How to Properly Identify Sperm, Eggs, Embryos, and Everything in Between

/in /by

“License and registration” can be two of the worst words any driver hears: simply stated, you are so busted! No matter how loud the radio is playing and how good you feel driving on the open road, going 85 in a 60 is not a good thing. After the “Officer, I really wasn’t going any more than 10 miles an hour over the speed limit” and the half-hearted attempt to sweet talk your way out of the ticket without so much as a smile from the highway patrol guy or gal, you pretty much take your ticket and drive away.

And although you may vow to go to court and fight it, most of us pay our fine (ugh) and move on. And while no one likes to waste their hard-earned money, the downside of losing some cash is not so catastrophic (although points on your license can be a real bummer). However, errors in proper identification, particularly in a fertility office, can be disastrous.

In any medical practice, especially a fertility one, you want to be “pulled over” every time you set foot in that medical building. From the staff at the front desk to the chaperones who put you in the exam room to the medical assistants who draw your blood, asking to see identification is a good thing. In fact, the more people who ID you, the better (yes, we are looking at your age☺). When any gametes (eggs, sperms, or embryos) are being used, it should be even more in your face—in the changing room, in the embryo transfer room, and twice prior to the transfer. If you find yourself becoming annoyed, that means we have done our job correctly. While redundant, we want to be more sure than sure that we have who we think we have. Like the cop on I-95, we mean business!

Expect us to ask your name, your date of birth, your Social Security number, and your partner’s name and date of birth (here, we will give you a pass on the SSN). No need to call LifeLock. We’re not trying to commit identity theft; we’re just ensuring that we have the right players in this game of baby making. We ask repeatedly to eliminate the chance that any errors occur. We have systems set up to double check everything not only twice but also by two people. In fact, the most common words you will hear in an embryology lab are “Can I get a check?” No eggs, sperm, or embryos are ever moved without two sets of eyes—always.

When it comes to identification, we don’t mess around. We don’t even joke about it. So, if staff personnel don’t ask you these important questions and you feel uncomfortable, in the words of the NYPD, if you see something, say something. Voicing your concern does not make you annoying; it makes you on top of it. And if things don’t change, then maybe that is not the right fertility practice for you. In general, we are pretty good bouncers and know who should come into the club.

Trust us, even the best fake IDs don’t get past us.

Is “the” Seat Spoiling my “Seat”? Cycling and Your Bottom Line

/in /by

As avid spinners (indoor cycling) ourselves, we get the “my bottom has gone numb sensation.” We also get the “um, things don’t feel so comfortable in the saddle” sensation. However, the bottom line is that your bottom line can tolerate a whole lot. While the pressure from constant sitting in a somewhat awkward position can cause numbness, it should not cause any long-term damage or have a negative impact on your sex life. And let’s face it, unless you are doubling and tripling (a.k.a. two or three back-to-back cycling classes), you are never in the saddle for more than 60 minutes, tops. However, if you are finding the ride particularly rough on your rear, here are some tips on how to smooth it out…

  1. Chafing: Thigh, bottom, and vaginal rubbing can happen to the best of us. And when it does happen, it can burn—big time. The best way to treat this is to apply Vaseline, Body Glide, or Aquaphor both pre- and post-ride. Keep the area lubricated, and make sure that all parts glide past each other without any friction!
  2. Outfit Change: While you may like the way a pair of pants looks, not every pair of pants was meant to go for a spin! Some are more comfortable than others. Try out different brands, materials, and sizes. Consider investing in a pair that has a cushioned bottom.
  3. Adjust Bike Settings: How you set up your bike can impact your body, from your head right down to your toes (and bottom). If things don’t feel right, don’t be afraid to readjust AND to ask a professional (a.k.a. the teacher or the studio staff) if things look right. Altering the position of the bike can change body mechanics and positioning. This alone can help combat some of the discomfort riders can experience. Different angles = different pressure points = no more discomfort.  If this doesn’t work, then consider adding extra padding to the seat. Most cycling studios have extra seat covers to give you extra padding if you need.
  4. Don’t be stationary: Although this may sound ironic, when sitting on a stationary spin bike, changing positions (from the saddle to second or third) can help get the blood flowing to different parts of your lower bottom. This can relieve the pressure on your bottom in a big way.
  5. Time it: When you ride and when you shave or wax is important. It’s probably not a great idea to do a class after getting a Brazilian wax. Following hair removal, the skin can be raw and sensitive. Sitting on a bike immediately after may not be the best idea.
  6. Space it out: No matter how much you love to ride (trust us, we get it!), it’s not a bad idea to take a break occasionally. A day off your bottom can often alleviate some of the discomfort. Additionally, it’s not a bad to explore new activities…you never know what you might find!

