CALL US AT: (877) 838.BABY


Archive for March, 2014

Infertility and TCM (Part 5) Channels and Points: TCM’s Gross Anatomy Equivalent

By David Kreiner MD

March 31st, 2014 at 2:05 pm

 

image courtesy of stuart miles/freedigital photos.net

 

As a new student in Traditional Chinese Medicine (TCM) and acupuncture one of the first and most important classes we must take is called “Channels and Points”. This to a former medical student is the TCM version of Gross Anatomy. Gross anatomy in medical school was my exciting introduction to the human body, essential to the study of medicine.  I owned the classic Gray’s Anatomy text which today is popularized by the TV show of the same name.  The course requires strict memorization of all the bones, nerves, ligaments, vessels and organs in the body.

Likewise, “Channels and Points” requires the memorization of the precise location of 365 points and the corresponding channels of Qi which course throughout the body and can be utilized in the practice of acupuncture.  How these channels and points relate to each other and to the different organs is important as that will also determine their usefulness in different clinical situations.  

It is believed that the location of the channels of Qi and their surface access points was discovered through centuries of observation of the existence of tender spots on the body during the course of disease.  Furthermore, it was observed that symptoms were alleviated when those points were stimulated by massage or heat.  

When a number of points became known, they were linked into groups with common characteristics and effects and hence a pathway for a channel was identified.  Knowledge accumulated over hundreds of generations documented in several ancient texts.  As information regarding the channels and points accumulated, theories evolved and often resulted in modifications of prior beliefs as more experience clarified more accurate placement and function of these channels and points.  

The first document that unequivocally described the channels and points in an organized system of diagnosis and treatment recognizable as acupuncture is The Yellow Emperor’s Inner Classic, dating from about 100 BCE. The information was presented in the form of questions posed by the Emperor, Huang Ti, and replies from his minister, Ch’i-Pai. The source of the text of his answers was likely a compilation of traditions handed down over centuries, presented in terms of the prevailing Taoist philosophy, and is still cited today in support of particular therapeutic techniques. There is evidence that acupuncture utilizing bronze, gold and silver needles was practiced around this time as well as moxibustion.  

A more contemporary view of the concepts of channels in which Qi flowed that was documented through the precise anatomical locations of acupuncture points developed later.  During the Ming Dynasty (1368–1644), The Great Compendium of Acupuncture and Moxibustion was published, which forms the basis of modern acupuncture. It includes descriptions of the full set of 365 points that represent superficial access to the channels through which needles could be inserted to modify the flow of Qi energy.

Unlike the bones, tendons, nerves and vessels of Gross Anatomy, the channels and points utilized in acupuncture do not have corresponding visible or palpable anatomic structures that may be identified in an effort to memorize.  These channels of Qi are not visible structures nor can they be felt through touching or palpation.  So how does the acupuncturist know where the surface access point is to direct his needle?  

The trained acupuncturist utilizes the surface anatomy such as bones, joints and ligaments to locate these acupoints.  The points typically are found between the ligaments, in bony crevices or between bones. Additionally, the body is divided into units of measure based on an individual’s own bone size.  The most basic unit, cun, is defined as the width of the individual patient’s thumb.  Two cun is the distance from second most distal or middle joint of the forefinger to the tip.  Three cun is the width of the forefinger to the pinky measured at the point of the middle joint of the fingers.  The arms are 9 cun from axilla to the transverse crease of the elbow and 12 cun from the elbow crease to the wrist crease.  The number of cun for every portion of the body is delineated so that the location of the acupoints is based on locating according to the distance by cun units from an identifiable spot on the surface anatomy of the patient and usually are found in between ligaments, bones or in the bony crevices which are palpated by the acupuncturist upon needle placement.  

There are also some points that are identifiable based on particular placement of the fingers and hands of either or both the acupuncturist and patient.  For example, if the acupuncturist places his finger on a patient’s styloid process then has the patient internally rotate his/her hand, the point is located where the acupuncturist’s finger ends up.  This point, currently my favorite, is Small Intestine (SI) 6 with the English name of Support for the Aged because it treats symptoms such as blurry vision, lumbar pain, neck pain and other aches and pains that affect individuals as they get older.  

