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Archive for the ‘blocked fallopian tubes’ tag

Infertility Care: Calm Down and Begin with the Basics

By Steven Brenner MD

January 7th, 2013 at 10:33 pm

credit: marcolm/freedigitalphotos.net

“Thinking the worst” is a very common reaction for individuals experiencing adversity.

This is especially true for people experiencing infertility. Concerns regarding the question of establishing the family someone has dreamed of since they were young is daunting and can leave a person with significant anxiety and doubt regarding her/his future.

In this context it is important to go back to basics regarding fertility and understand that many people suffering from this disorder will be successfully treated with relatively simple techniques and therapies. For the more severe abnormalities, it is comforting to know current available therapies can address these issues with great success.

Establishing a pregnancy without infertility treatment requires a healthy egg, functioning sperm and an anatomic path that allows sperm to ascend the genital tract and an egg to travel into a fallopian tube where fertilization takes place. The anatomic path needs to allow the fertilized egg to travel into the uterine cavity. A receptive uterine lining is then required for the pregnancy to implant and grow. To make things more challenging, sperm and egg have a very small window of time to find each for fertilization to take place.

Many couples have experienced infertility as a result of improperly timed intercourse.  This often results from the couple not being aware of the timing of ovulation and the short duration of egg viability. The “fix” for something like this is very simple, requiring merely an understanding of the basic physiology.  Sexual dysfunction can plague a relationship, but it is often not until fertility is compromised that couples seek treatment. The simple fix for fertility may involve nothing more than inseminations timed to natural ovulation. Much more in depth therapies may be required to overcome the other, additional concerns associated with sexual dysfunction.

Ovulatory dysfunction, while a very complex issue, is often very easily addressed with simple treatments. Weight loss or gain may be all that is needed to establish regular ovulatory cycles. Correction of hormonal abnormalities leading to problems with ovulation can often be treated with medications that do not require the intense monitoring of injectable fertility medications associated with in vitro fertilization procedures.  Sluggish thyroid activity and elevations in a hormone named prolactin are such issues that readily respond to oral medications.

A receptive uterine lining to allow for implantation of an embryo that formed in the fallopian tube is needed to allow a pregnancy to be established in the uterus. Although a scarred endometrium or one that is distorted from fibroids may require surgical repair, other disorders of the lining can be treated with local hormonal supplementation. The endometrium, the uterine lining, may not develop appropriately after ovulation secondary to hormonal abnormalities. This may reflect an abnormality in egg production and the hormones associated with ovulation.

Therapies directed at improving ovulation or directly supporting the lining of the uterus with vaginal application of the hormone progesterone may be all that is needed to correct this problem.

Anatomic problems such as scarring of the fallopian tubes may require surgical correction. However, blocked tubes may be opened by minimally invasive procedures at the time of a hysterosalpingogram (HSG). In such procedures, a tube blocked where it inserts into the uterus is opened with a catheter in a setting that does not require general anesthesia.

Many patients will be successfully treated with simple techniques and procedures that are not associated with the expense and invasiveness of the therapies that most people think they will require.

For each infertile person a plan of evaluation and therapy needs to be developed, beginning with the basics. It does not necessarily lead to those treatments that are more detailed and invasive.

* * * * * * * * * * *

Did you put off an infertility evaluation out of fear of needing expensive, invasive fertility treatments?

Photo credit: http://www.freedigitalphotos.net/images/search.php?search=worried&cat=&page=6&gid_search=&photogid=0

 

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Micro-IVF May Be Your Answer—and You Could Win a Free Cycle!!!

By David Kreiner MD, and Tracey Minella

August 21st, 2012 at 9:22 pm

credit:duron123/ freedigitalphotos.net

What better time than now to have Dr. Kreiner explain what Micro-IVF is all about!

Why? Because there are 5 days left to enter to win a FREE MICRO-IVF CYCLE FROM LIIVF! After you read all about the many benefits of Micro-IVF, I’m sure you’ll be excited enough to want to enter to win our annual contest.

Here’s the link for the contest: http://bit.ly/LHbmQR

Dr. Kreiner of Long Island IVF explains the process and who can benefit from it:

You’ve already crossed the bridge from “We’re going to get pregnant!” to “We need help…” But this other side looks filled with more obstacles, including expensive and risky fertility medications.

How far do you have to go just to have a baby?

Micro-IVF (sometimes called mini-IVF) may be your answer.

The primary point of MicroIVF: fewer fertility drugs, less cost.

Plus you get additional benefits: decreased chances of ovarian hyperstimulation syndrome and of multiple pregnancies.

Additionally, Long Island IVF patients who choose MicroIVF can increase their savings if they also use our Single Embryo Transfer Program — embryo freezing, storage, and future frozen embryo transfers are free.

Why go Micro?

I learned long ago that pregnancies of twins, triplets, and more can bring heartache to what should be a joyous journey for fertility patients. So the LIIVF team has dedicated our practice to the achievement of safe, healthy pregnancies.

IUI or IVF?

Intrauterine insemination (IUI) is often considered the first order of business for many infertility patients.

