Rosh Hashana 5770/2009 - Jewish Infertility

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Medical SHAAREI TIKVAH/ FALL <strong>2009</strong> Q Hi! I’m in middle of my 2ww post IVF. I’ve been having pelvic cramps on and off and what feels almost like light contractions - tightening. Anyone with this experience What could it mean AYou are asking a very good question that obviously is shared by many other posters. The intermittent cramping, stretching, pulling and any other sensations do not really mean a whole lot. I get asked this by my patients all the time and I counsel them every time that having symptoms does not mean anything nor does not having symptoms mean anything. I know that this is not a helpful answer, but there really is nothing to be learned from these feelings in terms of whether you are pregnant or not. don’t forget that in IVF, your ovaries enlarge, then have the egg retrieval procedure and then have to go back to their normal size. Most symptoms you describe can be ascribed to this process and don’t have any information regarding whether you are pregnant or not. My best advice is to not read in to too much and wait the 2 weeks (I know, not very easy) for a formal answer from the blood work. I hope this helps, B’Hatzlacha, Dr. Hurwitz Q Is it ok to take Aygestin if you could be pregnant ADuring pregnancy, natural progesterone is usually prescribed. Progesterone comes in several forms: Injections, vaginal suppositories or tablets, or oral micronized. The oral form is poorly absorbed and may cause excessive sleepiness, so is less popular than you would think. Progesterone is often prescribed is pregnancy, when a deficiency is suspected. If progesterone levels fall too low, the uterus will contract and expel the pregnancy (miscarriage). Low progesterone levels naturally occur when an abnormal pregnancy fails (the more likely situation), and this is the body’s signal that a healthy pregnancy is no longer there and that the uterus should evacuate itself. In those cases taking progesterone will delay, but NOT prevent the miscarriage. Synthetic progesterone-like medications (called progestins) are very well absorbed orally and inexpensive. They have been used for many years to induce menses, etc. Progestins include norethindrone acetate, NETA, Aygestin, Provera, medroxyprogesterone acetate, Megace, megestrol acetate, etc. They are NOT recommended for use during pregnancy as they all have a modification of the progesterone molecule which can interact with the androgen (male hormone) receptor. If taken during a pregnancy with a female fetus, they can cause virilization or ambiguous genitals, which would not be good. Dr. Peter McGovern Q DH has undergone TESE four months ago. He recently had his post-op evaluation, with ultrasound and bloodwork, to track scarring and FSH levels. B’h, the ultrasound did not show a lot of scar tissue. However, the nurse told me that his testosterone is on the low side. No mention of anything else, so I guess this was the only concern (never was an issue before surgery). We were told to retest in six months. I asked her if there is anything I can do to boost production, like taking vitamins, she said just let it heal. A friend of mine told me to give him Zinc and Vitamin E supplements. Can there be any harm in taking them If not, how much should he be taking We need to wait at least two years to try again, so I don’t want to waste time. DH is trying to quit smoking, and we want to utilize this time to maximize our chances in the future. Any other suggestions AHopefully your husband is starting to feel well again now. I am a little bit concerned about his low testosterone level, and this should definitely be followed as there are good medications that can correct this and help boost testes function. As far as vitamins go, the male fertility supplement is a good choice as is the zsk brand. They both have a variety of anti-oxidants which have shown to limit damage to sperm that can occur after they are produced. While no one can say for sure they help make sperm, they certainly can’t hurt. I think using one of these vitamins is a reasonable choice. Take care and good luck. Dr. Jonathan Schiff Q Does Femara have the same lifetime limit as Clomid or does it have less risks I am supposed to start 3rd round of Femara and if that doesn’t work then switching to Clomid. Does that mean I only have 3 cycles of Clomid before I reach my limit of 6 cycles or does Femara not have a lifetime limit AFemara is a relatively new drug versus clomid and it is being used as an “off label” use for ovulation induction. This means it has been approved by the FDA for other medical therapies. It just so happens that it also has a response that makes women develop eggs. There are no long term studies on its use for ovulation induction and its effects on the women who have used it for this. Therefore I can’t tell you if it should be included in your overall total cycles of stimulation or not and are there any downstream concerns in the future. However in certain scenarios, 6 cycles of ovulation induction would seem like a reasonable option. Has the rest of your evaluation been completed Have you had an HSG, Semen analysis or some assessment of the sperm number If you have tried a few cycles and have been unsuccessful in conceiving it would make sense to take the step back now before continuing the ovulation induction meds whether it is clomid or femara. If you have completed the total evaluation, then again it is not an un- 72
