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Showing posts with label Miscarriage. Show all posts

Why do women who miscarry feel they need surrogacy ?

Posted by nurul Tuesday, March 8, 2011 0 comments

All doctors know that the commonest reason for a miscarriage is a genetic abnormality in the fetus, and this is Nature's defense mechanism, to prevent the birth of an abnormal baby. While these defects are often random, they are commoner in older women. This is because the eggs of older women have more genetically abnormalities, because they have "aged" and have genetic defects, which cannot be screened for. This means that the usual reason for a miscarriage is a problem with the embryo - and most women who miscarry have a completely normal and healthy uterus !

However, a patient who had early recurrent pregnancy losses has a completely different world view ! She feels that the fact that she got pregnant in her bedroom means her eggs must be fine. She usually has regular cycles , and since all her blood tests for ovarian reserve and ultrasound scans for follicular monitoring are normal as well, she has medical evidence to back up this belief ! ( Little does she realise how inefficient human reproduction is; and how common random genetic errors are, even in health fertile women ! )

In her opinion, the fact that she could not grow any of her babies in her uterus beyond 8 weeks clearly proves that it's her uterus which is faulty. This is why the "common sense" approach is - let's change the uterus !

It's true that surrogacy seems to be a logical choice - but this logic is flawed ! In reality , the fact that she got pregnant means her embryo implanted successfully, which is very strong evidence that her uterus is normal ! Using a surrogate's uterus will not improve her chances of having a baby at all ! After all, if her uterus is normal, how will using another woman's normal uterus help her ? However, because implantation is a "black box" area which we do not have the scientific tools to explore, there are still a lot of myths and misconceptions which surround the reasons behind a failed pregnancy. A woman who has had recurrent pregnancy losses has very low self-esteem. She naively believes that if the surrogate has had a normal birth in the past, this proves that her uterus and her body works better than her own - and this is why she chooses surrogacy as a treatment option.

In reality, she would be much better off using donor eggs or donor embryos ! Surrogacy is an expensive and complex treatment option, which is best reserved for women without a uterus; or whose uterus is irreparably damaged ( as proven by hysteroscopy).

Sadly, most doctors will not bother to educate her ! They are quite happy to do surrogacy for her, because this is much more profitable for them !

Why is it so hard to make sense of your HCG levels ?

Posted by nurul Tuesday, March 1, 2011 0 comments

HCG ( also known as beta HCG or just beta) is a very special molecule. It's unique in that it's produced only by the placenta ( very very rarely, it's also produced by some ovarian and testicular tumours). This means that for all practical purposes, it's found only in pregnant women and is therefore a very good marker for pregnancy.

Since the HCG is produced by the placenta, the levels of HCG rise as the pregnancy develops, and there is very good correlation between the health of the pregnancy and the HCG level for the first few weeks of the pregnancy ( from about week 4 - week 7, as calculated from the LMP, last menstrual period).

However , it can be hard to make sense of your HCG blood levels. Let's look at some of the pitfalls in monitoring your beta levels.

Most patients naively assume that a beta of more than 1 mIU/ml means that it's positive and that they are pregnant. This is not true. The new kits are very sensitive , and even men can have levels of upto 10. This means that a level of less than 10 mIU/ml should be considered to be negative.

Secondly, remember that the HCG is produced by the placenta and not by the fetus. This means that the HCG levels may rise , even if the pregnancy is not viable ( such as an anembryonic pregnancy or a missed abortion).

Since HCG levels rises exponentially, there is a very very wide range of normal. This is why it's very hard to interpret just one level in isolation . It's important to check at least 2 levels at least 48 hours apart to determine the trend . In a healthy pregnancy, the levels should double every 48 - 72 hours. If they do not do so, this suggests your pregnancy may not be healthy.

It's not possible to determine whether the pregnancy is single or multiple based only on the HCG level. While it's true that HCG levels are higher in multiple pregnancies than in singletons, because there is so much overlap, you cannot jump to any conclusions based on the HCG level alone. This is why it's important to interpret the HCG level in conjunction with vaginal ultrasound scanning results.

Also, normal ranges can vary widely from lab to lab, because they use different kits. This is why it is important to check your HCG level from the same lab each time !

Finally, HCG levels are useful only in the first 7 weeks of pregnancy. After this, ultrasound scans are far more useful because they provide much more information about the location of the pregnancy; how many sacs there are; and whether the fetus is growing or not.

