Tubal Ligation

Periodically, patients in my practice have undergone a tubal ligation. These patients have the following treatment options at this time: One would be to have a tubal ligation reversal. The other option is do In Vitro Fertilization (IVF).

A tubal reversal is major surgery. The operation can take up to four hours. Because it is a major operation, it must be done in a hospital and the cost could be between $10,000 and $20,000. However, some insurance companies will cover this procedure.

IVF is not surgery. It is a much less invasive procedure. The cost for IVF is often less than the cost of tubal ligation reversal. However, there are not many insurance companies that cover the costs of In Vitro Fertilization.
IVF is often as, or more, successful than surgery.

Tubes that have been cut out or clipped may be repaired; those that have been "burned" (cautery) cannot be repaired. However, the reversal surgery can leave scars in the tubes. These scars are the cause of a 30 to 40% increase in tubal pregnancy (ectopic pregnancy).

IVF leaves your contraception method intact. Yet, it is possible to have more than one baby from your IVF cycle, if you have frozen embryos.

If you or someone you know has had a tubal ligation and is considering conceiving, feel free to drop me a line. I’d love to hear from you.

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Complimentary Medicine - Herbs and Fertility

Many people seeking treatment at the clinic where I practice are also interested in complementary and alternative medicine (CAM)such as herbs.

In the past, studies with fuzzy scientific designs supported anecdotal reports on complimentary or alternative therapies. Thanks to demanding consumers, the scientific community is responding to the use of these popular treatments with more accurate research. Progress has been made, but more studies are needed to fully understand the benefits and risks from herbs.


Herbal remedies, though considered "natural or Mother Nature's miracles", may produce a range of adverse reactions or side effects and may even counteract or interfere with other medications and treatments. Working with someone knowledgeable in the field is always recommended. Herbs should be used with the same caution you would use with any drug. Please click this link for a more in-depth analysis of herbs and conception.

At Pacific Fertility Center, where I practice, we welcome your questions and understand your desire to seek all possible successful treatments. Because the effects of some herbs may be harmful or counterproductive, it is important to discuss with your Doctor any additional therapies you may be using or considering while undergoing infertility treatments.

Click here for more supplement information: Office of Dietary Supplements

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How are embryos frozen?

Embryo freezing has shown to be an effective technique for allowing fertility patients to store excess embryos for later use. The technology involved in freezing embryos is quite fascinating and merits discussion on this blog.

Embryos can be frozen at different times after fertilization. Most typically, embryos are frozen 1, 3 or 5 days after the sperm and egg were put together. Freezing is a stressful process for an embryo, and only embryos that are growing well in the laboratory will tolerate the freezing procedure.

Step 1. Before an embryo can be frozen, all the water that it contains must be removed. Since water expands in size as it turns to ice, water inside the embryo would burst (kill) the embryo if we simply placed it in the freezer. To prevent the embryo from shriveling as the water is extracted, we replace the water with antifreeze. Antifreeze is a solution that does not expand in size when it freezes. The embryo is cooled to room temperature as the water is replaced with antifreeze.

Step 2. When most of the water has been removed the embryo is inserted into a carefully labeled vial, or more typically a small straw, and placed in the cooling chamber of a controlled rate freezer.

Step 3. The embryo is then cooled very slowly at -0.30C per minute. Slow cooling like this allows the embryologist to have precise control over the freezing process, to maximize water extraction from the embryo and to prevent formation of large ice shards that could pierce the embryo.

Step 4. The cooled straw is placed into carefully labeled metal canes and lowered into the tank with other frozen embryos. The entire process takes several hours and the embryo(s) are stored frozen at –1960C in liquid nitrogen. Liquid nitrogen is a safe and effective coolant, which is easy to work with in the laboratory.

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An Overview of Fertilization

Since this is a fertility blog, I think it only makes since to provide a brief overview of the dynamics of the fertilization process in an in-vitro fertilization (IVF) procedure. Once a sperm is inside the egg, the head of the sperm swells to form a nucleus. This "male" nucleus contains the genetic material or DNA from the father. The egg has its own nucleus containing the mother's DNA. Sixteen hours after insemination, the presence of 2 nuclei in the egg confirm that normal fertilization has taken place. On average, about 70% of all eggs will fertilize normally.
After the eggs have been checked, and fertilization has been documented, they are returned to the incubator for 24 hours.

