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

Relationships and Infertility

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Bringing a new life into the world may be the ultimate bonding experience for a couple; but if difficulties are faced on the path to parenthood it may begin to divide a couple’s relationship. Kristen Magnacca, author of Love & Infertility: Survival Strategies for Infertility, Marriage and Life, shares with us a few conscious steps partners can take to maintain or restore those loving feelings.
Kristen points out that the shift between making love and making a child is an energetic one. Something which was once spontaneous changes to something that has a purpose and measurable end point. How a couple manages this shift can make all the difference in how they cope as a couple while undergoing infertility treatments.
There are three strategies Kristen recommends for a couple to implement in order to ground themselves and to remember why they want to begin a family during those moments when the stresses of life may feel so overwhelming. These steps are helpful when they are taken proactively, before issues begin to mount. However, they can also help to bring back those loving feelings after the pressures have begun to take a toll on the relationship. The concepts outlined below are centered on self-loving and nurturing the bond between partners throughout the course of treatments or infertility – wherever the path leads.
1. Write your love story. Everyone has one. Sit down and journal about yours individually and then perhaps together. This process helps to reconnect the neural pathways in your brain that initially attracted you to one another, and can be a great way to re-live those exciting first moments and build upon them in the present.
2. Make a honey-do list. A honey-do list is a list of three things that you need from your partner TODAY to feel appreciated, loved and connected to the other person. For example, Kristen shared that during her and her husband’s journey it was important for him to call her three times per day and that was the first request that she wrote on her card. (You can begin by writing your request on 3X5 card and exchanging them daily.)
3. Love on the rocks! What are you putting in your jar?? This strategy can be done physically or metaphorically on paper. Either way the “rocks” are the most important things to you and your relationship. Write your expectations or these intentions on the rocks and put them into a jar. This exercise helps you stay focused on what will keep your relationship strong during this “rocky” time. It will also help to re-activate normal thought processes from before your relationship was introduced to the stress of infertility. The rocks are your solid ground and the building blocks of your relationship. After you put all the important rocks in your jar, fill it with sand. The sand represents everything else that comes into your relationship and lives. Take a look and read out loud the intentions on the rocks when you feel like there is too much “sand” to handle.
Implementing strategies that promote self-love and self-nurture is important for women and couples at this time because it facilitates receiving, maintaining and balancing energy. Taking steps like those above helps to ground you to the real reasons why you and your partner want to be parents. It takes focus off of all the rest of the “stuff’ that you have to deal with and re-focuses your energy on the truly important foundations of your relationship.
Click on the links below to read some excerpts from Kristen’s book, Love & Infertility. Also join Dr. Kiltz and Kristen for a future workshops by clicking here.
Click here for the “Honey Do List” book excerpt
Click here for the “Love on the Rocks” book excerpt