Genesis Fertility Clinic Blog
searching: “clinic”
May 6, 2012
Birth Defects
I haven’t been blogging lately as my parents came to visit 10 days ago. My parents live in Nova Scotia and their only memory of themselves at my age is some version of perfection. I don’t know why, but I still need to prove to my parents I am not a screwup in life.
I did notice that the media has picked up on a study published in the New England Journal of Medicine recently that examined 308,974 births in South Australia between 1986 and 2002.
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April 23, 2012Importing Eggs
Usually I can see the controversy coming, but this time I didn’t. I was driving to work listening to CBC Radio One, and a lead news story was on the importation of frozen eggs from the USA. The story suggested this practice was questionable, ethically and legally.
We’ve had the ability to freeze and thaw human sperm and embryos for over three decades. Consequently, sperm and embryos are quite successfully frozen and shipped all around the world on a regular basis.
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April 10, 2012Known donors and the courts
The Supreme Court of Canada declined to hear an appeal to a paternity ruling from the Quebec Court of Appeal. The Quebec Court ruled a sperm provider has paternity rights to a child he conceived with an ex-girlfriend who, it seems, had asked him to be a known “sperm donor.”
Effectively, the Supreme Court upheld this ruling. This has significant implications for women who use known sperm donors for reproduction.
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March 29, 2012Dietary Fats and Sperm
Not a lot is known about what effects sperm count and quality. We know that tobacco, marijuana, alcohol, cocaine and heat exposure can all reduce sperm count, but the role of other genetic and environmental factors is unknown. A study from Harvard published in this month’s “Human Reproduction” suggests that dietary fat intake may influence sperm count and quality.
A higher intake of omega-3 polyunsaturated fatty acids was associated with improved sperm count and morphology, while a higher intake of saturated fats was associated with lower sperm count.
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March 28, 2012Music to my ears
You might be surprised to learn that many surgeons have strong feelings about playing music in the operating room. Some feel it’s unprofessional, others feel it’s only professional if its classical music, others feel any music is fine.
A small study by a group of plastic surgeons found that patients seem to like it, at least if they are having surgery while awake (i.e. under local anesthesia rather than general anesthesia). This study found that patients were less anxious if they heard classical music during their surgery.
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March 19, 2012Holistic
We try our best to be holistic at Genesis. I know we could be better at times. I sometimes find myself obsessed with surgery or IVF techniques, and I forget that patients bring much more than a uterus, tubes, ovaries and sperm to their appointments. People bring expectations, fear, past experiences, relationship issues, dreams, and much more to their appointments and treatment cycles.
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March 17, 2012Blastocysts versus earlier embryos
During an IVF cycle after a sperm fertilizes an egg and an embryo is created, the embryo can be grown/cultured in a laboratory for 1-5 days. Historically, most IVF embryos are transferred into the uterus 3 days after fertilization. More and more laboratories are growing embryos to day 5-6 (called blastocysts). Blastocysts have higher pregnancy rates than day 3 or earlier embryos. The reasons are multifactoral, but, in essence, if an embryo is healthy enough (genetically and otherwise) to survive culture to day 5, it is more likely to implant in the uterus and result in a successful pregnancy.
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March 17, 2012MacLean's Magazine
MacLean’s Magazine, which represents Canada like the beaver, maple syrup and snow, has an article this week on Anti-Mullerian Hormone (AMH). A few fertility doctors, including myself, were asked their opinion on AMH testing. It’s a good review for those interested in tests of egg count/ovarian reserve.
You can read it here.
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February 16, 2012Uterine artery embolization. WAIT!
Uterine fibroids are very common, benign growths on the uterus. Most fibroids don’t cause a problem although some large fibroids can cause pelvic pressure and heavy periods, and fibroids inside the uterine cavity (called submucosal) can reduce fertility.
Depending on their size and symptoms, fibroids can be treated with medications, surgery or uterine artery embolization. For women who wish to conceive, the standard treatment of a symptomatic fibroid is surgical removal, called a myomectomy.
In the past week I have seen three women who have had uterine artery embolization (UAE) before they began trying to conceive.
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February 8, 2012Survey, Schmer-vey
I really find the results of a recent survey by the Guttmacher Institute hard to believe.
The group surveyed 1,800 unmarried men and women in the USA and found that 20% of people in their 20s believe they are infertile (when actually about 6% are). Huh? Hasn’t the focus of public health education for the past 3 decades focused on contraception and fear of an unwanted pregnancy? I thought that this age group believed they could conceive at any moment and are quite vigilant with contraception. What I see in my practice are couples who have spent years using contraception with the belief they are very fertile only to find out they are not after stopping contraception.
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January 29, 2012Caffeine
My colleagues and I sometimes joke that we went to university for 13+ years and now that we are in practice we get asked “can I dye my hair in pregnancy?” and we can’t answer it! We were never taught the answer! We learned about molecular mechanisms of disease, spent hours in the histology lab reviewing cell structures, sat through many lectures on metabolism and pharmacology, etc. but we were never taught the answers to many everyday questions.
One such question I’m often asked is “how much caffeine is safe when trying to conceive?”
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December 15, 2011Varicocele
There are lots of grey areas in reproductive medicine. Sometimes being unclear what the best treatment is makes my job interesting, and other times it makes it frustrating. One frustrating grey area is the management of varicoceles.
A varicocele is an abnormal dilatation of a vein in the scrotum that drains blood from the testicles. Varicoceles can cause pain or aching in the testicles and can effect sperm count and quality. There is little doubt that (at least large) varicoceles can impact sperm, but it is unclear whether fixing them meaningfully improves sperm counts.
