The AFA Blog

What’s the difference between a Hysterosalpingogram (HSG) and a Sono-Hysterogram?

by Fred Licciardi M.D.

This just happens to be one of my most frequently asked questions, and it’s a good one. Both are can be very important tests. Some women need only one, some both. In this blog you will see pictures and explanations. I enjoyed putting this blog together because I like taking things that are a little complicated and breaking them down into simple pieces to help make the readers understand every day things that were never made clear to them. Despite this I realize that there are some of you that get very intimidated when shown pictures of anything medically related, so I am sorry if some of this compounds your frustration. Give this one a shot and see how it goes.

Hysterosalpingogram, also known as the hysterogram or HSG. Hystero means uterus, salpingo means tube, so it’s a test to evaluate both the uterus and tubes. It’s a dye test that uses an x ray. As far as the patient is concerned, it starts with a speculum, like a pap smear. The doctor, through various techniques mentioned in previous blogs, squirts some dye into the uterus and it then runs out the tubes. The dye is actually as clear as water, but it’s called dye because it is white on an x ray. The dye then shows the shape of the interior of the uterus and the tubes.

Let’s start with the uterus. This is picture of a HSG x ray.



The uterus is perfect. The tubes are abnormal, but I am starting with this one because the view of the uterus is so ideal. You can see that is triangular in shape with the top being relatively straight across.
The hsg only shows us where the dye is, which is inside the uterus and inside the tubes. It does not tell us anything about the middle or outside of the uterus or tubes. The next picture is the same as above except I outlined the outside of the uterus and the approximate location of the ovaries.




You can see that the overall uterine size is greater than what is shown by the hsg, and how the outer uterus and ovaries are invisible using x rays.







The next picture shows what happens to an HSG when there are fibroids on the middle and outside of the uterus. I drew in some hypothetical fibriods in red. Fibriods like these would be invisible on hsg. As you can see, the shape of the inside of the uterus has not changed. So it is possible to have fibroids, and have a normal looking hsg. Fibriods that are closer to the cavity will make the HSG look abnormal. We will later see how certain fibroids can affect the look of the HSG, but in this case many fibroids did not change the HSG picture.


Now we will look an HSG that shows an abnormal uterus.









This hsg is abnormal. There is a black spot in the center, and this could be a number of things, all of which are abnormal. The center is dark because the dye cannot get to the center of whatever is growing in there. It is most likely a polyp, but it could be a small fibroid or even some scar tissue(less likely). The overall triangular shape of the uterus is good. This shows how an HSG can be used for diagnosing uterine problems such as polyps or fibroids that are growing in the cavity.

This is a good time to move over to salinosonohysterograms (sonohysts for short). Commonly called a saline infusion sonohysterogram (SIS). We will come back to HSGs in a bit. The sonohyst does not use an x-ray or x-ray dye. It instead is performed with a regular old ultrasound machine. Prior to performing the ultrasound, the doctor starts with a speculum and then puts a very little plastic tube inside the uterus and squirts some saline (salt water). The saline goes into the uterus and out the tubes.

Here is a normal uterine cavity on ultraound without the saline, its the regular old ultraound.










The next picture is the same, but I added white lines to show you the outline of the entire uterus.













Here is an ultrasound of a uterine polyp (could also be a fibroid). It’s that olive shape in between the arrows. No saline yet.















Here I put a circle around it to make sure you see what I am talking about.
















And below is a sonohysterogram of a similar polyp. The doctor put a little saline inside the uterine cavity. Saline or any watery fluid looks black on ultrasound. The black surrounds the polyp and makes it much easier to see. The arrows are not important, they are just pointing out the stalk of the polyp.















Here I would like to end on one very important point. Performing this sonohysterogram was not necessary. We can all see that the polyp is very obviously visible in the picture without the water. There is really no reason to do the sonohysterogram. However time and time again, the doctor will say, "it looks like a polpy, lets do a sonohysterogram to be sure." Yes the picture using the sonohysterogram is prettier, but what he is doing is having you undergo one more unnecessary test, that you may have to pay for, and it’s expensive. So if you are confronted with a sonohysterogram, ask your doctor if he is sure if it really needs to be done. Ask if it will give you any more information than you already have. The sonohysterogram is a great test and I use it all of the time, but not if I know the answer before it’s started.

