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  • Uterine Fibroids in Pregnancy

    by Devin Garza, MD F.A.C.O.G., Renaissance Women’s Group

    Uterine fibroids (leiomyomas) are commonly occurring benign smooth muscle tumors of the uterus. The effect of these tumors on pregnancy, and the effect of the pregnancy on these tumors is a topic of clinical concern. Although it is estimated that up to approximately 60% of  women have fibroids, the incidence of fibroids in pregnancy varies between 1.6 and 10.7 %. This prevalence increases with age and is greater in African-American women.

    Symptoms and clinical manifestations of fibroids either in the non-pregnant state, or during pregnancy depend on three main factors-size, number and location. Fibroids within the uterine cavity itself (submucosal) have been implicated with an increased risk for pregnancy loss especially if they are 3cm or greater, or multiple 1-3cm fibroids are present possibly due to a distortion of the cavity, altered blood flow and implantation site disruption. Growth of fibroids occurs in approximately one third of patients, and it is impossible to predict which fibroids in which patients will grow in size. Growth of fibroids in pregnancy may lead to an increase in clinical complications, most notably, pain. Pain is most commonly experienced in the late first and second trimesters as rapid growth of the uterus occurs. With this rapid growth, fibroids especially 5cm or greater in diameter may undergo an alteration and resultant lack of blood flow that cannot keep up with the rate of growth of the tumor which produces ischemia-related pain. This mechanism is much like pain associated with a heart attack.

    The incidence of preterm labor, preterm premature rupture of membranes and placental abruption are increased only slightly, but the risk increases depending on the fibroid’s relation to the placenta. Implantation (placental site) overlying a fibroid being the biggest risk factor. With implantation being completely random, it is also completely unpredictable which pregnancies will be at risk. Large fibroids distort the normal uterine contour and contractility of the uterine muscle. If located within the cavity itself, a large fibroid can cause fetal deformations due to spatial restrictions, but this is not common. Fibroids can lead to dysfunctional labor with decrease in contractile force. This in itself can increase risk for cesarean delivery, and fibroids located in the lower segment of the uterus are associated with mal-presentation of the fetus, which frequently leads to cesarean delivery. With all of these potential risks, what is the treatment of fibroids in pregnancy?

    It has been generally accepted with good support that surgical removal (myomectomy) during pregnancy is to be avoided with rare exception. Although the risk of cesarean section is increased, MOST women will have an uneventful pregnancy and vaginal delivery. Myomectomy during pregnancy or at cesarean section is associated with significant hemorrhage. Pain related to fibroids is managed conservatively with analgesic medications and narcotics as needed. PRE-conception myomectomy should be discussed and considered given a patient’s unique pregnancy history and symptoms and clinical manifestations of fibroids in the non-pregnant state. Myomectomy is the treatment of choice for large intra-cavity fibroids and is typically managed via a hysteroscopic resection. Large intra-muscular (intramural) fibroids can be managed via laparotomy or laparoscopy with newer surgical advances in robotic daVinci techniques with improved  laparoscopic suturing. As always, consult with your physician, and seek advice from trusted publications and sites to determine what is best for your unique situation.

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  • Meet Cyndi and Sharon

    Cyndi Suarez and Sharon Corcino are the Surgery Coordinators for Texas Fertility Center. Cyndi has been a part of the TFC family for over a year and Sharon has been with TFC for over two years.

    They both have vast experience and knowledge in scheduling surgical procedures.If your doctor determines that surgery is the next step, you will receive a phone call from Cyndi or Sharon to begin scheduling the procedure. The surgery coordinator will discuss the specifics of the surgical procedure to make sure that you fully understand the implications of the surgery. She will provide in-depth information including how the surgery is performed and what to expect including the recovery time that will be involved. The surgery coordinator will ask you questions about your menstrual cycle to determine the best time to schedule the procedure.

    Once your procedure is scheduled, the surgery coordinator will also schedule you for a pre-operative visit where you will come in to talk with your physician prior to having the surgery performed. She will also provide the patient with instructions on when to have pre-operative lab work done. The surgery coordinator will also investigate insurance benefits and review with you the potential insurance coverage for the procedure.

    Cyndi and Sharon are dedicated to helping to make patients comfortable and confident with having surgery with our physicians. They truly care about each patient and the quality of care that they receive. They understand that the idea of surgery can be overwhelming, and they are here to make the process as seamless and stress free for our patients as possible.

    When she is not at work, Cyndi enjoys going to the beach. She also loves to shop and has a weakness for jewelry. Cyndi also enjoys watching her son play baseball, reading, watching movies, and spending time with family and friends.

    Sharon is a loving mother of two children. She enjoys spending her free time with family and friends, watching movies, and any kind of jewelry. Her favorite restaurant is The Olive Garden.

