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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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The Failed HSG

award winning fertility doctor new york city

 

Today I will talk about why some women go in for an HSG and leave being told the test could not be done.

This is such a common problem, and it is usually all about the same thing. It’s about technique. The correct technique makes it easy, a different technique makes it unnecessarily difficult.

There are 2 ways to do a HSG. Remember the goal in performing a HSG is to get the dye in the uterus and then have it flow out of the tubes. To achieve this, many doctors slide a catheter through the cervix up into the uterus. This is the problem. If the cervical canal is narrow, whether naturally or as a result of some scarring after surgery, the catheter can’t get in easily. This results in pushing harder, and this causes pain, and pushing harder still may just jam the catheter against the side of the cervix. This leads to failure.

The second and easier way, for both the doctor and patient, is to put the dye in a syringe and put a soft cap on the end that snugs up against the cervix. We call this cap an acorn. The canal through the cap brings dye from the syringe to the cervical canal and up towards the uterine cavity.

Imagine trying to blow up a long skinny balloon by first shoving a straw half way in; it’s not so easy to get that straw through. But if you blow it up by just puffing into the hole (I know some of these balloons are hard to blow up but I’m just trying to illustrate the point) things go much easier.

Here are 2 pictures. Each has graphics that are a little different, but they are both drawings of HSGs, both represent a different way to do an HSG.


In the first, a catheter has been shoved through the cervical canal into the uterus. You can see the catheter inside with that little balloon at the tip. The balloon is designed to prevent the dye from backing up and coming out of the cervix. This makes sense, but there is a better way. In the second picture, the instrument is just pressed against the cervix, and that blocks the dye from coming out backwards. As you can see, nothing is shoved through the cervix. The dye finds its way into the uterus just from the pressure.

Even if the canal is very narrow, it does not matter, because the fluid dye will still have no problem following the path of the cervix. The same is true if the uterus is very ante-verted or retro-verted (tilted forward or backwards), both of which can make it very hard for the catheter to slide through the cervix and into the uterus. I’ll talk more about tilting soon in my upcoming blog about cervical stenosis.

I frequently see patients who some to see me having failed an hsg, meaning the test never got off the ground going because the catheter could not get into the uterus. The test was overly painful and there were no results to show for it.
All I do is repeat the test using the plug in the second picture and the test easily gets done. Occasionally I need to open the very end of the cervix in the place where the plug goes, but that’s much easier than needing to dilate the entire cervix to accommodate the full balloon catheter.

So if you had trouble with the HSG and live around NY, I would be happy to give it a go. Otherwise get the HSG done elsewhere, but ask first if they use the balloon. To be fair, even using my technique, rarely, rarely it still can’t be done and in that case I may need to dilate the cervix in the office or operating room.

Thanks for reading and please read the disclaimer from 5/17/06.

Dr. Licciardi

Who is Reading Your HSG?

Let’s say your HSG is performed in the proper way. What about the interpretation? The results of your HSG may have a big impact on your course of therapy. If it’s normal, but someone says the tubes are abnormal, you may be pushed into surgery or directly to IVF. If your tube or tubes are really blocked and the report says they are open, you will waste months or years trying intercourse or insemination with no hope for a pregnancy. And as we said in the last blog, the jury is out on what people are saying about the uterus. Is it really possible that the readings could be so off? You bet it is. It happens every day, many times per day. I see it over and over again.
Your infertility doctor needs to look at the films directly. When my patients bring in their films for me to review, the first thing they say is, “the report is in there too”. I say thank you and look at the report, but the report is mostly useless. It’s the films that I want to see.
Now to be fair, there are a few radiology groups who do an excellent job with both the films and the reports. Most, however, do not have the experience to write an accurate report. They may have experience in doing the x ray, but because they are not surgeons, it’s hard for them to relate the x-ray to what’s really going on inside.
So, make sure your fertility doctor looks at your films, not just the report. If you are concerned about the interpretation of your HSG, get a second opinion.
I will get to the accuracy of a hysteroscopy. Thanks for reading and see post 5/17/06.

References:

  • Steinkeler JA, Woodfield CA, Lazarus E, Hillstrom MM. Female infertility: a systematic approach to radiologic imaging and diagnosis. Radiographics. 2009 Sep-Oct; 29(5):1353-70.
  • Ayida G, Chamberlain P, Barlow D, Kennedy S. Uterine cavity assessment prior to in vitro fertilization: comparison of transvaginal scanning, saline contrast hysterosonography and hysteroscopy. Ultrasound Obstet Gynecol. 1997 Jul; 10(1):59-62.
  • Swart P, Mol BW, van der Veen F, van Beurden M, Redekop WK, Bossuyt PM. The accuracy of hysterosalpingography in the diagnosis of tubal pathology: a meta-analysis. Fertil Steril. 1995 Sep; 64(3):486-91.