Another critically important point and therefore given the distinction of being a Command Point for the head and nape of the neck is Large Intestine (LI) 7.  It is located when the acupuncturist places his/her index finger on the dorsal side of the patient’s hand and thumb on the ventral side in between the patient’s thumb and forefinger.  The acupuncturist will locate the point where the tip of his forefinger meets a groove in the anterior portion of the patient’s radius bone.  

How deep to place the needle and in what direction and angle are further issues to be learned another day.

* * * * * * * * ** * *** * *

Are you finding this educational journey into TCM fascinating? Do you have any questions for Dr. Kreiner about this or any other TCM topic he has covered so far?

1 comment

Nutrition, BMI, and Infertility

By Tracey Minella

March 28th, 2014 at 5:38 am

 

credit: surachaifreedigitalphotos.net


The practice of eating well while you’re pregnant is pretty common.  Most women know that, in addition to taking prenatal vitamins, eating the right foods during pregnancy can have a positive impact on their baby’s development. Even women who didn’t have stellar eating habits before conceiving often make healthier choices once they learn they are eating for two.

But did you know that proper nutrition and reaching a healthy weight for your height (also known as having a healthy body mass index, or “BMI”) prior to conceiving may help boost your chances of conception, whether naturally or through assisted reproductive technologies like IVF?

According to the American Society for Reproductive Medicine*, a BMI outside the normal range of 19-24 can impact the fertility of men and women. Obesity can contribute to low sperm count and motility in men and can cause irregular ovulation and irregular cycles in women. Underweight women may also experience irregular cycles or stop having periods altogether. In addition, there are several conditions that can impact achieving or maintaining a pregnancy… including PCOS, thyroid disease, gestational diabetes, and preeclampsia… which are often obesity-related.

To help you get to your nutritional peak and optimum fertility BMI, Long Island IVF offers nutrition counseling and safe, effective weight loss planning. If you are overweight, we can help you reach a healthy weight in a quick but safe way through the Take Shape for Life/Medifast program. In addition to medically- supervised weight loss, clients in the program learn lifestyle and behavior changes that support maintaining their weight loss success and improved health. If you are underweight, we offer nutritional counseling and life style change suggestions as well. If interested in either of these programs, please contact Mary Ann Vuolo, RN in the Melville office.

If you’d like to learn how fun eating fertility-friendly foods can be, join Long Island IVF for “Fun in the Fertile Kitchen”, a live cooking demonstration and multi-course dinner event on April 24, 2014, in celebration of National Infertility Awareness Awareness Week. For more details on this exciting, limited seating event, please see our website, our Facebook, or the previous blog post. To RSVP, contact our patient advocate, Bina Benisch at binabenisch@gmail.com

* * * * * *** * **

Do you struggle with maintaining a healthy BMI? What tips have you tried, or foods have you eaten, to improve your BMI or overall nutrition?

 

*https://www.asrm.org/Weight_and_Fertility_factsheet/

 

 

no comments

Long Island IVF Celebrates National Infertility Awareness Week with a Fun Fertile Cooking Event!

By Tracey Minella

March 26th, 2014 at 11:00 am

 

Move over, Emeril! Long Island IVF is “kickin’ it up a notch” for National Infertility Awareness Week this year with an offer you can’t refuse.

If you’ve been trying to conceive without success and could use a fun night out with other women in the same boat, this invitation is for you. And you do not even have to be a Long Island IVF patient to attend.

Be our guest for an evening of fun in the fertility kitchen with chef-lecturer, Patricia Bove at the quaint Long Island Cooking Café and Tea Room, 454 Main Street, Islip, New York, on Thursday, April 24, 2014 at 7:00 pm.

Experience the thrill of a live cooking demonstration while learning how you may improve your chances of conceiving. Savor the intoxicating aromas and treat your taste buds to a gourmet, sit-down, multi-course dinner of fertility-friendly foods. Kick back and let a professional chef entertain and serve you! You’ll walk away from this fabulous feast knowing how to optimize your chances of conceiving and take back some control over your fertility.