The upside to your rear side is that, for most riders, your bottom becomes pretty well acquainted with the saddle after a few rides. So keep on spinning. Who knows, your bottom may actually benefit from a couple of cycling classes.

The Enemy: Vaginitis

/in /by

Vaginal discharge and its friends—itching, odor, and irritation—need no introduction. When they arrive, you know they’re there. They are some of the most unwelcome guests, and you’ll pretty much do anything to boot them from your bottom. As complaints go, they’re the cause of many calls and visits to the GYN and overall can leave you miserable.

Vaginal discharge usually indicates vaginitis (the medical way of saying “inflammation” or “infection”). Vaginitis is the umbrella term used to describe all the lovely symptoms listed above. And when they’re present, it’s a sure sign that something is off in the vagina. Let us share what these things usually are.

For starters, the vagina is an acidic place (a.k.a. the pH of the vagina is usually about 4.0 to 4.5). Acidity is important because it assists in keeping the bugs away—bacteria and fungus are more fans of a basic environment. When the pH is off and things are skewing in the basic direction, bugs start to flourish.

Anything from menstrual cycle phase to a foreign body to sex to antibiotics can throw things off (a.k.a. the pH) and set the stage for vaginitis. In come the bacteria or the fungus, and out goes your comfort (bacterial vaginosis, candida vulvovaginitis, and trichomoniasis are the most common culprits). When it comes to symptoms, the most common symptoms women with vaginitis complain of are vaginal discharge, itching, burning, redness, pain with intercourse, pain with urination, and even spotting.

It’s important to call your doctor when you get that “things don’t feel right down there” sensation. You should trek to their office for a chat (a good history can tell you more than any test), a pelvic exam, a vaginal plus or minus cervical culture, a pH test, and a close look at the discharge under the microscope. While there are some classic features of different bugs (trichomonas usually present with a greenish-yellow discharge, candidiasis with a thick, white, cottage-cheese-like discharge, and bacterial vaginosis with a thin, fishy-smelling gray discharge), it’s best to make the diagnosis before initiating any treatment.

If the tests come up without a clear diagnosis (which happens in about 25–35% of cases), your doctor will start delving deeper into some of the more unlikely causes (low estrogen, medications, hygienic practices, allergies). Whatever the cause, we may have ways to treat you and end your torture. Whether it is an oral medication or a vaginal cream, we can find the right medication to return the vagina and its pH back to normal.

Vaginitis can be super annoying. It can sideline you from doing a lot of fun things (no explanation needed) as well as some not-so-fun things (a.k.a. working). But you don’t have to suffer in silence. And you shouldn’t rely on self-diagnosis. While your intuition is probably pretty spot on, without a microscope and a pH test, you can’t be certain. Although it is usually bacteria or a fungus causing the problem, it’s important to confirm which one. This will ensure that you get the right treatment and get right back into the swing of things.