    Stay tuned as we continue to feature different staff members to help you learn fun facts about us. We want you to know more than just our names. At Texas Fertility Center, you are part of our family.

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  • Abnormal Pregnancy

    A positive pregnancy test is a joyous occasion, but is the pregnancy normal? How do we know that things are ok? This is a common question patients have once the news has sunk in. The best way to follow an early pregnancy in via blood levels of the pregnancy hormone HCG. A gestational sac is not visible until about 5 weeks gestation or when the HCG is over 1500 miu/ml. Typically the HCG rises by 66% every 48 hrs during early pregnancy. This is why here at Texas Fertility Center we repeat the HCG 48hrs after the initial positive test. If the rise is appropriate then that is a good sign and we can wait for a week before rechecking and follow the trend. The rise in HCG may be inadequate in cases of abnormal pregnancies such as a biochemical pregnancy or an ectopic (tubal) pregnancy. These abnormal pregnancies need closer monitoring initially to delineate which of the two we are dealing with. Often in a biochemical pregnancy the HCG will rise initially and then starting dropping on its own. No further treatment is required in these cases and the HCG is simply followed down to <5 Miu/ml. In the case of an ectopic pregnancy, the HCG continues to have a slow rise and sonogram shows no gestational sac in the uterus. It is important to recognize and treat an ectopic pregnancy early to prevent tubal rupture which constitutes a medical emergency. If diagnosed early, most ectopics can be treated with a medication called Methotrexate. In more advanced cases or in the event of tubal rupture, surgery becomes necessary. Early diagnosis of an ectopic if extremely important. So, if patients are wondering why their HCG levels are being checked frequently, it is to be sure the pregnancy is following a normal trend and recognize abnormal pregnancies early.

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  • Annual Southwest Fertility Forum Conference

    Dr. Natalie Burger was the program director for The Southwest Fertility Forum in Houston this past weekend. This annual conference, which was started by Dr. Thomas Vaughn over 25 years ago, brings together OB/GYNs, REs, nurses, and embryologists from all over the United States to discuss the latest advancements in reproductive medicine.

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  • Dr. Silverberg Goes to Washington: TFC Physician Lobbies Congress for Proposed New Fertility Tax Credit

    Dr. Kaylen Silverberg, co-founder of Texas Fertility Center, recently traveled to Washington to lobby the Central Texas congressional delegation in efforts to gain support for a fertility tax credit bill. This bill would provide a $13,360 tax credit to those undergoing fertility treatments, which is very similar to the $13,000 adoption tax credit currently available to those expanding their families by way of adoption. His efforts are supported by national infertility groups such as the American Society of Reproductive Medicine (ASRM) and RESOLVE. For more information please visit www.txfertility.com.

    http://www.txfertility.com/articles/2011/tfc-physician-lobbies-congress-for-proposed-new-fertility-tax-credit.php

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  • What Your Fertility Nurse Wants you To Know

    The fertility process can be extremely overwhelming and we want you to know that we are here for you every step of the way. The staff at Texas Fertility Center truly cares about you and the outcome of your treatment cycle. We also feel the emotional impact of the negatives and positives of the fertility treatment cycle you are pursuing.

    Nurses provide an important relationship with the patients in our office. Your nurse is your true point of contact and will answer questions and also check up on your physical and emotional health. It is very important to not be afraid to ask your nurse a question. Chances are that we’ve heard that question before and every question you have is worth asking. Communication is a key part of your treatment cycle and we want to make sure that you feel well informed about the treatment options that your physician is recommending for you. If your nurse does not know the answer to your question, she will ask your physician and call you back promptly. Each staff member at Texas Fertility Center receives many phone calls a day, but if you call us before 4PM, we will return your call by the end of the business day. All of our staff stays until each and every phone call is returned.

    It is important for patients to call our office with questions instead of merely relying on research that they do on the internet. Although the internet provides an easy way to obtain information quickly, information found there needs to be read and interpreted with caution. While there are a large number of reputable medical websites, please be sure to validate any information or advice obtained on the internet with your nurse.

    Make sure that you understand each of the treatment options that are being presented to you. This will help to enable better communication with your doctor and nurse. Ask as many questions as you can to help familiarize yourself with the fertility treatment plan that is customized for you. It is important to understand the fertility treatment that your friend received may not be the right option for you, as every patient has factors unique to her or his case. We customize your treatment plan for your specific situation and do not want to waste time, resources, or your emotional energy on treatment cycles that are unlikely to work. Understanding the time commitment for each treatment cycle is essential and remember that there really is no “perfect time” to begin the process of starting your family. Making sure that you will be able to make the time and space in your life for treatment is important, and we will work with you to accommodate your schedule as much as possible.