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September 13, 2011NSAIDS + pregnancy = bad
If the amount of shelf space a pharmacy dedicates to a particular drug class is proportional to it’s sales, then non-steroidal anti-inflammatories (e.g. Advil, Motrin, Midol, Aleve) are big sellers. Pharmacy shelves are stocked with several different brands of these medications commonly used for pain. NSAIDS are also included in several cough and cold remedies. As North Americans over half of us have used an NSAID for pain in our lifetimes. When you are pregnant, though, you should reach for something different on your pharmacy’s shelf for pain.
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August 28, 2011Choosing who is right
I don’t know why I read Ian Brown, a Globe and Mail writer. Every time he writes about his son Walker, or how Walker’s disease relates to some topical issue, I cry. Last year when exerts from his book, The Boy in the Moon, were published by the Globe, I read, unable to hold back tears. Walker, who is now 15, has an impossibly rare genetic disorder that leaves him profoundly disabled.
This week, Mr. Brown wrote about his son in the Globe again. The article was about the new at-home fetal-DNA tests available in the USA.
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August 4, 2011Sex Position and Gender
Later today one of my dear friends is have a c-section to deliver her third child. Like her first two, this child is a boy. After having two boys, she and her husband really wanted to have a girl. She asked whether certain foods or sex positions can increase the chances of conceiving a girl.
She had read lots of different advice on the internet, based on common myths about gender selection. Sadly, none of these work.
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June 20, 2010Osteoporosis
Ok, infertility and osteoporosis aren’t intimately related, but as a “public service announcement” I thought I’d post that all women should be taking about 1,000 – 2,000 IU of vitamin D per day (depending on how much vitamin D you get in your diet and from the sun).
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June 16, 2010AMH
Fertility declines with age because egg number and quality decrease over time. This happens to all of us (unless you are a celebrity it seems! Ok, that’s a donor egg discussion I’ll leave for another entry).
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June 8, 2010How do people choose a clinic?
Driving down the strip in Las Vegas this past weekend while on vacation I heard an advertisement on the radio for a fertility clinic. My gut reaction was “ugh.” It sounded like they were announcing a mattress sale or deeply discounted used cars. It just didn’t feel right, and it made me wonder how many people choose a fertility clinic based on similar advertising.
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May 28, 2010Pregnant at 47
John Travolta’s wife is pregnant at the age of 47. I bring this up because daily since the news broke a patient who is aged 43-50 has asked me how they could get pregnant yet she can’t.
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May 9, 2010Mother's Day
Mother’s Day can be a particularly painful day if you are infertile. An American Infertility Awareness Association speaks to the difficulties the day can bring for women and some tips to make it better. Read here.
Here’s hoping the day brings joy and hope….
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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January 3, 2010Public Vs. Private Health Care
Nearly every week either a patient or someone I meet socially will ask me whether Genesis is a “private health care clinic.” The short answer is “no.”
According to Health Canada, private health care clinics in Canada are “facilities that receive no government funding: the physicians are not reimbursed by the provincial health care insurance plan and their patients must pay the full cost of the services rendered to them.”
At Genesis, we are fully within the public health care system, i.e. MSP. The catch is that not all the services we provide are covered by MSP.
I admit that the public versus private health care issue is a bit confusing as there are gray areas. The health care system in Canada is publicly funded but mostly privately delivered. Most people are treated by physicians who are in their own private practice (including your GP). This means that they are not paid a salary by the government, but they bill MSP for your medical treatment rather than charging you directly.
We are just like any other physicians or medical clinic in this regard: we see you at Genesis and bill MSP for treatments they cover. This includes your consultation with us, surgery, ultrasounds to monitor menstrual cycles, and emergency room treatment. Even your fertility tests are covered by MSP. There are a number of treatments that are not covered by MSP and these include IVF, some sperm tests and artificial/intrauterine insemination. The reason for this is that Health Canada has decided that:
… a number of services provided by hospitals and physicians are not considered medically necessary [including vitro fertilization and artificial/intrauterine insemination] and, thus, are not insured under provincial and territorial health insurance legislation. Uninsured physician services for which patients may be charged differ from province to province.
At the moment, Quebec is the only province that plans to covers IVF (likely starting in the spring 2010). However, there has been some promising progress in Ontario as a report released in August 2009 by the The Ontario Expert Panel on Infertility and Adoption proposed that Ontario health care should fund up to three treatment cycles and one session of counseling. The report argues that health care costs would be reduced by funding and regulating IVF. Currently, these recommendations are being reviewed by Ontario healthcare (OHIP), and if they were adopted that would put pressure on other provinces to follow suit.
At Genesis, we have been long-time advocates for IVF to be funded by public health care, and Dr. Albert Yuzpe sits on a national board that is lobbying the government.
We are committed to promoting reproductive health and advancing fertility treatments. In addition to caring for our patients at Genesis, we work at VGH and BC Women’s providing gynecology services and teaching medical students and residents.
And while it doesn’t help you if you are trying to conceive with IVF or other uncovered treatments now, we do hope that our efforts are going have an impact on the delivery of fertility treatment in the future.
Because the decision to fund or not to fund fertility treatments is largely political, public pressure on both your MLA and on the BC’s health minister Kevin Falcon may help bring about change. If you want to express your views on the need for public funding for fertility treatments like IVF, you can e-mail Kevin Falcon at Kevin.falcon.mla@leg.bc.ca
Dr. Beth Taylor
Reproductive Endocrinology & Infertility