3 Things You Should Know BEFORE Your First IVF appointment: This is not just for Kate and Toby

The episode of NBC’s hit show This Is Us that aired October 9th, 2018 featured a risky procedure that left us wondering if Kate was going to make it through.

Kate and Toby are trying to have a baby.

Kate’s doctor didn’t want to take her as a patient initially because she said the risks were too great. I almost said too large. That was the problem though. Kate’s weight increased her risks of having complications while going through IVF.

What this episode of This Is Us and previous episodes didn’t explain was what those risks were and how likely complications were. They also didn’t talk about one of the largest risks of IVF, which is not affected at all by Kate’s starting BMI. I think it is important to be specific.

Having a baby can bring about immeasurable joy. I don’t fault couples for accepting certain risks in pursuit of pregnancy. I think that couples should do and know 3 things before pursuing assisted reproductive technologies, like IVF. By the way, I am not an IVF doctor, so my recommendations are not laced with any motive other than to provide information.

Let’s get into it.

Do You Meet Criteria for the diagnosis of Infertility or Subfertility?

people in front of macbook pro
Photo by rawpixel.com on Pexels.com

People spend so much time and energy trying to not get pregnant that, when birth prevention is removed, they expect to get pregnant right away. Now, start taking prenatal vitamins 3 months prior to attempting pregnancy because you may get pregnant right away. If you don’t though, things may still be fine. Women under 35 can take up to one year of unprotected intercourse and still be normal. We give women who are 35 years old or older 6 months before pursuing further evaluation.

Well, Doc, we’ve only been “trying” for 3 months, but we haven’t used condoms or any form of birth control for over a year.

Then, ma’am, you have been “trying” for over a year. By a gynecologist’s definition, not preventing is considered trying. You don’t have to be tracking every change in your temperature or urinating on sticks to be trying. Simple sperm in vagina action counts.

It is nice to know even an estimate of when you are ovulating. A free period tracker app should do it. Intercourse at least every other day in your 3-5 day ovulation window should give you the best shot. Do your best to keep it fun and low stress. Get massages. Go on vacation. Relax.

Oh, and don’t go to any Zika territories. It’s still a thing.

Click here to see an up to date list of Zika territories you and your partner should avoid if you are or are planning to be pregnant.nrfspr3_4ye-klara-sasova

The point of meeting criteria for infertility is 2-fold. One, if you know that it may take a year, hopefully that takes some of the pressure off month to month. Stress and anxiety are counterproductive for fertility. Two, insurance companies often require a certain duration of attempted conception before they will pay for assistance.

Do You Have Insurance for Infertility Coverage?

If you are thinking about trying to conceive and your open enrollment for your health insurance is coming up, just check to see what your infertility coverage is. It is just good to know if you will need additional coverage if conception isn’t easy. Infertility coverage is not a part of all policies.

If it is a part of your policy, you may have a maximum allowable expense. All infertility treatments do not cost the same. In Vitro Fertilization (IVF) is significantly more expensive than Intrauterine insemination, or IUI. Quite honestly, Kate and Toby may have been candidates for IUI with Clomiphene.

Clomiphene, known by the brand name Clomid, is a medication that helps women ovulate, or release an egg. This is especially helpful for women who have very irregular periods because they may not be ovulating regularly, like women with PCOS. The story of Kate and Toby included Toby’s sperm that were underperforming. If they were just slightly low-functioning, IUI is a fertility treatment that can turn a sperm marathon into a 5K.

Don’t miss this article about how sperm quality can be dramatically improved by diet.twenty20_94092d03-c911-469a-bdec-d74a7069a4eb

Ultrasound and hormone testing are also evaluations that can often be done for women even if they don’t have insurance coverage for infertility. Still, though, waiting until you have given trying a good run is appropriate.

Risks of IVF are high, but so are risks of pregnancy.

Some of the risks of IVF are related to the high doses of hormones administered. Blood clot risks are higher, ovarian hyperstimulation is a significant complication, and ectopic pregnancy risk is higher with IVF  than with spontaneous pregnancy, to name a few. Blood clot risks are also higher than baseline for spontaneous pregnancy.

