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Archive for the ‘HSG’ tag

Negative Pregnancy Test Again! Now What?!

By David Kreiner MD

November 30th, 2014 at 9:51 am

 

credit: davidcastillodominici/ freedigitlaphotos.net


Women confronted with a negative result from a pregnancy test are always disappointed, sometimes devastated. Many admit to becoming depressed and finding it hard to associate with people and go places where there are pregnant women or babies, making social situations extremely uncomfortable. A negative test is a reminder of all those feelings of emptiness, sadness and grief over the void infertility creates.

We don’t have control over these feelings and emotions. They affect our whole being and, unchecked, will continue until they have caused a complete state of depression. This article can arm you with a strategy to fight the potentially damaging effects that infertility threatens to do to you and your life.

First, upon seeing or hearing that gut-wrenching news, breathe.
Meditation — by controlling and focusing on your breathing — can help you gain control of your emotions and calm your body, slow down your heart rate and let you focus rationally on the issues. It’s best to have your partner or a special someone by your side who can help you to calm down and regain control.

Second, put this trauma into perspective.
It doesn’t always help to hear that someone else is suffering worse — whether it’s earthquake or cancer victims — but knowledge that fertile couples only conceive 20% of the time every month means that you are in good company with plenty of future moms and dads.

Third, seek help from a specialist, a reproductive endocrinologist (RE).
An RE has seven years of post-graduate training with much of it spent helping patients with the same problem you have. An RE will seek to establish a diagnosis and offer you an option of treatments. He will work with you to develop a plan to support your therapy based on your diagnosis, age, years of infertility, motivation, as well your financial and emotional means. If you are already under an RE’s care, the third step becomes developing a plan with your RE or evaluating your current plan.

Understand your odds of success per cycle are important for your treatment regimen. You want to establish why a past cycle may not have worked. It is the RE’s job to offer recommendations either for continuing the present course of therapy — explaining the odds of success, cost and risks — or for alternative more aggressive and successful treatments (again offering his opinion regarding the success, costs and risks of the other therapies).

Therapies may be surgical, such as laparoscopy or hysteroscopy to remove endometriosis, scar tissue, repair fallopian tubes or remove fibroids. They may be medical, such as using ovulation inducing agents like clomid or gonadotropin injections. They may include intrauterine insemination (IUI) with or without medications. They also may include minimal stimulation IVF or full-stimulated IVF. Age, duration of infertility, your diagnosis, ovarian condition, and financial and emotional means play a large role in determining this plan that the RE must make with your input.

There may be further diagnostic tests that may prove value in ascertaining your diagnosis and facilitate your treatment. These include a hysteroscopy or hydrosonogram to evaluate the uterine cavity, as well as the HSG (hysterosalpingogram) to evaluate the patency of the fallopian tubes as well as the uterine cavity.

Complementary therapies offer additional success potential by improving the health and wellness of an individual and, therefore, her fertility as well. These therapies — acupuncture, massage, nutrition, psychological mind and body programs, hypnotherapy –
have been associated with improved pregnancy rates seen when used as an adjunct to assisted reproductive technologies.

A negative pregnancy test can throw you off balance, out of your routine and depress you. Use my plan here to take control and not just improve your mood and life but increase the likelihood that your next test will be a positive one.

* * * * * * * *

What have you done to get through the disappointment?

 

photo credit: http://www.freedigitalphotos.net/images/CouplesPartners_g216-Depressed_Young_Couple_p104407.html

 

 

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Infertility Care: Starting with the Basics

By Steven Brenner MD

October 18th, 2014 at 10:52 am

credit: wpclipart.com

“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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BFN! Negative Pregnancy Test Again! Now What?

By David Kreiner MD

May 16th, 2014 at 11:55 am

 

credit: david castillo/freedigitalphotos.net

Women confronted with a negative result from a pregnancy test are always disappointed, sometimes devastated. Many admit to becoming depressed and finding it hard to associate with people and go places where there are pregnant women or babies, making social situations extremely uncomfortable. A negative test is a reminder of all those feelings of emptiness, sadness and grief over the void infertility creates.

