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A Humorous View of Infertility

Hello to Everyone,

This month will mark my 26th year as a full-fledged Reproductive Endocrinologist. As many of you know, I started my career as a founder of the NYU Fertility Center, where I have proudly remained since. Those of you who have met me know that I do like being friendly and informative, but overall I am pretty serious when it comes to working with my patients to help them conceive. Infertility is a very serious, deeply personal problem that can become physically and emotionally (on so many levels) demanding. 

I would like to help you lighten the load a bit by introducing you to a book that takes a humorous approach to infertility and its treatment. I present to you:

 


Book Description: Hilariously Infertile is on a mission to make others who have struggled with infertility, laugh (perhaps while their feet are still in the stirrups and their vaginas are enjoying the fresh air of the fertility clinic). It is a comedic, self-deprecating, look into the harsh, scary, and often sad world of infertility. Hilariously Infertile will make you laugh out loud while wishing you could have a glass of wine with the author and discuss how you relate to her story. The author pokes fun at the infertility world, with jokes, such as, equating the constant gynecological exams to her sluttiest days in college, and wondering if her husband will be home in time to stick it (the IVF ass shot) into her butt.
The book is available at:

https://store.bookbaby.com//bookshop/book/index.aspx?bookURL=Hilariously-Infertile

 

About the Author:
Karen Jeffries is a fourth grade dual language teacher outside of New York City. She does not consider herself a writer by trade, but she did write a hilarious book about infertility, which she has been sharing with her followers for years. Karen is infertile and funny! This combination is equal parts unlikely and spectacular. In her spare time, she loves to spend time with her family and apply numerous layers of face cream, due to her recent realization that she is on the slippery slope to forty years old. More than anything Karen hopes to help other women through their infertility treatments, one laugh at a time.

Reviews:
This book is truly relatable for any person suffering with infertility. It shows us that we are not alone. Hilariously Infertile gave me an outlet to laugh during some of my darkest days. Thank you Hilariously Infertile for breaking the silence of infertility.
~ Mary Gilliard
Ontario, Canada
After reading Hilariously Infertile I felt instant relief that someone was feeling the same way as me! I could not wait for the next chapter so I could laugh instead of cry. Not only did this book make me feel like I was not alone, it inspired me to join the movement in breaking the silence of infertility.
~ Jaime Maldonado
Port Chester, New York
Karen Jeffries has a way of explaining the most vulnerable and heartbreaking situation a woman can be placed in, in a way that makes it not only tolerable, but humorous. By reading this book I am able to realize that I’m not the only one going through this incredibly lonely journey. I found myself nodding my head as I read because we all have the same crazy thoughts, but Karen was the one brave enough to put the words down on paper.
~ Hope
Pennsylvania
Hilariously Infertile’s followers will love this book. She writes with an engaging voice and tells her story with her trademark sense of humor. Her followers will appreciate reading about her journey while they face their own infertility issues. This book will provide both humor and comfort to anyone struggling to have a family.
~ Dorothy Sasso
Philadelphia, PA
Hilariously Infertile made both me and my lady parts laugh, cry, and most importantly, not feel so alone in the baby making journey called IVF and infertility. Thanks to Karen Jeffries and her honest, irreverent, and real deal tell it like it is book, I can actually feel like an IVF baby making warrior and can hold my head up high in the journey that is infertility.
Christina
Leesburg, VA

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New to Infertility

award winning fertility doctor new york city

 

Hello Everyone,

As the years have gone by, I have very much enjoyed explaining the fertility treatment in a way that is a little more detailed and hopefully more clear than what you might be getting at your doctors office or from other infertility web sites.

The first blogs were more of a “basic training” in infertility, and with time the posts have become more focused on more complex elements of diagnosis and treatment.

The next few blogs will go back to more basic information for those who are new to the infertility world and need a starting point.  Certainly, all of the posts are available for reference.  Here you are with todays entry.

 

Infertility: The Basics

Infertility is a disease, and as with most diseases, nearly all suffers never thought they would be the ones afflicted.  Becoming pregnant is natural, necessary for us all to continue, and it doesn’t make much sense that barriers to conception could exist.  Unfortunately, some if us are indeed sub-fertile or even infertile.  In some cases there have been indications along the way that a woman or man may have trouble conceiving, maybe due to treatment of other medical or surgical conditions, but for most people, finding out that pregnancy has become evasive is troubling news.  The bright side is that significant advances in infertility care have rendered more people fertile than ever before.

I will first establish a few definitions.  I don’t like to spend too much time categorizing patients because it can lead to depersonalization, but you may encounter some of these terms, so here are a few.

 Infertility: the inability to conceive after one year of actively trying. This should be modified in women over the age of 35 to 6 months of trying.  Age is a very sensitive subject: no one wants to be told they are older or not be enthusiastically treated due to age, but age matters, as we will discus in a later blog.

Primary infertility: infertile and never pregnant.

Secondary Infertility: infertile after being pregnant in the past.

So if you have been trying for 6-12 months with no pregnancy, what is your next step?  It’s time to see a doctor. The workup is very simple, and who knows, there may be something discovered that is very easy to remedy that can quickly fix the problem.  Some people are worried about seeing a doctor because they have heard or read misinformation about the diagnosis and treatment options, but you owe it to yourself to at least find out what the problem may be.  Plus a good infertility doctor will explain many things to you about natural and assisted conception; this is valuable information that you should get from an expert.  Alternative educational sources can be excellent (like this website), but having a single experienced resource put everything together will help you make the best decisions.

What does the doctor do to determine what the problem may be?  The testing phase is not very complicated.  There are 3 initial tests.