IVF can also increase your risk for twins or higher order multiples. This is because two embryos are sometimes placed in the uterus in hopes that at least one will implant. Well, sometimes both implant. A single embryo can also split, causing twins. Twins are cute and all, but twin pregnancies also lead to higher risks, like gestational hypertension, diabetes, preeclampsia, c-section etc.

So are you saying we shouldn’t try IVF, Doc?

Absolutely not. I just think that knowing your risks is better than being afraid of some unknown TV Land risks. Surveillance and monitoring are always high for women undergoing reproductive assistance, with hopes that catching any complications early will help improve the overall outcome.

chuttersnap-233105 smallWomen’s ages of first attempted conception are getting higher and higher.

The use of assisted reproductive technologies is becoming more and more common. Rebecca, Randal, hell EVERYONE was worried about Kate. I personally was happy when Toby spoke up and reminded everyone that this was their decision. If they understood what they were getting into, the risks, the benefits and the alternatives, they could make their own informed choices.

Check out another popular post from The Gyneco-bLogic about lesser known facts related to being pregnant at higher ages.

And as always, like and follow us here and on social media. Thanks for the LOVE!

Kate and Toby

 

Advertisements

5 Things You Need To Know About Chlamydia

Chlamydia landed a role on this season of HBO’s Insecure and I was happy. Why? Well, because Lawrence was living that free, unprotected, and frankly reckless life, but not even TV Land could save him from the consequences. Props, Issa Rae (she’s the show’s creator.)

There are a lot of misconceptions about this infection out there. Who would we be here at The Gyneco-bLogic if we didn’t tackle myths, and reveal truths? Let’s get to it. This game is called…

Chlamydia True or False

You’ll know if you have Chlamydia.

False. For women, up to 85% of infections are asymptomatic. In men, up to 40% are without symptoms. How do most people find out? By getting periodic screening. The CDC recommends screening at regular intervals and especially if becoming intimate with a new partner.

If you treat Chlamydia, you are cured of any and all consequences.

False. While antibiotics will often eradicate the infection itself, the residual effects can still persist, like pelvic pain or fertility issues, especially in the setting of pelvic inflammatory disease, or PID.

A partner who has Chlamydia will absolutely pass the infection on to you.

False. However, if you find out that a partner has the infection, while it is important to get tested right away, we do treat women presumptively for the infection in hopes of shortening it’s duration and minimizing the risk of PID or fertility issues later on. Also if you are diagnosed with Gonorrhea, we treat presumptively for Chlamydia.

It takes up to 3 weeks for a repeat Chlamydia test to be negative AND a person can retest to make sure it is gone.

True. While treatment should be effective by 7 days from initiation (which is the minimum duration one should obstain from intercourse,) the bacteria can linger in the vagina/cervix for up to 3 weeks. Since many Chlamydia tests are DNA tests these days rather than cultures, that means that the repeat test would still be positive.

Also, a person CAN request a test-of-cure a week after about 3 weeks to make sure the infection is gone, however since the antibiotic treatment for chlamydia is 97% effective, a test of cure is not necessary. A RETEST IS generally performed 2-3 months after treatment to make sure the person was not re-infected. All partners should be informed and treated before resuming any sexual relationship. Don’t forget, a person can get chlamydia in their throat.

A nickname for Chlamydia is The Clap.

False. A common misconception, but The Clap is a reference to Gonorrhea rather than Chlamydia, though as I mentioned, the two can often go hand in hand. I propose the following nicknames for Chlamydia.

  1. The Wind- Because you can’t always feel it, even though it is there.
  2. The News- Because getting that diagnosis is news you can use.
  3. The Smackdown- Enough said.

I want to applaud Issa Rae and character Lawrence of Insecure on HBO for not only including the diagnosis in the storyline, but showing the uncomfortable, yet necessary process of informing his previous partners. Big Ups to owning up to THE SMACKDOWN.

Wear a condom next time, Lawrence.

via GIPHY

Don’t forget to Like us on all things social and Subscribe to The Gyneco-bLogic above or below. We have that news you can use- wait, not Chlamydia.

 

 

 

 

Hold up, Molly! 5 Things you need to know before trying Molly (at Coachella or anywhere…)

#InsecureHBO lovers, listen up!

