Physician Visits

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Mother Knows Best: Your Reproductive History

As much as we hate to admit it, it’s hard to find many things that our moms were wrong about. From the most basic (eat your veggies!) to the most complex (bad boys will always break your heart!), their words of advice were thoughtful, poignant, and basically spot on. But it’s funny that, no matter how much we talked and shared with the woman who gave us life, the sordid details of her menstrual cycle, her fertility, and her menopause are all too often taboo subjects. When did you get your first period, did you have trouble getting pregnant, did you suffer multiple miscarriages, and when did you go through menopause are questions that over half of our patients have never discussed with their mothers. When asked, they stare back blankly, and together we attempt to piece together a timeline of events based on when their mother was shouting, “I’m too hot, I’m too cold” multiple times a day.

Much of what dictates the timeline of reproductive life (first period to the last period) is unknown. Why some women go through menopause at 30 and others at 60 remains in many ways a mystery. Sure, women who are given certain types of chemotherapy or have multiple surgeries on their ovaries will frequently have a shortened “reproductive life,” but for most women who experience the premature stop, we don’t have good answers to the question of why. As frustrating as this is for the patient, it can be in many ways equally as frustrating for us as doctors. We, like you, want answers. Not knowing why something happened can often make the experience even harder to deal with.

Here’s what we do know. We know that a large piece of the reproductive life timeline puzzle can be answered by genetics. Genes inherited from your mother will frequently dictate your personal reproductive path. Because of this, when we see a girl who is late to have her first period or a woman who appears to be going through an early menopause, we ask detailed questions about the family history, specifically the female members of the family. We can often find reassurance (in a girl who is late to get her first period) or an answer (in a woman who is having an early menopause) when we put a microscope to the women on your family tree.

Despite major strides in genetic testing, most of the genes that make us who we are, particularly our ability to reproduce, still elude us. But while we may not know exactly what genes are controlling how fast our eggs disappear, we do know that how it all went down for your mom, your grandmother, and your older sisters is important. Simply stated, if your mom had menopause before the average age (~51), you should know about it, and you should consider doing something about it. In fact, research has shown us that we tend to have a pretty hard time getting pregnant about 10 years before our mom went through menopause.

So let’s do some math; if your mom had an early menopause at 45, you may have some serious fertility issues at 35! (Remember, menopause is defined as one year without a period.) If you ask your mom and she remembers mood changes, irregular cycles, and hot flashes starting at 45 but her last period was at 50, her menopause was at 51 (get it?). The fun and wonderful changes associated with menopause (aka the peri-menopause or menopausal transition) can actually go on for several years before the real hammer (menopause) is dropped.

It’s safe to say that, in 10 years, our knowledge about the genes that code for reproduction will be vastly different from what we know today. Genetics is the fastest growing field in medicine; long gone are the days of Mendel and his fruit flies! Pretty soon, you might know more about yourself (and your future children) than you even dreamed (or desired) possible. We don’t want to go all Pandora and her box on you, but remember that, with discovery can come disappointment. So while we all wish to know more about ourselves, some information can be hard to swallow.  

But here’s the simple take-home message: we can’t predict a whole lot about what will happen to your ovaries just by looking at you. But we can predict a lot by talking to you. Start the conversation with your mom, your sister, and your gynecologist early. Know your own body as well as what happened to your mom and grandmother’s body. Whether you look like your mom or not does not dictate whether your insides do. If you want to plan for your reproductive future, the best person to seek advice from is your mom. Once again, she knows best.

While much of what dictates the timeline of a woman’s “reproductive life” (first period to the last period) and a woman’s fertility is unknown, many of these answers are in our genes (aka what happened to your mom or your grandmother may very well happen to you).  What we don’t know today about the genes that dictate fertility (specifically egg quantity and quality), we will likely know in a few tomorrows. Genetics is the fastest-growing field in medicine.

Let’s Dish on Dates: Last Menstrual Period (LMP)

When most of us hear the term dating, we think back to those days when we had butterflies in our stomach every time we imagined meeting our plus one for dinner and drinks. Questions from what should I wear to what should I say to when is it okay to stay flooded our minds. Fast-forward a few years, and now flings are out and fertility is in. Dates are now dictated by the arrival of our period and the most promising days to have sex.

The calendar is littered with red Xs and black circles rather than dinner reservations and drink locations. And while your chicken scratches can start to look like hieroglyphics, here’s why those “X marks the spot” notations really matter!

Pregnancies are dated (a.k.a. the due date of a pregnancy is calculated) based on the first day of a woman’s last menstrual period (LMP). Your chart will refer to this date as your EDC, a precise 40 weeks from your LMP.  This date is used to calculate when you ovulated and, therefore, when your egg met sperm. To confirm that you are spot on with when you saw that first “spot,” your OB/GYN will perform an early ultrasound measuring the length of the fetus (medically termed the crown rump length) to confirm that your date is consistent with the dates being picked up on the ultrasound. The two need to jive for the due date to be written in stone (or at least in your medical chart in black marker!).