Don’t Break My Heart: The Impact of Fertility Treatment on Heart Disease

/in /by

Be still, my beating heart: Does fertility treatment increase your risk for heart disease? The latest results from a large Canadian study made everyone’s heart skip a beat with its recent findings. The data showed an increased risk in heart disease in women who required fertility treatment to get pregnant. And while this study got a lot of press, before you have a heart attack, here are five things that you should know:

  1. Even with the increased risk reported in the study, the absolute numbers are very low (a.k.a. the number of women who experienced cardiovascular events was pretty small). While we aren’t turning a blind eye or a deaf ear to the results, we are interpreting them with caution.
  2. IVF in the 1990s and IVF in 2017 are VERY different. The treatment protocols and techniques have changed more than the fashion trends (#bellbottoms). Therefore, it’s nearly impossible to study the aftereffects of treatments given then to the aftereffects of treatments given now. Our medications are different, our stimulation styles are different, and our dosages are different. In fact, it’s hard to find anything that’s the same!
  3. When analyzing any research study, it’s important to distinguish between correlation and causation. Although they may sound the same and start with the same letter, they are very different in what they suggest and what they mean for you. When you think of causation, think of cigarettes and lung cancer: We all know cigarettes cause lung cancer. When you think of correlation, think of cigarettes and infertility. Cigarettes do not specifically cause infertility, but they have been associated with infertility. In this study, fertility treatment has been correlated with heart disease (to a modest effect), but fertility treatment has not been demonstrated to cause heart disease. And although the distinction may seem insignificant, it’s actually pretty important!
  4. Anyone who is going to undergo fertility treatment should be in good shape. While you don’t need to join us for regular 5:30AM workouts, you do need to be in good health. Pregnancy is no walk in the park; you want your body to be prepared for those nine months and the many months that follow!
  5. The primary outcome studied was “adverse cardiovascular events.” The authors lumped stroke, TIA (think of it as a temporary stroke), MI (a.k.a. heart attack), and heart failure altogether. And while they all may affect your heart and your brain, they are not all the same. By opening up the floodgates (or adding more diseases to the primary endpoint), you will almost certainly capture more women who fall into the “I got that disease” category. So, while more women who took fertility medications may have gotten the primary outcome, the primary outcome was pretty expansive.

Your heart is as important as your ovaries, your uterus, and your fallopian tubes to us fertility doctors. While we may seem to have a one-track mind (#makingbabies), we are not only focused on your fertility but also your future health. Therefore, we will keep following the latest scientific breakthroughs and bring them to you hot off the press. We cross our hearts!

Going Long: When the Finish Line May Be Further Than You Think

/in /by

For all of you runners, swimmers, and cyclists, you know what it takes to prepare for that long-distance jaunt. Aside from what you should eat (#carbLOAD) and what you should wear, how far your legs or arms need to take you is pretty important. Preparation, both physical and mental, is key to crossing that finish line.

The same can be said for individuals and couples going through fertility treatment. Knowing how many rounds or cycles it will take you to reach the finish line (#baby) will help you prepare for the journey. And while this is no straight-up calculation or predetermined training plan, information such as age, ovarian reserve, and fertility history can definitely help us estimate. Here’s how far you might need to go…

There are about 180,000 IVF cycles performed in the US each year. And from these cycles, about 65,000 babies are born. Over the years, the numbers have added up, and nowadays, nearly 2% of babies born each year are a result of IVF. Simply stated, more and more people are doing IVF, and more and more babies are born after IVF. However, the number that is less clear is how many cycles it took each person to get to her personal finish line (a.k.a. a baby).

And while this statistic may elude us, what is pretty evident is that those who hang in there longer (a.k.a. complete more IVF cycles) are more likely to conceive. In fact, a recent Swedish study demonstrated that women who did three IVF cycles had about a 65% chance of pregnancy. This was higher than women who stopped at one or two. And while we are certainly not advocating endless IVF cycles, we are recommending that you go the distance based on your doctor’s recommendations.