Lupus, infertility and pregnancy

by Corey Whelan

Lupus is a chronic, autoimmune disease, which can damage any part of the body.  While teenagers and men are sometimes diagnosed with lupus, women of child bearing age comprise the largest statistical group affected.  Like all other autoimmune diseases, lupus "tricks" the body into thinking that it needs to defend itself against it's own healthy tissue and organs.  This malfunction of the immune system creates an invasion of auto-antibodies, which attacks the immune system itself.

Common symptoms can include inflammation, joint and muscle pain, sensitivity to light or sun, debilitating fatigue, headaches, mouth and nose ulcers, weight and hair loss, and low grade fever.  Some people will experience a rash that appears in a butterfly shape across the cheeks and the bridge of the nose.  

Lupus is a chronic disease marked by flares - meaning that symptoms can flare up and worsen, and then go into remission, in an unpredictable pattern over the course of many years.  

Most patients diagnosed with lupus will experience normal fertility, however, a common drug often utilized to treat the disease, marketed under the name Cytoxan, can reduce fertility potential in both men and women.  Cytoxan can lower the sperm count and also reduce testicle size in men that have taken the drug for five years or longer.  It is recommended that men freeze their sperm prior to beginning treatment with Cytoxan.  In women, Cytoxan reduces fertility potential by speeding up the rate at which a woman’s egg supply is depleted, thus pushing her into premature ovarian failure, or early menopause.it is recommended that women with lupus only take Cytoxan when vital organs are involved, and/or corticosteroids aren't effective

Around 50% of all women who have lupus will be able to experience a healthy, normal pregnancy.  However, pregnancy can often signal a flare up of symptoms and for women with this disease, every pregnancy should be categorized as high risk.  This means that a high risk obstetrician who is well versed in lupus and its symptoms should be chosen to oversee your pregnancy.  As with most high risk pregnancies, pro active behaviors, including frequent medical check ups and getting adequate rest will be extremely important.

Additional complications of pregnancy may include:

• Miscarriage during the first trimester
• Formation of blood clots during the second trimester that can interfere with the function of the placenta or cause miscarriage, caused by a lupus antibody known as antiphospholipid antibody.   
• Pre-term birth and low birth weight babies
• High blood pressure, or preeclampsia

If you have lupus and are considering pregnancy, all of this may seem daunting.  However, it is important to remember that women with lupus can, and do experience normal pregnancies and deliver healthy babies.  The keys are timing and communication.  If you are ready to get pregnant talk to your doctor, if possible.  Your doctor will recommend against attempting conception during flare up times when your lupus is active.  Discuss your current medication protocol as well as the medications that will be recommended for you during your pregnancy.  Take care of yourself, and have hope for the future.  With careful timing, most women with lupus will be able to become moms both safely, and successfully.

For more information, click on these sources:

http://www.everydayhealth.com/lupus/pregnancy-risks-with-lupus.aspx

http://www.healthcentral.com/encyclopedia/408/118.html

http://www.targetwoman.com/articles/systemic-lupus.html

http://lupus.about.com/od/lupus101/p/WhatIsLupus.htm

http://www.wegenersgranulomatosis.net/Cytoxan_and_Fertility.htm

Reprinted with permission from Examiner.com

Desperate Housewives

by Merry Armentrout

Fall is here (at least in New England).  The leaves are starting to change color, the air is getting crisp and my TiVo is ready to roll.  I have a handful of favorite shows, and last week was full of season premiers for the fall line-up.  Idon't consider myself a TV junkie, but do relish those few hours a week where I'm able to see what kind of trouble my favorite characters (fictional and real) get themselves into and out of.  

I wrote a blog on the TV show Glee last season.  I think the show is wonderful, but I'm actually more impressed with the subjects the show broaches- infertility, adoption, LGBT family building, to name a few.  These are the things The American Fertility Association supports, and the conversations we want to take place in the mainstream- such as a prime time TV show. 

You can also find these conversations on Wisteria Lane.  Desperate Housewives capped off season six with Gaby, played by Eva Longoria, offering to donate her eggs to a gay couple, but at the last minute changes her mind, causing the Lee and Bob to break-up.  Though this television show is fictional, the issues it raises are reality for many people.

