Today I'm giving you guys a glimpse into this rotation. If you don't want to read all about infertility medicine, I suggest skipping this post today!
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If you know me at all, you know I am passionate about OBGYN and infertility medicine. So when I started PA school I knew I wanted to try to get an elective in infertility medicine. My program contacted the best infertility specialist in our area and he agreed to let me spend 4 weeks with him. I am about to finish my first week and it has been nothing short of amazing. It has been fascinating to learn so much about such a common problem that couples face when trying to bring a babe into the world.
The first step when a couple comes to see us is to have a "consultation" in the office to document the couple's medical history, length of infertility, etc. From there, we address the 3 most common reasons that couples have trouble conceiving:
1. The female's tubes are blocked, not allowed the sperm to reach the egg
2. The female is not ovulating (releasing an egg)
3. The male's sperm is abnormal
Couples tend to always think it is due to an issue with the female's body when very frequently it is due to low sperm count, decreased sperm motility, etc. Once the male has been "cleared", we usually do a hysterosalpingogram (HSG) next in addition to a progesterone level at the end of her cycle to determine whether or not she ovulated. An HSG is where dye is pushed into her uterus under live video and you can see whether the dye has problems going all the way through her fallopian tubes or not. Below is what a normal HSG looks like… you can see the white dye has filled up her uterus and fallopian tubes then is spilling out into her abdomen, which is normal. This tells us that sperm has no problem reaching the egg.
Then we measure a progesterone level. This is done after ovulation should have occurred. If it is below a certain number, she likely did not ovulate and we have to figure out why.
If she DID in fact ovulate and the male's sperm is good, the next step is likely intrauterine insemination (IUI). This is where the sperm is looked at under a microscope, spun down and made very concentrated, then placed into the female's uterus. I like to think of this scenario as a physical problem… all the "parts" are working on both ends, but the sperm just needs a little help reaching the egg.
If she did NOT ovulate, then likely the next step is oral medications to stimulate her ovaries to release a follicle. The most common medications used for this are Clomid, Tamoxifen, and Femara. While on these drugs, she comes to the office at least once a month to have an ultrasound done right before ovulation to measure her ovaries and the follicles inside them. This gives the doctor more insight into whether the dosage is correct based on how big her follicles are. Follicles are usually 20-24mm right before ovulation. If the follicles are the right size in preparation for ovulation, she is told to go home and "spend some time" with her significant other ;) If the follicles are not big enough, either her medication dosage can be bumped up or she may possibly be switched to another medication.
So, this was just a snapshot into what I learned this week! There is obviously SO much more that goes into infertility treatments but this is the "bread and butter", or the first steps. I have been so unbelievably blown away by the patience and strength these women have. Some of our patients have been trying for 2+ years to get pregnant.
Have you gone through any of these treatments or procedures? I'd love to hear any thoughts or experiences! And as always, praying for all the women that are wanting and trying for a babe of their own.
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Don't forget to enter the giveaway for an Erin Condren 2016 Life Planner!
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If you know me at all, you know I am passionate about OBGYN and infertility medicine. So when I started PA school I knew I wanted to try to get an elective in infertility medicine. My program contacted the best infertility specialist in our area and he agreed to let me spend 4 weeks with him. I am about to finish my first week and it has been nothing short of amazing. It has been fascinating to learn so much about such a common problem that couples face when trying to bring a babe into the world.
The first step when a couple comes to see us is to have a "consultation" in the office to document the couple's medical history, length of infertility, etc. From there, we address the 3 most common reasons that couples have trouble conceiving:
1. The female's tubes are blocked, not allowed the sperm to reach the egg
2. The female is not ovulating (releasing an egg)
3. The male's sperm is abnormal
Couples tend to always think it is due to an issue with the female's body when very frequently it is due to low sperm count, decreased sperm motility, etc. Once the male has been "cleared", we usually do a hysterosalpingogram (HSG) next in addition to a progesterone level at the end of her cycle to determine whether or not she ovulated. An HSG is where dye is pushed into her uterus under live video and you can see whether the dye has problems going all the way through her fallopian tubes or not. Below is what a normal HSG looks like… you can see the white dye has filled up her uterus and fallopian tubes then is spilling out into her abdomen, which is normal. This tells us that sperm has no problem reaching the egg.
Then we measure a progesterone level. This is done after ovulation should have occurred. If it is below a certain number, she likely did not ovulate and we have to figure out why.