Did you know that what you eat…or don’t eat…can affect your fertility? Are you aware that science has proven that both men and women can improve their reproductive health by eating certain foods? Well, Long Island IVF is raising awareness of infertility in a fun and novel way this NIAW with an event designed to entertain as well as educate.

Understandably, an event like this is bound to fill up quickly. Seating is limited and pre-registration is required. Please RSVP immediately to reserve your spot by contacting our patient advocate, Bina Benisch at 516-398-5248 or binabenisch@gmail.com.  Please do not call the Long Island IVF office or Chef Bove directly. Don’t delay, call today.

* * * * * * * * * *

Do you know any… or have some favorite… fertile foods? Will we see YOU at this fun event???

 

 

1 comment

TCM and Fertility: The Importance of Vital Substances and Maintaining Balance

By David Kreiner MD

March 20th, 2014 at 2:07 pm

 

image courtesy of stuart miles/free digital photos.net


Traditional Chinese Medicine (TCM) has presented such a challenge to my Western scientific perspective that I neglected to define the basic principles on which TCM is based. 

 

TCM, and life itself, according to Chinese tradition which developed over the past three thousand years starts with the vital substances, Qi and Essence, in addition to blood and body fluids.  Our human physiological functioning is dependent on these vital substances which the body attempts to maintain in balance between Yin and Yang.  The Qi and Essence, blood and body fluids will interact and perform their essential roles throughout the body dependent on the Zang-Fu and “extraordinary” organs and the states of Yin and Yang while traveling through vessels, channels, and branches that interconnect with each other.

The concept of Qi comes from the Chinese Taoist philosophy that has been described as a “life force” but is actually an aggregate of ideas that we Western thinkers like to separate to better understand.  To our way of thinking it likely is a form of energy, or electric potential that crosses cell membranes as it traverses from one part of the body to another.  Chinese tradition identifies many different forms of Qi each with different functions affecting physiology and life.  The acupuncturist studies the channels through which Qi flows in the body to modify its flow for a particular purpose… whether to eliminate pain or improve an individual’s health, both of which may be impacted by some pathology of Qi level or flow.

Essence (Jing) is considered one of the three treasures of TCM, along with Qi and Shen (spirit).  Jing is stored in the kidneys according to TCM and nourishes and fuels the body.  There is Prenatal Essence which is supposedly inherited much like DNA and cannot be renewed.  It is responsible for an individual’s constitution and congenital illness. Postnatal Essence can be replenished by food, herbs, acupuncture, or exercise such as T’ai Chi.  Total Essence is made up of both Prenatal and Postnatal Essence and is responsible for growth, development, and reproduction.  Effects of aging may be caused by a deficiency or deterioration of one’s Essence.

In Chinese philosophy, the concept of Yin and Yang is used to describe opposite yet complementary forces that are both interdependent and interconnected and give rise to each other.  Yin and Yang interact in a dynamic way.  Whenever one quality reaches its peak, it will naturally transform into the other.  In TCM, good health is directly related to the balance between Yin and Yang qualities within oneself. If Yin and Yang become unbalanced, one of the qualities is considered be either deficient or in excess… which can lead to illness and disease.

The traditional Chinese concept of human organs, known as Zang-Fu and “extraordinary organs”, are not primarily based on anatomical considerations.  They instead are defined as functional entities with a general location in the upper, middle, or lower Jiao separated by the diaphragm and the umbilicus.  The three Jiao (San Jiao) together is considered a functional organ in TCM and… in addition to separating the other organs into three cavities including chest, upper abdomen and lower abdomen… it functions in the transport of Qi and body fluids.  These Zang-Fu and additional “extraordinary” organs are interconnected with each other through channels of Qi in addition to vessels containing blood and body fluids.  As a result, a problem in one organ can affect the functioning of another.