The AFA is dedicated to educating and supporting all men and women concerned with family building - including hopeful lesbian, gay, bisexual and transgender (LGBT) parents. One way this is achieved is through third party reproduction.  There are many reproductive options for gay men and lesbian women, including a resource directory to find such services.

I have to admit, I'm a bit biased toward Desperate Housewives. Brenda Strong, the voice of Mary Alice Young on the show, is the national spokesperson for The American Fertility Association.  Strong struggled with infertility, and found yoga helped alleviate the stress brought on while undergoing fertility treatments. 

It might seem like a little thing, including infertility and family building in a TV show.  But it's the little things that become part of the bigger picture in today's reality for hopeful parents.

 

Who is Lisa Faulkner?

by Maria Portella

Who is Lisa Faulkner you may ask? I certainly did. Having been out of the UK for many years, and even when I was there not a massive TV viewer, I had no idea who this popular television actress was.

Yet, someone pointed her out to me recently as an exemplary woman, who showed the 'other side' of infertility/subfertility - where medical treatment doesn't work and you have to think of something else. For some, this will be adoption and for others it will be a decision to lead a child-free life. Each is a completely valid life-choice, yet this 'side' is so under-represented in the press.

The press rarely reports the cases where medical treatment doesn't work because (a) people like to hear success stories, not sad ones; and (b) individuals are probably less willing to put themselves out there if they fear they will be viewed as a 'failure' - so it is wonderful news, when there is an occasional story like Lisa's, to help change public perception about what it means to be a family. We need more honest accounts like this one.

There is nothing but positive information in her story. In Lisa's case, she and her husband, actor Chris Coghill, opted to adopt a child and there are some wonderful points that jump out from her story:

• the path to motherhood can be via a different route - adoption;
• you are no less a 'woman' if you build your family via this route and you can hold your head up in public and say 'look at me!';
• how emotionally and financially draining medical treatment can sometimes be, for some, perhaps even cruel;
• that the adoption process is not easy and requires determination; it took the couple two years to be approved given the vigorous review process that must be undertaken by prospective parents;
• adoption can be so rewarding - Lisa and Chris have loved every minute of having their little girl Billie. Says Lisa, "Adopting is such an incredible thing to do. I really can't imagine what our lives would be like without Billie."

It also highlights what a difference having a supportive husband or partner will make. Chris spoke of his desire to adopt if medical treatment didn't work, was supportive and had a great sense of humor through it all. Lisa was very lucky and I am sure that made a massive difference. They were on the same page with respect to how they wanted to create their family unit and got through it together. Not every couple is so fortunate on this front, and it can create a whole new set of challenges to work through when you have already gone through so much.

So I would like to congratulate Lisa for her honesty and for being a real woman . She tells it to us like it was for her. She doesn't hide the fact that medical treatment doesn't always work.  Even her miracle doctor, well known in London for his efforts on behalf of couple Rod Stewart and wife Penny Lancaster, was not able to acheive the same results for Lisa and Chris. But in the end that was okay, with mutual support for each other, the pair were able to create the family of their dreams via adoption.

 

Maria Portella is originally from the U.K. and now resides in the West Indies.  Her special interest is promoting better education about fertility amongst working women.  She reached out to The American Fertility Association because she wished to share her story.

Photo: Courtesy M. Portella

 

This too will pass.

by Corey Whelan

Everyone who knows me, including the 1,237 BFF's I have never met on Facebook, know that I ran the Tunnel to Towers 9/11 Memorial race today.  I ran, my kids ran, and so did  24,997 other people.  We all crossed that finish line.  And Included in that number was a rather large contingent of wounded warriers from Iraq and Afghanistan, who seemed to catapult over the finish line in their wheelchairs. 

All of the pieces of my life seem to converge together sometimes, when I think of the struggles we as human beings go through.  So many challenges and so many options, so many different ways to face those challenges.  Do we curl up into the fetal position and stay there forever?  Do we throw on widow's weeds and never look back?  Do we instead opt to find comfort in the face of a friend, the loyalty of a dog, the scent of coffee, a book, anything, how do you get through your darkest of days?  How do you get through the very darkest day?  That one. The BFN. The hard phone call.  The worst day.  That one.

Struggles are inherent in the human condition and the only thing that keeps us going is courage, and love.  Sometimes we provide it for ourselves and sometimes its a loaner. That''s it.  That's all she wrote.

