Posts

9
Sep

Dr. Kiltz Encourages Diagnostic Laparoscopy and Hysteroscopy for Endometriosis

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In the video below, Dr. Kiltz talks about how useful diagnostic Laparoscopy and Hysteroscopy can be for Endometriosis, especially prior to beginning your next fertility treatment cycle. At CNY Fertility Center, with locations in Syracuse, Albany, and Rochester, we provide comprehensive and affordable fertility solutions to clients worldwide. We offer phone and skype consults to connect to anyone, anywhere. No client is turned away due to age. We provide fertility solutions for the most complicated IVF cases and incorporate treatment for autoimmune challenges that can cause recurrent pregnancy loss. For more information call us toll free at 1-800-539-9870. Please note the webinar mentioned in this video has already taken place.
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13
Oct

Using Laparoscopy to Help Diagnose Unexplained Infertility

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One of the most challenging aspects of infertility care is helping couples understand why they have not yet become pregnant. About 20-30% of couples will have no definitive diagnosis after completing a standard infertility evaluation[r1] . In today’s fast-paced treatment paradigm, some patients prefer to move forward with treatment without further clarification. Although oftentimes appropriate, this strategy should not be applied to every patient/couple. Laparoscopy and hysteroscopy are minimally invasive, out-patient surgeries [r2] that can provide a diagnosis and sometimes even offer improved pregnancy rates if scar tissue or endometriosis is found and treated at the time of surgery.
Women with infertility are about eight times more likely to have endometriosis than women that have been pregnant. Treatment of endometriosis can not only reduce pain but also improve pregnancy rates as well. In fact, a large, randomized meta-analysis[r3] of the available research found that treating endometriosis was associated with about a 60% increase in the chance for a successful pregnancy. Additionally, if there is scar tissue preventing the egg from reaching the fallopian tubes this can also be identified and treated. So consideration of diagnostic surgical procedures can be beneficial. The challenge is in deciding which patients should pursue this option further.
A more recent study [r4] investigated the usefulness of these diagnostic surgical procedures from a financial perspective. They found that laparoscopy was cost-effective in improving pregnancy rates/outcomes based upon many factors including the potential impact of endometriosis. Finally, they also found that undergoing diagnostic surgery was associated with a lower rate of patients “dropping out” of fertility treatment before becoming pregnant. This suggests that having all of the information available prior to treatment is preferred by some couples experiencing infertility. In summary, if you are having trouble conceiving and want more information, minimally invasive surgery may be your best next step.
[r1]Link to http://jama.jamanetwork.com/article.aspx?articleid=197367
[r2]Link to http://www.asrm.org/uploadedFiles/ASRM_Content/Resources/Patient_Resources/Fact_Sheets_and_Info_Booklets/minimally_invasive_surgery.pdf
[r3]Link to http://www.ncbi.nlm.nih.gov/pubmed/12519555
[r4]Link to http://www.fertstert.org/PhoenixWeb/PhoenixServlet/article/S0015-0282(08)01236-3/fulltext

Robert Greene, MD, FACOG
CNY Fertility Center
e-mail me at rgreene@cnyfertility.com
Call our toll-free number at 800.539.9870 or request a consult here.

21
Aug

Endometriosis

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Endometriosis occurs when the inner lining of the uterus grows outside of the uterus. The lining can then attach itself to other areas such including the ovaries or the fallopian tubes. As well causing issues with fertility, this is often a painful condition.
There is no known cause that can be pinpointed for this painful disorder; however, there have been possible theories including:
• Hereditary factors
• Retrograde menstruation (period travels backwards through the fallopian tubes into the pelvis where they attach and grow
• Immune disorders
For many women, endometriosis can interfere with many aspects of their lives. Besides infertility issues, here are just some of the symptoms of endometriosis:
• heavy and/or irregular periods
• painful intercourse
• painful bowel movements
• urinary pain or difficulty
• abdominal pain
• backache
Sometimes if necessary endometriosis can be diagnosed (and treated) using laparoscopy. Laparoscopy is a minimally-invasive surgical procedure. Although there is no known cure for endometriosis, there are several treatment options, such as medications, that can be discussed with your health care practitioner.
Maya abdominal massage and acupuncture may help with blood flow to the reproductive organs and alleviate pain by eliminating toxins in the system. Herbal formulas and dietary changes may also be beneficial when treating the pain associated with endometriosis. Yoga can help to control weight gain and bloating that goes hand in hand with endometriosis. Yoga’s poses can also help to increase blood flow to the reproductive system and help to stretch the muscles in the back.
When endometriosis affects fertility, there are several options that can be discussed with one of the physicians at CNY Fertility Centers in Syracuse, Rochester, or Albany.
Request Consultation or Appointment
If you are a new patient and would like an initial fertility consultation, click here to request a phone or in-office visit, or call us toll free with your questions at 800-539-9870.

19
Jan

Gums and Gremlins: Endometriosis Research Update

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Gums and Gremlins: Endometriosis research update.
This information is provided for couples who are trying to conceive and have an interest in endometriosis research. For further information on this complex disorder see the information on this website and link to www.endometriosisassn.org. The association has a focus on research into dioxins in the environment and the link to this disorder. This article is provided by CNY Fertility Centers in Rochester, NY, Syracuse, NY and Albany, New York.

