LGBT Flag

LGBT

  • Meet Emily Butler

    Emily Butler is one of the Billing Representatives at Texas Fertility Center.   Emily has been a part of the TFC family since September 2009. Emily is always available to help answer questions regarding insurance coverage, billing questions, and to discuss financing options for fertility treatments. Emily assists our patients with insurance appeals when the insurance companies deny services that should be covered.   She will appeal any incorrect denials from the insurance companies on claims that should be paid.  She will also submit medical records to validate why the claims should be paid and she also makes sure that this is done in an accurate and timely manner.  Emily also helps in the front office by covering the front desk for patient check in and check out when we need some extra assistance, and she also works on the weekends and holidays as needed.

    Emily grew up in the California wine country, one of the most beautiful places in her opinion, and graduated with high honors from Humboldt State University in 2007 with a Bachelor’s degree in Business Management.  Emily has been married for just over a year and a half and she has known her husband since preschool.  She has one child, her 90 pound black lab named Brewster who keeps her company.  Emily enjoys running and has competed in several local 5ks and the Austin Capitol 10k.  In her free time, Emily enjoys being outdoors, reading, traveling, and spending time with her family and friends. Emily enjoys healthy eating, but has a serious weakness for pizza.

    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.

    •

    admin

    •

  • Men and Testosterone

    We talk a lot about women and female hormones when it comes to fertility, but what about the men?

    Is more testosterone better? Does it make the sperm super?

    Actually, the contrary occurs. Testosterone is very important for men as it is responsible for normal libido, muscle tone, feeling of well being and sperm health. But, if excess testosterone is taken in the form of an injection or gel/cream, it can actually cause infertility but impairing or eliminating sperm production.

    The reason for this is that testosterone supplementation can cause supra-physiologic levels of testosterone in the blood stream and these can shut down the production of some important hormones by the brain that stimulate the production of sperm. Men on testosterone supplements often end up with no sperm in the ejaculate.

    It can take months or even years (sometimes never) for the sperm production to return to normal even after stopping the testosterone supplements.

    It makes us cringe when a couple comes in for an infertility evaluation and the male partner tells us that he has been on testosterone because of fatigue and “low testosterone “ levels. This is probably one of the worst things to do for a man if fertility is desired.

    Body builders who intentionally take anabolic steroids to build muscle mass are especially prone to azospermia(no sperm in the ejaculate). So, to the men out there, never start testosterone supplements without a very good reason and talking to an infertility specialist.

    Primary care doctors are unfortunately not all aware of this effect of testosterone pertaining to fertility. If testosterone supplementation has to be initiated for whatever reason, then it may be worth considering freezing some semen specimens prior to starting therapy.

    •

    admin

    •

    ,
    , , ,

  • Uterine Fibroids and Fertility

    by Dr. Wendy Cutler

    Uterine fibroids are the most common benign uterine tumors. Approximately 30-50% of women have uterine fibroids. They are among the most common incidental findings of the female reproductive system. Fibroids can have a significant impact on fertility.
    Uterine fibroids are muscle tumors. More than 99% of the time, they are non-cancerous. The real reason why some women form fibroids — but others do not — is not known. There is some evidence that it runs in the family. The location of fibroids is the most important issue. If fibroids grow into the endometrial cavity (where a pregnancy grows) fertility can be affected. Thus, it is recommended to have these kinds of fibroids removed before conception. If fibroids are small and grow within the muscle or on the surface of the uterus, they usually do not cause any issues. Larger fibroids in these locations may affect fertility or cause an increase in physical symptoms.
    There are different treatment options for fibroids. Birth control pills may slow down the growth, but this is not an option for women seeking fertility. Lupron is an injection frequently given to women who have fibroids before a surgery to shrink the size of the fibroid(s). This can help to decrease the amount of blood lost during surgery.
    The surgery to remove fibroids is called a myomectomy and can be done in a few different ways. A hysteroscopic myomectomy is performed by placing a camera through the vagina and cervix and into the uterus. Alternatively, a surgeon may remove fibroids through the abdomen in a procedure called a laparoscopy or laparotomy. A laparoscopy is a minimally invasive surgery that surgeons perform through tiny little incisions on the abdomen. A laparotomy is a traditional approach in which the surgeon has to make a longer incision on the lower abdomen. However, each patient’s situation is different. It is recommended for a patient to discuss the best treatment option with their physician.
    Some women may wonder what to do if uterine fibroids are diagnosed during a pregnancy. This happens often. The good news is most of these fibroids are not in the endometrial cavity. Most pregnant women do well and have good outcomes.