So today, which began for me with news about the death of an old friend and which ended with a different kind of hurt, but which also included the race that I love, cherish, people I cling, no wait cleave to, and a courage that will never die, this day, the worst day, reminded me of words that I pull up every now and then, as needed.

This too will pass
by Grace Noll Crowell

This too will pass. O heart, say it over and over - out of your deepest sorrow, out of your deepest grief, no hurt can last forever - perhaps tomorrow will bring relief.

This too will pass. It will spend itself - its fury will die as the wind dies down with the setting sun; assuaged and calm, you will rest again, forgetting a thing that is done.

Repeat it again and again, O heart, for your comfort; this, too, will pass as surely as passed before the old forgotten pain, and the other sorrows that once you bore.

As certain as stars at night, or dawn after darkness, inherent as the lift of the blowing grass, whatever your despair or frustration - this, too, will pass!

 

And it will.   

Ban on gay adoption overturned in Florida

 

by  Carolyn Berger, LCSW

On Wednesday I learned that Florida will stop enforcing its gay adoption ban, which has been in existence for 33 years.

 Until now, Florida was the only remaining state to ban adoption by gay men and women without exception.

 Honestly, I don’t know whether to celebrate or cry.  It’s undeniably a great step forward, but difficult to comprehend why Florida allowed gays and lesbians to become foster parents, but refused to allow them to adopt.

The story of Frank Martin Gil and his boys is at the heart of Wednesday’s decision.  When the two half- brothers came into his home as foster children, they were four years old and four months old. Their parents were crack-addicted, and like other kids removed from their home and placed in foster care, they were abused and neglected.  They both had ringworm. One of them had an untreated ear infection.  The four-year-old couldn’t speak, and he spent all of his time taking care of his baby brother.

In 2008 the ACLU represented Gil in his desire to adopt the boys, who were clearly thriving.  Adoption would give these children permanency, meaning that Gil would be their “forever” parent rather than their foster parent.  Judge Cindy Lederman wrote a decision stating it is clear that sexual orientation is not a predictor of a person’s ability to parent, and she ruled that Florida’s ban on gay adoption was unconstitutional. Gil was able to adopt his boys.

Later, the Florida Department of Children and Families challenged Judge Lederman’s decision, saying that the court had erred and the adoption was illegal.  On Wednesday Florida’s Third District Court of Appeals in Miami upheld the lower court’s 2008 ruling, and Gil’s adoption was deemed permanent.

Now it is said that The Florida Department of Children and Families is weighing whether to appeal at the Florida State Supreme Court.  Since Wednesday’s ruling applies to the Gil family only, a decision from the state’s highest court would provide a clear resolution in all jurisdictions.

We need a clear resolution—for gay rights and for children’s rights.  Both sides of the original 2008 case agreed that the boys were doing extremely well in their foster parent (and his male partner’s) home.  Both sides agreed that gays and heterosexuals make equally good parents. 

A final resolution of this matter would allow countless other gay foster parents in Florida to adopt kids and give them safe, secure homes, as well as the knowledge that their families couldn’t be taken apart by the State—unless, of course, there was evidence of abuse or neglect.

This is as it should be.  Right now there are 114, 550 U.S. children in foster care waiting to be adopted, according to the Dave Thomas Foundation for Adoption, a leader in the nation’s efforts to find homes for these kids. 

So, when two children who have endured abuse and neglect from their biological parents and have found physical and emotional well-being with their new parent, don’t we want this to continue?  All too often, foster children are shifted from home to home, never knowing the kind of family life so many of us take for granted. 

 Would we really want to interfere with a family that is doing so well just because the Dad is gay?

 I don’t think so. But don’t take it from me-- ask the 114,500 children who are waiting for permanent homes.

 Carolyn Berger, LCSW, is a Founder, Board Member, and Chair of the Adoption Advisory Council of The AFA. She has a private practice specializing in Fertility and Adoption in Larchmont and Manhattan.

 

 

 

 

 

What causes problems with sperm, and how can they be treated?

 
by Harry Fisch, M.D.

