Facing Gynecologic Surgery While Experiencing Infertility

Posted by Brigham and Women's Hospital April 21, 2015

Antonio Gargiulo, MD, Medical Director, Center for Robotic Surgery

Today’s post is written by Antonio Gargiulo, MD, Medical Director, Center for Robotic Surgery and a fertility expert in the Center for Infertility and Reproductive Surgery (CIRS) at Brigham and Women’s Hospital in Massachusetts and the Center for Reproductive Care at Exeter Hospital in New Hampshire.

Often my patients experiencing infertility need gynecologic surgery because certain conditions can either cause infertility or impair infertility treatments. Most of these conditions can be treated through minimally invasive surgical techniques, resulting in fewer complications and quicker recovery.

The following post provides information about conditions requiring gynecologic surgery and your treatment options. I recommend that all women of reproductive age that need gynecologic surgery should consult a reproductive surgeon (infertility specialists who practice gynecologic surgery). These physicians have received highly specialized surgical training, which is critical in successfully treating gynecologic conditions that may affect your fertility. I also remind patients that obtaining a second opinion before agreeing to any surgical plan is an essential step in their care.

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Polycystic Ovarian Syndrome: What You Need to Know

Posted by Brigham and Women's Hospital August 21, 2014

There are a number of treatment options for women with polycystic ovarian syndrome.

Author: Dr. Rachel Ashby, Director of the Donor Egg and Gestational Carrier Program at the Center for Infertility and Reproductive Surgery at Brigham and Women’s Hospital.

Polycystic ovarian syndrome (PCOS) affects between five and ten percent of women. This common endocrine disorder can cause disruption in ovulatory and menstrual cycles, as well as an excess production of male type hormones, all of which can cause infertility. The cause of PCOS is likely a combination of genetic and environmental factors. There is a twenty to forty percent incidence of PCOS in women where either a mother or sister has also been diagnosed with the disorder.

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IVF Helps Deliver a Gift worth Waiting For

Posted by Brigham and Women's Hospital October 29, 2013

Leah Miriam Urovitch was born on March 30, 2013, healthy and one day ahead of schedule.

Leah Miriam Urovitch was born on March 30, 2013, healthy and one day ahead of schedule. But her parents, Josh, 45, and Lisa, 43, had been waiting for this little girl for years.

Josh and Lisa were married in 2009, and, because of their ages, they started trying to have a baby right away. They continued trying to conceive naturally for more than a year before deciding to seek professional help.

In 2011, they reached out to Dr. Elena Yanushpolsky, an infertility specialist with the Center for Infertility and Reproductive Surgery (CIRS) at Brigham and Women’s Hospital (BWH). At that point, the primary options for Josh and Lisa were intrauterine insemination (IUI) treatments or in vitro fertilization (IVF).

For IUI, the male partner’s sperm is collected and then injected into the female partner, usually on two consecutive days at the time of ovulation. IVF, on the other hand, is a more involved process and can be broken down into four steps: using medications to stimulate the ovaries to produce multiple mature eggs; surgically removing the eggs; fertilizing and incubating the eggs; and returning the eggs to the uterus by means of a catheter.

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Fertility Preservation: Saving for the Future

Posted by Brigham and Women's Hospital September 25, 2013

Freezing eggs is one option for cancer patients who want to preserve their fertility.

Today’s post is written by Dr. Elizabeth Ginsburg, a physician at the Center for Infertility and Reproductive Surgery at Brigham and Women’s Hospital. She discusses fertility preservation options for patients who may need to put parenthood on hold while they undergo treatment for cancer.

Recently, I saw a young woman who was diagnosed with non-Hodgkin’s lymphoma. After undergoing tests and meeting with her oncologist, it was determined she would need chemotherapy.  However, the chemotherapy was expected to put her at risk for infertility. Though this woman is not married, she has always wanted children. Her oncologist referred her to me for a consultation.

Cancer is a frightening diagnosis, and although cure rates have improved dramatically, many treatments increase the risk of infertility or may cause sterility in both men women. Studies have shown that for some young men and women facing cancer treatment, the loss of fertility can be as devastating as the cancer diagnosis itself. Fortunately, there are methods which can help cancer patients preserve their fertility.

For men, sperm can be banked (or frozen) for future use as part of in vitro fertilization (IVF). IVF is very effective and the likelihood of having a healthy baby using this technique is excellent.

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The Other Half of the Fertility Equation: Male Fertility

Posted by Brigham and Women's Hospital June 10, 2013

Don't forget the other half of the fertility equation - male fertility.

Today’s post was written by Dr. Elena Yanushpolsky, an infertility specialist with the Center for Infertility and Reproductive Surgery at Brigham and Women’s Hospital (BWH). Dr. Yanushpolsky is also the Director of the BWH Center for Infertility and Reproductive Surgery at South Shore Hospital in South Weymouth.

A couple, both about 33 years old, recently came to my clinic after trying to conceive for 18 months without success. After evaluating both of them, we learned that their inability to conceive was due to the husband’s infertility. This couple’s situation is not unusual. In 20-25 percent of cases, infertility can be attributed exclusively to male factor problems, and an additional 10 percent of couples have male infertility in addition to other factors.

The first step in evaluating whether male infertility is a factor is a detailed health history. Once adequate sexual performance has been confirmed, the next step is a semen analysis. This test measures several characteristics of a man’s sperm, including the number of sperm (volume and concentration), the shape of the sperm (morphology), and the ability of sperm to move (motility). If the results of the semen analysis are abnormal, the test is repeated in three to four weeks. If the second test is abnormal, a man will be referred to a urologist for further evaluation.