TCM differs from Western Medicine mostly in its holistic approach as compared to our Western reductionist way of scientific thinking.  Disease and illness according to TCM is a result of a disharmony in the functions of Yin and Yang, Qi and its pathways or meridians, the organs (Zang-Fu and “extraordinary”), Essence, and/or the interaction between the individual and his/her environment.  Therapy is based on which disharmony pattern is identified and may include behavioral modifications including diet and exercise, treatments including herbs, acupuncture, and moxibustion, as well as other interventions.

 

* * * * * * * * * * *

What TCM concept explained above is most fascinating to you? Which would you like to learn more about?

 

no comments

The Role of Luck in Infertility

By Tracey Minella

March 17th, 2014 at 11:44 am

 

credit: Gualberto107/freedigitalphotos.net


Shamrocks are the symbol for the luck of the Irish. And a four-leaf clover is the luckiest. But if you’re reading this, chances are you are suffering from infertility. And feeling quite unlucky.

The connection between luck and fertility goes way back. Can you remember a time before you’d give your right arm to get pregnant? I’m talking waaay back when a pregnancy would have been an unwelcome surprise. Maybe, like Rizzo in Grease, you too dodged a bullet. A false alarm. You felt lucky.

Then your situation changed and you were ready to start a family. You stopped birth control and wondered how quickly you’d conceive. What did you figure? Maybe a month or two?  If you were lucky.

But it didn’t happen for you. Your family and friends got pregnant easily though. They were lucky.

This “luck” obsession follows you everywhere. Even into the IVF clinic. So you sit in the waiting room with all the other so-called unlucky ones. And you notice some of the same faces during morning blood work and sonos. You are cycle-mates with these women. You know some of you will succeed and some will not this cycle. Maybe you even silently torture yourself… playing a game in your head trying to figure out the odds. Who looks older or less healthy? Oh, that one with the stroller will obviously succeed. Wait, did that older woman say she’s using donor eggs? (Like I said…it’s torture.) And you wonder …who will be the lucky ones?

In the spirit of the luck of the Irish, I offer you this hope:

Though you may enter the IVF clinic feeling unlucky, every single patient who comes in is in a position for their luck to change. You are taking the steps to change your luck simply by being there.

So remember that as you sit waiting. (And if you have lucky charms with you, hey that couldn’t hurt either.)

Some patients’ luck changes after a simple office procedure, hormonal therapy, or surgery. Others may find luck with IUIs or IVF.  IVF success rates continue to rise due to skilled doctors and better technology, but there will always be some element of luck involved. How else can you explain the picture perfect, highest-graded, double embryo transfer not resulting in a pregnancy or the less promising, lower-graded, single embryo transfer scoring a solid positive beta?

There’s an expression for good luck in infertility circles…it’s called “baby dust”. And people all over the blogosphere wish “baby dust” on those trying to conceive. Since I personally loathe that expression…and everyone deserves alittle luck of the Irish today…I will send out my own Irish fertility blessing to all ye lassies:

May there be a baby in that pot at the end of your rainbow. Well, not instead of the gold—more like nestled on top of it. Lord knows you deserve the gold, too. (Besides, a baby in an empty pot is just creepy.)

Oh, and may the rain stop soon so you can find it.

* * * * * * ** * ** ** * * ** * * *

What lucky charms or lucky traditions do you have or do on your fertility journey?

 

no comments

My Stork Went South for the Winter

By Tracey Minella

March 13th, 2014 at 7:59 pm

 

credit: njaj/freedigitalphotos.net


I don’t know about you, but I am beyond done with this winter.

A normal, dreary winter is enough to send folks… especially those suffering from infertility… into a serious bout of the blues. And these back-to-back blizzards have been just another reason to climb into bed and hide under the covers. And sulk…justifiably.

Spring coaxes us out of hibernation with warmer air and the promise of new beginnings. Longer daylight hours brighten our moods and invite us back to nature through exercise or gardening. And even those who respectfully decline those invitations are generally less down as the weather warms up.

Now that the clocks have been changed and spring is supposedly on the way, it’s a good time to reassess and possibly recommit to your infertility treatment plan. To do some mental “spring cleaning”. To try to grasp hope if it has eluded you lately.

