Genesis Fertility Clinic Blog
searching: “pregnancy”
July 3, 2010
Health and relationships
With the HST, school-board funding cuts, and numerous other political bad news stories many of us are disillusioned with government these days. There is a small good news story, however. The provincial government is introducing a new initiative that focuses on the relationship between health care providers (e.g. family doctors) and patients. The concept is that if patients have meaningful, trusting relationships with their health care provider they will have better health outcomes. They assert that care happens within relationships built over time and providing care, as opposed to delivering depersonalized “units” of health service, makes people get better faster, and feel better about their care, while bringing deeper meaning to the work of providers.
You can read the Vancouver Sun report here.
The government is trying to help people who want a family doctor find one, help family doctors communicate with other physicians more efficiently and improve patient’s relationship with their physician.
There is no doubt in my mind that if a patient interacts with their physician over time in a positive way, trust is built, both parties understand each others needs better and testing/technology/treatments are better personalized.
For more information the BC Medical Association’s report on this initiative can be read here
Some good news out of the legislature! Now, if they could legislate some sunny days….
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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May 4, 2010IVF Pregnancies: As healthy as the rest?
It remains unclear if pregnancies that follow IVF have the same risks for preterm birth, stillbirth, growth restriction, and other pregnancy complications as those conceived without fertility treatment (spontaneously conceived pregnancies). I think it’s reassuring that the answer is unclear. If pregnancies following IVF were significantly more complex or risky, we’d know by now as there have been over 3 million such pregnancies in the world to date.
A Japanese study published in 2010 examining over 53,000 singleton IVF pregnancies found no significant increase in perinatal risk (including stillbirth) to the pregnancy or fetus. In contrast a study published this year of over 20,000 women with singleton pregnancies in Denmark found that risk of stillbirth in women who conceived on their own (spontaneously) was 0.4% compared to 1.6% for those who conceived with IVF. When big studies like this contradict each other, it’s hard to know just what to say to infertile couples.
Twin pregnancies are riskier than singletons whether they are IVF or spontaneously conceived. A recent review suggests that IVF twin pregnancies have a higher risk of premature birth and low birth weight than spontaneously conceived twins.
My belief is that IVF pregnancies may have more risk than spontaneously conceived pregnancies, particularly twin pregnancies, but the increased risk is small. Whether an increased risk is a product of fertility treatment or possible reproductive problems in the couple (i.e. is it the treatment or the couple?) is unknown.
In my opinion and experience, few couples decide not to pursue treatment because of small, unclear pregnancy risks.
Hopefully, in time the picture will be clearer and even more reassuring.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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April 14, 2010Robitussin to the rescue?
Some remedies go in and out of fashion. Flat ginger ale for nausea, lemon & honey tea for a sore throat, beer for limp hair, vitamin E for wound healing, tea tree oil for warts, etc. They all have a plausible relationship to their believed effect and they have all been reported to help their ailment.
But did they really help or was it coincidence? That’s where science comes in. It’s the difference between anecdotal-based medicine and evidence-based medicine. Evidence-based medicine has been what has defined “good medicine” for the past 40 years; prove that a treatment is better than luck and physicians will support it.
I do my best to practice evidence-based medicine, and I know I would want evidence-based medicine practiced on me. If I had a cancer I’d like to know that the treatment I was given was tested on X number of people and found to be the best possible treatment, compared to all others.
Recently, the Globe and Mail published an article on the use of Robitussin for fertility. This is anecdotal medicine. Let me explain. About 2% of couples with infertility are infertile because of a problem with the woman’s cervix, mostly thick mucus that is “hostile” to sperm. In the 1960s and 70s physicians would perform a post-coital test to examine the mucus to see how the sperm were faring. “Hostile” mucus was thick and had few motile sperm. While interesting, it did not seem to be a very valuable test as women got pregnant on their own just as often if their mucus was “hostile” or not. So, the test was pretty much abandoned. (I still have a few patients see me with post-coital test reports from fertility clinics, mostly clinics in the developing world.)
