ARC® Fertility Articles

Endometriosis from a Patient’s Point of View

By Wendy Vogt, a patient of Dr. Andrew Cook
http://www.vitalhealth.com
Vital Health Institute
15055 Los Gatos Blvd., Suite 250
Los Gatos, CA 95032-2025
(408) 358-2511

When you type “endometriosis” into Google and hit Search, you get something like 6,370,000 matches. Clicking on the definition link at the top gives you this:

A condition, usually resulting in pain and dysmenorrhea, that is characterized by the abnormal occurrence of functional endometrial tissue outside the uterus.

Well, that’s … uh, I have no idea what that means. I’m not a doctor – I’m just a normal person trying to get information. Let’s try somewhere else. What about the Wikipedia? You get this:

A common medical condition where the tissue lining the uterus (the endometrium, from endo, “inside”, and metra, “womb”) is found outside of the uterus, typically affecting other organs in the pelvis. The condition can lead to serious health problems, primarily pain and infertility. Endometriosis primarily develops in women of the reproductive age.

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New Therapy for an Old Nemesis: Neural Tube Defects

Keith A Hansen M.D.©
http://womens.sanfordhealth.org
Sanford Health Fertility and Reproductive Medicine
1500 W. 22nd Street, Suite 102
Sioux Falls, SD 57105
(605) 328-8800

Art begins in imitation and ends in innovation. – Mason Cooley

Neural tube defects (NTDs), the second-most common major congenital anomaly, can occur as an isolated event, with other anomalies, or as a component of a syndrome and may cause significant neurologic morbidity for the affected individual. These defects occur due to fusion abnormalities of the developing neural tube prior to 6 weeks gestational age and include abnormalities in formation of the brain or the spinal cord. NTDs are multifactorial in etiology, with both a genetic predisposition as well as an environmental influence.

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An Uncommon Etiology For A Common Problem: Hirsutism

Emily Winterton, MD; Kathleen Eyster, PhD; Keith A Hansen M.D.©
http://womens.sanfordhealth.org
Sanford Health Fertility and Reproductive Medicine
1500 W. 22nd Street, Suite 102
Sioux Falls, SD 57105
(605) 328-8800

Abstract
Hirsutism is a common problem affecting women that is usually the result of a benign etiology. However, sudden onset or rapidly progressive hirsutism, especially when accompanied by virilizing signs, is suspicious for androgen producing neoplasms of the ovaries or adrenals. A 28-year-old female presented with the rapid onset of hirsutism and virilizing signs, accompanied by a markedly elevated serum testosterone. Initial imaging studies demonstrated
normal adrenal glands and ovaries. She was later discovered to have a rare steroid-secreting ovarian tumor. This case emphasizes the importance of a high level of suspicion for an androgen-producing neoplasm in the patient with sudden onset or rapid progression of virilizing signs and symptoms.

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A Cost Efficient Approach to Infertility Diagnosis and Treatment for the OBGYN Generalist

Georgia Reproductive Specialists

This page, and all contents, are Copyright © 2007 by IVF.com, Atlanta, GA, USA.

Introduction

The purpose of this proposal is to outline suggested clinical pathways for the management of infertility and common reproductive endocrinology problems. The goal is to create an approach that provides the greatest success while using limited resources in the most cost-effective fashion.

A traditional approach to the management of Reproductive Endocrinology & Infertility problems can be found in any traditional text. However, most texts do not take into account the limited availability of resources within a managed care environment, and do not address the issue of stratification of care into that provided by an OB/GYN generalist and that provided by the reproductive endocrinology subspecialist. To that end, this outline will attempt to focus on what care is best provided by which practitioner. To design a cost-effective, medically appropriate evaluation and treatment plan, we must take the patient’s age into consideration. While there is little necessity to initiate aggressive therapy for the 20 year old with unexplained infertility, those over 35 deserve a more aggressive approach.

