be performed to look at the uterus, ovaries, ovarian reserve and fibroids. Additionally a laparoscopy and hysteroscopy could be recommended. These are operative procedures to look into the woman’s pelvic organs and uterine cavity. Through these procedures we are able to look for adhesions which may affect the transport of the egg and sperm. Both hysteroscopy and laparoscopy are out patient procedures, often done in the office.
Endometriosis is an infertility factor which we believe is the implantation of the glands from the endometrial cavity, either coming directly out of the fallopian tube or just spontaneously growing on the reproductive organs, causing inflammation and scar tissue and sometimes diminishing ovarian reserve. Via the laparoscopy, endometriosis and adhesions can be removed and increase a couple’s odds of delivering a baby.

It may be that the cycles are regular, the fallopian tubes are open and the semen analysis is normal. It may be as simple as trying a few timed clomiphene citrate cycles with intrauterine insemination, which will bump your delivery rate from about 1-5% per cycle to 5-10% per cycle. There are some side effects from medications. Clomid has an anti-estrogenic effect and can often cause some emotional upheaval, some depression, anxiety, PMS type symptoms, or premenstrual syndrome.

There are many options available to couples experiencing infertility, both invasive and non-invasive, Eastern and Western, and each offers some benefit to the patient guiding them closer to parenthood. I believe that doing something is always better than doing nothing, especially when trying to create a family. For more information about any of our services you can call CNY Fertility Center and CNY Healing Arts and speak with our highly knowledgeable staff.
Have a spectacular day!
Dr. Rob

25
May

Hydrosalpinx

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What is Hydrosalpinx?

Hydrosalpinx is a condition in which one or both fallopian tubes are blocked with fluid.

How is Hydrosalpinx detected and diagnosed?

A doctor can diagnose hydrosalpinx in a number of ways:

  • Hysterosalpingogram (HSG): a special dye is injected into the uterus and fallopian tubes to be viewed through a fluoroscope (similar to an x-ray machine). If the fluid spills out of the fallopian tubes, they are not blocked. If the fluid remains, then the patient may have hydrosalpinx. HSG is the most common way Hydrosalpinx is clinically diagnosed.
  • An ultrasound: a traditional transvaginal uses sound waves without any saline, die, or contrast to visualize the woman’s reproductive organs. Hydrosalpinx can often be missed by ultrasound alone.
  • Laparoscopy: a surgical procedure where small incisions are made in the abdomen, and a camera is inserted to visualize the reproductive organs. While often detected before a laparoscopy is done, this would allow a  surgeon to see the organs and remove fluid or other issues.

 

What causes Hydrosalpinx?

Hydrosalpinx can be caused by a number of different issues including:

  • endometriosis (which is 8x more likely in women suffering from infertility)
  • previous or current pelvic inflammatory disease
  • ruptured appendicitis
  • abdominal surgeries 
  • sexually transmitted infections (STIs aka STDs)
  • physical trauma to the abdomen
  • developmental abnormalities

When the body suffers injury, infection, or is subject to chronic inflammation, inflammatory immune cells along with fluid are brought into the area as part of an immune response which can result in the closure of the tube.

What are the symptoms of Hydrosalpinx?

Symptoms can vary depending on the individual. Some women do not experience any symptoms.

Some possible symptoms of hydrosalpinx include:

  • abdominal and pelvic pain
  • unusual vaginal discharge
  • infertility

If hydrosalpinx effects both tubes, then sperm and egg would be physically unable to meet and cause pregnancy. Because hydrosalpinx often does not have any physical symptoms, many women discover they have the condition when only when trying to get pregnant and undergoing infertility testing.

How is Hydrosalpinx treated?

Hydrosalpinx is often treated by having surgery to remove the affected tube(s).  Surgery may also be offered to remove scar tissue or other adhesions that could be affecting fertility.

If  Pelvic Inflammatory Disease is known to be the cause, the doctor may first prescribe a course of antibiotics prior to any surgical intervention.

Sclerotherapy is another treatment option where an ultrasound-guided needle is used to draw fluid out of the affected tube before injecting it with a chemical agent designed to prevent the fluid from building back up again.  However, minimal research on sclerotherapy has been carried out so it is difficult to determine its effectiveness and the risk associated with such procedure.

Hydrosalpinx and Fertility Treatment Options:

The most common fertility treatment used for those with hydrosalpinx looking to expand their family is in vitro fertilization (IVF). In Vitro Fertilization removes eggs from the woman’s ovaries, fertilizes them with sperm in a laboratory, and grows them for a few days prior to transferring them back into the woman’s uterus thereby bypassing the woman’s tubes altogether. 

However, some studies indicate hydrosalpinx can decreases conception by about 50% and also increases miscarriage when undergoing IVF.  Therefore, your specialist may recommend that your tubes (with hydrosalpinx) be removed through laparoscopic surgery prior to undergoing IVF. Women who have one hydrosalpinx and one open tube can also benefit from removing the hydrosalpinx and will increase their chances of conceiving on their own or with subsequent fertility treatments.