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  • What happened to the postcoital test (PCT) test?

    Cervical mucus changes throughout a woman’s cycle. After the menstrual flow has ceased, the cervix begins producing cervical mucus in response to the increasing levels of estrogen. The mucus increases in volume and the texture changes. Estrogen increases until ovulation and the mucus (referred to as fertile mucus) becomes clear, slippery, and stretchy. Once ovulation occurs, the ovary begins producing progesterone, which changes the mucus into a sticky state. Sperm can more easily penetrate the fertile mucus than the mucus that becomes sticky.

    The first reported evaluation of sperm and the cervical mucus was performed by J. Marion Sims and later described by Max Huhner. The test became known as the Sims-Huhner test. The purpose of this test was to evaluate the sperm interaction with a woman’s cervical mucus. The test must be done within one to two days before ovulation, when the cervical mucus is abundant and has the qualities of being slippery and stretchy. Basal body temperature charts or ovulation-predicting kits are very helpful in determining the time of ovulation. A couple should abstain from intercourse for 2 days before ovulation, and then have intercourse 2-8 hours prior to the office visit for the PCT. Women are instructed to not use a lubricant during sex and to not douche or take a bath after sex, although taking a shower is permissible.

    This PCT test is a quick and painless. Patients undergo a pelvic examination very similar to a Pap smear. A vaginal speculum is inserted into the vagina to visualize the cervix. A catheter with a syringe is used to aspirate the mucus from the cervix. The mucus is placed on a slide and examined under a microscope. The physician evaluates the slide for the presence of active sperm in the mucus. A normal result would be the presence of many moving sperm on the slide. If no sperm are seen or only non-motile sperm are seen, the PCT test is considered to be abnormal. It is felt that a poor PCT may indicate sperm or mucous problems and, possibly, immune factors that could inactivate sperm.

    There have been many studies suggesting that the test is neither accurate nor predictive of fertility. With the application of principles of evidenced-based medicine, the role of the PCT has been questioned and its use has become controversial. A classic study by Collins from Canada in 1984 essentially discredited the PCT. Collins reviewed data on couples who had completed their fertility evaluation. These couples were contacted to determine who had become pregnant without any further fertility treatments. He correlated this information with results from their PCT. Patients were compared who had many motile sperm, some motile sperm, few motile sperm, only non-motile sperm, and no sperm in their cervical mucus. The percentage of pregnancies was statistically equal in all of the groups.

    Our group has only performed the PCT on a very rare occasion in the last 15-20 years. Since it appears to be of very limited value, we have eliminated the PCT as one of the tests for the basic evaluation of couples having trouble conceiving.

    　

     

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    Thomas Vaughn, M.D.

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  • Holiday Survival Guide

    The holidays can be a very difficult time for couples who are struggling with infertility. The holidays are typically the time of year where most people want to socialize with others more than usual and are in higher spirits. For couples facing infertility, many times feelings of joy and happiness are replaced by feelings of sadness, anger, and despair. For these couples, this can be a very painful time of year where it is difficult to be around family and friends.

    It is important to make decisions during the holiday season that are sensitive to your needs and that will nurture and protect you. The strain between your needs and the pressure coming from family and friends can be difficult to manage. This is why it is very important that you and your partner strategize together on how you will handle these situations and have a survival guide in place for the holidays.

    It is important to carefully choose which holiday gatherings you wish to attend, especially concerning ones where a lot of pregnant women and children will be in attendance. Remember that you do not have to accept any invitations and you should not feel guilty about choosing to skip certain events. It is important that you focus on one another and help each other get through this difficult time of year.

    Make sure that you know in advance how you will handle any difficult situations that may include insensitive questions and remarks. It may be a good idea to discuss and practice specific answers you may use if certain questions are asked. Look to those who have been there for you, and lean on them for support during this time.

    It may be a good idea to make plans with friends or couples who do not have children if you do not think that you will be able to handle family events that are taking place. If you are heading to a family gathering, it may be best to arrive just before the festivities start, and leave shortly after. This way you do not have to spend much time if it is hard to be around the children in the family.

    It is important to focus on you and your partner this holiday season and do the things that you all like to do best. If it is too difficult to attend the holiday festivities, plan a special trip somewhere you have always wanted to go. Although your family may be disappointed that you don’t attend, it is important to do what you believe will be best for you. You can also start your own family holiday traditions that celebrate your love for one another.

    Remember what the holiday season really is all about; coming together and celebrating the blessings that you do have in your life. It is important to take into account all the things you are doing for your family, your partner, and yourself. Taking good care of yourself and one another and being there to provide comfort and support is the most important thing you can do during this, sometimes difficult, holiday season.