Genetics
Perhaps surprisingly, much of male infertility is thought to be due to genetics. With the human DNA sequence completed by the Human Genome Project in April 2003, more conditions of male infertility caused by genetics will be discovered in coming years. Some known genetic causes of problems with male fertility include (among many others):

• Klinefelter syndrome: two sex X chromosomes in addition to the Y (XXY)
• Kallmann syndrome: pituitary production of LH and FSH is low or absent
• Kartagener syndrome, primary ciliary dyskinesia, immotile cilia syndrome: these are structural problems in the microscopic tubes in the sperm tail
• Congenital bilateral absence of the vas deferens (CBAVD): changes in the gene responsible for cystic fibrosis cause the vas deferens on both sides to be absent
• Androgen insensitivity syndrome: the receptor that binds to testosterone is altered
• 5-a-reductase deficiency: the enzyme that converts testosterone to the more active form dihydrotestosterone is altered
• Persistent Müllerian duct syndrome: female organs develop in the male embryo
• Changes in the deleted in azoospermia (DAZ) gene: alterations in a gene on the Y chromosome involved in making sperm

Azoospermia
Azoospermia refers to the condition where no sperm are found in the ejaculate. Azoospermia is different than anejaculation, where the man does not ejaculate. Azoospermia with a low ejaculate volume (typically less than one milliliter) may be caused by:

• Obstruction of the ejaculatory ducts emptying semen into the urethra. This may be treated by using surgery to open the ejaculatory ducts, or if surgery is not possible or unsuccessful, to extract sperm directly from the testis or epididymis for IVF.
• Retrograde ejaculation of sperm into the bladder. Rather than being propelled forward during ejaculation, sperm goes backwards into the bladder. This may be treated by medicines to strengthen the bladder neck, or retrieving sperm from the bladder for artificial insemination or IVF.
• Conditions like CBAVD which cause problems in development of the prostate and seminal vesicles. These may be treated by extracting sperm directly from the testis or epididymis for IVF.

Azoospermia with a normal semen volume may be caused by obstruction of the epididymis or vas deferens ("obstructive azoospermia", OA) or to problems with spermatogenesis ("non-obstructive azoospermia", NOA). A doctor can distinguish between obstructive and non-obstructive azoospermia with approximately 90% accuracy by measuring testis size and FSH. Biopsy of the testis is occasionally necessary to determine whether azoospermia is obstructive or non-obstructive.

A man may be born with obstructive azoospermia or he may have had a vasectomy, injury or infection as a cause later in life. The treatment of obstructive azoospermia is to correct the obstruction with microsurgery if possible. If surgical reconstruction is not possible or successful, sperm is extracted from the testis or epididymis. As it is immature, sperm extracted from the testis or epididymis must be used in IVF, typically with intracytoplasmic sperm injection (ICSI).

Like obstructive azoospermia, non-obstructive azoospermia may be present from childhood, or acquired later in life due to injury or infection. A man with non-obstructive azoospermia may be treated with medicine to stimulate spermatogenesis, requiring three months or more of treatment. If sperm is not found in the ejaculate after treatment, or if the couple prefers immediate treatment, sperm is extracted from the testis for IVF.

A surgeon may use many different ways of extracting sperm from the testis, including open surgery, microsurgery, using a needle to aspirate draw out sperm, and retrieving sperm from the testis or epididymis. All choices are possible with obstructive azoospermia, as large numbers of sperm are present in the testis. Non-obstructive azoospermia limits a surgeon's choices. In order to obtain enough sperm, a surgeon may use microsurgery, open surgery, or multiple needle punctures from the testis.[9]

Extracted sperm may be frozen for later use with IVF. Advantages of freezing sperm include that the couple may choose a date for the extraction procedure, the female partner may be present for the extraction, and the couple will know whether sperm was able to be extracted before IVF is done. There is no difference in the success of IVF with frozen sperm or sperm extracted on the day of IVF.

Hormones
Failure of the pituitary to release LH and FSH causes failure of the testis to produce testosterone and sperm. This condition is diagnosed by low testosterone accompanied by relatively low LH levels. The most extreme example of pituitary failure is Kallmann syndrome, which may be treated with HCG and recombinant FSH, often requiring lengthy treatment periods of a year or more. Milder forms of pituitary problems are common, and may be treated with clomiphene citrate if the pituitary is responsive.