1)   The hysterogram (the long word is the hysterosalpingogram, also abbreviated HSG). This is an x-ray test to confirm that the fallopian tubes are open. In order for pregnancy to occur, the egg has to make it from the ovary in to the tube, and then pass through the tube into the uterus.  And, the sperm needs to swim up from the uterus into the tube.  Thus, blockage of the tube does not allow for pregnancy to initiate.  The HSG also confirms that the shape of the uterus is normal. Previous uterine surgery can alter the shape. Also, some women are born with an abnormal shape to their uterus, which at times can be corrected.  Some doctors perform alternatives to the HSG, but others believe it is the best test to confirm normal anatomy.

2)   The Semen Analysis.  This is where the sperm is counted and checked for motility (movement) and morphology (sperm shape). If the counts or motility are low, the male partner may be referred to a urologist who can develop a treatment strategy.

3)   Analysis of ovarian reserve. All women lose eggs as they age, and unfortunately, even some very young women are left with a low or absent egg number.  The lower the egg reserve, the more difficult pregnancy becomes. To test for a diminished ovarian reserve you may be asked to have a blood test in day 2 or day 3 of your cycle for the hormones FSH, Estradiol and AMH (more on this in the next blog).

Once all of these tests are performed, your doctor can help you formulate a plan. There are many options available, your doctor will work with you to develop a course of action that is best for you.

Thank you for reading and I look forward to writing again soon,

Dr. Licciardi

AMH (Anti-Mullerian Hormone)

 

award winning fertility doctor new york city

 

Hello to all.

In this blog I will review the usefulness of Anti-Mullerian Hormone, otherwise referred to as AMH. AMH is one of the hormones, along with estrogen and a few others, produced by the ovary.

Like estrogen, AMH is produced by the granulosa cells. The granulosa cells are the small cells that surround each egg.  These small cells are tightly attached to egg surface whereby they help to vitalize and, when the time is right, mature the egg.   This egg-granulosa cell unit is called the follicle.

No one yet knows what the function of ovarian AMH in females.  AMH is present in males, and we know that it has a very important role in the development of normal male sexual anatomy.  What we do know about AMH in females is that the more healthy follicles one has, the higher the AMH levels.

Measurement of AMH levels can help us predict a woman’s fertility, in a very general way.  We already said that estrogen is also produced by the granulosa cells, so why wouldn’t we just need to measure estrogen levels to find out about ovarian health?  Because estrogen only comes from follicle at a time; the one that is in the process of ovulation. A woman may have 100,000 follicles, but on most cases only one per month gets involved in ovulation and becomes an estrogen producer.   Follicles may make different amount of estrogen each month, so judging fertility based on an estrogen test is not helpful.

Many follicles at one time, however, are producing AMH. Now it’s not every follicle, but it is a large number.  It works like this. The ovary contains different follicles in different stages of maturity.  Here is a microscopic view of the ovary.

 

Some follicles are very immature and have few granulosa cells; just one layer surrounding the egg.   Some follicles are more mature and their granulosa cells have multiplied into more cells in multiple layers.  These are the ones producing the most AMH.  In general, if you have a lot of eggs, you have plenty of follicles in all of the stages of development, giving you higher AMH levels.  Lower AMH levels mean fewer follicles of all types.

Follicles are always making AMH therefore levels can be measured any day in the cycle. In fact, it does not matter if a woman is on oral contraceptives, AMH is still produced and can be measured.

AMH may turn out to be and excellent way to measure a woman’s fertility potential, but we are not quite there yet. We do know that a high AMH is good and a low AMH is bad. What’s a good high level? We are still not sure. We know a little.  Any level over 2 is really not bad at all. Certainly, higher than 2 is better still. We know that undetectable levels, less than 0.16, are bad.  But, we have had women with these low levels become pregnant.  The odds of pregnancy are much worse for women with low levels, but people frequently get pregnant with low odds.  Some women have asked me if the level can be too high.  High levels may indicate the presence of polycystic ovaries (ovaries with an above average number of follicles).  While it is true that some women with polycystic ovaries have trouble conceiving, a high AMH level is not the issue.

Recent studies (one was in the headlines a few weeks ago) have used AMH levels to predict IVF outcome.  But again, really high levels were shown to be good and really low levels bad, but overall, not predictive enough to tell someone they can or can not get pregnant.

What we typically do is to put all of the information we have together to estimate ovarian health.  If we use age, FSH levels, AMH, antral follicle counts, the prognosis becomes a bit more clear, but the system is still not perfect.

AMH testing will become more useful sometime soon. More and more women need to have the test done do we can compare levels to outcomes on a large scale. In addition the laboratories need to get better at the testing.  But once we get better with AMH levels, we may be able to do some very important things.

For instance, some studies have been done comparing AMH levels to the time of menopause. Again, not ready for prime time, but the concept may be very important.  What if we could measure AMH in a young woman and determine at what age she will start losing her fertility? Or at what age will she lose half her fertility? What if we could measure AMH levels in a woman destined for chemotherapy and determine if she should freeze her eggs first?

These would all be wonderful uses of this test and it may be that in the future we could reach these goals.

It’s more likely that newer tests will be developed to improve ability to predict.  As alluded to before, combination tests may be more accurate. For example labs are starting to market “fertility profiles” based on AMH, FSH, inhibin and other hormones.

But in the end, like in all of medicine, the genetic tests will dominate.  Scientists are looking for a gene or groups of genes that control the fertile lifespan of women.  As genetic testing becomes less expensive and as we increase our ability to look at more and more genes at one time, the goal of accurately determining a woman’s ovarian age and potential will be reached.

 

Thanks for reading and please don’t forget to read the disclaimer from 5.17.06

 

Dr. Licciardi