Many women have trouble getting pregnant due to irregular periods. One of the most common reasons for having irregular menstrual cycles is polycystic ovary syndrome (PCOS). The typical symptoms of PCOS are unpredictable periods and evidence of high male hormone levels (such as excess hair growth on the face or body). Two other common features of PCOS are excess body weight and insulin resistance.

 It is because of this insulin resistance that many women with PCOS are prescribed metformin. Metformin (Glucophage) is an insulin-sensitizing medication that is widely used in treating type 2 diabetes. Women with PCOS do not necessarily have type 2 diabetes, (although they have a higher lifetime risk of developing it), but their bodies may respond in a manner similar to someone who does have diabetes. Therefore, metformin has been extensively studied in women with PCOS.

 Women with PCOS are often given fertility medications to help them ovulate. These medications can come in the form of oral pills, such as clomid or letrozole, or in the form of shots, such as gonadotropin injections. Metformin can be used in addition to any of these medications. It is not uncommon for women with PCOS to be on a combination of metformin and ovulation induction medications in order to achieve a pregnancy. Metformin is a category B medication that has been shown to be safe in pregnancy and is usually continued into the first trimester.

 Women with PCOS may need to do in vitro fertilization (IVF) to become pregnant. One of the risks of IVF is ovarian hyperstimulation syndrome (OHSS). PCOS patients are at a higher risk for developing OHSS because they tend to be young with many follicles. Last month, a randomized controlled trial was published in the Fertility and Sterility journal which showed that metformin reduces the risk of OHSS in patients with PCOS undergoing IVF. 120 patients were studied in which 60 women were placed on metformin and 60 women were given placebo pills. The group of women on metformin had a significantly lower rate of OHSS. There was no difference in embryo quality or pregnancy rates between the two groups.

 If you have irregular periods or have been diagnosed with PCOS, consider asking your physician if metformin may be a good medication for you to try.
~ Dr. Deborah Wachs

You have diligently taken your injections, come to multiple ultrasound appointments, put up with numerous side effects from medications, undergone surgery to retrieve your eggs... and then you get the call. The one in which your nurse case manager tells you to have a full bladder for the transfer of your embryos. This may well be the thing that sends a patient's anxiety level into overdrive. You might be thinking "How on earth do I hold my urine long enough to get through this procedure?" Well the best answer to this question is, you may not have to. All patients are different and depending on how full your bladder is when you arrive for your transfer, you will more than likely be letting some of that urine out. There is a happy place in the middle where the patient is feeling like this might just be doable and we can still see the uterus well to help guide the catheter that will be placing your embryos. There are three things that the full bladder helps us with. The urine in bladder provides an acoustic window to conduct the sound so that we may see the endometrial cavity well, helps to straighten the uterus so that the cather passes easily, and lastly helps to push the intestines out of the way which also helps with the view.

This brings to mind another question. You might be wondering "How do I let out a little urine without going all the way?" When you arrive for your transfer the technician will do a quick ultrasound on your abdomen to see how full you are. Once it has been determined that you can let some out, she will give you a number to count to. Usually you will be told to "go" for 5-10 seconds. This is much easier to do if you don't sit down. Most people just pretend that they are in a public restroom and that there are no seat protectors. You will then have another ultrasound to check the view and many times you will be sent to the restroom again to let a little more urine out. It is much easier to empty a little from your bladder than it is to try to fill one that is empty. You can even practice this technique of "letting a little out" before the day of transfer. Remember that we want the best experience for you and will do our very best to help you achieve "the happy medium".

~Amy Simpson, Ultrasound Tech

 

As part of the routine health screening that RSC does for all patients planning pregnancy, we order a fasting cholesterol panel for any patient over 40. We can also run this panel for you if you have a family history of cholesterol or have any risk factors (obesity, Polycystic Ovarian Syndrome) or complicating factors for heart disease (high blood pressure, diabetes.)

The following articles will help give you an overview of cholesterol disease and the steps we often take prior to pregnancy and during pregnancy. They were written by other doctors and nurses but we agree with what they say.

 

Every day at RSC we see patients who choose to use donor sperm to conceive. The reasons are varied. Some are single women about to embark upon the most important journey of their lives, and the one they feel they have no time to delay. Some are married couples and after years of struggling with infertility they have turned to the one choice they feel will allow them to finally be parents, and still allow the wife to carry a baby in her womb. And some are lesbian couples, who are being careful and thoughtful about the genetic traits their child may inherit and how to integrate this donor into their life story for their child.

No matter the circumstances, there are many questions that arise. Should I use a sperm bank, or a friend, or even a family member? What characteristics are important to look for in donor sperm? Do I want my child to be able to know about the donation? Should my child be able to contact the donor at some future point in time?

Many of these questions can be discussed with your physician at RSC. We can also refer our patients to a team of psychologists and social workers who are experts in this arena. Taking time on the front end to do your research and explore your emotions will serve you well in the long run. Our RSC Ethics Committee recently met to review some of the issues regarding anonymous and known sperm donation and made some recommendations to the practice.

These recommendations include encouraging all doctors to discuss the choice of disclosure of genetic origin with patients, and to advocate that patients seek psychological advice before using donor gametes.

There are also many books and websites that present views on choosing donor sperm. New research is surfacing every day that helps patients make better informed decisions.

To learn more, see www.thirdpartyfertility.com or contact us for an appointment!

~ Mary Hinckley, M.D

My patients are a loving couple. M's husband adores her; you can see it in his eyes. Each hurdle that they had to leap, he was always there giving her encouragement. M. had the stamina and inner strength of few people I have ever met. She shed many tears and she endured many disappointments, but she never once complained to me. Every time we had a negative result, I was challenged to find a reason and also a different treatment course. And each time I offered her a new option, a new possibility, and she took it.

For M., that meant major surgery to remove a fibroid tumor. When she first came to see me, I did not think the fibroid posed a problem. It was not near the uterine cavity. Many women with fibroids conceive and have pregnancies. But when she did not conceive after several inseminations, I had to look for further, think differently. M. endured. We tried inseminations again, but still no luck, and still, no other identifiable problems.

So I recommended the next step, which was IVF. This was the standard of care. I was relying on my medical training, following guidelines from others, based on outcomes from many other patients. I relied on a collective wisdom. I relied on mine. My patients relied on me.

M. had a picture-perfect first IVF cycle. I was so excited for her. She conceived but at 8 weeks the fetus stopped growing. That was a very difficult time for them. M. was strong and her husband was the forever cheerleader. Fortunately, they had decided to participate in the ATTAIN program and the financial commitment to try IVF again had already been made. We kept trying. Each time we tried something a little different. And every time, M. and her husband said "yes" let's try again.

Thankfully, it did pay off. And, truthfully, I am not really sure what did the trick. Was it a different protocol? Or just the chance of another cycle?

That Saturday morning I met their beautiful 6-month-old daughter with full cheeks, big brown eyes. Any outsider looking at this family would never know the pain and hard work that went into having this child. I saw M. smile and laugh and kiss her baby. She said she was able to quit her job and be home full time. She said she was in love and her daughter was the most important thing in her life. I felt her joy. Her husband joked, " I am no longer important."

I thanked M. and her husband. These are the moments that I work for. I don't know why it took so long for them to have this child; I don't know what could have been done differently. I don't even feel responsible for this little miracle. I could not have done this without them, without their trust, their faith, and their endurance. What I do know is that sometimes it takes perseverance, immense inner strength and hope. For M., her dream finally came true.
~ Dr. Susan Willman