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

21
Aug

What is a Semen Analysis?

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A semen analysis is an important diagnostic tool that can indicate male factor infertility. The male partner collects a semen sample in a sterile cup, either at home or at the medical center. A small volume of the specimen is placed on a Mackler counting chamber, which has a grid with 100 squares. The sperm concentration is determined by counting the number of sperm in ten squares, then multiplying by 1 million. The motility of the specimen is determined by calculating the percentage of the sperm that are moving in the same 10 squares. The progression of the sperm (forward motion) is graded on a scale of 0 (no motility) to 3+ (moving quickly across the grid in a forward direction). The pH, agglutination (attraction between sperm), viscosity (gelatinous texture of the sample), and number of red and white blood cells are recorded. Read more

26
May

Varicoceles

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Forty percent of men who are diagnosed with male factor infertility may have a varicocele. A man’s testicles have veins that support proper circulation of blood back up to the heart. There are valves in the veins that stop blood from flowing backwards. When the valves fail, blood pools in the veins of the testicles, creating a varicocele. These veins may bulge, causing discomfort or a heavy feeling in the scrotum. The veins are similar in appearance to spider veins seen in the legs.
The testicles are located outside of the man’s body because they need to be at a lower temperature for proper sperm production. Varicoceles cause an increase in the temperature of the testicle, which often results in lower sperm concentration and motility, and an increase in abnormal sperm shape. All of these parameters, which are observed in a routine semen analysis, contribute to a man’s infertility.
A varicocele is diagnosed by ultrasound or a Valsalva maneuver, in which the patient stands in a warm room and bears down as if having a bowel movement. As more blood is forced to the testicles, the physician is able to palpate the testicles to locate the bulging vein.
Varicoceles are treated with surgery. A urologist makes a small incision in the abdomen and locates the varicocele. The vein is then closed off, stopping its blood flow. An alternative approach is to inject alcohol or coils into the vein to stop blood flow. Both procedures are out-patient, and have a three to four day recovery period.
Results from varicocele repair vary, however studies report that 33% of men’s semen parameters improved following surgery. Approximately 30-60% of these men were able to naturally conceive within one year of their surgery. Improvements in semen parameters are visible after four months; however, if improvements are not seen within six months, additional fertility treatments may be necessary to attain a pregnancy.
Lifestyle changes also help to improve success rates before and after varicocele surgery. Eliminating smoking, recreational drugs, anabolic steroids, and alcohol improves semen parameters. Exercising and taking vitamins that have antioxidants improve sperm production as well. Lubricants should be avoided when trying to conceive.
For more information about varicoceles, ask your physician at CNY Fertility Center.