    •

    admin

    •

    ,
    , , ,

  • Progesterone Levels

    Progesterone is an important hormone in a woman’s reproductive cycle. It is critical in maintaining the uterine lining so that an early pregnancy can grow normally. It is produced by the follicle (egg sac) that originally released the egg that fertilized and implanted in the uterus.
    Before ovulation, progesterone is found in low levels in the blood. After ovulation, it rises quickly, reaching a peak about 1 week after ovulation (which is also usually 1 week before the next period is expected). Thus, for women who have regular 28 day cycles, ovulation typically occurs around cycle day 14, progesterone peaks around cycle day 21, and menses occur (if pregnancy has not happened) around cycle day 28/29. (Women with shorter or longer periods will have ovulation – and thus peak progesterone – occurring earlier or later.)
    For a woman with fairly regular cycles, a progesterone level done approximately 1 week before expected menses can show if she ovulated (released an egg) in that particular cycle. A level greater than 3ng/ml indicates that ovulation has occurred.
    A progesterone level drawn during a menstrual cycle is only good for indicating that ovulation has occurred. Though some providers feel that having a higher progesterone level (i.e. >10 ng/ml) is better, there is actually no good evidence that this indicates a better overall situation. The reason is because the progesterone hormone is secreted in pulses – thus, if a woman were to have 10 progesterone levels drawn in a single day, the levels may actually vary considerably.
    A better evaluation of adequate progesterone production is to look at the number of days occurring between ovulation and the very next period. (Note: consider the day after a positive ovulation kit to be the likely day of ovulation.) If there are fewer than 12 days between ovulation and a menstrual period, this may be an indication of a progesterone problem – the so-called ‘luteal phase defect’. This can be treated easily with progesterone supplementation.
    In summary, a progesterone level drawn during a menstrual cycle has only 1 benefit – to show that ovulation has occurred. We have other ways of detecting ovulation – even before it has occurred: ovulation kits and ultrasound monitoring. Because these methods also allow us to time intercourse or intrauterine insemination, we frequently don’t check progesterone levels during a menstrual cycle. With pregnancy, though, we will monitor your progesterone levels closely and supplement if needed!

    •

    admin

    •

    , , , , ,

  • A Guide to Fertility Testing

    When you have your first visit with your fertility specialist they will review your medical history along with your partner’s history for clues as to why things are not working.  For some folks, the reasons will be obvious, while other couples may not have a clear reason for infertility based on history alone.  Fertility testing can help identify potential problems and guide your fertility specialist in recommending the most appropriate and efficient treatments for success.

    Typically, fertility testing will include the following 4 ‘tests’:  Bloodwork, ultrasound/examination,  hysterosalpingogram (HSG a.k.a. x-ray dye test) for ‘her’ and semen analysis for ‘him’.

    Bloodwork: For some patients, especially for women who are 35 years or older, bloodwork will be ordered for the 3rd day of your menstrual period.  If it is inconvenient to go on this particular day, day 2 or 4 of your menstrual period are okay as well.  The 3rd day of your period is defined as 2 days after the 1st day of red, heavier flow. 

    FSH/estradiol:  To test ovarian function, your specialist may order levels of FSH (follicle stimulating hormone) and estradiol.  FSH is a hormone produced by your brain, and estradiol is a hormone produced by your ovaries.   A normal level for FSH is <10 miu/ml; between 10-15 miu/ml is considered ‘borderline’; above 15 is considered very concerning for diminished ovarian function.  It is important, however to test estradiol along with FSH since a high estradiol can ‘mask’ a high FSH.  A normal level for estradiol is <50 pg/dl; between 50-80 pg/dl is considered ‘borderline’; above 80 pg/dl is concerning for diminished ovarian function.  Thus, an ideal test result would both a low FSH and a low estradiol level. 

    TSH:  Your specialist may screen for a thyroid problems with a TSH (thyroid stimulating hormone) test.  Thyroid problems can contribute to irregular or absent periods and thus problems with infertility.

    Prolactin:  This is a hormone that, if elevated, can subtly or significantly change your menstrual pattern.  Thus, your provider may check this as well.

    Ultrasound/examination:  It is important to rule out general physical problems as well as to evaluate the uterus and ovaries through a combined physical examination and internal ultrasound.  Depending on your situation, your fertility specialist may want this done during a certain time of your menstrual cycle. 

    Physical examination: This commonly involves listening to your heart and lungs and also having a brief pelvic examination.