    From the staff and physicians at Texas Fertility Center, we wish you a healthy, enjoyable, and safe holiday season.

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    Jamie Leonard, RN

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  • Meet Missy Dillard

    Missy Dillard is the Billing Supervisor at Texas Fertility Center. Missy has been a part of the TFC family for a little over eight years. She has had experience in almost every role in the front office. She started checking patients in at the front desk and worked her way into our billing department. She is truly a “jack of all trades”. Missy is always the go to person, in the office, when there are any questions having to do with billing.

    Missy also takes care of all of our physicians new credentialing. She helps coordinate all new insurance contracts and manages our current contracts to help ensure that our patients are receiving all of the benefits that they are entitled to. Missy assists our patients with insurance appeals when the insurance companies deny services that should be covered. She is also; extremely knowledgeable about financing options for fertility treatments. Missy is the “financial guru” as her peers call her and she is the point of contact for patients and staff who have billing questions or concerns.

    Missy has been married for almost ten years, to the love of her life. She is the mother of three and her children are everything to her. She spends time watching her son’s sporting events, and her daughters are interested in fashion and design as well as, art. If Missy could be anywhere in the world it would be with her family. Her favorite foods include anything Mexican and pizza. Missy’s favorite part of her job is helping patient’s win the battle against their insurance company, as we all know they can be difficult to deal with from time to time. Missy is an invaluable asset of the TFC family and we are so glad to have her here with us.

    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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    Jamie Leonard, RN

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  • A Weighty Issue

    Among the things that a woman can do to optimize her chances of getting pregnant – either naturally or with help – is to maintain a healthy body weight.  Women who are either underweight or overweight have a lower fertility rate than normal weight women.

    The United States is currently experiencing an obesity epidemic – over 60% of women are overweight and 33% are obese.  A patient with a body mass index (BMI) over 25 is considered overweight; a patient with a BMI over 30 is considered obese.  The association between a higher BMI and subfertility appears to be related to a hormonal imbalance of the insulin hormone.  Having a higher insulin level can cause elevations in the male hormones, disrupting the normal ovulation process.  However, even women who ovulate regularly and who have a higher BMI seem to experience a lower fertility rate.

    Conversely, having a low BMI (I.e. <18.5) is also associated with a lower fertility rate.  Though it is clear that underweight women who do not experience ovulation (and thus have irregular/absent periods) are at risk for infertility, even women who do experience more regular menstrual cycles may still have problems.

    It is important to be honest with yourself regarding your weight.  A BMI calculator can be easily found on the internet and can help you to assess your current weight status.  An optimal BMI for fertility (and health) appears to be between 18.5 and 25.  If you do not fall within this range, consider talking further with your physician about strategies to safely change your weight.  Even if you are not able to modify your weight to this range, even small changes in the right direction can make a major impact on your health and fertility!

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    Natalie Burger, M.D.

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  • What is Premature ovarian failure?

    The average age of menopause in the U.S. is age 51 yrs. If a woman enters menopause before age 40 yrs, she is considered to have premature ovarian failure (POF) which essentially means that the ovaries have stopped functioning earlier than would be expected. The signs and symptoms would include seldom or absent periods as well as hot flashes, which are a frequent complaint. There are certain genetic conditions that are associated with premature failure of the ovaries, such as fragile X syndrome. It is now recommended by the American College of Obstetricians and Gynecologists (ACOG) that women with premature ovarian failure be offered testing for Fragile X syndrome. This syndrome is the most common cause of inherited mental impairment and is caused by an abnormality in the gene FMR1 located on the X-chromosome. Mostly males are more severely affected and females are usually carriers of the mutation. This mutation is important to test for because it can propagate in severity over generations.

     Other things that can cause premature ovarian failure are autoimmune conditions, Turner’s syndrome, prior multiple ovarian surgeries, lifestyle factors like heavy smoking, and a lot of times the cause is idiopathic, which essentially means that the cause is unidentifiable with current tests and knowledge. The important thing to remember is that in young women with POF, it is important to get started on hormone replacement therapy (HRT) for protection against osteoporosis and cardiovascular disease, at least until natural age of menopause is reached, after which the indications for HRT can be reassessed. For the purposes of fertility, women with POF typically have to use donor eggs.  Although, in some women with POF, occasional spontaneous ovulation and pregnancy can occur, this is exceedingly rare. Donor egg remains the best option. Diagnosis of premature ovarian failure is made by clinical history of absent periods and significantly elevated levels of the hormone FSH in the serum.