Episode 5 of Insecure Season 3 on HBO made waves. I’m going to limit the spoilers for those of you who still need to catch up #dobetter, but I’m still stuck on the part when Molly, Issa, Tiffany and Kelly were offered Molly before the concert.

giphy-1

#ThisIsHappening

The fastest-emerging drug problem in the United States is the synthetic drug market, which now includes Molly.

1. What is Molly?

According to the DEA:

Molly is the powder or crystal form of MDMA — or 3, 4-Methylenedioxymethamphetamine, a chemical drug most commonly known for its use in the pressed pill Ecstasy…

The DEA labels it a Schedule 1 controlled substance, considered to have a high potential for abuse and no accepted use in medical treatment, which means it’s illegal.

It is a drug that is used frequently at concerts and is growing rapidly in its availability and users. It’s also considered to be one of the safer drugs to cause euphoric highs because it is considered more “pure” and less strong than Ecstacy.

First-time users are often between the ages of 14 and 24. Some users are as young as 12.

giphy-5

2. What symptoms does Molly cause?

It makes you feel good. Check out these personal accounts (Not from me):

“It felt like everything was amplified. It felt euphoric — almost like a crazy adrenaline rush for a long time,”

“You feel a lot more loose and comfortable in your environment,” said recent Georgia high school graduate Jessica, who’d never used Molly until the concert in July — a friend’s recommendation convinced her to give Molly a try.

And then, usually after a few hours — depending on the dose that is taken — of dancing and moving and talking, the trip comes to an end.

“(After it was over), it wasn’t like a depression, but it was like, ‘Aw man, I wish I felt that way again,’ ” Jessica said.

“Honestly, if I were to pick a drug out of anything else to do, I would pick Molly. Molly has a lot to do with loud music and seeing lights — getting excited about seeing something that’s already cool and making it cooler.”

It sounds cool. So why not give it whirl the next time you hit up the next dope concert?

3. Why is Molly so dangerous?

giphy-6

For one, you have no idea what you are actually taking. While Molly is supposed to be MDMA, a hallucinogenic drug slightly weaker than Ecstacy, 1 gram of pure MDMA retails for over $100. Shady Joe, your Molly pusher, cuts it with whatever he can find that will still make you high for cheaper than that. One reporter wrote a story about the contents of 3 different Molly pills purchased for $10-20 each.

So, what was in the “Molly” they bought?

The first capsule, puchased in South Beach for $10, was tested by Gavins and gave a false postive as being MDMA, when it fact it was cathinone, i.e: bath salts.

The second capsule was also purchased and Miami, and cost $20. Howards tested this capsule and concluded it was mostly meth, with some MDMA.

The third capsule is purchased for an unspecified amount of money in New York, just after a Molly overdose claimed two young lives at Electric Zoo. This capsule has coke, meth, some MDMA and an opiate, which they believe to be an “oxycodone chaser.” An intrepid researcher (not the writers) consumes the Molly, and says it “felt like tripping on heroin.”

Okay, so the ish isn’t pure. Why do I care?

4. No really, why do I need to worry about taking Molly?

giphy-4

I’ll give you 3 GOOD reasons:

(1) It can lead to serious health complications like overheating (hyperthermia), seizures, heart abnormalities and extreme cases, death.

(2) Depending on the contents in your particular version of Molly, the risks of complications when mixing with alcohol or other drugs could be devastating.

(3) The low that comes immediately after the drug wears off is one thing, but an even greater low comes days after use that can lead to long-term depression.

From one drug enforcement agent:

The amount of active ingredients can be dangerously different, because “the dosing for these sorts of drugs are in the micrograms.”

“The room for error is tremendous, and we’ve seen a lot of deaths with some of these compounds.”

Also, Molly is on the spectrum of Crystal Meth, for those who will respond more to the judgment of being associated with such a rachet drug rather than just an unsafe one. According to one source, the strength of the drugs from weakest to strongest is as follows:

The chain from weakest to strongest methamphetamine is Adderall.. Crystal Meth.. Molly(MDMA).. Ecstasy. It really does blow my mind that so many people admit openly about doing Molly and ecstasy but are disgusted at the thought of doing meth when in fact it is a weaker version of what there doing.