Sometimes called “artificial insemination,” the usual protocol — oral and injectable fertility medications to induce superovulation (of more than one egg in a cycle), followed by insemination via exam room procedure — is believed to be simpler and, therefore, less costly than IVF.

That’s just not true any longer.

The facts now are that success rates can be far better for IVF than for IUI, depending on the individual’s or couple’s cause of infertility. Many women undergo several IUI’s before achieving conception.

Some infertility causes — pelvic adhesions/scarring, blocked fallopian tubes, endometriosis, and severe male factor issues — will not respond to IUI but are treatable with IVF.

Even patients who would otherwise try IUI to get pregnant will find that choosing Micro-IVF can result in cost savings and greater safety:

Micro-IVF fee (current as of August 2012): $3900

ICSI (if required): $2000

Anesthesia (as requested): $550

IUI with hormone injections: $3500 to $4500

Is Micro-IVF right for you? Each patient’s case is considered carefully and individually.

The following are conditions that might respond best to Micro-IVF:

Young healthy women with PCOS or who otherwise produce many follicles

Women with pelvic adhesions or scarring, blocked fallopian tubes, or endometriosis

Couples with severe male factor infertility

Micro-IVF really is a case of a little treatment going a long way! With it, you can access the world’s most successful assisted reproductive technology at far less cost.

* * * * * * * * * **

So, are you excited or interested in learning if you are a good candidate? Why not enter our contest before it ends this Sunday?

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Infertility Podcast Series: Journey to the Crib: Chapter 8 Hydrosalpinx

By David Kreiner MD

May 10th, 2012 at 2:48 pm

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Eight: Hydrosalpinx. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.eastcoastfertility.com/?p=57

Hydrosalpinx
A hydrosalpinx is a fallopian tube that is blocked at its distal end opposite the entrance to the uterine cavity.  It is filled with inflammatory fluid most likely the end result of a pelvic infection.  This fluid can flow into the uterine cavity thereby creating a hostile environment for a potentially implanting embryo.
Aside from preventing natural conception due to an inability for the fallopian tube to pick up an ovulating egg, the hydrosalpinx may complicate an in vitro fertilization procedure by creating a uterine cavity that is unfavorable for a transferred embryo to implant.   Furthermore, the transferred embryo may be pushed into the fallopian tube by a uterine contraction and be stuck in this diseased tube where it could grow and develop into an ectopic pregnancy.   In normal tubes the embryo is swept back to the uterus by the air like projections found in the lining of healthy tubes.
Fertility surgery to open hydrosalpinges provides a 20% pregnancy rate with a very high risk to result in the development of an ectopic pregnancy.  We therefore recommend instead removal of these tubes or at least ligation where the flow of the inflammatory fluid into the cavity or travel of the embryo out of the cavity into the tube is prevented.
Salpingectomy, removal of the fallopian tube or a tubal ligation is performed by laparoscopy.  Recently, hysteroscopic procedures have been developed to create a blockage at the junction of the tube and the uterine cavity.  This is a much less invasive vaginal procedure.  There is no cutting and may sometimes be performed without anesthesia.  The tubes may take three months to completely scar to create the necessary obstruction prior to proceeding with IVF.   
* * * * * * **  * * * *
Was this helpful in answering your questions about hydrosalpinx and its effects on a woman’s fertility?

Please share your thoughts about this podcast here. And ask any questions.

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Infertility Care: Beginning with the Basics

By Steven Brenner MD

April 16th, 2012 at 12:01 am

 “Don’t Ignore Infertility” is this year’s theme for National Infertility Awareness Week, which runs from April 22-28, 2012. Sometimes people may suspect a fertility problem, but like an ostrich with its head in the sand, they ignore it out of fear.

 If you fit that profile, Long Island IVF’s Dr. Steven Brenner’s post may calm your fears:

 “Thinking the worst” is a very common reaction for individuals experiencing adversity.

 This is especially true for people experiencing infertility. Concerns regarding the question of establishing the family someone has dreamed of since they were young is daunting and can leave a person with significant anxiety and doubt regarding her/his future.

 In this context it is important to go back to basics regarding fertility and understand that many people suffering from this disorder will be successfully treated with relatively simple techniques and therapies. For the more severe abnormalities, it is comforting to know current available therapies can address these issues with great success.

Establishing a pregnancy without infertility treatment requires a healthy egg, functioning sperm and an anatomic path that allows sperm to ascend the genital tract and an egg to travel into a fallopian tube where fertilization takes place. The anatomic path needs to allow the fertilized egg to travel into the uterine cavity. A receptive uterine lining is then required for the pregnancy to implant and grow. To make things more challenging, sperm and egg have a very small window of time to find each for fertilization to take place.

Many couples have experienced infertility as a result of improperly timed intercourse.  This often results from the couple not being aware of the timing of ovulation and the short duration of egg viability. The “fix” for something like this is very simple, requiring merely an understanding of the basic physiology.  Sexual dysfunction can plague a relationship, but it is often not until fertility is compromised that couples seek treatment. The simple fix for fertility may involve nothing more than inseminations timed to natural ovulation. Much more in depth therapies may be required to overcome the other, additional concerns associated with sexual dysfunction.

