Patient Testimonial – Kristine Bonfantine

On the Cutting Edge

Resilience – the capacity to recover quickly from difficulties; toughness.

Every day I get to see resilient women in the battle of their life to build their family. For some it involves many cycles of disappointment, for others it occurs more quickly. But for all it is a challenge. But we women are resilient.

In this issue we met Kristine whose fertility battles began with the realization that she had so many fibroids, that there may not be any normal uterus left. She endured followed by two rounds of in vitro fertilization and major surgery to remove her fibroids. Then a first embryo transfer did not result in implantation before finally getting pregnant! Kristine and her family embody the importance of being resilient during this process!

I hope that her story was able to provide inspiration to our readers. Thank you Kristine!

Best

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Choosing a pediatrician

By: Diana Montgomery, M.D.

Choosing a pediatrician is an exciting – and sometimes daunting – milestone. It’s one thing to find a doctor for yourself. But deciding on a doctor for your baby brings one of those moments when you realize that you will soon be someone’s parent, wholly responsible for a completely new person. Now what? Here are some suggestions to guide you towards finding a great fit with your pediatrician.

Consider your sources. Family, friends, co-workers, your obstetrician – ask around and see who they take their kids to. Are they happy with their choice? What do they like about their pediatrician and their pediatrician’s office? What do they wish could be better? This may help you generate a list of practices to investigate further and maybe some to skip. Online forums and websites can be great – but don’t believe everything you read. Recommendations from people that you know and trust are likely to be much more reliable.

Logistics are important. Is the office convenient? Assuming all goes well, you can expect to take your baby for a visit with the pediatrician eight times in the first year – and that’s just for regularly scheduled well checks. Is it important to you to see a doctor with an office in your neighborhood or are you willing to drive across town for the right person? There’s no right or wrong answer here – it’s just good to know what your tolerance is for a commute. Is moving to Marin a likely possibility for you? It might make sense to choose a practice with multiple office locations so that you won’t have to change doctors when you change counties.

Logistics are really important. What if you have a question for the doctor outside of a regularly scheduled visit – or your baby needs to be seen after hours? Find out how this works. If you call the doctor’s office for advice, who calls you back – and how quickly – during business hours and beyond? Some practices have a nurse available by phone but require that you make an appointment in order to speak with your doctor. Other practices will have your doctor respond to non-urgent medical questions during the day, but have an after-hours advice line staffed by nurses who relay messages to an on-call doctor as needed. Some doctors take their own calls after hours. If your child needs to be seen for an illness, are you likely to see your regular doctor or whoever is available in the practice? You may be comfortable with a large practice and lots of different faces – or you may prefer more consistency. If your child needs to be seen in the evening or over the weekend, know whether your office has extended hours or has an after-hours clinic that they refer to. If you are willing and able to pay a fee that is over and above what your insurance reimburses, concierge practices and private doctors provide greater access to your physician – and even house calls. So think about your needs, and make sure that your pediatrician’s office is set up to provide care in a way that works for you. No parent should feel left alone to worry about their baby without support from their baby’s doctor.

What’s your style? This may be the hardest piece to suss out. Answers to the questions above can be found on the web and from other parents. But really knowing whether your baby’s soon-to-be doctor will work for you requires a conversation with the pediatrician, either by phone or in person. Here again, there is no right or wrong answer. Some parents prefer a dialogue with their doctor about various treatment options – others prefer to have a doctor who calls the shots. I suggest asking a question and seeing how the doctor answers. Ask about their advice on sleep training an infant or how they support breastfeeding or what their take is on circumcision. What they answer is probably less important than how they answer. Is this a doctor you trust to guide you through babyhood and beyond?

Good luck – and welcome to parenthood!

 

 

Antihistamines – Are these a bad cocktail?

By : Jennifer Agard, M.D.

Seasonal allergies are one of the most common ailments in couples undergoing In Vitro Fertilization (IVF). But many women are unclear whether they can use anti-histamines? To further complicate matters, some fertility forums discuss individual use of anti-histamines to improve pregnancy rates during IVF when patients have a history of recurrent pregnancy loss. Others strictly warn against anti-histamines, quoting a potential risk of vaso-constriction or reducing blood flow to the ovaries and uterus, as it acts in the nasal passages. So what’s a woman to do?

At present, there are no well designed clinical studies that have evaluated the effect of anti-histamine use on fertility. Research has shown that there are histamine receptors in the uterus1, that human embryos secrete histamine2, and that the interaction of histamine from the embryo helps the embryo implant into the endometrium of the uterus. But, there is also one study showing that anti-histamines decrease blood flow to the uterus. So while the research suggests that anti-histamines interfere with reproduction, we don’t have a clear answer. What can we do until we know more?

We can do the best with what we know now. We know that histamine is a naturally occurring molecule that may aid in implantation. We know that we may not want to hinder histamine. Therefore, while limiting use of anti-histamines when possible is reasonable, there is no evidence that anti-histamines make a difference on fertility or IVF outcomes.

References:

  • Histamine enhances cytotrophoblast invasion by inducing intracellular calcium transients through the histamine type-1 receptor, Liu et al, Mol Reprod Dev 2004 Jul;68(3)345-53.
  • Identification of a histamine-releasing factor secreted by human pre-implantation embryos grown in vitro. Cocchiara et al, Journal of Reprod Immunology 1988 Jun;13(1):41-52
  • Effect of mepyramine, a histamineH1 and burimamide, a histamine H2 receptor antagonist, on ovum implantation in the rat. Brandon et al, J. Reprod. Fertil. 1977 July;50(2)251-4.
  • Implantation and deciduation process after the action of the antihistamine preparation diaprizin in early rat embryogenesis. Ontogenez 1981; 12(6) 596-604.

ABOUT THE AUTHOR

JenniferJennifer Agard, MD, Reproductive Endocrinology and Infertility Specialist. Dr. Agard completed her medical training at UCLA, Saint Barnabas Medical Cen-ter, and Eastern Virginia Medical Center. Her special interests are in polycystic ovarian syndrome, thyroid disease, therapeutic reproductive surgery, and di-minished ovarian reserve. Dr. Agard is committed to the model of delivering individualized patient-centric care. ??er greatest reward is being able to help create the family and life plan that is unique for each of us.

The Girlfriend’s Guide To Surviving IVF

LFM_Surviving_IVF_Feb2015Let’s face it, IVF can be taxing. It uses emotional and financial resource – often more than we expect. Most women enter the process having been successful at controlling their lives – careers, relationships and health. However,

  • Pick your team – You cannot do this alone! You cannot do this alone! You should not do this alone! So whether you are are single, married or partnered, find someone to help you. You may need emotional support, a ride from your retrieval or help picking up medications.
  • Be your own project manager – there are a lot of moving pieces in an IVF cycle. There are appointments, consents, medication orders, procedures, and endless decisions to be made. Keep a master file of everything from your calendars to your receipts.
  • Dress for success – hormonal injections result in bloating and weight gain. Most women gain somewhere between 5-10 pounds during their stimulation. And since the goal is pregnancy this weight will likely not go away. So put away the skinny jeans and pull out the maxi dresses!
  • Just say no! … To everything else. An IVF cycle takes all of your focus and energy. So, while you are in the process give yourself permission to say no to all of the other commitments in your life. It is the wrong time\
  • Hire a housekeeper – OK, not really. And if you are like most people going through IVF, you are already stretching your budget. But instead do plan ahead. Prepare food in advance, do some extra laundry and get your partner or friends to pitch in and help you.

What worked for you? Share your tips with our readers.