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    Kathy Reynolds, RN

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  • Things your fertility nurse wants you to know

    Nurses in our office have a very important relationship with the patients in our office who are trying to conceive.  Your nurse is your true point of contact at our office, we answer or obtain answers to your questions, and we also check on your physical and emotional health.

    The fertility process itself 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.

    Another important thing to know is that you should not be afraid to ask your nurse a question.  Chances are that we have heard that question before and every question you have is worth asking.  It is important that you ask questions so you feel well informed about the treatment that is recommended by your physician. If your nurse does not know the answer to your question, she will ask your physician and call you back.  Although the nurses receive many phone calls every day, you should always know that if you call us we will return your phone call by the end of the business day.  All of the staff stays until each and every phone call is returned.

    It is important for patients to call our office with their questions instead of relying on research you do on the internet.  Although the internet provides an easy way to obtain information quickly, the information obtained from the internet needs to be read with caution.  While there are a large number of reputable websites, please contact your nurse to discuss information and validate any information or advice you get from the internet.

    It is also very important that you understand all of the treatment options that are being presented to you.  This will help you better communicate with your doctor and your nurse.  Ask as many questions as you can to familiarize yourself with the fertility treatment plan that is customized for your specific circumstances.  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 is important and we will work with you to accommodate your schedule as much as possible.

    The nurses at Texas Fertility Center are here to help guide you through the fertility process.  We are here to help answer questions, discuss your concerns, share in your excitement and disappointment, and most importantly, make this 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.

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    Jamie Leonard, RN

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  • Ectopic Pregnancy

    An ectopic pregnancy is a pregnancy which occurs where it should not.  The most common location is within the fallopian tube, but ectopic pregnancies have been reported on the ovary, on the bowel, and even on the aorta!  Unfortunately, an ectopic pregnancy cannot be replaced into the correct location (the uterus), and thus it must be treated appropriately to avoid potentially serious harm to the patient.

    Sometimes ectopic pregnancies can be definitely diagnosed by ultrasound.  Many times, however, the diagnosis of an ectopic pregnancy may not be definitive – but there may be enough concern based on ultrasound, bloodwork, and patient symptoms that a patient will still be treated for a presumptive ectopic pregnancy.

     If an ectopic pregnancy is caught early, medication (i.e. methotrexate) may be given to resolve the pregnancy.  Methotrexate is given as an intramuscular injection by a nurse.  Though 1 dose is frequently enough, sometimes a 2nd dose may be required.  The medication can cause gastrointestinal symptoms (i.e. pain, nausea, vomiting, and diarrhea).  Also, monitoring of bloodwork is still necessary to make sure that the ectopic pregnancy is treated appropriately.  The earlier the ectopic is discovered or presumed, the greater the likelihood of success using medical treatment. 

    If the ectopic pregnancy is caught later, if the methotrexate has been given and has not worked, or if the patient prefers, a surgery can be performed to remove the ectopic pregnancy from the fallopian tube.  Sometimes the fallopian tube may need to be removed with the ectopic pregnancy, and other times the ectopic may be removed by itself, leaving the fallopian tube in place. Typically, this is done via a laparoscopy, though occasionally a larger incision may be required if the patient is having serious internal bleeding. 

    The risk of a future ectopic pregnancy is generally increased in someone who has already experienced an ectopic pregnancy.  Your provider can give you a better estimate of risk in your particular scenario.  In the worst case scenario, ectopic pregnancy can cause severe blood loss and even death.  However, because of the early pregnancy monitoring which is available these days – and with the advancement of medicine and surgery – this is a rare outcome in this day and age.

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    Natalie Burger, M.D.

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  • Meet Catherine Mendez

    Catherine Mendez is responsible for taking care of all medical records requests and other critical back office operations at the Texas Fertility Center. She sends out records in response to patient requests, doctor’s offices request, and requests from insurance companies. Catherine also manages all the doctors’ dictations and helps coordinate all of the meetings that our physicians are involved in.

    Catherine does so much more than medical records and is everyone’s Mom at the office. She makes sure that everyone is taken care of. She orders supplies for the office. She makes sure that we get a signed birthday card from everyone at the office as well as a birthday gift. She also has a birthday cake made once a month to celebrate all of the staffs’ birthdays. She organizes our potlucks and makes sure that the RSVP list is completed for all office functions. You name it, Catherine probably does it.

    Catherine has been with TFC for nine years and we are so happy to have her as part of our family. Catherine is the proud mother of three beautiful children. They keep her constantly busy with dance team, band practice, athletic activities and or church activities. Catherine always comes to work with a smile on her face, after she has had her morning cup of coffee, and is always willing to go the extra mile to get things done.