Ovulatory dysfunction, while a very complex issue, is often very easily addressed with simple treatments. Weight loss or gain may be all that is needed to establish regular ovulatory cycles. Correction of hormonal abnormalities leading to problems with ovulation can often be treated with medications that do not require the intense monitoring of injectable fertility medications associated with in vitro fertilization procedures.  Sluggish thyroid activity and elevations in a hormone named prolactin are such issues that readily respond to oral medications.

A receptive uterine lining to allow for implantation of an embryo that formed in the fallopian tube is needed to allow a pregnancy to be established in the uterus. Although a scarred endometrium or one that is distorted from fibroids may require surgical repair, other disorders of the lining can be treated with local hormonal supplementation. The endometrium, the uterine lining, may not develop appropriately after ovulation secondary to hormonal abnormalities. This may reflect an abnormality in egg production and the hormones associated with ovulation.

Therapies directed at improving ovulation or directly supporting the lining of the uterus with vaginal application of the hormone progesterone may be all that is needed to correct this problem.

Anatomic problems such as scarring of the fallopian tubes may require surgical correction. However, blocked tubes may be opened by minimally invasive procedures at the time of a hysterosalpingogram (HSG). In such procedures, a tube blocked where it inserts into the uterus is opened with a catheter in a setting that does not require general anesthesia.

 Many patients will be successfully treated with simple techniques and procedures that are not associated with the expense and invasiveness of the therapies that most people think they will require.

 For each infertile person a plan of evaluation and therapy needs to be developed, beginning with the basics. It does not necessarily lead to those treatments that are more detailed and invasive.

 * * * * * * * * * * *

Did you put off an infertility evaluation out of fear of needing expensive, invasive fertility treatments?

 

Photo credit: http://www.wpclipart.com/phps.php?q=ostrich

 

 

 

 

 

 

 

 

 

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To Do List: Annual Fertility Screening

By Tracey Minella and David Kreiner MD

December 8th, 2011 at 8:06 pm


As the year winds down and you reflect on the past, and make resolution for the future, it pays to consider an annual fertility screening. Some of you may be well into treatment already, but others may just be starting out with their family-building plans…or may be putting off starting a family or adding to their family. It may be wise to have a baseline or annual fertility screening done, just to help rule out identifiable and underlying fertility problems you may already have and are unaware of. Armed with the knowledge a screening gives you, you can make a more informed decision about how long you may want to wait before beginning or resuming your family building plan.

Dr. Kreiner explains what a fertility screening means:

Fertility screening starts with a blood test to check the levels of FSH (follicle stimulating hormone), estradiol and AMH (antimullerian hormone). The FSH and estradiol must be measured on the second or third day of your period. The granulosa cells of the ovarian follicles produce estradiol and AMH. The fewer the follicles there are in the ovaries the lower the AMH level. It will also mean that less estradiol is produced as well as a protein called inhibin. Both inhibin and estradiol decrease FSH production. The lower the inhibin and estradiol the higher the FSH as is seen in diminished ovarian reserve. The higher the estradiol or inhibin levels are then the lower the FSH. Estradiol may be elevated especially in the presence of an ovarian cyst even with failing ovaries that are only able to produce minimal inhibin. However, the high estradiol reduces the FSH to deceptively normal appearing levels. If not for the cyst generating excess estradiol, the FSH would be high in failing ovaries due to low inhibin production. This is why it is important to get an estradiol level at the same time as the FSH and early in the cycle when it is likely that the estradiol level is low in order to get an accurate reading of FSH.

The next step is a vaginal ultrasound to count the number of antral follicles in both ovaries. Antral follicles are a good indicator of the reserve of eggs remaining in the ovary. In general, fertility specialists like to see at least a total of eight antral follicles for the two ovaries. Between nine and twelve might be considered a borderline antral follicle count.

As you start to screen annually for your fertility, what you and your doctor are looking for is a dramatic shift in values from one year to the next.

What Does the Screen Indicate?

A positive screen showing evidence of potentially diminishing fertility is an alarm that should produce a call to action. When a woman is aware that she may be running out of time to reproduce she can take the family-planning reins and make informed decisions. The goal of fertility screening is to help you and every woman of childbearing years make the choices that can help protect and optimize your fertility.

Although none of these tests is in and of themselves an absolute predictor of your ability to get pregnant, when one or more come back in the abnormal range, it is highly suggestive of ovarian compromise. It deserves further scrutiny. That’s when it makes sense to have a discussion with your gynecologist or fertility specialist. Bear in mind, the “normal” range is quite broad. But when an “abnormal” flare goes off, you want to check it out.

It’s important to remember that fertility is more than your ovaries. If you have risk factors for blocked fallopian tubes such as a history of previous pelvic infection, or if your partner has potentially abnormal sperm, then other tests are in order.

Regardless of the nature or severity of the problems, today, with Assisted Reproductive Technology there is a highly effective treatment available for you.

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

Did you put off a fertility screening… and end up regretting it? If so, what advice do you have for other women who may be doing the same thing?

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