If your doctors think you have the potential to push on (you are still making a good number of eggs, you are having advanced embryos transferred, your embryos are passing the genetic screening test), then we recommend that you keep on keeping on. Just make sure that you know how far they think you should go, and in turn, make sure they know how far you want to go.

Going back to our original metaphor, think of it like this… If someone told you that you had to run five miles and then midway through told you it was actually 10 miles (oops!), you would be pretty peeved. You would probably doubt your ability to go the distance and maybe even decide to bow out before the race was over.

On the contrary, if you planned to do a 10 miler but midway through found out the race was only half that distance, you would feel pretty good. Energized and invigorated, you would kick that race’s butt and sprint to the finish line. Fertility treatment might make you go the distance. While we certainly hope the race is over shortly after it starts, if it goes longer we don’t want to leave you out there on the course without the appropriate gear.

Information, preparation, and participation (a.k.a. a doctor who consults with you after every IVF procedure) will guide you through this often-torturous race. But having a good idea about the course before you start will make each passing mile a bit easier.

Chew on This: What Pregnancy Can Do to Your Teeth

/in /by

Pregnancy is like the ultimate detective. It leaves no stone (or body part) unturned. It will make your hair fall out, your skin stretch, and your feet grow (say goodbye to many of your pre-pregnancy shoes!). And the fun doesn’t end there. Pregnancy also takes a hit on dental health; cavities, gingivitis, periodontitis, and tooth erosion are on the list of pregnancy pleasures.

Here’s what can be on the to-do list of your teeth…

  1. Gingivitis (Gum Disease): Just like your hands and feet, your gums can swell during pregnancy. An increased inflammatory response to plaque can cause your gums to swell and bleed. Those who enter pregnancy with their dentist already on speed dial (a.k.a. you had gum disease before pregnancy) are more likely to experience a worsening during pregnancy. If this is you, make sure to pay particular attention to what your teeth and gums are doing!
  2. Loose Teeth: Due to an increase in hormones, flexibility in your joints and ligaments increases during pregnancy. And while this may make you excel in yoga, it makes your teeth super loose. Beware of sticky foods!
  3. Tooth Erosion: Your teeth like food. Your teeth like water. Your teeth don’t like vomit. Vomit contains gastric acid, and gastric acid can eat away at the enamel of the tooth, causing tooth erosion. Therefore, women with serious morning sickness are at risk for serious tooth erosion. Rinsing your mouth with a basic solution (baking soda + 1 cup of water) can help neutralize the acid.
  4. Cavities: What you take in and what your mouth puts out change during pregnancy. The pH of the mouth shifts to a slightly more acidic level. This acidity, combined with pregnancy cravings (a.k.a. more sweets and sugary foods), increases the risk of cavities. Don’t go to bed without brushing and flossing!
  5. Periodontitis: When gingivitis is ignored, it can become periodontitis. Simply stated, when bacteria make the gums their permanent home destroying the gum and the teeth, you have yourself a case of periodontitis. You can look forward to loose teeth, lost bone, and sometimes, even bacteria in the bloodstream. The latter, in the worst-case scenario, can lead to preterm labor. Don’t let it get to this point. If your gums don’t feel right, go right to someone to check them.

There is a lot about pregnancy that makes you smile and a lot that makes you frown. Whichever way your mouth is going, don’t forget about the 30-plus structures that stand behind them. Your teeth need to last you through pregnancy, postpartum, and beyond. Make sure to take care of them. After age 12, the tooth fairy brings nothing but a bill and a big-time headache!

When to Cut the Cord

/in /by

While we can’t tell you how long your kids will hang on to you for support, we can talk a little bit about when to cut the umbilical cord! Delayed umbilical cord clamping has become all the rage these days—almost as popular as those fidget spinners!

What’s all the buzz about delayed cord clamping, and what does it mean?

After your baby is delivered, the umbilical cord (what connects Baby to the placenta, an organ that feeds Baby while inside Mom) is often clamped and cut soon after delivery, usually around 15 to 20 seconds afterwards.