Failure of the Leydig cells in the testis to make testosterone results in low levels of testosterone accompanied by very high levels of LH as the negative feedback of testosterone on the pituitary is decreased. Treatment is surgical extraction of sperm if possible, as the body is already providing its own hormonal stimulation.

Testosterone therapy is not used for male fertility. Although the blood levels of testosterone rise with external application of testosterone, negative feedback on the pituitary and the resulting fall in LH causes the very high levels of testosterone in the testis to fall. For this reason, scientists have studied external testosterone for male contraception.

High levels of the female hormone estradiol may impair male fertility; this condition can be treated with medications such as anastrozole (Arimidex). High levels of sex hormone binding globulin may also lower the amount of effective testosterone, referred to as “bioavailable” testosterone. If the total or bioavailable testosterone is too low, clomiphene citrate may be used to increase the production of testosterone in the testes.

Varicocele Because it is outside of the body, the testis is cooler than other organs, a condition that is important to sperm survival; conversely, heat is toxic to sperm production. The cords transporting blood to and from the testis are arranged in a radiator-like “counter current heat exchange.” A common cause of male fertility is varicose veins in the scrotum that heat the testis and disrupt sperm production. Varicose veins in the scrotum are called a varicocele. Until the 1990s, doctors argued whether varicoceles were important to male fertility, and if treating them helped. It was discovered that treating varicoceles that were neither felt nor visible to the naked eye was not helpful, but that varicoceles that could be felt or were visible damaged sperm production, and that male fertility improved with treatment. Treating a varicocele usually involves an outpatient surgical procedure called a “varicocelectomy,” which may be done with the surgeon using magnifying lenses or the operating microscope to preserve the tiny arteries carrying blood to the testis. A varicocele may also be treated by an experienced interventional radiologist.

Childhood conditions Sperm production in the pre-adolescent boy is inactive until he reaches puberty. If the testis does not descend in the scrotum, a condition called cryptorchidism, early sperm cells may be permanently damaged. Early treatment of cryptorchidism by surgery to bring the testis into the scrotum, called orchidopexy, is important to preserve a male's later fertility. Other childhood conditions that may affect future fertility include:

• Mumps orchitis: mumps involving the testis. Treatment is prevention of mumps, or if it occurs, treating as best as possible the episode of mumps.
• Testis torsion: the testis twists on itself. Treatment is surgical untwisting of the testis as soon as possible.
• Testis trauma: injury significant enough to disrupt the inside of the testis. If the outer sheath of the testis is ruptured, treatment is surgical repair.

The immune system
White blood cells in the semen release toxic chemicals that may affect sperm function. Antioxidants and anti-inflammatory medication may help prevent sperm damage by excessive white blood cells in the semen.

If the man's body is producing antibodies to his own sperm, “antisperm antibodies,” steroids may be used to desensitize the immune system. Intrauterine insemination with washed sperm may be used , but IVF with ICSI may be necessary to treat antisperm antibodies.

Problems with erections and ejaculation
Difficulty with erection of the penis becomes increasingly likely as a man ages. Many treatments are available to treat erectile dysfunction. Problems with ejaculation may be due to injury to the nerves controlling ejaculation, such as in spinal cord injury, or disease of the nerves by conditions like diabetes. Anejaculation (a condition where a man cannot ejaculate) may be treated by collection of sperm with vibratory stimulation of the penis or stimulation of the nerves using a procedure called electroejaculation, or by surgical extraction of sperm from the testis or epididymis and IVF.

"This is our time"

by Ken Mosesian

So was the call to arms issued by Dr. Ajay Nangia at the CDC's conference on Men's Reproductive Health in the United States. The day was truly groundbreaking in that we brought together key stakeholders to share, to listen, and to learn. 

The morning began with an overview of male reproductive health and a description of the CDC's activities related to the topic. The presentations that followed were enlightening and well-articulated, featuring topics such as male contraception, male factor infertility, fertility preservation for men with cancer, lifestyle issues, and mental health issues. 

The afternoon featured a panel discussion with the leaders of national non-profit associations, a conversation about the gaps in research and practice and a proposal for moving forward. A very lively discussion followed, and I learned a great deal about the passion of everyone in the room! 

Most significantly, the Male Reproductive Health Alliance, of which began with a conversation between The AFA and The CDC in November of 2008, is continuing to meet regularly in order to form an action plan based on the input from the conference. 