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The Future of Fertility

Thirty years ago people suffering from infertility had few treatment options — surgery or hormonal therapy for the woman and varicocoele repair for the man. The birth of Louise Brown, the world’s first test tube baby, marked a genuine medical breakthrough. Initially, In Vitro Fertilization (IVF) was used only to treat fallopian tube damage. Since then other associated technologies such as Intra-Cytoplasmic Sperm Injection (ICSI), Embryo Cryopreservation, Assisted Hatching, Egg Donation, Preimplantation Genetic Diagnosis (PGD), Preimplantation Genetic Screening (PGS) have contributed greatly to fertility treatment for male infertility, optimal use of extra embryos, older patients, genetic diseases and other conditions. These technologies collectively became known as Assisted Reproductive Technologies or ART. Newer approaches such as Single Embryo Transfer (SET) are helping to ensure treatment success while reducing complications such as multiple pregnancy. ARC and its network physicians have been leaders in much of the research and clinical progress that has helped bring The Future of Fertility™ to hundreds of thousands of patients.

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At what cost?

Eric Flisser, M.D.©
http://rmany.com
RMA of New York
635 Madison Ave, 10th Floor
New York, NY 10022
Telephone: (212) 756-5777

Infertility therapy can be emotionally taxing and financially burdensome.  The “necessity” of such therapy is the source of much debate, since not having children is not, by itself, considered a disease, and therefore many insurers consider treatment for subfertility a luxury, rather than a pathologic condition requiring treatment.  The field of third-party insurers is filled with seemingly arbitrary decisions on what deserves reimbursement.  Anyone who has ever signed up for a health plan is familiar with “in network” physicians or benefits.  In addition, some prescribed medications may be covered, but others are not – and the group of medications “on formulary” vary from plan to plan.

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The Stumbling Blocks to IVF

By G. David Adamson, MD, FRCSC, FACOG, FACS©
Board Certified, Reproductive Endocrinology and Infertility
http://www.pamf.org/fertility/
PAMF Fertility Physicians of Northern California
2581 Samaritan Drive, Suite 302, San Jose, CA 95124  (800) 597 2234
3200 Kearney Street Fremont, CA 94538 (800) 497-2234

 

Many couples who might successfully utilize IVF techniques to build their families fail to benefit from these technologies.  Although roughly half of the three million infertile couples in this coungtry seek medical intervention to have a child, the overwhelming majority stop short of IVF.  This is true even when their chances of achieving a live birth through that technology are good.

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What is in a Name? A Higher Cost!

Keith A Hansen M.D.©
http://womens.sanfordhealth.org
Sanford Health Fertility and Reproductive Medicine
1500 W. 22nd Street, Suite 102
Sioux Falls, SD 57105
(605) 328-8800

There are no such things as applied sciences, only applications of science. – Louis Pasteur

Preterm birth remains a cause of significant morbidity and mortality in the newborn. In 2008, the March of Dimes reported that 11.9 percent of all live-born infants were born premature in the state of South Dakota. After congenital anomalies, preterm birth is a leading cause of morbidity and mortality in neonates. Preterm neonates are at higher risk of complications, which are increased in frequency and severity the earlier in gestation at the time of delivery. These complications comprise, but are not limited to, intraventricular hemorrhage, necrotizing enterocolitis, bronchopulmonary dysplasia and the need for prolonged neonatal intensive care unit stays. These difficulties are not only life-threatening but also can have a significant impact on neurodevelopment and the need for lifelong specialized medical care.

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Infertility: Helping Mother Nature

Infertility is a highly personal and emotional subject and it’s a medical problem that is growing. In fact, six million American adults will be touched by infertility this year representing all ages, socioeconomic groups, and genders. Because of the personalized nature of infertility—the inability to conceive or take a baby to term—there is no one rule as to when to seek treatment but there are guidelines including:

  • Couples over the age of 35 and six months of unprotected intercourse with no pregnancy;
  • Couples under the age of 30 with one year of unprotected intercourse with no pregnancy,
  • Known medical or health issues that could impact natural conception (i.e., cancer, diabetes, sterilization procedures, etc.) It’s important to note, however, that every couple is different and a consultation might in order much sooner. If nothing else than to provide peace of mind.
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Infertility Evaluation

Infertility Evaluation Definition

The textbook definition of infertility is when a couple has difficulty achieving pregnancy after trying for one year. However, the work-up can be started earlier even if a couple has attempted pregnancy for a shorter period, especially if the female partner is older than 35. Some women have a known condition that will not allow a chance of conception without help and should get help without delay. In the female partner some of these conditions include blocked fallopian tubes from infections or tubal ligations, ovulation defects, and/or moderate to severe endometriosis. Very low sperm counts or no sperm in the male partner can also warrant immediate intervention or treatment.