However, if you’re feeling really depressed, it may be more than the “winter blues”. According to the Mayo Clinic, Seasonal Affective Disorder (SAD), is a type of depression that occurs at the same time every year, usually in the fall through winter months.*

If your depression is persistent or is interfering significantly in your daily life, you might consider group or individual counseling. Long Island IVF offers several therapy options, available to both existing patients and those who are not yet patients. For more information, see the Mind-Body section of our website: http://www.longislandivf.com/mind_body.cfm

 So get outside and take a deep breath. Open the windows and let the stale winter blow away. The buds will be returning to the trees soon.

And maybe that stork will be coming over the horizon soon, too.

* * * * * * * **

Do you find the winter months to be more depressing? Can you share any tips for how you handle feeling blue? What works for you?

 

*http://mayocl.in/1eigxod

 

no comments

Acupuncture: What’s the Point?

By David Kreiner MD

March 12th, 2014 at 3:29 am

 

image courtesy of stuartmiles/freedigitalphotos.net

I have previously mentioned the conundrum facing a Western-trained physician embarking on the study of Traditional Chinese Medicine (TCM).  It is part of our nature after a lifetime of scientific training to explain natural phenomena such as health and illness in ways that have been documented with physical evidence. 

The basic physiology on which TCM is constructed has no corresponding physical support that can be seen or measured…a requirement that scientific thinkers rely on to reassure ourselves about the validity and rationale of a proposed theory or treatment.

Instead, it feels to me as I study TCM that I am memorizing random “facts” with corresponding syndromes and treatments.  For now, I must push myself to continue my studies unconcerned that these basics I am committing to memory are not supported by any physical evidence other than the stories of successful therapies.  It is premature for me to pass judgment for as they say, “the proof is in the pudding”. 

In fact, as a practicing reproductive endocrinologist I have seen patients with poor ovarian function or previous failed pregnancies succeed in their child-building endeavors after acupuncture intervention is added as an adjunct to their fertility treatments. 

For this reason, I persevere to learn as much as possible because despite my own admission that TCM is difficult for me to accept as “scientific truths” I believe that it offers potential advantage to my patients as they go through their Western fertility therapies.

* * * * * * * ** * *** * * * * * * * * * * * ** *

How important to you is the science…or measurable physical evidence…behind an infertility therapy? Can you take a leap of faith and hope “the proof is in the pudding”?

2 comments

Acupuncture: What’s the Point?

By David Kreiner MD

March 11th, 2014 at 8:22 pm

 

image courtesy of stuart miles/free digital photos.net

I have previously mentioned the conundrum facing a Western-trained physician embarking on the study of Traditional Chinese Medicine (TCM).  It is part of our nature after a lifetime of scientific training to explain natural phenomena such as health and illness in ways that have been documented with physical evidence. 

The basic physiology on which TCM is constructed has no corresponding physical support that can be seen or measured…a requirement that scientific thinkers rely on to reassure ourselves about the validity and rationale of a proposed theory or treatment.

Instead, it feels to me as I study TCM that I am memorizing random “facts” with corresponding syndromes and treatments.  For now, I must push myself to continue my studies unconcerned that these basics I am committing to memory are not supported by any physical evidence other than the stories of successful therapies.  It is premature for me to pass judgment for as they say, “the proof is in the pudding”. 

In fact, as a practicing reproductive endocrinologist I have seen patients with poor ovarian function or previous failed pregnancies succeed in their child-building endeavors after acupuncture intervention is added as an adjunct to their fertility treatments. 

For this reason, I persevere to learn as much as possible because despite my own admission that TCM is difficult for me to accept as “scientific truths” I believe that it offers potential advantage to my patients as they go through their Western fertility therapies.

* * * * * * * ** * *** * * * * * * * * * * * ** *

How important to you is the science…or measurable physical evidence…behind an infertility therapy? Can you take a leap of faith and hope “the proof is in the pudding”?

no comments

Infertility, Sacrifice, and Deprivation

By Tracey Minella

March 7th, 2014 at 4:27 pm

 

credit: magesticimagery/freedigitalphotos.net

As if not being able to have children when you wanted them… without medical intervention and the expense of it…weren’t bad enough, infertility is fraught with other kinds of sacrifice and deprivation.