We don’t have control over these feelings and emotions. They affect our whole being and, unchecked, will continue until they have caused a complete state of depression. This article can arm you with a strategy to fight the potentially damaging effects that infertility threatens to do to you and your life.

First, upon seeing or hearing that gut-wrenching news, breathe.
Meditation — by controlling and focusing on your breathing — can help you gain control of your emotions and calm your body, slow down your heart rate and let you focus rationally on the issues. It’s best to have your partner or a special someone by your side that can help you to calm down and regain control.

Second, put this trauma into perspective.
It doesn’t always help to hear that someone else is suffering worse — whether it’s earthquake or cancer victims — but knowledge that fertile couples only conceive 20% of the time every month means that you are in good company with plenty of future moms and dads.

Third, seek help from a specialist, a reproductive endocrinologist (RE).
An RE has seven years of post-graduate training with much of it spent helping patients with the same problem you have. An RE will seek to establish a diagnosis and offer you an option of treatments. He will work with you to develop a plan to support your therapy based on your diagnosis, age, years of infertility, motivation, as well your financial and emotional means. If you are already under an RE’s care, the third step becomes developing a plan with your RE or evaluating your current plan.

Understand your odds of success per cycle are important for your treatment regimen. You want to establish why a past cycle may not have worked. It is the RE’s job to offer recommendations either for continuing the present course of therapy — explaining the odds of success, cost and risks — or for alternative more aggressive and successful treatments (again offering his opinion regarding the success, costs and risks of the other therapies).

Therapies may be surgical, such as laparoscopy or hysteroscopy to remove endometriosis, scar tissue, repair fallopian tubes or remove fibroids. They may be medical, such as using ovulation inducing agents like clomid or gonadotropin injections. They may include intrauterine insemination (IUI) with or without medications. They also may include minimal stimulation IVF or full-stimulated IVF. Age, duration of infertility, your diagnosis, ovarian condition, and financial and emotional means play a large role in determining this plan that the RE must make with your input.

There may be further diagnostic tests that may prove value in ascertaining your diagnosis and facilitate your treatment. These include a hysteroscopy or hydrosonogram to evaluate the uterine cavity, as well as the HSG (hysterosalpingogram) to evaluate the patency of the fallopian tubes as well as the uterine cavity.

Complementary therapies offer additional success potential by improving the health and wellness of an individual and, therefore, her fertility as well. These therapies — acupuncture, massage, nutrition, psychological mind and body programs, hypnotherapy –
have been associated with improved pregnancy rates seen when used as an adjunct to assisted reproductive technologies.

A negative pregnancy test can throw you off balance, out of your routine and depress you. Use my plan here to take control and not just improve your mood and life but increase the likelihood that your next test will be a positive one.

* * * * * * * *

What have you done…or what tips can you add… to get through the disappointment?

Photo credit: http://www.freedigitalphotos.net/images/Gestures_g185-Depressed_Woman_Sitting_On_Floor__p99322.html

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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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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

 

 

 

 

 

 

 

 

 

no comments

Time for Your Fertility Workup!

By Tracey Minella and David Kreiner MD

September 13th, 2011 at 6:41 pm


Well, summer’s over and we’re all settling into the new routine.

Second only to January’s New Year’s resolutions, September has always been a time to reorganize life and  reassess goals.

That means fall cleaning. Garage sales. Preparing for winter. Maybe that pre-holiday diet or renewed gym membership?

Well, fall is also a good time to get your “fertility business” in order. What have you been putting off?

Have you been delaying seeing a reproductive endocrinologist, despite TTC for quite awhile? Or have you had an exam, but put off the follow-up testing?

Dr. Kreiner of East Coast Fertility discusses the fertility workup:

I have received an enormous amount of email from patients over the years asking for information about how they should get started with their infertility workup.  Apparently, they are women, men and couples who have experienced difficulty conceiving and now want some direction about how they should proceed.  Building a family was something they had imagined their entire lives to be a natural progression–from student to career, getting married then having a family–and they’re frustrated that their difficulty conceiving has affected their lives.  For many—some of whom have never experienced a health problem– it prevents them from appreciating or even doing anything else.