I'm proud to be involved in the advancement of male reproductive health in the United States and I look forward to making a positive impact with the work the lies before us.

 

The day the earth shook my ovaries...

By Jamie Schenk DeWitt

As I slowly regained consciousness from my second egg retrieval surgery, a 4.9 earthquake shook the recovery room.  I turned to my right and there was my husband’s tender loving face just the way I had left him.  “It is an earthquake honey.  Everything is going to be fine.”  

I turned to my left and the nurse who got me prepped and ready for surgery was holding on to my IV stand and bag for dear life.  “Don’t worry we got your eggs out. Ten of them.”  

 I looked in front of me and there were nurses and doctors racing through the room.  I was definitely groggy still from the aenesethia, but I knew enough to know that it was an earthquake.  It registered in my brain something like, “Ohhhhh…it is an e a r t h q u a k e Ohhhh…TEN EGGS!” 

Thankfully the earthquake lasted for only thirty seconds, but as anyone knows who has lived through an earthquake those seconds can feel like minutes. There were no injuries to the medical facility and surrounding area and within a few minutes the recovery room was operating back at normal speed.  

 Now that the earth stood still once again, I could focus on having ten eggs extracted, which was A LOT for me. During my last IVF extraction, my doctor extracted 6 eggs and only 3 were viable for transfer.   I suffer from elevated FSH.  My egg production is rapidly decreasing, which makes it difficult for me to produce healthy eggs. 

After the earthquake, my doctor approached my bed with a gentle smile to make sure that I was recovering comfortably.  “We extracted ten eggs.  Several of them are premature.  We’ll just have to wait and see how they all develop over the next three days.” 

 Agh, the next three days of having to wait to see if the sperm takes to the egg.  Waiting to see if I have any embryos and then if those embryos grow into 2 cells, 4 cells, then hopefully to the optimal number of 8 cells.  

 The nurse leaned over and said “Ten eggs are great.  Your eggs are so healthy and so good that they shook the earth.”  I laughed and said, “From your mouth to GOD's ears.” But what I was really thinking was, “Please let me be so lucky to have just one of these eggs be healthy enough to grow into my much desperately wanted unborn child.”

Paul Revere's Ride, or How a Yankees Fan Learned to Love Boston

by Corey Whelan

My kids were less than thrilled to find out I was overseeing The AFA's Everything Fertility event in Boston.  Dyed in the wool New York Yankee fans, they didn't love the idea of their mom trespassing into foreign territory.  But given the fact that close to 45 people rsvp'ed for this event, off I went.

Boston is an amazing city, and Massachusetts is a beautiful state.  I got the opportunity to walk the Freedom Trail, peek into Paul Revere's house, and eat amazing seafood in Gloucester, the seaside town where The Perfect Storm was filmed.  But mostly, I got to sit and break bread (Boston Apple Brown Betty of course) with eager potential moms and dads, who came out to attend Everything Fertility.

Our speakers did a terrific job, and I was proud of them.  Hats off to Susan Crockin, Esq.; Merle Berger, M.D., and Susan Gordon Pinnell R.N.   I was thankful to Fertility SOURCE Companies for sponsoring the event.

I was impressed with the caliber, and fortitude, of the attendees. Looking at their faces, I remembered what it was like to be in the thick of it, trying to get pregnant, not knowing what to do next, keeping a brave face on, simply looking for answers, or even a magic fertility bullet.

I don't know if we gave the folks that joined us that night a magic bullet, but I do know we gave them knowledge; simple, clean, honest next steps.  I know we gave them answers to questions, previously unanswered. Said one attendee, "Thanks for running the seminar last night. We got alot more out of it than we thought we would. We're starting our first cycle this month and if it's not successful we're going to call you folks. We're tired of the silent treatment and "do it yourself" attitude of the big hospitals. Your approach seems so much more civilized and stress-free."

I think we gave them hope.  I know they gave me memory.  I never cease to be humbled in the face of this new generation of hopeful parents.  I never cease to be humbled, and grateful, that I have been called to serve them.         

____________

Yes, of COURSE that's a photo of George Clooney.  If you had the chance to put a photo of George Clooney into your blog, you would do it too. 

Photo of George Allmoviephoto.com

Boston Red Sox logo fanhouse.com