Molly, your girls should have stopped you, rather than joining in on the okey-doke.

giphy-3

5. One more thing. Put on a condom, Issa!

I know this is unrelated to Molly and Molly, but as much as I love Insecure, if I see one more spontaneous sex scene without any reference or illusion to the use of a condom, I am going to scream!

I just care about your safety, and your lady parts, Issa.

giphy-7

Don’t you know the STD rates in this country are rising out of control? Oh, you don’t? Here, let me tell you a little bit about it.

I will leave you with these final thoughts:

Is seeing Beyonce not enough? What more do you need?

If the headliner at your concert isn’t dope enough to experience without a drug that could, at it’s best, cause you to hallucinate and pee on yourself, and at it’s worst send you to the Emergency Room with hyperthermia and heart problems and lead to a prolonged depression or DEATH, stay T. F. AT HOME! Don’t even go to the concert. If you need Molly, you don’t like the artist enough.

I just don’t need that kind of drama in my life. I’ll stay with my booze in moderation. Nothing more! Tell a friend and check out the post I wrote at the start of Insecure Season 2, last year. It got “Hella” love.

Now, are you gonna try Molly?

giphy-2

RIP Mac Miller.

Don’t forget to subscribe to The Gyneco-blogic.

Why Am I Growing Hair On My Chin?

giphy

Okay, so this lady has a problem. Does she have what you have, though? Will your chin turn into this if you don’t break out your tweezers? Dr. Google strikes again. I typed in the following words:

Hair On Chin

And this is the first article that my search engine optimized…

6 things that hair on your chin could mean - Google Chrome 9_3_2018 9_20_21 AM (2)

My problem is this: It sounds so scary! “And why you should never ignore it” seems like my little whiskers are going to take me out. My tweezers are in my bathroom drawer for a reason. That reason is not to mask some unforeseen force that is trying to compromise my health.

Is chin hair ever a sign of something harmful?

Possibly. But in most cases, it isn’t. So how do you know if you are experiencing hair growth that is concerning for your health? Ask yourself the following questions:

  1. Is the hair located in places that it has never been before? Are you newly growing chin hair? Chest hair? Hair around your navel where it has never been before?
  2. Is the hair course? Fine hair that you can only feel or see in the sunlight is a different type of hair caused by a different health state than the dark, thick hair that is noticeable without squinting and turning your head to the side.

giphy

3. Have you also been experiencing irregular periods and unexplained weight gain in addition to increased course hair growth? This combination can signify a hormonal imbalance.

What are the worrisome diagnoses?

Well, the ones that you can sometimes have an effect on are PCOS, or polycystic ovarian syndrome, and medication side effects. I’m not talking about birth control either. Birth control can sometimes improve hair growth and acne by regulating hormones. Adrenal tumors and other hormonal tumors can also change the hair growth pattern, but these diagnoses are rare.

Genetics often plays a big role. Your mama might have tweezers that she has been using for years and just never volunteered the information to you. Also, weight gain can change your hormones and increase hair growth without you having PCOS. Either way, seeing your doctor can help shed light on the situation.

adult bricks face fashion
Photo by Pixabay on Pexels.com

I hope this post helped bring understanding to why your faithful few chin hairs keep coming back. If you have more than a faithful few or suspect other causes, it is never wrong to see your doc.

My hope is that Dr. Google doesn’t give you more anxiety than understanding. Make sure you subscribe to The Gyneco-blogic today. We’re trying to replace the scary with the probable, while still leaving room for you to investigate your particular situation. Tell us how we’re doing in the comments and on social!

Oh, and subscribe to my YouTube channel for more of these shenanigans…

What You Need To Know About Beyoncé’s Pregnancy Complication: Blood pressure, Bey-have

I always knew that Beyonce and I had something in common.

Well, one thing in common.

I guess if you include that we are both black women, three things in common.

I digress, already. The queen of the Bey-Hive revealed recently to VIBE magazine that she developed preeclampsia, also known historically as toxemia, while pregnant with her twins. As a result, she needed to undergo an emergency c-section.