In cases where there is a serious discrepancy, your OB will often re-date the pregnancy (that is, calculate a new due date based on the measurements noted on the ultrasound). Re-dating is dependent on how pregnant you are measuring at the time of the ultrasound and how discrepant the ultrasound findings are with respect to your LMP. Here’s when things need to change…
If you are 8 weeks pregnant based on your LMP but you are measuring 6 ½ weeks pregnant on the ultrasound, then your due date will need to be pushed back by 1 ½ weeks (you ovulated and conceived a little later than you thought!)  Additionally, if you are 10 weeks pregnant based on your LMP but your ultrasound measurement shows you to be 11 weeks and 3 days pregnant, then your due date will be pushed up by 10 days. While we don’t expect you to do this math alone we do want you to be comfortable with the numbers and the changes that might occur. Take a look below to see when things needs to be modified:

Pregnancy Weeks based on LMP Ultrasound measurement discrepancy
Less than 9 weeks If > 5 days off, change due date
9-14 weeks If >7 days off, change due date
14-16 weeks If > 7 days off, change due date
16-22 weeks If > 10 days off, change due date
22-28 weeks If > 14 days off, change due date
28+ weeks If > 21 days off, change due date

However, a change is only permanent if confirmed by a second ultrasound. In fact, every due date needs to be confirmed twice (sort of like sending a text and an email to say we will meet at 8PM!). Even in cases where you are for-sure positive about your last menstrual period (a.k.a. LMP), we will confirm it with an ultrasound.

In cases where you don’t have a clue in the world about when you conceived, we will use two ultrasounds to create and then confirm your due date. This is particularly true for women with irregular cycles. Additionally, in pregnancies conceived after fertility treatments, we will use dates such as the day of ovulation, the day of the IUI, and the day of the ET to help us decide when the infamous D-Day (a.k.a. due date) is.

So even when you find yourself seeing a plus sign or a smiley face, don’t throw that calendar out. What you have written down, even if illegible to anyone but you, matters. It will help your OB pick your due date and know when measurements are off (say, the baby looks too small or too big). Dating is the real deal for us OBs—so make sure to keep us in the loop about those Xs and Os, no matter how hectic your schedule!

Doctor’s Note: Truly, MD

While this note won’t get you out of work or off from school, it will give you information on who we are and why we built Truly, MD. It will tell you why we are lending our voices to everything female and why we, a couple of girls in the know, are sharing our medical knowledge and personal experiences with anyone who will listen.

We are doctors, moms, and athletes, and we are on a mission. Our goal is to empower and educate women on all things reproductive. We are honest, we are direct, and we don’t sugarcoat the truth. From your first period to your last, Truly, MD, offers answers, insight, and awareness of all things female-related. Is birth control bad? Am I fertile? When do I need to see a fertility doctor? Are these pregnancy symptoms normal? Can I exercise in pregnancy? Do I have to breastfeed? Can I take hormone replacement therapy? You name it, and we will talk about it. From the complex to the basic, we are going to give you answers, real answers.

At Truly, MD, no conversation is off limits. No question is dumb, and nothing is too controversial. Truly, MD, was born (no pun intended) out of our desire to change the dialogue, shake up the conversation, and revamp the answers women were being given about their reproductive health. It is our quest to help women conquer their future with accessible, digestible, and honest medical advice.

We, Jaime and Sheeva, are fertility specialists who work and live in New York City. For a full run-down of education and articles written, click here. Our practice is devoted to helping women achieve their goal of parenthood. Using a team approach (two minds are always better than one) rooted in honesty and transparency, we are redefining the doctor-patient relationship. We give it to you straight, like your best girlfriends would, but with years of medical training and experience to back it up.

However, there are only so many patients we can see in a day, only so many women we will meet in our day-to-day activities, on the spin bike, in the line at Starbucks, and at our kids’ school. Time and geography will limit which women we cross paths with. We wanted to take our message nationally, possibly even globally, educating and empowering more women to become their own advocates through our medical advice. And that’s why we launched Truly, MD.

At Truly, MD, we care about you as a whole. The body and the mind, the fitness and the food, Western and Eastern medicine. You are a sum of a lot of parts, just like we are a sum of all members on our team. It takes more than one doctor to treat you and more than just a pill or a shot to heal you. We get how complex things can be. We want to help you find what you need to make you healthier, stronger, cognizant, and empowered. Our words are simple, and our message is clear, true, and honest. Take our medical advice, and use it to change your reproductive future. Take our personal experiences, and use them to change your overall future. Take what we, a couple of girls, know, and shape your now.