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Help for Couples Facing Infertility

Posted by Brigham and Women's Hospital April 25, 2013

National Infertility Awareness Week (April 21-27) aims to educate the public about a condition that affects over seven million Americans of all ages, races, and incomes. Today’s post features a summary of HealthHub posts addressing infertility, with insights from physicians at Brigham and Women’s Center for Infertility and Reproductive Surgery.

When to See a Fertility Specialist

As a couple, you’ve been trying to conceive for several months without success. Should you keep trying or should you see a fertility specialist? The correct answer is that it depends. Dr. Elena Yanushpolsky, an infertility specialist at Brigham and Women’s Hospital (BWH), discusses when it’s time to see a specialist.

 

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When to See a Fertility Specialist

Posted by Brigham and Women's Hospital April 23, 2013

Dr. Elena Yanushpolsky

Today’s post was written by Dr. Elena Yanushpolsky. Dr. Yanushpolsky is an infertility specialist with the Center for Infertility and Reproductive Surgery at Brigham and Women’s Hospital (BWH) and the Director of the BWH Center for Infertility and Reproductive Surgery at South Shore Hospital in South Weymouth. She discusses when its time to see a fertility specialist.

As a couple, you’ve been trying to conceive for several months without success. Should you keep trying or should you consult a fertility specialist? The correct answer is that it depends. Here are some things that can help you determine how soon to see a specialist:

  • Getting Ready:  It’s important for both partners to have a general health evaluation with a primary care doctor before seeking fertility evaluation and treatments. Many illnesses can have an impact on a couple’s fertility.

I also recommend that my patients maximize their chances for conception by using urine ovulation predictor kits which can be purchased over the counter. Other ovulation detection methods, such as basal body temperature measurements and cervical mucous evaluations can be used, though they are less precise than urine ovulation predictor kits.

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Fertility Treatment Options for Women with Endometriosis

Posted by Brigham and Women's Hospital March 13, 2013

Dr. Marc Laufer, founder of the Boston Center for Endometriosis

March is Endometriosis Awareness Month. Today’s post is written by Dr. Marc Laufer, a senior gynecologist in the Center for Infertility and Reproductive Surgery, Brigham and Women’s Hospital. He also founded the Boston Center for Endometriosis in 2012. This post also appeared on the blog of RESOLVE New England, a nonprofit organization helping patients facing fertility issues.

Recently, I saw 37-year-old woman who was concerned about her difficulty becoming pregnant after she and her husband had been trying for four months. Though her pelvic ultrasound was normal, she mentioned she had significant pain during her periods and some pain with sex. She had experienced this pain for many years. Given her history, I suspected she might be suffering from endometriosis.

Endometriosis occurs when the cells that normally line the inside of the uterus (endometrial cells) are found in other parts of the body, usually in the abdomen or pelvic cavity. Endometriosis can cause severe pain and, if undiagnosed or untreated, can result in fertility problems. There is no correlation between the amount of disease and the amount of pain experienced. Some women have a small amount of disease but experience significant pain, while others have no pain but still experience fertility problems. The more advanced your endometriosis, the more difficult it may be to become pregnant.

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Lasers, Robots, and a Cast of Thousands

Posted by Brigham and Women's Hospital January 4, 2013

Dr. Gargiulo demonstrates his robotic technique to an audience of more than 1,000 surgeons.

Dr. Antonio Gargiulo, Medical Director of Robotic Surgery at the Brigham and Women’s Hospital (BWH), has performed hundreds of computer-assisted laparoscopic surgeries, but the one he performed on October 22, 2012, was very special.

The surgery, a robotic myomectomy to remove a uterine fibroid tumor in a 29-year-old patient, was beamed live from Brigham and Women’s Faulkner Hospital (BWFH) to an audience of more than 1000 fertility surgeons attending the 68th Annual Meeting of the American Society for Reproductive Medicine (ASRM) meeting in San Diego, California. Over the course of two hours, Dr. Gargiulo narrated the ongoing surgery while answering a steady stream of questions from the audience via three moderators.

Dr. Gargiulo and members of the robotic team at the Center for Infertility and Reproductive Surgery (CIRS)  were chosen by ASRM to broadcast the procedure based on their innovative work in robotic reproductive surgery, such as performing the first single incision robotic myomectomy in 2012.

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New Research Sheds Light on Link Between Obesity and Fertility in Women

Posted by Brigham and Women's Hospital November 1, 2012

Obese women are more likely to have egg abnormalities associated with infertility.

Modern reproductive science has unlocked the key to a vast array of fertility problems, and researchers at Brigham and Women’s Hospital have now discovered a possible link between obesity and egg quality.

Obesity has long been associated with poor reproductive outcomes, but the reason has largely been unknown. With one-third of all American women of childbearing age battling obesity, it is a major barrier for many wishing to grow their family.

A new study released earlier this month shows that severely obese women are more likely to have abnormalities in their eggs that can make it impossible for them to be fertilized normally. The abnormalities involve the spindle, a critical egg structure responsible for normal arrangement of the chromosomes. A normal egg must have one spindle organized in a very specific way, with the chromosomes lined up correctly. The study showed that severely obese women have a much greater chance of having eggs with multiple spindles and disorganized chromosomes.

“This study is the first to shed light on how BMI (body mass index) might adversely affect egg quality in women,” said study lead, Catherine Racowsky, PhD, Director of the Assisted Reproductive Technologies Laboratory at Brigham and Women’s Hospital.

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