NORMAL SINGLE PREGNANCIES

Day after HCG or LH ( DPO)	Average mIU/ml	High mIU/ml	Low mIU/ml	#
14	48	119	17	12
15	59	147	17	18
16	95	223	33	23
17	132	429	17	21
18	292	758	70	19
19	303	514	111	23
20	522	1690	135	13
21	1061	4130	324	12
22	1287	3279	185	22
23	2034	4660	506	13
24	2637	10000	540	16

The information in the table above is part of a study carried out by Dr. Sherbahn

Top 10 myths about infertility

Posted by nurul Friday, January 7, 2011 0 comments

Probably one of the most enjoyable books I've read on infertility is: A Few Good Eggs: Two Chicks Dish on Overcoming the Insanity of Infertility by Julie Vargo and Maureen Regan. This guide is actually targeted to infertile women residing in the US, and it is designed in the currently fashionable "chick-lit" style. It's amusingly put together; and it is certainly a breath of healthy air, if you are the type of individual who discovers a sense of humor can help you deal much better with infertility.

This book is loaded with lots of Top-10 lists, and here is their valuable listing of Top 10 Myths Regarding Infertility:

10 Mis(sed)-Conceptions Regarding Infertility

1. Infertility will not happen to me.
2. I cannot be infertile. I already have got a child!
3. I can easily conceive, therefore i do not have fertility problems. I basically have miscarriages.
4. I am just too young to possess fertility problems!
5. My physician shared with me that i don't need to visit any fertility expert unless I have 3 miscarriages.
6. I am fit. I work out on a regular basis. I cannot become infertile.
7. I am certainly not infertile. I am just not having good enough sex.
8. A person can easily wait a long period to have a child.
9. Males cannot be infertile. They produce sperm regularly.
10. Normal is a miracle.

Below are my remarks on this list:

1. Infertility will not happen to me.

This really is wishful thinking. The unfortunate truth is that the inability to conceive is a common problem which affects around one in ten couples. This means your likelihood of being infertile is around 10%. Sadly, there isn't any trustworthy technique of being able to check your own fertility (short of really conceiving a child!). There isn't any sign or indication or hint that will tip you off that you may be infertile. That is why numerous couples are "pre-infertile" - they get worried (often unnecessarily) as to whether they might have issues conceiving when they fail to get pregnant the very first month they attempt to have a baby!

2. I cannot be infertile. I have already got a child!

I'm sorry. As economic consultants tend to be so keen on reminding us, previous performance is no guarantee of future results! If you had a child previously, this only denotes that you were fertile that time - this can be no promise that a new problem might not have cropped up in the meanwhile which is causing you to become infertile now! This is known as secondary infertility - and is usually is much more annoying, since it is absolutely unexpected.

3. I can easily conceive, therefore i do not have fertility problems. I basically have miscarriages

An extended meaning of infertility includes woman who have repetitive pregnancy failures (miscarriages) - ladies who can't carry the pregnancy to term. This is because the outcome in both the cases is the same - not being able to have a child to adore and to hold.

4. I am just too young to possess fertility problems!

Regrettably, infertility doesn't care how old you are! While it's true that older females possess a significantly higher possibility of being infertile, as they have "older" eggs, young females may also be infertile for a lot of reasons - for example damaged tubes.

5. My gynec told me that I don't need to visit any fertility expert unless I have 3 miscarriages.

A miscarriage takes place in around 10 percent of all pregnancies. Since this is this kind of a common event, and frequently takes place for random genetic causes which usually do not recur, many doctors will not evaluate women who have experienced only 1 miscarriage. Not just is the assessment a waste of time and funds, it offers very little helpful information. This is the reason why the majority of physicians perform testing only when you have had at least two miscarriages. However, if you require further reassurance after experiencing a miscarriage, please ask your physician as to exactly what he or she can do in order to guide you.

6. I am fit. I work out on a regular basis. I cannot become infertile.

There is simply no connection in between your general wellness and your fertility. For instance, your fallopian tubes may be blocked without creating any kind of symptoms or indications. You have no method of knowing this, until you get them examined.

7. I am certainly not infertile. I am just not having enough sex.

This is a chance only when your lovemaking consistency is less than once a week. If it is much more compared to this, the probabilities of your having sex during your "fertile period" are usually quite high - you most likely will "hit the jackpot" at some period over the course of a year. Nevertheless, improving your love-making frequency is actually a simple (and enjoyable!) approach of enhancing your fertility. However, several women delude themselves and believe infrequent sex is the reason they are not having a baby, because they would rather deny the possibility of their having a medical problem for which they may need medical intervention.

8. Its fine to wait to have a child.

This is actually not a very good idea, for 2 reasons. First of all, if you have not conceived on your own in 1 year, the likelihood of your doing so on your own falls substantially. Secondly, fertility declines as an individual get older, and there is absolutely no point in losing time and decreasing your probabilities of success. Everything in life comes back again, except for time. It is a valuable, non-renewable resource - use it smartly!

9. Males cannot be infertile. They produce sperm regularly.

It is correct that males produce sperm all the time. However, around 10% of males tend to be infertile, simply because they generate poor quality sperm. Some possess no sperm in their semen at all - and there is no method of examining this without performing a semen analysis in the pathology laboratory.