If she DID in fact ovulate and the male's sperm is good, the next step is likely intrauterine insemination (IUI). This is where the sperm is looked at under a microscope, spun down and made very concentrated, then placed into the female's uterus. I like to think of this scenario as a physical problem… all the "parts" are working on both ends, but the sperm just needs a little help reaching the egg.
If she did NOT ovulate, then likely the next step is oral medications to stimulate her ovaries to release a follicle. The most common medications used for this are Clomid, Tamoxifen, and Femara. While on these drugs, she comes to the office at least once a month to have an ultrasound done right before ovulation to measure her ovaries and the follicles inside them. This gives the doctor more insight into whether the dosage is correct based on how big her follicles are. Follicles are usually 20-24mm right before ovulation. If the follicles are the right size in preparation for ovulation, she is told to go home and "spend some time" with her significant other ;) If the follicles are not big enough, either her medication dosage can be bumped up or she may possibly be switched to another medication.
So, this was just a snapshot into what I learned this week! There is obviously SO much more that goes into infertility treatments but this is the "bread and butter", or the first steps. I have been so unbelievably blown away by the patience and strength these women have. Some of our patients have been trying for 2+ years to get pregnant.
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Don't forget to enter the giveaway for an Erin Condren 2016 Life Planner!
Erin Condren 2016 Classic Life Planner giveaway with
I'm so glad that you're loving this rotation and you're so invested in it. There is definitely a LOT of new information out there that people just don't know about until they go through it. Thanks for sharing so it's not as "uncommon" of knowledge!
ReplyDeleteI think it's wonderful you are so passionate about this rotation. Infertility seems to be everywhere and having people like you that can help others is so important. xoxo
ReplyDeleteLove that you're so passionate about this rotation! I'm so excited and happy for you to get to work with these women and learn so much. <3, Pamela Sequins & Sea Breezes
ReplyDeleteSuch an amazing rotation, and I love your passion for this subject! It breaks my heart that so many couples suffer from infertility, but there is such a wealth of information and help out there. I have a few girlfriends that have been blessed with miracle babies after being told their chances of conceiving and holding a child through term were very slim to none so this is one of my favorite areas of medicine as well. *Fingers crossed* for you girl to be able to continue working in this area of medicine ;-)
ReplyDeleteGreen Fashionista
this is very interesting. i have some close friends that have gone through this and i've seen the battle that they've faced - it's way more common than i realized growing up! love that you're getting to work in your passion!
ReplyDeletexoxo cheshire kat
The facts are so important here and I thank you for sharing some of what you've learned with us!! xo, Biana -BlovedBoston
ReplyDeleteThis post was extremely intriguing to me from the clinical aspect and also you know being a female ;-) I was initially going to go into midwifery and possible infertility when I started out. Is this clinic hiring? :)
ReplyDeleteLove this post and love that you have a passion for this field! I had no clue how prevalent infertility was until I joined the blogging community. We haven't started trying yet, but it's so comforting to know that, if we do struggle, there are others going through the same thing.
ReplyDeleteI love reading about your rotations. I find it all so interesting, but I know I'm not cut out for a career in the medical field.
ReplyDeleteThis is so interesting to me! My brother- and sister-in-law have had infertility issues, but are very hush-hush about it, so it's enlightening for me to read about it.
ReplyDeleteMyself and my husband had been trying to get pregnant for 18 months before I was referred to Native Iyabasira fertility solution. We had no definite diagnosis of what was wrong and had become very frustrated. In November 2015 I was given a thorough reproductive health work up, I found out I had low progesterone, thyroid issues and a stomach issue which was affecting my ability to get pregant. This was a very thorough process involving dietary, hormonal and physical investigations and started the recommended treatments in Feb 16 2016. I was pregnant by april 16. I had a baby boy in march 2017. I was carefully monitored and mother Iyabasira was always available for me. I can recommend native iyabasira more highly so much so we are hoping to start trying for a second baby under her guidance.
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ReplyDeleteAfter trying to get pregnant for four years, 40-year-old I underwent a lot of testing and i was told by the doctor that i only had a 10% chance of getting pregnant naturally. Because of my age and health conditions, the doctor cautioned that their next option, IVF, might not work the first time either.
“I only had 1 fallopian tube” And only one ovary working. My FSH (egg quality) was borderline menopausal. I had a Thyroid problem. I had a lot against me.”
