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Evaluating and Treating Infertility

4/26/2016

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Dealing with infertility can be one of the hardest challenges couples face.  In addition to the frustration that comes from difficulty having a child, the emotional burden can affect not only each individual in the relationship but also have a negative affect on the dynamics of the relationship itself.  One of the most important things to know as you face infertility is that you aren’t alone, and in fact, impaired fecundity (the inability to have a child) affects as many as 6.7 million women in the U.S., or roughly 11% of reproductive-age women.

However, women aren’t alone as the cause of infertility, and in approximately 40% of infertile couples, men are either the sole cause of infertility, or at least a contributing factor.  In fact, in about 25% of all infertile couples, there are more than one element that contribute to the infertility.  So, with all of the possible causes, how do we know when and where to start in order to help you?

Infertility workups are undertaken when between 6-12 months of unprotected intercourse doesn’t result in successful pregnancy.  We generally begin our workup looking at the 3 basic parts of infertility.  First, let’s get the men’s part out of the way since it’s easy (insert your joke about guys always being easy here).  Essentially, a semen analysis can let us know if there are adequate sperm numbers and whether they look and move normally.  It’s simple, noninvasive and relatively cheap.

Like the women we test, the female evaluation is a little more complex than the male’s and involves two separate components.  First, we want to know if the woman is ovulating as well as the quality of eggs that she has.  This functional aspect is often checked using a Day 21 progesterone and an AMH (anti-Mullerian hormone) level.  There is also a structural component to check, and this can be done using various imaging studies depending on provider preference and clinical suspicion. 

After the evaluation is done, there is good news for most couples.  Between 85-90% of couples are able to conceive with either medication (ie clomid, letrazole, etc) or minimally-invasive surgical intervention (ie myomectomy, tubal ligation reversal, etc).  Even for those couples who require IVF, we are now able to refer to infertility specialists who come to Idaho Falls monthly, so a trip to Salt Lake is no longer required.

Whether you’re just beginning the evaluation, or if you need medical assistance with ovulation or the latest in robot-assisted surgical intervention, make an appointment with Teton Women’s Healthcare to learn about all of your infertility options.​  You can also check out resolve.org for more information.

Nick
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What is Umbilical Cord Blood Banking and Should I Do It?

4/19/2016

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What is cord blood banking?
After the baby is born we can take blood from the umbilical cord and send it for a fee to a private blood bank (you can use a public bank as well) to be processed and stored.  Because this blood is rich in stem cells ( cells that have the ability to become any human cell), the idea is that it could be used in the future to treat your child or relative with certain diseases.  Banking umbilical cord blood is a way of saving stem cells that can potentially be life saving rather than throwing it away after birth.

This sounds like a great idea so why doesn't everyone do it?
While this sounds like a great idea, the odds that your child or relative will ever use stem cells from umbilical cord blood is very low.  The American Academy of Pediatrics suggests the odds that your child will use his or her umbilical cord blood is 1 in 200,000.  In addition there are very few documented cases of a child actually receiving his or her own banked cord blood as treatment.  The primary reason for this is that the conditions that umbilical cord blood stem cells could treat are very uncommon.  
Additionally, while the odds of using umbilical cord blood is low the costs of acquiring and storing this blood is rather high.  Cord blood banks can charge up to $2000 to $3000 for the initial processing and an additional $100 per year that it is stored. This is hefty price tag especially since the chance of using umbilical cord blood is so small.  Also remember cord blood can only be used to treat children because only 3-5 oz are taken from the umbilical cord and this will not be enough to treat an adult.  Most people who need a transplant of stem cells receive it from bone marrow transplants. Most children who become sick with leukemia receive stem cells via bone marrow transplant from a relative or a bank and are not likely to receive it from their own umbilical cord blood.  In addition, there is concern that if your child became sick, infusing its own blood may not provide as strong of an immunological response or may have some of the same genetic flaws that caused the disease in the first place!

When would storing umbilical cord blood be a good idea?
That being said if you have a child who has leukemia, sickle cell anemia, or other blood disorders, banking your baby's umbilical cord blood could be of potential benefit and your insurance may even help cover some of the costs.  There may be future uses for stem cells in umbilical cord blood for everything from spinal cord injuries to heart disease, however, at this time, this is all theoretical. 

At the end of the day it is a personal decision whether or not to bank your baby's umbilical cord blood but if you don't have unlimited income or a sick child, investing in your baby's future college fund may be far more valuable than preserving umbilical cord blood that likely will never be utilized.  If you do decide to bank your baby's umbilical cord blood please please inform your obgyn because this cord blood needs to be taken immediately after birth and all cord blood banking kits are different.  If you have a sick child that may benefit from the stem cells in your baby's umbilical cord blood, the last thing you want is a snafu during the collection process of these precious stem cells.  

​Pam
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Eating your placenta: a tasty treat, or a health hazard?

4/4/2016

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Eating your placenta after you give birth is called placentophagy.  It has become increasingly popular in recent years.  Animals do it and so do some celebrity moms like January Jones, Kourtney Kardashian, and Alicia Silverstone.  You can eat it raw, blend it into a smoothie, or have it dehydrated and pulverized into capsules for $250.00.  The question is "Is there any benefit to eating your placenta, or is it harmful?"

What is the placenta and what does it do?
The placenta is attached to your uterus and has a complex network of tissue and blood vessels that allows for exchange of nutrients and oxygen between mom and baby.  It clears waste products and provides a selective barrier to prevent certain harmful substances from reaching your developing baby.  

Why has this practice become popular?
The practice among animals especially mammals seems to be fairly common and while the exact reasons unknown, scientists suspect that one major reason may be to avoid having a bloody temptation to predators next to the mother and baby.  The mammalian placenta was consumed raw and immediately after giving birth.  However, in historical/anthropological studies of humans, the practice is rare, and it has only more recently become common as there have been claims that placentophagy decreases postpartum depression, increases energy, decreases post-delivery pain and increases milk production.

So are the benefits to placentophagy real?
In 2015 researchers at Northwestern University School of Medicine reviewed 10 published studies on the practice, and they found no data to show that consuming the placenta, whether raw, cooked, or encapsulated provided any protection against postpartum depression, decreased post delivery pain, increased energy, or increased milk production.  And of course, given the timing of bleeding with delivery, unless you’re taking a fork and knife to the placenta immediately after delivery, it is unlikely to help reduce postpartum bleeding as the majority of postpartum bleeding occurs within the first few minutes following delivery.

There are also few studies as to what nutrients or harmful materials (such as mercury) the placenta may contain.  Since its primary purpose is to filter anything harmful from the baby’s blood supply, one would assume that these chemicals would collect in the placenta.  I would also advise caution in consuming the placenta if there has been any intrauterine infection, meconium (baby poop), preeclampsia or other placental abnormality.  Additionally, while the placenta contains iron and hormones such as progesterone, once the placenta is cooked, dehydrated or processed for consumption, it is questionable as to whether any nutritional value remains.

Still, whether to eat the placenta or not remains a personal decision, and if it is something a woman is interested in doing, she should discuss her choice with her provider to ensure it is not disposed of or placed in formalin.  After all, the recipe for placenta chili begins in the hospital :)

​Pam

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2001 S Woodruff Ave #10
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