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How do I choose a fertility specialist?

Finding the right physician under any circumstances can be a daunting task. A patient who needs help with fertility may be faced with complicated medical decisions. Friends, family, and even the press and the Internet can provide contradictory information, making it extremely important that each patient find the most appropriate physician to advise her, support her and guide her through treatment. The reproductive endocrinologist will be responsible for directing medical testing and directing the appropriate treatment. Clearly, finding the right doctor to guide a patient through the process can be difficult.

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Hope. Dream. Hold Your Miracle.

After months of trying to get pregnant without success, “infertility” is never a word a couple wants to hear from their physician. Today, many couples are gaining hope from improvements for infertility diagnosis and treatment — making the dream of conceiving a child a real possibility.

Infertility is a common disease many couples face during their reproductive years. It occurs in about 15% of couples and is defined as the inability to conceive after twelve months of unprotected intercourse. Women over the age of 35 who are unable to conceive after six months and have irregular cycles, or men and women who have a past history of infertility can also fall under this definition.

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The Good Egg…Everything You Need to Know About Ovulation

the-good-eggOvulation is perhaps the single most important factor when trying to conceive. Women who have infrequent, irregular, or no ovulation (anovulation) will find that conceiving is either very difficult or downright impossible.

Understanding Ovulation

Ovulation is when a mature egg is released from the ovary and makes it way through the fallopian tube in anticipation of fertilization. Hormones have already prepared the lining of the uterus for the potential pregnancy. If pregnancy does not occur, the egg and the lining of the uterus are expelled through menstruation and the ovulation process occurs again.

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Ask the Experts: Fertility Q&A

For many in our audience who are not familiar with the science of Reproductive Endocrinology and Infertility maybe you can provide a brief overview?

Reproductive Endocrinology and Infertility is a branch of medicine that identifies and treats infertility in both men and women. In the United States, 15 percent of all couples will face fertility issues, and many will be diagnosed with a reproductive disorder. Many infertile couples choose to see a reproductive endocrinologist when deciding upon fertility treatments. The reproductive endocrinologist will identify factors involved in a couple’s infertility and select the appropriate methods to treat these factors.

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Fertility 101 (Part 2)

Fertility 101 Part 1 addresses the basic infertility work-up. This article will discuss specific causes and their evaluation.

Male Factor

The male factor is estimated to be significant in 40%-50% of couples. To determine the adequacy of the spermatozoa, the man must submit a semen sample for analysis after at least 2, but no more than 5 days of sexual abstinence. Sperm morphology has shown to be the most important semen parameter in predicting fertility rates and pregnancy outcome in assisted reproduction. Abnormal semen parameters can result from fluctuations in hormonal levels, from genetic or congenital abnormalities, and from drug use, infections, previous surgery, and exposure to occupational and environmental toxins.

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Fertility 101 (Part 1)

Infertility is defined as a failure to conceive after 1 year of unprotected, appropriately timed intercourse without conception. The prevalence of infertility among couples in the United States is approximately 10%-15%. Possible contributing factors include advanced maternal age due to delay in child bearing and a decrease in sexual activity with increasing length of relationship. The natural fecundity rate (the percentage of fertile couples achieving a live birth) per month is estimated at 20%-25%. Life table analysis reveals that 64% of women with primary unexplained infertility (when all standard clinical tests yield normal results) and 79% with secondary infertility (when a previous pregnancy has occurred) will conceive within 9 years. Nevertheless, the decision to institute diagnostic tests and treatment should be made on an individual basis. This article will address the basic infertility work-up. Next month we will discuss specific causes and their evaluation.

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