International findings from endometriosis research were grouped into the February 2009 issue of Fertility and Sterility, the journal of the American Society for Reproductive Medicine.   Perhaps the most innovative came from China. Levels of Gremlin 1, an oddly named chemical antibody, were found to be elevated the blood of women with endometriosis. This is a highly specific test which relates to growth of small blood vessels such as occur in the endometrium. It is hoped that this could develop into a biomarker for the disease which is a common cause of infertility. Currently only laparoscopy is definitive in diagnosing endometriosis. Other biomarkers are being explored but have not proven to be specific. Sha G et al. Elevated levels of gremlin-1 in …patients with endometriosis Fertil Steril 2009; 350-37.

In a study of interest from the University of Michigan, the link between two diseases which involve inflammatory processes were explored. The odds of having gingivitis inflammation of the gums were 57% higher than normal if a woman had endometriosis. Both diseases involve altered immune response. Interestingly preterm labor is among several disorders associated with gingivitis. Further, women with endometriosis and gingivitis have increased incidence of other autoimmune diseases such as asthma, lupus, and multiple sclerosis. The term global immune dissociation has been used. Kavoussi SK et al Periodontal disease and endometriosis Fertil Steril 2009; 91:335-342

A team for Florence Italy explored the reduced immunity which allows endometrial cells to implant in the pelvis in women who have endometriosis. It is normal for cells shed form the endometrium to travel out the tubes and into the pelvis during menses. In 5-20 % of women, there may be an immune defect in the peritoneal cavity which allows those cells to grow. It has been shown that the endometriosis patients have decreased natural killer cells and T cells. A special messenger peptide called CXCL10 has been found to be low in the blood and abdominal cavity in women with endometriosis. Galleri L, et al Low serum … CXCL10… in endometriosis. Fertil Steril 2009;91:331-334

Perhaps the reduced immunity which allows endometriosis to occur also predisposes to gingivitis and other disorders.
Editor, Joe B Massey MD

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

Endometriosis

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Endometriosis is a condition where the endometrial tissues are displaced from inside the uterus to elsewhere in the body, such as on the outside of the uterus, ovaries, fallopian tube, bladder or bowel. During a normal menstrual cycle, the endometrial lining of the uterus builds up with blood and tissue that is ready to receive an embryo. When an embryo does not implant, the lining sheds and is released through the vagina, and a women’s menarche or period occurs. With endometriosis, endometrial tissue continues to act normally, building up and shedding with each menstrual cycle. However, when it is trapped elsewhere in the body, there is no where for the lining to escape to. This can result in inflammation or cysts of endometrial blood and tissue called endometriomas, which may lead to pain, discomfort and infertility for women. Endometriosis can also lead to adhesions, which are scars in the abdomen that cause infertility.
Approximately 30-50% of women who have endometriosis have infertility issues. Some symptoms of endometriosis are painful periods, pain during intercourse, infertility, lower back pain, fatigue and pain during bowel movements at the time of menstruation. Endometriosis may have an immunological component to it, so women may also experience eczema, chemical sensitivities and allergies.
It is uncertain what exactly causes endometriosis, however there are many theories. One theory suggests that renegade endometrial tissue is backed up out of the fallopian tubes into the abdomen, however many women without endometriosis experience this phenomena as well. Another suggests that endometrial tissue is transported from the uterus via blood and lymph to other areas of the body. Researchers also theorize that it is genetic, and that women are predisposed to having endometriosis because their immune system cannot handle properly disposing of these tissues. There is also a theory which suggests that embryonic tissue that a woman retains into her adulthood can turn into endometriosis, or that certain adult tissues are able to change to endometrial tissue, under specific conditions. Women who have had surgery may experience endometriosis, suggesting that surgical transplantation is responsible.
The environment has also been studied as a cause of endometriosis. Exposure to dioxins (from incineration of certain plastics) and pcb’s (pesticide chemicals) is thought to be a possible cause. In a case study where rhesus monkeys were exposed to dioxins, 79% of the colony developed endometriosis. There is concern that the incineration of medical supplies, such as pvc tubing from medical plastics like IV lines, releases dioxins into the environment. These chemicals infiltrate pastures, are ingested by livestock and eventually passed on to humans.
A physician may initially diagnose a patient with endometriosis because of symptoms; however, a true diagnosis cannot be made until a laparoscopy is performed. While under general anesthesia, small incisions are placed in the abdomen and a laparoscope is used to visualize the endometriosis inside the pelvic cavity. The endometriosis is graded on severity. Women who have severe cases benefit more from the laparoscopic removal of endometriosis and endometriomas than women who have light to moderate endometriosis. Some women experience an increase in fertility up to approximately nine months following surgery.
Surgery by laparoscopy is the most thorough means of removing current endometriosis, but does not prevent future symptoms. The use of a hormone regimen, like birth control pills, to reduce the estrogen in the body can help with pain symptoms and the development of future endometriosis, but does not remove current endometriosis. Alternative practices like Traditional Chinese Medicine (TCM), which uses herbs and acupuncture, have been noted as being helpful with the management of symptoms. TCM is offered at CNY Healing Arts (www.cnyhealingarts.com).
If you think you may have endometriosis, there are options to help increase your fertility including surgery and Traditional Chinese Medicine. For more information about endometriosis call us at any one of our three centers. Syracuse 1.800.539.9870, Albany 1.866.375.4589 or Rochester 585.244.1280.