See an RE for a Fertility Workup

My response to these emails has been to tell the patients to seek assistance from a reproductive endocrinologist, whose specialty and experience is in helping infertility patients conceive.  A reproductive endocrinologist, who has two to three years of additional specialty fellowship training in infertility after completing an OB/GYN residency.

The RE will conduct a history and physical examination during your initial consultation.  This exam typically includes a pelvic ultrasound of a woman’s ovaries and uterus.  He/she can tell if there are any uterine abnormalities that may affect implantation or pregnancy as well as assess ovarian activity and rule out cases of moderate or severe endometriosis.

Pelvic Inflammatory Disease

If he elicits a history of previous abdominal or pelvic surgery, a physician may suspect that scarring may have developed that typically interferes with fallopian tube transport of the egg to the sperm and the conceptus to the uterus.  An infection that develops after a pregnancy may lead to pelvic adhesions affecting the tubes as well as scarring within the uterine cavity itself which can prevent implantation.  Pelvic inflammatory disease, PID, can lead to tubal disease and may be associated with other sexually transmitted diseases including HPV, Herpes and especially Chlamydia.

Semen Analysis

The semen analysis is the simplest test to perform and will reveal a male factor in 50% of cases.  A post coital test performed midcycle around the time of ovulation when the cervical mucus should be optimal can detect a male factor or cervical factor when few motile sperm are detected within hours of intercourse.

Hysterosalpingogram

A hysterosalpingogram, HSG, is a radiograph x-ray of the uterus and fallopian tubes after radio opaque contrast is injected vaginally through the cervix directly into the uterus.  It can detect uterine abnormalities that can affect implantation and pregnancy as well as tubal patency.  Unfortunately, this exam may be painful and in some patients with PID can result in serious infection.  Some physicians will administer antibiotics prophylactically for this reason.

Hydrosonogram

A hydrosonogram is an ultrasound of the uterine cavity performed after injecting water vaginally through the cervix directly into the uterus.  It can also detect uterine abnormalities and shares some of the risks seen with HSG but to a lesser extent and usually with less associated discomfort.

Hysteroscopy

A hysteroscopy is a surgical procedure in which a telescope is placed vaginally through the cervix directly into the uterus.  The physician can visually inspect the cavity to detect uterine abnormalities.  The risks of pain and infection are also seen with hysteroscopy.

Blood Tests

Blood tests may be run to identify if a patient is ovulating with adequate progesterone stimulation of the uterine lining.  Day 3 E2, FSH and LH levels can give information regarding ovarian activity and ovulatory dysfunction.  AntiMullerian Hormone (AMH) levels correlate with ovarian reserve.   That is the number of eggs remaining in the ovaries.  Hormones that can affect fertility such as thyroid and prolactin are also assessed to ensure that extraneous endocrine problems are not the cause of the infertility.

Laparoscopy

Laparoscopy is a surgical procedure in which a telescope is placed abdominally through the navel thereby allowing a physician to inspect the pelvic organs.  He/she can identify endometriosis, cysts, adhesions, infection, fibroids etc. that may be causing the infertility.  Unfortunately, only about 25% of cases in women who have a laparoscopy performed will conceive because of treatment performed at the time of the laparoscopy.

Workup Results and Treatment

Treatment can be directed at the cause such as surgery to correct adhesions or remove endometriosis, uterine polyps or fibroids.  Treatment can also be independent of the cause but improve fertility nonetheless.   Ovulation induction increases the number of eggs and therefore the likelihood that an egg will fertilize.  Gonadotropin injections stimulate many more eggs to develop in a cycle than clomid fertility pills.  IVF with minimal or full stimulation is the most successful treatment for any cause of infertility.  The decision as to what treatment to undertake will depend on numerous factors including your age, duration of infertility, cause of infertility, cost of treatment and success of treatment as well as your insurance coverage for the treatment and your motivation to conceive and willingness to accept the risks associated with the treatment.   Today, there is a highly successful treatment available for nearly all women.

 * * * * * * ** *

So, what test are you putting off and why?

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