So, I had this epiphany while lamenting my barely two day old decision to give up chocolate for Lent. I got to thinking about all the things infertile women and men give up in the quest for parenthood. Things they enjoy that may not be good for their pre-conception health or that of the baby they’re trying to conceive. Things they must give up for months, or even years… certainly much longer than the 40 days of Lent. (Boy, I feel shame now about the chocolate thing.)

These deprivations and sacrifices, well, it’s like adding insult to injury.

I’m not talking about smoking, street drugs, or any of those obviously taboo habits you should check “no” to on the new patient questionnaires. Science has offered up boatloads of undisputed proof of the harm of these practices on unborn children. If having a healthy baby and living long enough to watch it grow up isn’t motivation to quit doing these things, than nothing is. What I’m talking about are the vices many of us indulge in on an occasional basis that make us happy.

Remember couples vacations before the diagnosis? The ones you never enjoyed because you secretly wanted to be at Disney on a two hour line for the Dumbo ride with a frustrated, crying toddler. Here’s what I remember about those exotic island trips:

  • Let’s sit at the poolside bar and sip frozen margaritas all day. No can do. Alcohol.
  • Let’s soak in the hot tub and let the bubbles lift our spirits. Nope. Kills sperm.
  • Let’s whoosh down the giant waterslide at the water park and play like children again. Can you say atomic wedgie? Sorry, but pool water forced into the vagina at speeds of 120 mph is not advisable.
  • Hey Stud, model me that new bathing suit. No can do. Tight, tiny Speedos are hazardous to “the boys”. And so on. And so on…

Then, more deprivation as the costs of fertility treatment forces many patients to forgo vacations altogether. Besides, even if there is money, there’s no time available. All vacation time is saved to be used for fertility treatments.

It is no wonder infertile couples are stressed. On top of not having children yet, they have no fun and no time to really relax and indulge. And the longer this deprivation goes on, the more depressed the couple will get.

So, what’s a couple to do?

When deprivation becomes more than you can stand, consider a quick switch of strategy to moderation. If you’re taking a break from treatment, ask your doctor if you can have a real margarita if a virgin margarita doesn’t do it for you. Strut in that Speedo for just awhile. Maybe even dip into the hot tub if the doc says your man’s got time to “rebuild”. Or lock those ankles and go for the waterslide!

Even if it sometimes seems like the day will never come, the odds are that someday your kid will puke on you after riding that elephant ride (or you will puke on yourself after riding It’s a Small World 18 times). So until then, try to enjoy the couple’s time you have and when deprivation gets to you, consider moderation to get you through. Or talk to a professional counselor from our group who specializes in helping couples suffering from infertility. http://www.longislandivf.com/mind_body.cfm

* * * * * * * * * * *

What is the hardest thing you’ve given up during your journey to parenthood?

Photo credit: majesticimagery/http://www.freedigitalphotos.net/images/agree-terms-alternative.php

no comments

March is Endometriosis Awareness Month

By David Kreiner MD

March 5th, 2014 at 6:35 am

 

credit: wikipedia

 

I don’t have to tell you that endometriosis can be a very painful illness and that it can cause infertility. It is often a reproductive lifelong struggle in which tissue that normally lines the uterus migrates or implants into other parts of the body, most often in the pelvic lining and ovaries. This leads to pain and swelling and often times difficulty conceiving.

If you have endometriosis, you are not alone. Five to ten percent of all women have it. Though many of these women are not infertile, among patients who have infertility, about 30 percent have endometriosis.

Endometriosis can grow like a weed in a garden, irritating the local lining of the pelvic cavity and attaching itself to the ovaries and bowels. Scar tissue often forms where it grows, which can exacerbate the pain and increase the likelihood of infertility. The only way to be sure a woman has endometriosis is to perform a surgical procedure called laparoscopy which allows your physician to look inside the abdominal cavity with a narrow tubular scope. He may be suspicious that you have endometriosis based on your history of very painful menstrual cycles, painful intercourse, etc., or based on your physical examination or ultrasound findings. On an ultrasound, a cyst of endometriosis has a characteristic homogenous appearance showing echoes in the cyst that distinguish it from a normal ovarian follicle. Unlike the corpus luteum (ovulated follicle), its edges are round as opposed to collapsed and irregular in the corpus luteum and the cyst persists after a menses where corpora lutea will resolve each month.