    Ultrasound:  This ultrasound is commonly done internally (via the vagina) as it gives much better pictures and information than an abdominal ultrasound about the pelvic anatomy.  This ultrasound helps your doctor to identify certain abnormalities of the uterus (e.g. septum, fibroids) and also gives important information about the ovaries (e.g. are there cysts – what kind; how big are the ovaries; how many follicles (egg sacs) do they contain; are the ovaries in the right location?)

    Hysterosalpingogram (HSG):  Since the ultrasound generally gives no information about the patency of fallopian tubes, it is important to look at them through a test called an HSG.  This test is done by a radiologist and involves placing a thin catheter into the uterus and injecting dye into the cavity of the uterus (where a pregnancy would grow).  This dye shows up on x-ray, and pictures are taken during this test to determine if both fallopian tubes are open.  This test can also give more information about the inside of the uterus.  This test is generally short (about 15-20 minutes usually), but it can cause cramping.  Consider talking to your nurse about taking extra pain medication (e.g. ibuprofen) 30-60 minutes before the procedure.  Even though it is not a comfortable test, it can be very informative for evaluation of anatomy – there also appears to be a mild fertility boost for some couples in the first few months following this test.

    Semen analysis:  As sperm problems affect around 30% of couples with infertility, it is important to do a semen analysis to identify any issues.  After 2-5 days of abstinence, the male partner can provide a semen sample into a sterile cup.  This can be done at home if the couple lives within an hour of the clinic.  Alternatively, a collection room can be available.  Usually collection is done via masturbation; however, a ‘collection condom’ can be used to collect sperm during intercourse.  The semen analysis will give information about sperm numbers, the percentage of sperm moving, and the percentage of sperm that look ‘normal’.  Certain treatments are not successful with low numbers of moving sperm, so this is important information for your fertility specialist to have.

     The above tests are commonly done for couples having problems with fertility.  Your doctor will let you know if there are further tests to consider for your specific situation.  After basic testing, the next step will typically be a consult visit with your doctor to determine the best approach to get you closer to your goal of growing your family!

    •

    admin

    •

    , , , , , , , ,

  • Things your IVF nurse wants you to know

    IVF can be a very overwhelming process for many patients trying to conceive.  At Texas Fertility Center we do our best to make your IVF cycle as stress free as possible.

    Attending the monthly IVF orientation prior to your starting your IVF cycle is extremely helpful.  The IVF orientation is presented by one of our physicians, one of our embryologists, and one of our nurses, and it gives you a really good overview of the IVF process and what to expect.  It also gives you an idea about what happens in the embryology lab.  The physician and embryologist stay after the presentation to answer any questions you may have about your personal situation.  It is a great way to further educate yourself about IVF at Texas Fertility Center.

    We want you to take the IVF process one step at a time.  You will work very closely with your IVF nurse who will provide you with step by step instructions throughout your entire cycle.  Your IVF nurse is your direct point of contact, and she will be there to answer any questions or concerns that you may have and guide you through your IVF cycle.  It is important to ask your IVF nurse and your physician any questions that you have as they arise about your IVF cycle, as it is imperative to have a clear understanding of the treatment plan that was recommended for you.

    Once your plan is developed, you will meet with your nurse one on one to review your customized IVF treatment plan, provide injection lesson training, and sign the necessary paperwork that is required for your cycle.

    Although we will give you a clear, typed plan that provides you with both an overview and step by step instructions for every part of your cycle, it may be helpful to look at each office visit during your IVF cycle like a checkpoint.  At each visit, we will tell you what you will need to do next and how to prepare for your next visit.   You do not need to try to remember everything all at once as you will get the information each time you’re seen in the office.  Although you will be seen by your physician at every office visit (one of the unique aspects about how we do things at Texas Fertility Center), please feel free to ask to meet with your IVF nurse anytime you are in the office.

    It is essential to understand the time commitment involved in an IVF cycle.  The IVF process itself is usually takes six to eight weeks from start to finish.  Our office will always try very hard to accommodate your schedule – we even hired a certified ultrasound specialist so that we can offer to see you very early in the morning to help decrease the amount of time you may miss from work.  Once you begin the stimulation part of your IVF cycle, you will be seen for blood work and an ultrasound examination about every three to four days.  We suggest that you take the day of your egg retrieval off from work, and we also recommend that, if possible, you take two days off for the embryo transfer – the day of the transfer and the following day – so that you can rest at home. 

    It is important to avoid caffeine, cigarette smoking, and high impact exercise as well as excessive aerobic exercise during this process.  We usually recommend no more than four hours of cardiovascular exercise per week.  There is a suggestion in the literature that endorphins you produce during exercise can sometimes interfere with the way your body responds to stimulation. Give yourself a break during this time; light walking is a great way to relieve stress and exercise without getting your heart rate up too high.

