HSG at FTC…

There are three major advantages to having an HSG X-Ray at the Fertility Treatment Center.

The physicians at FTC use a “Soft Technique” which causes minimal discomfort compared to techniques used at most other facilities.  If indicated, oil contrast is used to further boast subsequent pregnancy rates. If blocked fallopian tubes are discovered then tubal cannulation procedures are immediately available which usually results in opening the tubes. In addition to these advantages, HSG X-Rays performed here at FTC are done so by Board Certified reproductive endocrinologists (infertility specialists) not radiologists, eliminating the need for a written report to he issued by a radiologist which takes time, thus often causes a subsequent delay in a patient’s fertility treatment.

1. Soft Technique

Over the years, HSG X-Rays have acquired a bad reputation as a difficult procedure, and an especially painful test. Standard techniques used by most radiology facilities often cause severe pelvic cramping and discomfort.

Many patients who have had the test are often reluctant to repeat the HSG X-Ray due to their unpleasant prior experiences.  At Fertility Treatment Center, the HSG X-Ray usually allows for a much more pleasant experience, with minimal or no discomfort— due to the unique and special methods developed at our facility.

We do not use a tenaculum (sharp metal clamp), instead a lighted plastic speculum that is specially designed to tilt the cervix to the proper position is substituted, resulting in proper alignment of the uterus in almost 95% of all patients.

A soft balloon tip dye injector is used instead of a rigid metal injector, and the balloon is inserted only a minimal distance into the cervix —thus avoiding significant cramping and allows the doctor to have a better view of any abnormalities that might be present in the uterus.  Dye is injected into the uterus and out the tubes slowly and with low pressure, a technique that dramatically reduces or eliminates cramping pain during this phase of the procedure.

The average time for the entire test is less than 4 minutes, and patients usually go home 10 to 15 minutes later.

2. Immediate cannulation of blocked fallopian tubes

In approximately 25% of cases, routine HSG X-Ray reveals blockage of one or both fallopian tubes at the point where the fallopian tube exits the uterus.   If proximal occlusion is encountered with HSG, at FTC the option of immediately opening the fallopian tubes using a Novy tubal cannulation device is done.

….Stay Tuned for more about this time and cost saving technique in my next blog entry.

Hysterosalpingogram X-ray

Hysterosalpingogram X-ray

The hysterosalpingogram x-ray is a valuable fertility test used primarily to determine whether fallopian tubes are open. It is both a diagnosis test and a fertility therapy.  Pregnancy rates are often doubled or tripled for several months after the HSG x-ray.

What might be found on HSG x-ray ?

Normal uterus and tubes -

The most common result of HSG is normal anatomy. Usually no abnormal uterine or tubal findings are encountered. In this case, the HSG x-ray is still worthwhile due to the significant increase in pregnancy rate for several months afterwards.

Tubes blocked — proximal, mid, or distal

Proximal tubal block is the point where the tube exits the uterus, and blocked fallopian tubes are discovered then a tubal cannulation procedure is done resulting in approximate 70% success in reopening the tube

Mid tubal block – is 2 or 3 inches down the fallopian tube, rarely encountered, cannulation doesn’t work

Distal block — at the end of the fallopian tube, a relatively common finding, can be opened by laparoscopy surgery.

Hydrosalpinx -

A type of distal block where the end of the fallopian tubes fills with fluid and balloons out like a water balloon. This may significantly decrease pregnancy rates as stagnant fluid in the tube cannot escape out the blocked end, so it occasionally backs up into the uterine cavity and poisons embryos. Even In Vitro Fertilization success rates are cut in half or two thirds by the presence of a hydrosalpinx. A Novy cannulation doesnt work opening this type of tubal blockage.  It is fixable by laparoscopy to either open the end of the fallopian tube (neosalpingostomy) or to remove an unfixable tube. After surgery, success rates are typically doubled or tripled.

Salpingitis Isthmica Nodosa (S.I.N.) -

A common type of proximal tubal block, usually opened by cannulation

Filling defects in the uterus

Defects in the uterus are often encountered on HSG x-ray. These tend to be smooth uterine polyps, the most common finding. If they are small and out of the way, no therapy is required and they do not interfere with pregnancy success rates. If they are large or in the middle part of the uterus, they may decrease pregnancy rates, but can be easily removed with a minor 12 to 15 minute outpatient procedure. Other types of uterine defects include small fibroids inside the uterus or scar tissue (Ashermann’s syndrome) which is left over from a previous difficult delivery or a dilation and curettage procedure. If minor, it is easily corrected and does not interfere with subsequent success rates. If a significant amount of scar tissue is present, then a more advanced hysteroscope correction procedure will be required, but usually results in good pregnancy rates afterward.

Uterine anomalies

These include congenital uterine defects such as uterine septum, didelphic uterus, T-shaped uterine cavity, or asymmetrical uterine cavity. These defects, including T-shaped cavity, are usually correctable by operative hysteroscopy procedures.

IN VITRO FERTILIZATION AS A DIAGNOSTIC TEST

Why hasn’t this couple achieved pregnancy?
While IVF is an effective form of infertility treatment, what many don’t know is that IVF can also be an invaluable diagnostic tool. It is the only “test” that allows fertility doctors to diagnose one or more of the following hidden causes of a patient’s infertility:

#1 Empty Follicle Syndrome

We obtain several ultrasound images of the ovaries during each IVF cycle and expect about 80% of ovarian follicles to contain an egg. Sometimes, after we “tap” the follicles we find there are actually no viable eggs inside. In these patients we know that Empty Follicle Syndrome is to blame for the patient’s infertility.