However, studies have shown that blood is still transferred from the placenta to the baby during those first few cries after delivery. As long as Baby is doing okay after delivery, those extra few ounces of blood can give your newborn a leg up on iron and blood stores.

In pre-term babies (those born before 37 weeks), this can mean a better transition to life on the outside, fewer blood transfusions for low red blood cell counts, and a smaller chance of a few other complications of prematurity.

For term babies (those born after 37 weeks), waiting to clamp and cut the cord can also increase iron stores and decrease your baby’s chance of having anemia (low red blood cells) in the first few months of life. Giving your baby a few more red blood cells post-delivery may increase his or her chance of needing therapy for newborn jaundice (think those UV lights newborns are sometimes under), but that chance seems to be small, based on the studies so far.

So, delayed clamping seems to be great for Baby, but what about mom? Mothers seem to do just fine, with no increase in bleeding or postpartum hemorrhage (see our post here) in studies.

How long is long enough? It seems 30 to 60 seconds should be good. Some people like to wait until the cord stops pulsating, but it seems most of the benefit from delaying clamping happens in the first minute of Baby’s life.

Now, what if something happens during your delivery and you can’t delay cutting the cord? Remember, the main goal is a healthy mom and baby. If Baby needs some extra attention from the pediatricians after delivery, that may mean you can’t wait to clamp and cut!

Think of it as one of the first of many compromises you make as a parent. While, of course, we always want to give our kids the best of everything, sometimes we can’t always do things by the book.

Big Girls Do Cry

/in /by

Showing emotion has too long been viewed as a sign of weakness. “Tough” and “strong” meant holding in how you were really feeling, especially as a mom trying to juggle it all. Fear of being judged or being seen as weak or imperfect prevented us from sharing our emotions. No one wanted to be the odd woman or mom out. But unlike the lyrics of the song most of us know from the Dirty Dancing soundtrack, big girls do cry. Shedding a tear doesn’t make you a wimp or pathetic; it makes you real.

Whether you are the mother of a newborn, a toddler, or a teenager, parenting is hard. And although the problems may change (getting your little one to sleep through the night to getting your teenager to come home at night), tackling them is equally as challenging. It can drive the sanest of us insane! Add to that another child or two, and the tasks don’t double, they quadruple: your head is spinning. Without your Google calendar attached to your hip telling you whom to pick up and when, you would be lost. But sometimes, even the most organized planner, the best parenting books, and the cleanest diaper bag can’t replace how lost you really feel.

Fear of being seen as lesser, imperfect, or subpar makes most of us hold our feelings in. And as the emotions build, so do the walls we put up to hide how we are really feeling. But the walls not only keep our feelings hidden, but they also keep the support of others out. They prevent us from making contact, from building relationships, and from seeking help.

When we share how we feel, our failures, and our fears, we create community. We create connections. We work together. And together, as a unit of women, moms, partners, sisters, and friends, we can stand stronger. Start a movement of honesty and truth by being honest and true with who you are and your fallibilities. You never know whom your words will reach and whom you will inspire.

So, take it from two big girls who frequently cry: crying is not a bad thing. In fact, it’s a pretty good thing. Just find the shoulder of someone you trust when you do. It will make the whole process a whole lot easier!

Take a Bite Out of This: What Your Teeth Could Be Doing to the Rest of the Body

/in , /by

There may be no bigger hassle than a dental problem. A root canal, an implant, a denture, or a chipped tooth: it’s all a big pain and a big hit to your bank account. And unfortunately, as we age so do our teeth. Just like your ovaries, they have been present for all your bad decisions. The sweets, the “oops, I forget to brush and floss,” and the endless packs of gum have taken their toll. (Trust us, we know, we do it too!) And while it may come as a shock to you, what’s going on your mouth may be a barometer for what’s going on in the rest of your body.