    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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    Jamie Leonard, RN

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  • Fibroids

    Uterine fibroids are the most common tumor of the female pelvis.  They are so common that by age 35, 25% of Caucasian women, 40% of Hispanic women, and 50% of African American women have clinically significant fibroids – in other words, tumors that cause symptoms.  These tumors are essentially always benign (not cancer), but they can cause significant fertility problems nonetheless.  Fibroids are important for a variety of reasons, primarily because they can cause symptoms like heavy bleeding and/or cramping with menstrual periods, pelvic pain, and bowel or bladder problems.  In addition, fibroids can also dramatically reduce a woman’s chance for pregnancy – depending on their size and location.

     Fibroids can develop on the outside of the uterus, in the wall of the uterus, or inside the uterine cavity.  Fibroids that develop on the outside, called “subserosal” fibroids, don’t usually affect fertility, although they can certainly cause other symptoms as they enlarge by pushing into the bladder or by compressing the intestine.  As a result, subserosal fibroids do not usually need to be removed in women seeking pregnancy unless they are causing symptoms.  Fibroids that develop in the cavity, “submucosal” fibroids, have the worst effect on fertility.  They can act almost like an IUD, either by preventing a pregnancy from implanting on the uterine wall or by making it less likely that the pregnancy will remain attached to the wall.   Therefore, these tumors have to always be removed.  The most common type of fibroid is the “intramural” fibroid, or the fibroid that grows within the uterine wall.  There is a lot of controversy in our field about whether these tumors need to be removed or not.  The best data on this subject suggests that intramural fibroids measuring 3 cm or more (slightly more than an inch in diameter) should be removed prior to pregnancy.

     Many fibroids grow from one location into another – for example, many intramural fibroids are also partially subserosal or submucosal.  Their location – in addition to defining their potential effect on fertility – also determines the best surgical approach to remove them.  Submucosal fibroids can be removed via hysteroscopy, ie. by passing a surgical telescope through the vagina and cervix into the uterus without making an incision in the patient’s body.  Subserosal fibroids and many intramural fibroids can be removed via laparoscopy, ie. by passing a surgical telescope and other surgical instruments through the patient’s belly button into the abdominal cavity.  Patients with very large fibroids, multiple fibroids, or fibroids that grow all the way through the wall into the cavity should usually be removed through a slightly larger abdominal incision, or “laparotomy”.  Both hysteroscopy and laparoscopy are outpatient procedures.  In other words, patients can go home the same day of surgery and can usually return to work within a couple of days.  Patients who require a laparotomy typically spend 1-2 nights in the surgery center or hospital and can usually return to work within one week. 

     In summary, fibroids are a significant problem that we encounter in a lot of our patients.  Fortunately, they can be very effectively treated so that they do not need to prevent your pursuit of pregnancy

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    Kaylen Silverberg, M.D.

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  • A little support goes a long way

    I had the opportunity to attend the American Society for Reproductive Medicine annual meeting that was held in Denver Colorado this year. It was an incredible opportunity to be a part of. I always leave the meeting with my head spinning with all of the information I have learned and all of new projects I want to try to complete.

    I attended a roundtable meeting where a small group of professionals from doctors to nurses to counselors get to discuss a specific topic. I attended the session that’s primary focus was on support groups for couples coping with infertility. This is something I am very passionate about. Infertility is so overwhelming and it is easy to assume that you are the only one that it is affecting when in truth your friends could be dealing with similar experiences. It is something that people in general just do not talk about.

    It was interesting to see how many different centers are considering starting a support group for patients having fertility issues. Texas Fertility Center was the only office, out of those that were represented, that already had a support group directly through the office. I got to share my experiences with our support group at Texas Fertility Center and how beneficial it has become for patients to realize that they are not alone. Patients are able to connect with others who have similar circumstances and are all hoping to achieve the same goal of having a healthy baby. I also left with many new ideas to try to implement into our support group to help make it more successful than it already is.

    It was a unanimous conclusion from the discussion at the meeting that Support Groups are important for helping patients throughout the infertility process and it is my hope that more practices will consider offering a support group directly through their offices. It is instrumental in helping patients develop a network of others that can relate to what they are experiencing emotionally, mentally, and physically.

    At our next meeting we will be having a fertility yoga instructor, who has struggled with infertility herself, teach us how to decrease stress using some Yoga techniques for relaxation. With the holidays quickly approaching, we thought this would be the perfect time to have her join us. We will of course have time for reflection and of course discussion with your new friends.

    We look forward to seeing you at our next meeting and helping you make friends through the fertility process. Click here for more information about the support group.

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    Jamie Leonard, RN

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