I love this conversation so much! No, I don’t love that she had preeclampsia, but I love that she decided to discuss it in a world where false pretenses prevail and beach bodies follow eerily closely behind pregnant bellies.

How do I know if I have preeclampsia? What are the signs?

While everyone thinks that their cankles equal preeclampsia, leg swelling is no longer a part of the criteria to diagnose preeclampsia. *A Cankle is a term that describes the fusion of a Calf and an Ankle, btw.

The way we doctors, nurses and midwives diagnose preeclampsia is by a few signs, or criteria:

  • Elevated blood pressure
  • An abnormal amount of protein in the urine
  • Blood work abnormalities, sometimes.

A woman can also experience symptoms of preeclampsia, but they are not always consistent with the diagnosis.

Said differently, a woman can have symptoms that seem like they are caused by preeclampsia but NOT have it, and conversely, a woman can not have ANY symptoms but have full-blown severe preeclampsia.

I was one of those people. I was a second-year OBGYN resident and was getting my prenatal care at Rush University Medical Center by an amazing nurse practitioner. My entire birth story is in this previous post, but the summary is that I developed preeclampsia in the course of a week without ANY symptoms. I even had to deliver early because of it. My delivery was a whirlwind too!

What I hope women take away from Beyonce’s story,

… is that getting prenatal care is vital to the health and safety of mothers and babies. There are some who think that doctors and hospitals are the enemy. Especially after the stats recently came about that maternal death rates are higher in the US than in many other industrialized countries and are rising.

The fact is that those stats suck, but as sad and true as they are, the solution is not to avoid hospitals or doctors. The answer needs to come from improving administrative systems that will stop preventable deaths. Monitoring blood loss closely, managing high blood pressure carefully and responding to changes in vital signs and symptoms are just a few ways that subtle yet dangerous maternal complications can be prevented.

Serena Williams had pregnancy complications too.

Serena had the knowledge to advocate for herself in the face of her life-threatening blood clot. Beyoncé was, I’m sure, being monitored 24/7 because of the complications that can occur with twins. But what it you aren’t The Queen Bey or the best tennis player in the world (she’s coming back y’all)?

My advice is simple:

  • Pay attention to your body.
  • Ask questions.
  • Take notes.
  • Get clarity if there is something you don’t understand.
  • Ask again if your question is not being addressed completely.
  • Get a second opinion if you are uneasy.

There is no evidence behind this advice. No studies. There is only my desire to keep you under the care of someone who you can understand and who will communicate with you. The root of so many medical pitfalls is poor communication. I think as the patient, you should start there.

Check out this post I wrote a few months back that contains the BEST BIRTH-PLAN EVER.

And as always, like, share and subscribe. Please and thank you.

 

A Birth Story from the OB Herself: It May Help You Through…

I can’t believe I never shared this here before!

I originally posted this little gem on Sassy Plum. Here it is!

I was a resident physician and had just finished performing a c-section. We had helped bring a new life into the world. That usually puts me right on cloud nine, even to this day, but this day I went straight to the desk and put my face down on the cold table.

One line appeared…then line two…”

A: “Are you okay?”
Me: “Yeah, I’ll be fine. I’m just a little nauseous and hot. It was hot in the operating room. I’ll be fine in a minute.”
A: “You’re pregnant.” (OB/GYNs always suspect this first.)
Me: “What? You’re crazy. No I am not. I’m on birth control, and, well, I’m just not.”
T: “I’m getting you a test from the ER.”
Me: “Fine, but I’m not.”

Line one appeared… then line two…
Disbelief.
I slowly walked back out into the hall where I was intercepted by my senior resident.
Me: “What does this mean? We just got a dog yesterday.”
T: “It means that your pregnant. Let’s go back to the call room and call your husband.”

Me: “Hey babe. I’m, well, I’m pregnant.”
Ed: “But we just got a dog…”

That was the beginning. That little twinkle in my eye is 8 years old now, but that was how my pregnancy began. Now fast forward to the end of the pregnancy.