So the test doesn’t help. What about treatments that thin the mucus making it less “hostile?” This is where Robitussin comes in… the active ingredient does a half-decent job at increasing the water content (thereby thinning) mucus in our lungs when we have a cold. This thinner mucus is easier to cough out so Robitussin’s active ingredient, guaifenesin, is an expectorant. If it works on lung/airway mucus, perhaps it works on cervical mucus? Well it probably does, but does that make you more likely to get pregnant? No. Firstly, if you are infertile there is a 98% chance that you have another explanation besides your cervix. If you are in that 2% it could help, but the science to date (I will admit it’s limited) indicates that making your cervical mucus less hostile doesn’t matter.
I believe the best place to conceive is at home in your own bedroom, so I am very supportive of treatments and strategies that can help at home. I just don’t think this is one of them.
So, what do I suggest? If there is no other explanation for your infertility and you are young (i.e. you have some time to spend trying), you might chose to try this for a month or two, understanding that what you are doing it is similar to drinking a can of flat ginger ale to settle your stomach. Sometimes your stomach feels better afterwards, but it probably would have felt better anyway.
If you are infertile, here’s hoping you find success whether it comes from modern medicine or good luck. Robitussin is in the “good luck” category.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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April 6, 2010Embryo donation
On Saturday the Globe and Mail had an article on a new embryo donation program in Ontario called Beginnings Family Services. The article includes an interview with Dr. Jason Hitkari of Genesis.
Click here to read the Globe and Mail article.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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March 24, 2010World's Oldest Moms
The CBC program, the Passionate Eye, has a rather interesting documentary titled “World’s Oldest Moms.”
It explores the very controversial journey of post-menopausal women (up to age 72!) to achieve a pregnancy. This is the extreme of fertility treatment in the world. In general, Canadian clinics will not help a women conceive after age 51.
It is fascinating to see just how far people and their doctors will go.
Just because we can, should we?
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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March 10, 2010Does race affect IVF outcome?
According to a Statistics Canada report released this week, by 2031 visible minorities will be the majority in Vancouver. What does this mean for fertility care?
Differences in reproductive outcomes across racial groups have been reported. It is controversial, however, just how significant the differences are and how to apply studies of racial differences to our patients. We have mixed race couples, mixed race patients, and patients who have lived for variable amounts of time in Canada (e.g. some just arrived from another country this year while others’ families have lived in Canada for generations). No studies to date have examined these categories of patients; instead, we have information on women whose race can be “accurately” categorized.
What do we know about the influence of race on IVF outcome?
Black women have lower pregnancy rates from IVF compared to white women. Hispanic women have similar IVF pregnancy rates as white women but have higher miscarriage rates. Asian women have lower pregnancy rates than white women but higher than black women.
Once pregnant, black and Hispanic women are more likely to deliver preterm. White and Asian women have the same risk of a preterm delivery.
There are many possible reasons: differences in obesity rates, causes of infertility, socioeconomic status, environmental exposures, and behavioural factors.
At Genesis we adjust treatment protocols based on many patient factors. Going forward we look for trends in IVF outcomes of different racial groups to continue to try to optimize pregnancy rates.
Click here to read more about race and reproduction.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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February 23, 2010Thyroid hormone, Cows and IVF
A recent study from the Ontario Veterinary College found that adding thyroid hormone to the culture media in which IVF cow embryos develop might improve the embryo quality. In general, better quality embryos are associated with a higher pregnancy rate with IVF. See the Globe and Mail — Fertility research: Thyroid hormone may boost in-vitro conception.
Potentially, human IVF success rates could be improved by the addition of thyroid hormone to the culture media. Before we can conclude this, however, we need to determine if the better quality embryos created in the study mean higher pregnancy rates. Then the same study needs to be done in humans. If there is a benefit, then we would incorporate this practice into our embryo media.
At present, we require that women undergoing IVF at Genesis have normal thyroid hormone levels. Thyroid hormone is known to affect egg development and uterine lining (endometrium) quality. As a result, women with abnormal (high or low) thyroid hormone levels have lower success with spontaneous conception and conception with IVF.
It is so important that we explore human and non-human models of IVF as we work to optimize IVF pregnancy rates and the health of the children created by IVF.