10. Normal is a miracle.

Actually, this is true (just slipped it in to make sure you were paying attention!). When you think about how much precise synchronisation needs to be achieved for a good embryo to implant in the uterus to grow to be a baby, every birth is genuinely a remarkable feat - it's remarkable how the individual body achieves this with such ease for so many couples!

Why do doctors advise bed rest after an IVF pregnancy ?

Posted by nurul Tuesday, October 19, 2010 0 comments

When an infertile patient gets pregnant after IVF , they are on top of the world. All that hard work and effort has finally paid off - and you can now look forward to cradling your baby in your arms soon !

However, there are still 8 months to go before your baby is born - and the pregnancy can be packed with anxiety and suspense. Will everything go well ? Will the baby be normal ? Every ache and twinge causes worry because you are scared you may miscarry. This is a "precious pregnancy" - and you do your best to take things easy and be as careful as you can, so you can nurture your baby.

This is one of the reasons why many doctors advise bed rest during an IVF pregnancy. In fact, some patients will voluntarily place themselves under house arrest, because they do not want to take the slightest risk !

The truth is that there is no sensible biological basis for providing this advise. In fact, bed rest can be demoralising and is very unhelpful, because your mind starts playing games when you sleep in bed all day long !

However, it's often patients ( and their relatives) who force the doctor to provide this kind of advise.

When I tell my patients they do not need bed rest, many of them look at me in disbelief, as if I am an idiot and do not know what I am talking about !

Isn't it "common sense" that pregnant women need bed rest to prevent a miscarriage - after all, this is what doctors ( and midwives) have been advising for generations, so it must be true ! Won't walking around cause the baby to fall out ? Isn't this an "artificial" pregnancy which needs to be treated with much more caution and attention ?

If a doctor agrees with this advise , then patients are happy, and feel he is a good doctor because he is providing advise which is sensible by their preconceived notions

However, if he does not agree, then they start wondering if they can trust anything he says ! If he does not even understand the medical importance of bed rest, then his medical competence is suspect !

Most doctors are too busy to argue with patients. It's also good for them to advise bed rest. They can charge extra for home visits ! And if something goes wrong, then the doctor cannot be faulted, because he provided the right advise !

However, if he does not advise bed rest, and the patient miscarries, then no one will ever forgive this doctor. They will actually blame him for the miscarriage ! ( Didn't he know how precious this pregnancy was ? How could he be so callous and careless ? I wish we had gone to a better doctor !" ) His entire reputation will be tattered and torn to bits - and in a few years, he will be left with no patients !

For most doctors, it's much easier to toe the line and tell patients what they want to hear, rather than to spend time educating them and correcting these old wives' tales. This is why all these myths and misconceptions continue to flourish !

Did the doctor cheat us ?

Posted by nurul Friday, July 2, 2010 0 comments

I got this email from a patient today.

I am 28 years old . I require your help. Recently I had a IVF done through the doctor based in Mumbai. The doctor had extracted around 10 ovums and informed that they were of very good quality.

Ovum pickup was on 1st June and he got 6 healthy embryos and he transferred 3 healthy embryos on 3rd june and advised complete bed rest with progesterone tablets to be inserted in the vagina and other injections and tablets etc. He was saying many times that everything is fine and confirmed 110% pregnancy as everything was fine. My uterus was strong etc. etc. I had blood test done on 19th June and it confirmed pregnancy. I was very happy. Later again on 24th when the blood test was done he said the foetus did not grew properly and got aborted. I started bleeding on 26th and my bleeding was normal like periods there was no heavy blood clots etc. when I checked with the doctor about the next steps to be taken he said I can got for IUI, IVF or even for natural pregnancy as we both are healthy.

I am finding it too difficult to believe that I had a miscarriage when everything was fine.

Doctor can you please help as to why this happened. What can be done next. Did the doctor cheat us ?

It's highly likely that this patient was in fact cheated ! Any doctor who talks about a 100% pregnancy is not likely to be very reliable. But rather than criticise this doctor, I feel this patient was begging to be cheated. She is remarkably poor informed about her treatment and does not even what her blood test result was on 19th June. While patients should trust their doctors, they cannot afford to trust the doctor blindly and a " trust, but verify" policy works best !

I have always felt that there's little point in talking to doctors about ethical medical practise. Good doctors will always be ethical , and do not need to be told anything. Bad doctors will never improve, no matter what you tell them ! The secret for making sure doctors are ethical is for patients to take a proactive approach, and to make sure they are well-informed about what is happening to them. Any doctor who talks about 110% success should immediately raise a red flag that he is over-promising ! It's best to do your homework and be well-prepared, rather than harbor a suspicion later on that your doctor may have cheated you !

Empty Arms - The Lonely Trauma of Miscarriage

Posted by nurul Tuesday, May 4, 2010 0 comments