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I want to share a great testimony on this website on how great Priest Babaka help me in falling pregnant,me and my husband have been trying to have a baby for over 4years, but they where no luck so we decided to contact the family doctor and after all the test have been done,he said to us that my fallopian tube is not functioning.then one day i was in the office when a friend of mine who have the same problem with me, fall pregnant after she contacted Priest Babaka .she directed me to him and when i contacted him through his email and he did the purification on the pregnancy spell and i used his herbal remedy , in 2weeks time i was feeling some how and i went to meet the family doctor who told me that i am pregnant.if you know that you have a similar problem like this, or any fertility issue and you want to be pregnant you can contact Priest Babaka via Email: babaka.wolf@gmail.com or Facebook at priest.babaka
ReplyDeleteI want to share a great testimony on this website on how great Priest Babaka help me in falling pregnant,me and my husband have been trying to have a baby for over 4years, but they where no luck so we decided to contact the family doctor and after all the test have been done,he said to us that my fallopian tube is not functioning.then one day i was in the office when a friend of mine who have the same problem with me, fall pregnant after she contacted Priest Babaka .she directed me to him and when i contacted him through his email and he did the purification on the pregnancy spell and i used his herbal remedy , in 2weeks time i was feeling some how and i went to meet the family doctor who told me that i am pregnant.if you know that you have a similar problem like this, or any fertility issue and you want to be pregnant you can contact Priest Babaka via Email: babaka.wolf@gmail.com or Facebook at priest.babaka
EFFECTIVE LOVE SPELL TO GET EX HUSBAND/BOYFRIEND OR EX WIFE/GIRLFRIEND AND CURE HERPES AND INFERTILITY THAT WORKS WITHIN 24 HOURS. Contact Dr. Odunga at odungaspelltemple@gmail. com OR Whats App/CALL +2348167159012
ReplyDeleteI got my ex husband back to me and also got fertile and gave birth to twin girls after 12 years of marriage.
When I came online last year, I saw a testimony about Doctor ODUNGA and how he has been helping people with marriage issues and I decided to contact him. We spoke on email at odungaspelltemple@gmail. com and later he gave me his WhatsApp number which is +2348167159012. He assured me he would help me get my ex husband back after 3 years of no contact. Doctor Odunga is the best spell caster I must say. My husband called me after 24 hours of contact. The third day, I received natural herbs for fertility and after using it, I became fertile and conceived. I and my husband reconnected, had sex and I was pregnant. Presently I am happy to say I am the mother of twin girls and this is ALL THANKS TO DOCTOR ODUNGA. I came online to say this If you need help, I believe you are saved with this man. Contact his email at odungaspelltemple@gmail. com OR Whats App/Call +2348167159012 and you too will give a testimony too to help others
“So I’m someone’s mom!” Welcoming our first child, Cecily , at 12:24 p.m. on Tuesday, July 14. We are absolutely head over heels in love with Cecily, and parenthood is already the most insane and beautiful thing in existence, It's made me excited to have a little spitfire of a daughter of my own. I remembered when i found out i was pregnant 3years ago and was about to walk away from the musical. But at eight weeks, i had a miscarriage. i was so unhappy, until i seek help spiritually from Priest Babaka the herbal practitioner, who helps and guide me to get pregnant again, even at the trying times few weeks in April when i battled symptoms of the coronavirus including "a cough that makes it feel like my head is splitting open from the inside out, but luckily, the baby was okay with the Priest help. i am happy to finally be a mother, couples out there that needs help, trying to conceive a baby, contact Priest Babaka on babaka.wolf@gmail.com or Facebook at priest.babaka , you will definitely have a baby to make you a parent. He handle Pregnancy related cases.
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ReplyDeleteAn amazing testimony on on how i conceive, also cure from fibroid, i wonder why people still don't believe that roots and herbs are very essential and fruitful in different aspect, especially when you can't conceive and bear children. I am a living witness because I tried all I could to be pregnant but all to no avail, on this faithful day, i decided to check the net for updates on healthy living and i came across testimonies of lot of women who Priest Babaka has helped with his native herbs to conceive. i decided to put a try because this has been my greatest problem in life so I emailed Priest Babaka, and he told me what to do which i did, after which he sent me some roots and herbs syrup and gave me step by step guild lines on how and when to have sex with my man. I missed my menstrual flow within a short period of taking it, and the doctor confirmed that I am pregnant. I am very glad to tell the world that I just put to bed a bouncing baby boy last week. Contact Priest Babaka for your own testimony via Email: babaka.wolf@gmail.com Or Facebook at priest.babaka
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