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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February 18, 2010Home-made twins
Of the 30 people you in Canada one of them is likely to have a twin brother or sister. The lowest chance of meeting a twin is in Asia, where 1 in 70 persons is a twin and the highest chance in Nigeria where 1 in 12 persons is a twin.
There are two types of twins, dizygotic (DZ) and monozygotic (MZ) twins. DZ twinning occurs when two separate eggs are released during the same menstrual cycle and are fertilized by two sperm, creating “fraternal twins.” MZ twinning occurs when a single egg is fertilized by a single sperm and the resulting embryo splits a few days later creating “identical twins.”
DZ twins can occur spontaneously (i.e. home-made!) or as a consequence of fertility treatments. Patients will sometimes ask me about their risk of having twins; “my mother was a twin so am I more likely to have twins?” If you are undergoing fertility treatments the major increase in twin risk is due to the treatment. The minor influence of family history is washed away by the large fertility treatment effect. For example, if a woman’s mother is a DZ twin the woman is about twice as likely to have a DZ twin pregnancy (to about 1:15). If that woman does fertility treatment she has up to a 40% chance of having a DZ twin pregnancy (depending on the type of treatment of course).
It is known that your mother’s family history of twinning effects your chances as does your age (older women have a higher chance of conceiving DZ twins). A study published this month in Fertility & Sterility observed that a woman’s height and body mass index also affected her chances of having DZ twins. Specifically tall women and overweight women have more DZ twins. Current thinking is not that being tall or overweight increase your risk, per se, but are related to a gene that causes multiple ovulations.
Other factors that increase your risk of conceiving DZ twins include increasing female age, conceiving in the summer or autumn, cigarette smoking, recent use of the oral contraceptive pill, and folic acid consumption (controversial).
Understanding factors that influence DZ twinning can help shed light on the mechanism of multiple and single ovulations. The more we know….
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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October 19, 2009DHA and pregnancy
Once we help a couple get pregnant one of the most common question I get asked is “what supplements should I take?” Seems there’s lots of advice given out at health food stores, pharmacies and by our friends about all sorts of things like raspberry tea, coenzyme Q10, fish oil, ginger, vitamin B6, etc.
What have large studies of women in the developed world shown that pregnant woman should be taking? A multivitamin containing folic acid (0.4mg to 1.0mg unless you are in a high risk group for a neural tube defect) and perhaps DHA. That’s it. We need iodine to prevent thyroid disease in the newborn but we get enough in our salt in Canada. So, if you have a reasonable diet and take a multivitamin with folic acid (the best studied are Materna and Pregvit) and perhaps some DHA you are doing everything right from a evidence-based nutrition perspective.
Sure, some people swear you should take extra B6 or a miriad of different herbs, but until a big studies suggests there is a benefit, and most importantly no harm, I’d stick with the basics. DHA is an interesting one…. there is some evidence that it helps with an infant’s gross motor control and visual acuity if taken in pregnancy. When to take it and how much isn’t clear. So, what do I take (I am 38 weeks pregnant now)? I take a DHA supplement daily that has been purified from fish oil (NOT fish oil as many preparations have too much vitamin A) that has 900mg of DHA and 180mg of EPA. The Institute of Medicine in the USA recommends 300mg/day while a similar European regulatory body suggests much more. So I take somewhere between the two. When to take it? Probably the last half of pregnancy – that’s when it’s been most widely studied.
I hope this helps… and if you are reading this I hope you have to decide on what supplements to take in pregnancy soon!
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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September 6, 2009Pregnant at a Fertility Clinic
When you are struggling to get pregnant it seems everyone around you is pregnant or pushing a baby stroller. Friends volunteer their conception story hoping to help but it often makes you feel worse. Stories like “we weren’t even trying,” or “I’m so fertile I got pregnant on the pill,” or “if I even look at my husband I get pregnant.” It’s hard. At least at a fertility clinic nearly everyone is either struggling like you or is pretty sensitive to your cause because they work here.
Currently at Genesis we have 4 pregnant staff and I am one of them. I’m not sure how my patients feel about seeing a pregnant fertility doctor but I’m guessing for some it’s not easy. My due date is in early November so it’s just been the past few weeks that my pregnancy has been obvious. A couple of our nurses are a little farther along in their pregnancy, so for the next couple of months when you come to Genesis you’ll likely see a pregnant woman…. we know that can bring up mixed feelings.