#2 Egg Immaturity

In general, the larger the follicle size on ultrasound, the more mature the egg. However, we sometimes find follicles that look great on ultrasound, but once we extract the eggs, we find that they are immature and won’t fertilize well.

#3 Fertilization Defect

In many instances, a patient may have many viable appearing eggs and their partner’s sperm also look great, but the two just simply bounce off each other and won’t fuse together and fertilize. IVF is the only way we can evaluate the Fertilization Rate, by looking through a microscope to see if a patient’s eggs fertilize or not.

#4 Slow Embryonic Development

Once a human egg is fertilized, it should undergo cell division every 10 hours. In some cases, the cell division may be slower, for example every 18 to 20 hours, running so far “behind schedule” that it cannot implant into the uterus to achieve pregnancy.

The great thing about In vitro fertilization is that I can not only use it as a wonderful diagnostic tool, but I can usually treat the diagnosis problem during the IVF cycle. If a patient’s eggs are immature, we add a special maturation fluid. If they don’t fertilize, we’ll make them fertilize by doing ICSI, injecting the best sperm directly into the egg. If the embryos develop slowly, we can simply freeze them and wait for the right time to implant them during the next cycle.

At Fertility Treatment Center, we treat our patients as individuals…and take great care in personalizing treatment plans that meet each patient’s specific needs.

It’s Not Just Getting Pregnant But Staying Pregnant…

Recurrent Miscarriage
One of the more common reproductive disorders we treat at all of our offices is a condition known as recurrent miscarriage syndrome.

Recurrent miscarriage syndrome has been recognized by medical science for centuries. However, only in the last 30 years have effective diagnosis techniques and therapies become available to treat this relatively common syndrome.

Some women have great difficulty achieving pregnancy, only to lose many or most of these hard won pregnancies to miscarriage.

Other women have no difficulty achieving pregnancy, however may encounter difficulty caring the baby to term, and unfortunately lose multiple pregnancies to repeat miscarriages.

Traditionally a diagnosis of recurrent miscarriage is made after two consecutive miscarriages, or three total miscarriages.

At Fertility Treatment Center, we know that having a baby is of paramount importance to our patients, so we tend to expand our definition of recurrent miscarriage syndrome to include women who have experienced two miscarriages—consecutive or not.

Nearly all women diagnosed with recurrent miscarriage have one or more of the following issues:

Uterine abnormalities: Uterine fibroids, large uterine polyps, or uterine septum, which can be easily diagnosed and corrected through relativity simple outpatient surgical procedures.

Uterine infections: Can be diagnosed by a simple Q tip test, and usually treated with a course of carefully selected antibiotics.

Hormonal disorders: These include very low thyroid levels or very high
prolactin levels, low progesterone level, or high insulin levels.

Genetic disorders: Includes shifted chromosome sections in the mother or the father, or surprisingly, very high sperm counts resulting in multiple fertilization of the egg.

Immune system disorders: These are the most common, and include blood clotting abnormalities resulting in microscopic blood clots plugging up the early placenta, antibody attack of the placenta, underproduction of the folate vitamin, or incompatibility of the mother’s and father’s immune system HLA type.

Each category of recurrent miscarriage has its own tests, and nearly all diagnosis have a specific therapy. FTC does organized, efficient diagnostic evaluations and customizes treatments that are tailored to the diagnosis and to the individual patient. This maximizes the chance of holding onto the pregnancy until the due date and of delivering a healthy baby.

Mismatch.Com???

Welcome, this blog entry is appropriately entitled “Mismatch.com”, where those seeking an egg or sperm donor can learn what traits they should look for prior to selecting the right donor.
It may be good advice to select a donor who has traits that are the opposite of your partner’s, as doing so may help reduce many recessive, or quasi-recessive disorders, such as Autism and Muscular Dystrophy.
To illustrate this point lets look at a few examples—some that are good “matches” and others that are “ mismatches”.  Plain and simple: Albert Einstein and Madame Curie should not have kids together.
Males and females who both are highly intelligent often are at an increased risk of having children with Autism.  While many are shocked to discover that the highest autism rate in the entire world is found in Silicon Valley, California, most of us in the field of infertility therapy are not surprised one bit.  Silicon Valley is the epicenter of  “smart”, a place where brilliant men and women meet at their high-tech jobs, marry, and have children.  It is also a place where you can find autism schools— seemingly on every corner.  Surprised by this advice?…Then check this out…
You don’t want an Olympic athlete to marry another Olympic athlete, Mary Lou Retton and Michael Phelps, defiantly not a good combination.  Athletes such as these may have a greater risk of having children with Muscular Dystrophy.
Just as in the case of athletes and brainiacs, you really don’t want two top artists to get together and have babies because the children of Pablo Picasso and Georgia O’Keefe sadly may have an increased risk of developing schizophrenia.
So what do you want in an egg or sperm donor?
Ladies and gentlemen, it is rather straightforward.  Look for somebody who is a good physical match but has different interests than your spouse.  If you are a woman seeking an egg donor choose one who has characteristics that are in stark contrast to those of your partner.  If your husband is nuclear physicist don’t use an egg donor who is a neurosurgeon.  Find the artist, fashion model, or the tri athlete instead.  If your partner is an artist find an engineer or a football player.
While the evidence to support this methodology of donor selection might be somewhat murky, when the decision comes down to choosing between 2 different donors, the following statement can be a good rule of thumb to follow.
Select a donor that seems to be the furthest apart from your partner.
Until next time…

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