“I didn’t feel like I had preeclampsia”

I had endured 80-hour work-weeks, no vacation (I had to save it all for maternity leave), nausea and vomiting that never completely went away, and sparse weight gain because of my vomiting tendencies. I would run down the hall to the bathroom to throw up and hear new nurses saying, “Where is she going?” Then I would hear the nurses who knew me saying, “Oh, she is just going to throw up.” They knew me so well.

At 35 weeks, I had my first elevated blood pressure in the office. It was only mildly elevated, in the “pre-hypertensive range”. My awesome nurse practitioner told me to recheck my blood pressure a few more times in the coming week, since she knew that I would be in the hospital every day. Being the disobedient doctor that I was, I waited 6 whole days to check my blood pressure again. The day before my next prenatal appointment, I was working in OB triage and I asked Miriam to take my blood pressure. “160/100.” Wait, what? Excuse me? So what are we saying? “Take it again.”

It was still stupid high.

“So how about I go home, rest a little bit and come back?” My doctor literally looked at me with an “are you crazy?” face. I knew better. My own patient wouldn’t be able to walk out of my eyesight with a blood pressure like mine. But I must have been different. I felt fine. I didn’t feel like I had preeclampsia. So what was the problem?

Multiple severely high blood pressure later, and after receiving IV blood pressure medications on top of IV medications (the big guns), my fate was sealed. I needed to be induced at 36 weeks. That was 4 weeks before my due date.

But we weren’t ready…

I had 4 more weeks left. I had work to do. The baby’s room wasn’t even started, let alone finished. My husband was an intern in the ICU and had just finished placing a life-saving central line when he got the call that it was about to go down.

My husband called in emergency favors and commissioned a group of friends who, over pizza and beer converted his DJ room/man cave to a baby’s room, complete with a hand-me-down crib and clothes and diapers from our baby shower 2 weeks prior. He then went to Target and bought a bassinet. So I guess we were ready. All that a baby really needs are clothes, diapers and a safe place to sleep, right?

“While history was being made, I was pushing”

I was admitted Sunday night. The decision was made to induce Monday morning. After a cervical balloon, some pitocin, breaking my bag of water, more pitocin, flipping me all over, an epidural, and a bunch more pitocin, I started feeling the pressure. I was tanked full of magnesium to prevent seizures that could be caused by preeclampsia and was feeling rather delirious on that Tuesday morning when the time came to push.

I remember looking up to see two of my favorite people in the world on the news. One had on the flyest yellow coat dress I had ever seen. The other had on a dapper black coat, a bright red tie, and had his hand on the Bible as he was being sworn into office. It was January 20th, 2009.

I had to watch the ceremony reruns later to take it all in because, while history was being made, I was pushing. I needed an emergent vacuum assistance because the baby’s heart rate dropped to dangerous levels. The vacuum failed twice, and my attending had to save the day by pulling my 4lb 13oz baby boy out with forceps (yes, the salad tongs). He is amazing today. He is smart, handsome and has a younger brother and sister.

“I am SO anti-delivery story”

You don’t know this about me, but I am SO anti-delivery story. Why, you may ask? Because knowing what happened in your delivery in NO WAY has any bearing on what will happen in mine. Did reading the details of my deliver change you or your pregnancy in any way? NO. I don’t even know you. This story, as with any other story, should be used for pure entertainment. Storytelling can be therapeutic and even fun. When it becomes anxiety provoking as you search for ways to stop what happened to me from happening to you, it has gone too far.

“Separate yourself from the stories that you hear”

My take-home message is this: If you are pregnant or desire to be, separate yourself from the stories that you hear. Remind yourself that YOUR pregnancy is normal until proven otherwise. I had to exercise this practice myself as an OB/GYN, considering the multitude of complications that I have seen in my career. If you are no longer pregnant but desire to tell your story to someone who is, remind that person that these crazy things happened to you, not to them. There is no need to drop emotionally charged delivery stories on a newbie, but if you do, don’t just leave them shaking in their boots. Reassure them and comfort them. Oh, and make sure that they listen to their doctor. Denial is not therapeutic.

If you had a normal, beautiful delivery, share that too. Sometimes the ladies who share the most are disproportionately the ones who had complications. Far more women have normal, safe, uneventful deliveries.
Check out another post by me that lists many other things to say and not say to pregnant women. Remember, my story is MY story. You will have your own.