easonable option to try the total of 6 cycles. If you have not conceived after 6 cycles, you may want to move onto some other therapy. Hope this was helpful. The best of luck! Harry Lieman, MD Q Is there any supplements to take when going through ivf to improve embro quality Also would accupuncture help AIt is important to maintain good nutrition when trying to conceive. However, there are no magic supplements. And, you should never take anything whether prescribed or over the counter or from a health food store without consulting with your physician. Various so-called natural substances and even vitamins in high doses can cause birth defects. What is safe or harmful in animals may not be so in humans. There have been a number of studies looking at acupuncture and conception. Overall the studies are pretty evenly mixed among those that show a benefit and those that do not. The most important factors that influence embryo quality related to underlying sperm and egg factors and to ovulation induction and laboratory factors. If your embryo quality is not good, the best person to speak with is your doctor to see if changes can be made in your protocol to improve the quality. Dr. Lobel Q I’m looking for opinions of what our next step should be. History: We are in our thirties. TTC for over 4 yrs. We have done IVF + ICSI due to MF. First fresh transfer resulted in pg which spontaneously aborted at 5.4 weeks. Third frozen transfer resulted in a twin pg- 2 heartbeats at 6 weeks. At 7 week u/s no heartbeat and both fetuses measured 6.3 wks. Did the thrombophilia panel and came out positive for Antiphospholipid Syndrome. The hematologist recommended 60 mg of Clexane (low molecular weight Heparin) from the start of hormone treatment and an additional 100 mg baby aspirin from a heartbeat on u/s. The second fresh transfer resulted in a pg with numbers doubling. During the fifth week the numbers stopped doubling but still rose and then dropped the beginning of the sixth week. At what should have been 6.4 the fetus measured 5.6 and had a weak heartbeat. Started BA. At a repeat u/s 3 days later the fetus measured 5.6 with no heartbeat. The hematologist doesn’t recommend any changes for the next cycle. The RE suggested losing weight before cycling again as he thinks that obesity is exacerbating the APLA. Q: 1- Is losing weight really the only thing that needs to be changed Will 20 lbs (still obese) make a difference 2- Should there be any further testing done 3- Should there be any changes in the medication Thank you. AQuestions: 1- Is losing weight really the only thing that needs to be changed Will 20 lbs (still obese) make a difference Losing weight is always good, but I would not delay your treatment for more than a few months (2-3) which may be too little time to see a major change in body weight. I believe time is more the enemy of fertility than weight. 2- Should there be any further testing done Yes, I would make sure the uterine cavity is OK. You can have retained tissue or adhesions if they did a D+C. 3- Should there be any changes in the medication No. Remember that any treatment for miscarriage can only work 80% of the time, as 20% of pregnancies normally are lost. G-d bless and good luck.Dr. Peter McGovern Q I’ve been taking Provera monthly for a couple of months now and am just wondering a couple of things. 1) My doctor said that Provera does not prevent or inhibit getting pregnant in any way. Is this true 2) If I do unknowingly get pregnant and take Provera, will I still see blood after stopping the Provera And if yes, is that a cause for worry AYes, Provera is not oral contraception and will not inhibit ovulation or pregnancy. Typically if you are pregnant and take it, you will not experience a withdrawal bleed after stopping the Provera. If you fail to bleed after taking Provera, usually your doctor will recommend a pregnancy test. If you are not pregnant but do not bleed after Provera, there are a few possibilities and your doctor will have to see you to figure out which one is the issue for you. Dr. Peter McGovern SHAAREI TIKVAH/ FALL <strong>2009</strong> 73
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lssue 61/Fall 2009 22 Chizzuk From
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Letter from the Editor SHAAREI TIKV
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After acknowledging that our lives
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Table of Content Table of Contant E
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man, Mrs. Frady Oshry and the rest
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SHAAREI TIKVAH/ FALL 2009 11 Britis
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SHAAREI TIKVAH/ FALL 2009 13 And wh
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Hashem made the Avos and Imahos wai
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We can use our own challenges or ex
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THE RONALD O. PERELMAN AND CLAUDIA
Page 22 and 23: Chizuk Chizzuk From Within An Unusu
Page 24 and 25: Chizuk Today I tell my patients who
Page 26 and 27: Chizuk When it comes to those who a
Page 28 and 29: Chizuk Communication By Rebbetzin C
Page 30 and 31: Chizuk Hashem’s Garden By Baruch
Page 32 and 33: Chizuk The Holy Succah By Baruch Tw
Page 34 and 35: Chizuk A Visitor to the Inn SHAAREI
Page 36 and 37: Chizuk Perspectives Rosh Hashanah T
Page 38 and 39: Chizuk To Forgive and To Be Forgive
Page 40 and 41: Chizuk When a person has mercy on o
Page 42 and 43: Chizuk “Every year, during my Sha
Page 44 and 45: Chizuk Together We Stand SHAAREI TI
Page 47 and 48: ® GENESIS Fertility & Reproductive
Page 49 and 50: Doing teshuva means recognizing my
Page 52 and 53: Chizuk Ask the Expert Bitachon vs.
Page 54 and 55: Chizuk Lessons of Life Written by R
Page 56 and 57: Chizuk Music A symphony Created by
Page 58 and 59: Chizuk On The Wings Of The Dove By
Page 60 and 61: Chizuk Relationships Solving Proble
Page 62 and 63: Chizuk Remember, you do not need to
Page 64 and 65: Chizuk A Low-Tech Approach to Ferti
Page 66 and 67: Medical BREAKING NEWS Growing Immat
Page 68 and 69: Medical Small Changes Big Gains SHA
Page 70 and 71: Medical Ask the Doctor SHAAREI TIKV
Page 74 and 75: Medical 10 Perfect Foods Nutrient-r
Page 76 and 77: Medical antioxidants like anthocyan
Page 79 and 80: METRO DRUGS IS A FULL-SERVICE PHARM
Page 81 and 82: SHAAREI TIKVAH/ FALL 2009 81 I am p
Page 83 and 84: Finally, I have learned that no mat
Page 85 and 86: For three decades, the Center for H
Page 87 and 88: A Single Step SHAAREI TIKVAH/ FALL
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Page 95 and 96: Shloime Kaufman's Avodos Tzedakah a
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Rosh Hashana 5770/2009 - Jewish Infertility

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