Truly Yours,

Jaime and Sheeva

About Doctors Jaime and Sheeva

Our Details

Friends for almost twenty years and colleagues for about 10, Dr Knopman and Talebian will be practicing together at CCRM NY in the Fall 2016.  Areas of medical specialty include:  treatment of menstrual irregularities, assisted reproductive technologies, in vitro fertilization, oocyte cryopreservation, oncofertility, same sex reproduction, and third party reproduction.

 

Jaime M Knopman, MD FACOG

Education:

University of Pennsylvania, B.A. 2000

Mount Sinai School of Medicine, M.D.  2005

Residency in Obstetrics and Gynecology NYU School of Medicine 2009

Fellowship in Reproductive Endocrinology and Infertility NYU School of Medicine  2012

Certifications:

Board Certified Obstetrician/Gynecologist

Board Certified Reproductive Endocrinologist & Infertility

Awards:

Summa Cum Laude, University of Pennsylvania

Phi Beta Kappa, University of Pennsylvania

Alpha Omega Alpha, Mt. Sinai School of Medicine

Personal

Born and raised on Long Island, New York Jaime now lives on the Upper East Side of Manhattan with her husband and two daughters. Jaime starts every day with a workout (running, cycling, pilates) and ends it writing for Truly, MD.  In addition to her love of medicine, Jaime has a true passion for writing!

 

Sheeva Talebian, MD FACOG

Education

Columbia University, B.A. 1997

Mount Sinai School of Medicine, M.D. 2001

Residency in Obstetrics and Gynecology NYU School of Medicine 2005

Fellowship in Reproductive Endocrinology and Infertility NYU School of Medicine 2008

Certifications:

Board Certified Obstetrician/Gynecologist

Board Certified Reproductive Endocrinologist & Infertility

Awards

Magna Cum Laude, Columbia University

Phi Beta Kappa, Columbia University

Personal

Born and raised on Long Island, New York Sheeva now lives on the Upper West Side of Manhattan with her husband and two children.  When not wearing her mommy or doctor hat, Sheeva can be found sweating in a cycling studio or running in Central Park (most often before 7am!).

 

Peer-Reviewed Manuscripts

Murashov AK, Talebian S, and Wolgemuth DJ.  Role of heat shock protein Hsp25 in the response of the orofacial nuclei motor system to physiologic stress.  Mol Brain Res 1998. 63:14-24.

Knopman JM, Talebian S, Keegan D, Grifo JA.  Heterotopic abdominal pregnancy following two-blastocyst embryo transfer.  Fertil Steril. 2007. 88(5):1437.e13-5.

Knopman JM, Copperman AB.  Value of 3D Ultrasound in the management of suspected Asherman’s syndrome. J Reprod Med, 2007. 52 (11): 1016-22.

Grifo JA, Talebian S, Keegan DA, Krey LC, Adler A, Berkeley AS.  Ten-year experience with Preimplantation Genetic Diagnosis (PGD) at The NYU Fertility Center (New York University School of Medicine).  Fertil Steril 2007. 88:978-81.

Knopman JM, Copperman AB. Endometrial thickness measured by ultrasound scan in women with uterine outlet obstruction due to intra-uterine or upper cervical adhesions. Hum Reprod, 2008. 23 (5): E14.

Knopman JM, Noyes N, Talebian S, Krey LC, Grifo JA, Licciardi F. Women with cancer undergoing ART for fertility preservation: a cohort study of their response to exogenous gonadotropins. Fertil Steril, 2009. 91(4): 1476-78.

Knopman JM, Krey LC, Lee J, Fino ME, Novestsky AP, Noyes N. Monozygotic twinning: an eight-year experience at a large IVF center. Fertil Steril, 2010. 94 (2): 502-10.

Knopman JM, Talebian S, Berkeley AS, Grifo JA, Noyes N, Licciardi F. Fate of Cryopreserved Donor Embryos. Fertil Steril, 2010. 94 (5): 1689-92.

Knopman JM, Papadopoulos E, Fino ME, Grifo JA, Noyes N. Surviving childhood and reproductive age malignancy: Effects of treatment on fertility, gametes and future parenthood. Lancet Oncol, 2010. 11(5): 490-8.

Knopman JM, Noyes N, Grifo JA. Cryopreserved oocytes can serve as the treatment for secondary infertility: a novel model for egg donation. Fertil Steril, 2010. 93 (7): 2413.e7-9.

Noyes N, Knopman JM, Labella P, McCaffrey C, Clark-Williams M, Grifo JA. Oocyte Cryopreservation Outcomes Including Pre-Cryo and Post-Thaw Meiotic Spindle Evaluation Following Slow Cooling and Vitrification of Human Oocytes. Fertil Steril, 2010. 94 (6): 2078-82.