Women with any stage of endometriosis (mild, moderate, or severe) can have severe lower abdominal and pelvic pain – or they might have no pain or symptoms whatsoever. Patients with mild endometriosis will not have a cyst and will have no physical findings on exam or ultrasound. It is thought that infertility caused by mild disease may be chemical in nature perhaps affecting sperm motility, fertilization, embryo development or even implantation perhaps mediated through an autoimmune response.

Moderate and severe endometriosis are, on the other hand, associated with ovarian cysts of endometriosis which contain old blood which turns brown and has the appearance of chocolate. These endometriomata (so called “chocolate cysts”) cause pelvic scarring and distortion of pelvic anatomy. The tubes can become damaged or blocked and the ovaries may become adherent to the uterus, bowel or pelvic side wall. Any of these anatomic distortions can result in infertility. In some cases the tissue including the eggs in the ovaries can be damaged, resulting in diminished ovarian reserve and reduced egg quantity and quality.

The treatment for endometriosis associated with infertility needs to be individualized for each woman. Surgery often provides temporary relief and can improve fertility but rarely is successful in permanently eliminating the endometriosis which typically returns one to two years after resection.

There are no easy answers, and treatment decisions depend on factors such as the severity of the disease and its location in the pelvis, the woman’s age, length of infertility, and the presence of pain or other symptoms.

Treatment for Mild Endometriosis

Medical (drug) treatment can suppress endometriosis and relieve the associated pain in many women. Surgical removal of lesions by laparoscopy might also reduce the pain temporarily.
However, several well-controlled studies
 have shown that neither medical nor surgical treatment for mild endometriosis will improve pregnancy rates for infertile women as compared to expectant management (no treatment). For treatment of infertility associated with mild to moderate endometriosis, ovulation induction with intrauterine insemination (IUI) has a reasonable chance to result in pregnancy if no other infertility factors are present. If this is not effective after about three – six cycles (maximum), then I would recommend proceeding with in vitro fertilization (IVF).

Treatment for Severe Endometriosis

Several studies have shown that medical treatment for severe endometriosis does not improve pregnancy rates for infertile women. Some studies have shown that surgical treatment of severe endometriosis does improve the chances for pregnancy as compared to no treatment. However, the pregnancy rates remain low after surgery, perhaps no better than two percent per month.

Some physicians advocate medical suppression with a GnRH-agonist such as Lupron for up to six months after surgery for severe endometriosis before attempting conception. Although at least one published study found this to improve pregnancy rates as compared to surgery alone, other studies have shown it to be of no benefit. The older a patient is, the more problematic post surgical treatment with Lupron will be as it delays a woman’s attempt to conceive until she is even older and less fertile due to aging Unfortunately, the infertility in women with severe endometriosis is often resistant to treatment with ovarian stimulation plus IUI as the pelvic anatomy is very distorted. These women will often require IVF in order to conceive.

Recommendations

As endometriosis is a progressive destructive disorder that will lead to diminished ovarian reserve if left unchecked, it is vital to undergo a regular fertility screen annually and to consider moving up your plans to start a family before your ovaries become too egg depleted. When ready to conceive, I recommend that you proceed aggressively to the most effective and efficient therapy possible.

Women with endometriosis and infertility are unfortunately in a race to get pregnant before the endometriosis destroys too much ovarian tissue and achieving a pregnancy with their own eggs becomes impossible. However, if you are proactive and do not significantly delay in aggressively proceeding with your family building, then I have every expectation that you will be successful in your efforts to become a mom.

* * * * * * * * * * * *  *

Do you suffer from endometriosis?

 

Photo credit: http://en.wikipedia.org/wiki/File:Endometriosis,_abdominal_wall.jpg

no comments


The Fertility Daily Blog by Long Island IVF
© Copyright 2010-2012