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The Dreaded Biochemical Pregnancy

Here I will tell of a typical story about a woman who has been suffering from infertility, and finally becomes pregnant. After the relief of a positive pregnancy test her doctor repeats the test and says, “Well Lisa, it looks like your pregnancy is biochemical”.
Now I can’t completely describe what Lisa is saying to herself, but it’s probably something like this.
“What is he talking about? A biochemical pregnancy? Did I get pregnant? Am I pregnant? Biochemical? It’s bad enough I have felt like a science experiment, now I’m biochemical?”
Let me try to straighten this out. The definition of a biochemical pregnancy is a pregnancy that stops growing before it is large enough to be seen on ultrasound. It’s a very early miscarriage. The causes are the same as for any miscarriage. By far, the most common reason is that the embryo is genetically abnormal, that is it doesn’t have the right number of chromosomes. And although it has the tools to grow for a while, as the embryo grows and needs to become more complex, the tools run out and the embryo can grow no more. There are other causes of miscarriage and that will be topic of a later blog.
The word “biochemical pregnancy” is a terrible term. It’s very cold and scientific and inhumane. I try not to use it, I just say it’s a very early loss. I thing the fertility community should throw out the word. I’m going to ask them if they will.

No More Happy Birthdays

I wanted to be a doctor from a young age. I was one of the few kids who thought it was neat to get a shot. I was inspired by my physicians, and I think MASH is still the best show on television.
When I started medical school I was sure that I would be a family physician. Yes I enjoyed medicine, but I found that paying attention of the personal aspects of care to be very rewarding. Asking patients about their family, jobs and family was very appealing to me.
So I went on to became a fertility specialist, but attention to the personal details was still important to me. I like asking patients the details about their lives outside the fertility world. And that’s how I became frustrated with “Happy Birthday”.
Birthdays are difficult for women who are infertile. As they get older, the hands of their biological are chipping away at their chance to be a parent. When I first started practicing I would feel awkward about bringing up the subject.
And then I thought, what force has the right to take away one of our most basic pleasures? Who doesn’t remember the fun in having an entire day dedicated to you? Blowing out the candles was always thrilling. Heck, you even got presents for no reason at all, except for the fact that this was the anniversary of the day you graced the world with your presence.
So I say now have a very Happy Birthday. It’s your day, soak it up.

From No Sperm, to a Few Sperm, to Twins

This story took place over 10 years ago, but I still hear of the same problem today. A couple came to see me because they were told the only way they could conceive was by using donor sperm. What was that based on? Well in fact, he did have no sperm. So the next step would be to do a testicular biopsy to see if there are any sperm in the testicle that are not making it out when called to duty. And he had the biopsy, which showed no sperm in the testicle.
After listening to the histories of he and his wife, I explained how to go about ordering donor sperm, and how the insemination is performed. But I also said, “let’s have one more person look at your biopsy slides before we do anything”. I had to be careful not to get their hopes up, but I have seen experienced reproductive urologists find sperm on biopsies labeled as “zero sperm”. Sure enough, there were a few sperm seen. They went on to have an in vitro procedure with another testicular biopsy where just enough sperm were retrieved. Pregnancy resulted and she delivered twins. As it turns out she was related to a cop in town, so it was nice for me to feel a little more connected to the community.
I have seen similar cases where the husband was told there is no sperm and a repeat semen analysis with very careful washing in the right lab revealed a few. And there’s a big difference between zero and “a few”.
So the point is when you are given a diagnosis of disaster, find the best provider you can and get a second or third opinion. You may end up with the original bad news, but you may end up with an entirely different picture.

A woman who thought her Hysterogram was normal

Each holiday season I receive many wonderful cards from patients, most accompanied by photos of their new families. There are usually some from people I have not heard from in years, and its great to see these photos because they are not of babies, but of pre-teen, on their way to adulthood, beautiful boys and girls. This year was no exception. When I get time, I try to call as many of these card-givers as I can, but a card from a memorable patient from years ago elicits an immediate response. After receiving a card with a picture of 4 kids, I picked up the phone and called the sender. I had had a very comforting conversation about her overcoming her fertility problems, and she reminded me of how our relationship started with a hysterogram.
She was seeing me for a second opinion. As with all of my patients, I asked for the films of the hysterogram another doctor had performed(if it has not been done I do it myself). I did not want the report, just the films. In her case, the report and her first doctor said the tubes were open. When I looked at the films, I had to tell her that her tubes were not open, they were blocked, and this was the reason she could not get pregnant. The reason my diagnosis was different was that one tube did have dye coming out, but it was through a tiny hole on the side, and not through the larger opening at the end. So the radiologist read it wrong, and her doctor didn’t look at the film, he just went with the report. Over the next few years she was treated with a combination of surgery and IVF, the result being 4 healthy kids.
So the bottom line is your doctor needs to carefully look at the films, not the report. If you ever go for a second opinion, bring the films so the new doctor can read them too. This story is a very common scenario. I am sure there will be later postings about hysterograms and the wrong diagnosis.

Welcome From Dr. Licciardi

Welcome to the first installment of the Infertility Blog. My name is Dr. Licciardi and I am an infertility specialist at the NYU Fertility Center(NYUIVF.com and DrLicciardi.com). My goal for this site is to educate people about infertility through example. I see many types of problems each day, and I will bring lessons from my experiences to this site. This will help people get a better understanding of their problem, and maybe get them better care by raising questions about the service they are receiving from their current health provider. That’s it for now, more to come.