    We have an on-call IVF nurse who is available from 6-830am before the office opens, from Noon to 130 during lunch, and from 430 to 10pm, after the office closes.  You are never without a way to contact someone at our office should a question arise after hours. 

    Your IVF nurses are here for you to help support and guide you through your IVF cycle.  Please do not hesitate to contact your IVF nurse at 512-451-0149, option 4 for IVF.  All of us at Texas Fertility Center are committed to making this process as easy and as stress free as possible for you and your partner.

    •

    admin

    •

    , , ,

  • Endometriosis? Who, Me?

    Many patients who we see at Texas Fertility Center are surprised to find out that the primary cause of their infertility is endometriosis.  Although this condition is very common, there are still many misconceptions about endometriosis.  Over the course of the next few weeks, I’d like to take a few minutes to discuss this disease and why it’s important that we diagnose and treat it.

                    First of all, what is endometriosis?  In a nutshell, endometriosis is normal uterine lining in an abnormal location.  Every month as your egg develops, the cells around the egg (“granulosa cells”) make estrogen.  This estrogen causes your uterine lining to thicken.  When you ovulate, the granulosa cells undergo some changes that cause them to make both estrogen and progesterone to stabilize the uterine lining and prepare it for pregnancy.  If you are not pregnant, estrogen and progesterone production stop and the uterine lining dies and comes out.  In 95% of women, some of the lining cells remain alive and – rather than progressing through the cervix and out, they flow backward through the fallopian tubes.  They can then land on any of the pelvic organs (most commonly the ovaries, the intestine, or the lining of the abdominal cavity), they attach, and they continue to grow.  Every month, as your normal uterine lining grows and then bleeds, the lining now in your abdomen or pelvis does essentially the same thing.  These areas of endometriosis – called “implants” – get larger and larger and they also occasionally bleed.   

    Endometriosis is an extraordinarily common condition among women of reproductive age.  Studies in the literature suggest that somewhere between 25% and 45% of ALL women of reproductive age have it.  The incidence in women with infertility is even higher – up to 65% in some studies.  While most women erroneously believe that you must have severe symptoms, such as pain, in order to have endometriosis, in fact this is not the case.  Unlike most other medical conditions in which the severity of the patient’s symptoms and the severity of the disease are related, this is not the case with endometriosis.  Women with absolutely no symptoms can have severe disease.  Conversely, women with excruciating pain may just have one little area of disease.

    The most common symptoms of endometriosis are dysmenorrhea – or pain with periods, dyspareunia – or pain with intercourse, infertility, and pelvic pain in general.  Although almost all women have some sort of cramping with their periods, dysmenorrhea is more than just your run of the mill cramps.  It is pain that is frequently not completely relieved with the usual treatments of non-steroidal anti-inflammatories (like Advil, Aleve, ibuprofen, etc.).  Many women with endometriosis say that their pain and cramping starts a couple of days before their menstrual flow and then it lessens or goes away once their flow really peaks.  Other women describe pain that coincides with menstrual bleeding. 

    Dyspareunia means any type of pain with sexual intercourse.  For purposes of this discussion, however, there are two basic types of pain with sex – pain with entry and pain with deep penetration.  Most women with endometriosis-related dyspareunia describe pain with deep vaginal penetration.  This pain may be sharp or dull and it is frequently cyclic – being most severe near the end of the monthly cycle, just before or during menstrual bleeding.  Sometimes the pain is also severe in the middle of the cycle, around the time of ovulation.  Oftentimes the pain is positional, and many women clearly recognize that certain sexual positions that they may have enjoyed in the past are now frequently problematic.  Usually positions in which the woman can control the depth of vaginal penetration are the least bothersome whereas others may become “off limits”.   Some women say that the pain is related to the angle of penetration – frequently being most severe with the penis is directed either anteriorly toward the bladder or posteriorly toward the rectum.  Endometriosis may also interfere with a woman’s ability to enjoy orgasm.  Part of the pleasurable sensation of an orgasm is mild contraction of the uterus that accompanies the orgasm itself.  For many women with significant endometriosis, that uterine contraction is unbearable.  This unfortunate condition can lead women to avoid sex altogether, leading to feelings of inadequacy and creating a strain on their marriage.

    For all of these reasons, it is important to diagnose and treat endometriosis appropriately, as all of these symptoms are preventable and/or treatable.  Over the course of the next several weeks, we’ll discuss many more aspects of endometriosis, so please keep checking our blog or call your TFC nurse with any questions that you may have.