    It is very important to take care of yourself and take care of your partner. Taking care of your body as a whole means including diet and exercise in your daily routine, while eliminating smoking and alcohol. It is also important to take your prenatal vitamins. It is not necessary to take an excessive amount of vitamins, as more is not necessarily better. These changes will maximize your chance for fertility by making sure your body is the best it can be.

    The nurses and staff at Texas Fertility Center are here to help guide you through the fertility process. We are here to help answer your questions, discuss your concerns, and assist in making the process as stress free as possible. You can reach your clinical nurse at 512-451-0149 option 3 or your IVF nurse at 512-451-0149 option 4. Thank you for entrusting us with your fertility care.

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  • How to Make Love to a Plastic Cup

    There – do I have your attention?

    Before I get any credit for coming up with the catchy title, let me tell you that this is the title of a new book written by Greg Wolfe – who underwent the challenges of fertility treatment with his wife. In contrast to the many available books that are written from a woman’s point of view, this has the interesting vantage point of seeing infertility from a male perspective. Although you may not think of infertility (and its treatment) as funny, this author is able to blend important information with personal anecdotes and deliver it in a guy-friendly and very readable style.

    To quote a recent description:
    “Greg Wolfe went through four cycles of IVF on his rocky journey to fatherhood—and now, with profound sympathy and side-splitting humor, he lays it all out for guys on similar baby-making quests. “How to Make Love to a Plastic Cup” is not your typical nuts and bolts (no pun intended) medical guide but a helpful handbook designed specifically with the male partner in mind, with answers to his most pressing questions about the infertility process.”

    In addition to “How to Make Love to a Plastic Cup”, another recent book written from a guy’s perspective is “What He Can Expect When She’s Not Expecting” by Marc Sedaka. The co-author (Dr. Gregory Rosen) is a board-certified reproductive endocrinologist in practice in California.

    A recent description:
    “Marc Sedaka stood by while he and his wife endured endless rounds of drug therapies, sixteen artificial inseminations, ten in-vitro fertilizations, three miscarriages, and, finally, a gestational surrogate (“womb for rent”) who carried their twin girls to term. He was as supportive and loving as he could be, but he really wished he’d had a book like “What He Can Expect When She’s Not Expecting” during the process. Most books about dealing with infertility are geared toward women, leaving the man to his own devices when it comes to comfort and encouragement (never a good idea).”

    This blog is not a book review site.

    However, I wanted to bring these books to the attention of couples going through the infertility treatment process. It is so common for guys to feel uncomfortable and awkward discussing their scenario with other friends and family. Thus, guys can feel very alone/isolated and angry about their predicament; this can further compound the stress that the couple is experiencing through their journey of treating infertility. Thus, I am excited to see more resources that are geared for men going through this process as they may feel more connected and realize that there are many other men going through the same situation.

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  • TFC Physicians Speak on Recurrent Pregnancy Loss

    Texas Fertility Center physicians presented an educational dinner program on Recurrent Pregnancy Loss to local OB/GYNs, their Physician Assistants and Nurse Practitioners as well as residents in Brackenridge Hospital’s Residency Program on 5/10/2011 at Fleming’s Downtown Restaurant. The event was sponsored by Apothecary Shoppe and was very well attended and considered extremely informative on the most up-to-date treatment options available by those able to participate in this physician outreach program.

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  • National Infertility Awareness Week

    Couples having trouble with conception are certainly not alone; approximately 1 in 6 couples are thought to have issues with infertility. An infertility evaluation is warranted after one year of trying if the woman is under age 35. For women over age 35 an evaluation is recommended if they have been trying for 6 months without success. Natural fertility in a young, healthy couple with no fertility issues is approximately 15-20 % chance of conception per menstrual cycle. By the end of one year of trying, 85% of couples with no fertility issues will have successfully achieved a pregnancy. The key to treatment of infertility is early diagnosis of the cause and targeted treatment. A woman’s age has a profound impact on chances of success, for this reason couples are encouraged to seek timely evaluation if they are having difficulty conceiving. Treatment for fertility does not necessary mean In-vitro fertilization (IVF). For most couples, use of much easier treatments or surgery will help them successfully achieve pregnancy. In the spirit of National Infertility Awareness week, we at Texas Fertility Center encourage couples struggling with infertility to take the first step and seek and evaluation. Whether to pursue treatment or not is a personal choice, but it is a choice you have if you know what the options are.

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  • Just in time for National Infertility Awareness Week

    Dr. Vaughn was invited to share his expertise with readers in an upcoming issue of Uptown Magazine in which 3 couples share their emotional, yet rewarding journeys towards parenthood. Here’s an inside look at the May issue available now on newsstands everywhere and online at:

    http://uptownmagazine.com/2011/04/overcoming-infertility/

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