One aspect of fertility treatment that exacerbates the frustration of many couples is the uncertainty. They often don’t have a specific reason for their problem—even after their testing is completed. They also don’t understand the typical challenges that everyone faces on a monthly basis. Without this information, it can be difficult to create realistic expectations. I believe it also makes the most logical and simple recommendations seem very appealing.
Basic Fertility care is often introduced as ovulation induction (OI)—using medication to regulate the menstrual cycle and optimize the timing of the “fertile window.” This procedure is often combined with “sperm wash” where the partner’s specimen is processed to optimize its potential and then placing that into the woman’s uterus—known as intrauterine insemination (IUI). This treatment has been available for decades. There have been few changes in how this is done over the last 10 years.
I reviewed the subject of OI/IUI back in 2015 and those studies are still very relevant. So please check that out as well. More recently, we have had a couple of publications that provide even more data for us to guide patients through these important decisions. Please consider the watching the following video blog for a quick (less than 10 minute) summary ( https://youtu.be/GwmbkIpw3ek ) . In case you can’t access the link, here is a brief summary of findings;
- Ovulation Induction with intercourse wasn’t much better than trying to conceive naturally
- Insemination without ovulation induction had success rates comparable to natural conception
- In considering OI/IUI
- Success rates drop dramatically after three or four attempts
- Having more than two follicles is not recommended due to increased risk of multiple pregnancy
- The timing of the insemination is more flexible than most anticipate
- There is no greater benefit in having more than one insemination per cycle
- For women over 40, success rates were modest and associated with a lower risk of multiple pregnancy—even when three or more follicles were available
I hope that you find this information helpful and empowering as you consider your treatment options and plan your family.
With kindness and optimism
Robert Greene, MD, FACOG
Conceptions Reproductive Associates of Colorado
As we continue to adjust to life during the SARS-CoV-2 outbreak it is important that we adjust our activities. Fertility treatment is ESSENTIAL care for those that need it. Our goal is to continue continue to provide this care for all of those seeking treatment–but it will require their assistance as well. Here in Colorado our use of social distancing has clearly reduced the severity of the outbreak. I’ve summarized in a videoblog the recommendations to keep our patients, our staff and our community safe: https://youtu.be/7sBN7WgC35I .
So please continue to stay safer-at-home when possible and follow established social distancing when out in public place.
With kindness and support,
Robert Greene, MD, FACOG
Conceptions Reproductive Associates of Colorado
As fertility treatment resumes following the pause created by the COVID19 Outbreak, we have experienced marked improvement in air quality. Many are unaware the of the unfortunate effects that pollution has upon fertility. Here on the 50th Anniversary of Earth Day is a great time to update you on how our improved environment can boost your chances of achieving and maintaining a healthy pregnancy: https://youtu.be/Iq93CXlrp4Q .
I hope that you found that information to be encouraging. Let’s see if we can take it a step further and make some better choices as we move forward in to the future.
REFERENCES from this video:
Treatment for fertility patients has been challenging during the COVID19 Outbreak. There is agreement that fertility treatment is essential and not elective. But whether or not it was urgent created some confusion as whether or not treatment should be continued or halted during the early days of the outbreak in the United States.
At this point, it is becoming more apparent that various regions are experiencing this pandemic very differently. Here’s the latest update for patients seeking care at our center in Colorado: https://youtu.be/Ky5lcP-Rzus.
Stay safe, stay well and if you can please stay home.
~Robert Greene, MD, FACOG
There is increasing concern over Corona Virus or COVID19 as this infection spreads. In perspective there are other infectious diseases that people seeking pregnancy should also consider. Here is a link to a videoblog we recently created to try to answer some of these questions and provide some practical advice: https://youtu.be/a6p4uUC8hgk
One of the most common questions that patients focus on is identifying the reason for not becoming pregnant easily. I typically begin a consultation by re-framing the question. Take a listen: https://youtu.be/XhPXGE9Q6ps
In our effort to remain relevant and provide you with current and relevant content–we’re starting a new YouTube Channel called Clinical Conversations. My partner in this project–Lisa White–is a licensed counselor that has actually gone through fertility treatment herself.
Our goal is to help support you by providing you with some short dialogues about topics that you find to be most relevant. Consider signing up or emailing us some suggestions for topics.
If you can’t find us at the link above just search “clinical conversations–fertility chats” on YouTube.
We hope to see you there!
Do you want to know more about my journey in medicine as part of a dual physician couple and my path to motherhood? Would you like to learn about when the “right” time is to have a family? Check out this podcast!Click here
This is an expression that describes when miners would carry birds (canaries) down into the mine tunnels with them. If dangerous gases such as carbon monoxide collected in the mine, the gases would kill the canary before killing the miners, thus providing a warning to exit the tunnels immediately
New research suggests that infertility can be the canary in the coal mine for men .
Men with infertility are at higher risk of prostate cancer. In particular, men who needed IVF technology for male factor were more likely to develop prostate cancer and at an earlier age than men who fathered pregnancies naturally. This finding does not mean that fertility treatments themselves raise men’s prostate cancer risk.
Men with infertility should tell their other doctors that they have infertility. Because infertility may be the canary in the coal mine for other medical conditions, including prostate cancer.
Stress is not a cause of infertility
Infertility is caused by things like a male factor (low sperm count) or female factor (blocked fallopian tubes, endometriosis, low egg number). But stress is not a cause of infertility.
Stress is very common when trying to conceive. As many as 57% of patients have clinical depression or anxiety before they even start fertility treatments. Stress during infertility can also be severe: many couples report higher stress levels with infertility diagnosis than those with a new diagnosis of cancer.
Stress is something we need to consider because it is common in couples with infertility and because it impacts the chances of being successful with treatment. Stress reduction can increase chances of success with treatment and improve pregnancy rates. This is true regardless of stress reduction technique: yoga, meditation, acupuncture, and/or therapy.
I take a pro-active approach and talk about stress with all of my patients. At the new visit, I review how common stress is with infertility and provide resources. I also will try to check in on my patients during fertility treatments and ask “How are you doing with the emotional aspects of your treatment?” At times, I recommend pausing fertility treatments to optimize mental health.
The best way to have a healthy uncomplicated pregnancy is to start with a happy healthy family before conception. You are not alone. Your mental health is worth taking care of and so are you. ❤️