    •

    admin

    •

    , , , , , , , , , , , , ,

  • Meet Daria Gant

    Daria Gant is one of the Billing Representatives at Texas Fertility Center.   Daria has been a part of the TFC family for almost three years. Daria has always loved the medical field as she started her career as a Certified Nurse’s Aide with the state of Texas and has been in the medical billing field for nineteen years.

    Daria is always available to help answer questions regarding insurance coverage, billing questions, and discussing financing options for fertility treatments. Daria assists our patients with insurance appeals when the insurance companies deny services that should be covered.   She will appeal any incorrect denials from the insurance companies on claims that should be paid.  She will submit medical records to validate why the claims should be paid and she also makes sure that this is done in an accurate and timely manner.  Daria also helps the in the front office by covering the front desk for patient check in and check out when we need some extra assistance, and she also works on the weekends and holidays as needed.

    Daria has a gorgeous 13 year old son who is the center of her universe.    She enjoys watching television programs and watching movies.  She also likes Country music the best and her favorite Country singer is Reba McIntyre.  Her favorite food is “anything from Chick-Fil-A”. 

    Daria really enjoys working for Texas Fertility Center and feels the work that our practice does in helping make patients dreams come true is very rewarding.

    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.

    •

    admin

    •

  • 2011: A Year of Change?

    Who hasn’t at the first of every year vowed to make some major changes in his or her life?  We have all heard the phrases “Change is Good” and “Everything Changes”, but for most of us, those well-meaning resolutions fall by the wayside as we get caught up in our daily routines and continue on with life as we know it.  I don’t think that’s such a bad thing.  As we become more mature, confident adults, I think most of us work towards achieving the life we desire, but we do it gradually.   For me, somewhere around the age of 34 or 35, I began to realize that the circumstances of my life-personally, professionally, socially, spiritually-were very close to what I had been working for.  But if you compared it to my life of only 5 years earlier, it would look drastically different! Nothing had really changed dramatically; it had EVOLVED.

    For some people, dramatic change is desirable and necessary.  I saw one of my former patients this week after several years had passed since her last visit to TFC.  She looked AMAZING.  She had completely altered her diet and lifestyle and was positively glowing-and happy, and ready to focus on getting pregnant.  Another woman e-mailed me to tell me that she and her husband had smoked their last cigarettes Christmas Eve!

    We should all look inside and determine those changes that will have a positive effect on our own happiness and the happiness of those we interact with every day.  I think that starts with being less critical of ourselves and focusing on the positive results of the changes we’ve made the previous year.  For me, that translates into being kinder and more honestly connected to those people in my life I value, as well as more accepting and forgiving of my own shortcomings.  Here’s to change in 2011, be it gradual or drastic, but hopefully the exact change we need.

    •

    admin

    •

    , ,

  • Villainous carbs?

    Around the holidays overindulgence in carbo- loaded sweet treats may be nearly impossible to avoid, and many of us will be making a New Year’s resolution to quit consuming carbohydrates, but are carbs really all that bad for us? Obesity can certainly have a negative impact on fertility and even a 5% weight loss can cause significant improvement in metabolic parameters.  Many people who are trying to lose weight however, have the misperception that carbs are the bad guys and must be eliminated from the diet.  Carbohydrates are not all bad, just the refined sugars and white flour products don’t have much to offer nutritionally. A well balanced diet should include 60% of calories from carbohydrates, 30% from protein and 10% from fat. The carbs chosen however should be in the form of complex carbohydrates such as whole wheat or whole grain products. When buying a loaf of bread, be sure that the first ingredient is whole wheat or whole grain, not just unbleached wheat flour. Fiber is very important to prevent the glucose and insulin spikes that can come with eating refined sugars/flours. All whole grain products have some fiber, higher the fiber content, the better.  

    My usual advice to patients is to not go on any “fad” diets that can’t be sustained for the rest of your life, because once the diet is over, the weight invariably returns.  A well balanced diet composed of all 3 food groups is very important.  The difference lies in the choices we make with regards to which carbs/proteins/fats to eat.  Also, the bottom line is the total amount of calories consumed in a day, regardless of the form.  Caloric requirements are different for different people based on their sex, height, frame and activity level, but in general if one is calorie deficient, they will without a doubt lose weight.  Daily caloric requirements can be determined by going online and finding a calculator or also by having a visit with a nutritionist or dietician. So, to sum up, as you’ve heard before, everything in moderation is the best way to go for a life- long pattern of healthy eating habits.

    •

    admin

    •

    ,
    , , ,