Interestingly, most of us didn’t get pregnant easily. We’ve all taken a path to get there – some of us needed surgery, some needed IVF, some needed clomiphene, some needed a combination. On some cosmic level I wonder if we ended up working at a fertility clinic because we had our own fertility issues?
So take heart that we empathize with your struggle and truly do appreciate that’s not easy to see a pregnant belly when you would really like one of your own. We’ll work hard to give you one!
Dr. Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility
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May 16, 2009At the end of the day
At the end of a day, one of the things that we doctors at Genesis like to do is to sit down together and talk about the day. We talk about difficult cases and great success stories and everything in between. It is a great opportunity to bounce ideas off each other. Often, someone will have read a medical article that he or she feels should be shared and discussed. We also talk about cases from the past that may shed more light on what is going on with a particular patient now.
These kinds of informal discussions are really important for both us and our patients. For our patients, this kind of communication makes sure that all heads are being put together to try to optimize their care and treatment cycle. For us, it allows for a forum of discussion and keeps the work interesting and challenging.
As our computer software improves, what we are finding is that it gets easier and easier to access patient information quickly. What we docs have been doing at the end of the day lately is reviewing the pregnancy test results that have come in that day. It is tremendously exciting to see a positive pregnancy test result in patients but it is also very important to know whose result was negative.
Being a fertility doctor is incredibly satisfying work for many reasons – most of which is helping our patients with their fertility journey. Some patients get pregnant relatively easily and they are thrilled, sending cards and thank-you’s with pictures of their new babies. Many patients struggle and get frustrated and angry with their journey. Believe me, we get frustrated too. Sometimes we have no answers or we have found problems that are insurmountable. These can be frustrating conversations but they are conversations that must be had.
It is in these little meetings at the end of the day that we docs can talk about our patients and spend some time reflecting on the work that we do and the things we have yet to know.
Dr. Jason Hitkari, MD, FRCSC
Reproductive Endocrinology & Infertility
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April 16, 2009Misconceptions
I am currently reading Naomi Wolf’s book “Misconceptions.” The book is an exploration of her and her friend’s experiences getting pregnant, being pregnant and delivering. It’s a very honest look at the fears, values, and the misconceptions we, as women, have about pregnancy and child birth that our often paternalistic society supports. It is terribly cynical of the US health care system and I believe much of it doesn’t apply to Canadian’s (e.g. greedy US hospitals pushing amniocentesis as it is apparently profitable, or obstetricians motivated not by patient best interest but by medical-legal factors) as we fortunately have a public health system and doctor’s medical-legal risk is low. Nevertheless there are some lessons to be learned from these women’s journey’s and the section on infertility really struck a chord with me.
The women paint a picture of very dismissive, impersonal and incomplete fertility care. Some of the women had to wait 2 hours for their appointment, were ill informed of what to expect after fertility surgery (e.g. laparoscopy), were given limited information on the cause of their problems, etc. The most disturbing part for me was that women were left feeling that they had failed. That their doctor allowed them to be “…primed for self-hatred.., or at least a sense of being defective.” It made me rethink some of the diagnoses we give couple’s like “premature ovarian failure,” “failed fertilization,” etc. I think it’s easy to forget how powerful words can be and how important the patient’s emotional well being is to the success of fertility care. The connection between a couple and their doctor, even the whole clinic, probably influences the outcome of treatment . The words we use, the time we spend with each other and how we all feel about the treatment plan probably matter as much as the medical intervention itself. I spent 14 years in training (not because I am slow, it just took that long!!) and I think I am pretty good at the medical interventions of fertility care. “Misconceptions” reminds me that the medical aspect is just a part of what I do. Now to keep working on the rest of fertility care….
I encourage women, mostly pregnant women, to read “Misconceptions.” Actually most of Naomi Wolf’s work is interesting, in my opinion, to the post-feminist 30-40-ish woman.
Beth Taylor, MD, FRCSC
Reproductive Endocrinology & Infertility