Oral health disorders like periodontal disease (a medical way of saying “gum disease”) have been associated with problems like cardiovascular disease, diabetes, Alzheimer’s, respiratory infections, and even preterm labor. Inflammation in the gums can lead to inflammation in other parts of the body. Picture this—bacteria make their way into the body through the gums. The gums have lots of blood vessels. Blood vessels act like a shuttle transporting bacteria throughout the body. Wherever they land, they bring inflammation. Inflammation in the blood vessels can cause the blood vessels to narrow. Narrow blood vessels cause blood flow to slow down and clots to form. Such clots increase the risk for heart attack and stroke. Because women post-menopause are already at increased risk for heart disease due to age and other medical risk factors, you don’t want to add to it by introducing gum disease and inflammation.

But there is more to the teeth’s story than gum inflammation and bacteria. After menopause, estrogen levels drop. This drop not only causes hot flashes and vaginal dryness but also the loss of bone in the jaw. Bone loss can lead to loose teeth and tooth loss. And unfortunately, when you lose a tooth at 55, there is no tooth fairy—just a lot of dental bills and inconvenience!

On top of the age and decreased estrogen part, medications that are used for osteoporosis have been linked to osteonecrosis (a.k.a. bone decay). And while this is very rare and most often seen in women with cancer who are on high-dose bisphosphonates, it is important to give your dentist frequent updates on your medication list so that your dental work is scheduled appropriately.

To make matters a little more distasteful, menopause and its hormonal fluctuations can also bring oral discomfort. Post-menopausal women report changes in their taste perceptions and dry mouth. And your gums feel it, too. Receding gums and sensitive gums are not uncommon.

Age gets us all over. From your hair and skin to your bones and toes, time takes a toll. Your teeth didn’t want to be left out! To decrease damage, the American Dental Association recommends that you make a trip to see your dentist twice a year. And for your homework, they suggest daily brushing and flossing. Also, limiting sugary foods and things that stick is a sure-fire way to improve your dental health.

So, don’t follow the nearly 35% of US women who did not see a dentist last year. Make an appointment to get those pearly whites (or at this point, some shade of white) checked out. You will be doing your whole body good.

FRIENDSHIP

/in , /by

From the friendship bracelets we made in camp to the BFF necklaces we wore in middle school and the matching outfits we wore in high school (unplanned, we still do this!), advertising friendship has always been the thing to do. You wore your friendship status like a badge of honor, proud to show that you were never alone, and eager to report that you were surrounded by others. But more than the status friendship gave you, it also gave you comfort, it gave you peace, and it gave you reassurance.

You were not alone. Ups and downs, successes and failures, and wins and gains would never be experienced in solitude. You had your crew or your bestie to weather the most unpredictable storm, and that was better than any umbrella, Weather Channel update, or blizzard survival kit.

Truly, MD, is rooted in friendship. Two girls who have known each other for longer than you can imagine who have stood by each other’s sides through the marathons of their careers, motherhood, and everything in between. Although admittedly one runs WAY faster (Sheeva is the real deal out there on the road), we always finish together.

The power of our friendship has allowed us to run the steepest of hills, traverse the hardest of terrains, and push a minute or mile longer than the day before. While we at Truly, MD, may never meet you in person, gab with you on the phone, and share a glass of rosé on a summer day, we are your friends. We are here to break it all down, from the medical topics that make you say “hmm” to the mom stuff that makes you say “ahhh.”

We tell it to you just like your closest GFs would. We use words, phrases, and sayings that your nearest and dearest would employ, but admittedly, we say it with more umph because of our medical backgrounds. Just like your closest companions, we dish about it all and hold nothing back (and like your friends, we can be blunt at times—don’t take offense!). Think of us as a couple of girls in the know who want to welcome you into our community, offer you our friendship, and make you a part of our crew. In the words of Henry Ford, “My best friend is the one who brings out the best in me.”

Let Truly, MD, bring out the best in you!