Noyes N, Labella P, Grifo JA, Knopman JM. Oocyte cryopreservation: a feasible fertility preservation option for reproductive age cancer survivors. JARG, 2010. 27 (8): 495-9.

Mullin CM, Fino ME, Talebian S, Krey LC, Licciardi F, Grifo JA.  Comparison of pregnancy outcomes in elective single blastocyst transfer versus double blastocyst transfer stratified by age.  Fertil Steril 2010. 93: 574-578.

Noyes N, Knopman JM, Long K, Coletta JM, Abu-Rustum NR. Fertility considerations in the management of gynecologic malignancies. Gynecol Oncol, 2011. 120 (3): 326-33.

Noyes N, Knopman JM, Melzer K, Fino ME, Friedman B, Westphal L. Oocyte cryopreservation as a fertility preservation measure for cancer patients. RBM Online, 2011 (Epub).

 

Does My Positive Pregnancy Test = Baby?

When the stick starts to smile, reads pregnant, or gives you a double line, most of us have to do a double take. After we double check (in the form of another test; trust us, we all do it!), we usually pick up the phone and call our plus one, our best pal, or our partner in crime. Whether you were waiting for this for years or just started trying a month ago, finding out that you are preggers can be pretty overwhelming. The emotions can be as volatile as the weather in the tropics. Even if you have a child (or children), adding to your clan can make you clamor.

For most of us, those first few minutes/hours after that positive test are dominated by questions—and the majority are about the very distant future (a.k.a. nine months away). When is my due date? Will this baby be a girl or a boy? Do we have enough space in our home? When should we tell our family and friends? And while we, too, love a good future plan, unfortunately, there is not all that much that we can make of or plan for after one positive pregnancy test. The reality is that, from the pregnancy test to the postpartum unit, there are A LOT of hurdles. In fact, a good chunk of positive pregnancy tests don’t even make it past the first week or so.

Although many of us blame that box we lifted or that bike ride we took, in most cases, early pregnancy losses have nothing to do with our actions. It has everything to do with the embryo that implanted. The majority of early pregnancy losses are the result of abnormal embryos (an extra or missing chromosome). In the land of embryos, fetuses, and human genetics, 46 is the sweet spot. We get 23 chromosomes from our mom and 23 from our dad. Anything more or less than 46 is considered abnormal.

While not all pregnancies with abnormal chromosomes miscarry or don’t make a baby, the majority does not make it very far. Very few abnormal derivations of 46 chromosomes are even compatible with life. And luckily for us, the body knows this and puts up a big red STOP sign to the pregnancy.

We in no way mean to rain on your pregnancy parade. A positive test definitely means something, and for many, it is the beginning of a long and fruitful journey. And while we, too, get super excited at the pregnancy texts and emails our patients and friends send us, we want to remain cautiously optimistic.

Tempering your emotions can soften the blow when things don’t go right. Remaining realistic in the beginning of a pregnancy is key. While we certainly don’t recommend you walk around with your head and heart low, we do suggest that you hold off posting your pregnancy test on Facebook. Give it some time; see how things progress. Let your doctor confirm that he or she sees fetal development and a heartbeat before you let your heart go crazy. It can prepare you for those potential skipped beats.

Truth

The truth can be hard: hard to hear, hard to say, and even harder to accept. It’s one of those things that, no matter how many times we cover our eyes and hold our ears, it never leaves us alone. But while the truth can be brutal, it should never be ugly. It should be real, it should be transparent, and it should be unbiased. But it should never be ugly. If it is, you likely waited too long to hear it, too long to say it, or are hearing it from the wrong person. Go out and look elsewhere because what you are looking at may not be your truth at all.

When searching for your personal truths, you must remember to be true to your mind and true to your body. At Truly, MD, we are here as ambassadors to the truth about your bodies. From when they start to menstruate to when they hit menopause, we casually but factually tell you the truths about all things gynecologic and obstetric. We break down the most complex medical topics, answer the seemingly simple questions, and dish on everything and anything in between. Our focus in doing this is simply to tell the truth.

While we may not have lived it all, we have been around the block. We know what you want to know, what you should know, and what you need to know, and we are here to give it to you straight up (with no juice and on the rocks). Although it may burn going down, it won’t leave you tipsy. In fact, it will leave you clear headed and ready to conquer the world.

We will also bare our own selves and share with you our own personal truths, the ones we didn’t learn in medical school but rather as real women. We hope by sharing our truths, both the ones we learned as doctors as well as the ones we learned as daughters, mothers, sisters, wives, and friends, that we are able to create a community that is rooted in honesty, transparency, and truth. Here, there is no judgment, no false pretenses, and no biases, just a couple of girls who have been true to their friendship, their patients, and their passion for empowering others. Our pledge to you is to always tell it like it is. Your promise in return is take our truths and turn them into your realities. Together, we can make a change. And that’s the truth.