Cleavage of fertilized eggs
Once the genetic material from the father and mother has come together, the egg becomes an embryo. The egg is a single large cell that divides or cleaves to become a 2-cell embryo about 18 hours after fertilization was confirmed. Thereafter, the cells of the embryo cleave about every 16 hours. This means that by 3 days (72 hours) after the retrieval procedure, most embryos have between 4 and 8 cells. The cells cannot become separated as they are contained within the shell or zona pellucida.

Cleavage stage embryo transfer
At Pacific Fertility Center, where I practice, most couples choose to have their embryos transferred back to the uterus 3 days after the egg retrieval procedure. The Embryologist assesses each embryo individually and ranks the embryos from best quality to worst. The best embryos will have 8 or more cells and the cells will be evenly shaped and similar in size. Poor quality embryos will have less cells or uneven or fragmenting cells. The information on embryo quality is then discussed with the patient and a decision is reached on how many embryos to transfer and how many to freeze for later use.

I hope that gives you the basics of the fertilization process in an IVF laboratory. If you have any specific questions about the process, I would love to hear from you.

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Therapy and Infertility

It is hard to imagine an experience as stressful as battling infertility. To address the emotional aspects of infertility, some fertility clinics (including ours), offer an in-house marriage and family therapist who is available to discuss the key psychological issues affecting individuals and couples experiencing infertility. I had a chance to discuss with our in-house marriage and family therapist, Peggy Orlin, MFT, about why patients come to see her. The information should be worthwhile. Although Peggy references patients she sees in my practice, the content should be applicable to all those dealing with infertility-related stress and seek the help of a therapist.

What is the most common reason why someone comes to see you at PFC?
At Pacific Fertility Center everyone who uses a known or unknown egg or sperm donor or a gestational carrier is required to meet with me. This is mainly an educational session designed to help people think through and discuss the issues involved with using a third party to assist them in building a family. Each meeting is custom tailored to meet the patient’(s) particular needs.

What are some of the other reasons people seek your help?
Some patients have had a failed cycle and are having trouble coping with the losses. Other patients have experienced a miscarriage. Both of these scenarios can leave patients feeling bereft and not sure how to move forward. During a session, I can help them understand the grieving process and we can discuss ways that they might ritualize their loss in order to move forward.

The stress of infertility diagnosis and treatment often brings them to me either at the center or in my private practice. It is important to understand that no two people will have exactly the same experience and that infertility can strongly impact those within a committed relationship. A recent diagnosis of infertility, as well as the stress and/or disappointments of treatment, can lead to feelings of isolation and depression. Additionally, people may experience grief over the loss of fertility choices. It is not uncommon that I am the first person, other than their partner, with whom they discuss their feelings about their infertility challenges.
There are those who are at a critical decision point and are seeking help thinking through their reproductive alternatives. This may include deciding whether or not to do one last IVF, move on to egg donation, select an egg donor or complete their family through adoption or childfree living. In the therapy sessions, we discuss and explore the pros and cons of a decision from the unique perspective of their life beliefs and situation.

Others may need help with developing positive coping mechanisms and stress reduction techniques such as setting aside time each day to discuss infertility with their partner, rather than allowing it to be a constant topic of conversation. We may also discuss how they can reduce their isolation possibly by talking with others who are having similar experiences. We may even explore how to include moderate exercise in their schedule to reduce symptoms of depression.

Depression frequently accompanies infertility. When should someone seek a therapist?
The experience of symptoms of depression which last more than a couple of weeks is an important reason to set up an appointment with me or a therapist of your choosing. Remember, everyone will feel some of these symptoms, some of the time. They become a problem when the number and intensity of symptoms increase and/or don’t abate.

Symptoms of depression:
Feelings of emptiness or extreme sadness
Loss of interest and motivation to do regular activities
Increased level of anxiety
Decreased level of energy
Difficulty sleeping or sleeping more than usual
Difficulty concentrating
Abnormal weight loss or gain
Obsessive thinking about your infertility
Feelings of isolation from friends and family
Extreme and persistent feelings of anger
Persistent thoughts of death or suicidal thoughts or attempts
Persistent feelings of inadequacy, or worthlessness

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Male Infertility Treatments

A vast majority of the talk surrounding infertility surrounds female treatments. Male factor infertility does indeed play a role in a significant number of the cases I see. Thankfully, with today’s reproductive medicine, even men with the most severe infertility cases (i.e., men who have undergone chemotherapy and have scant amounts of sperm), can have biological children thanks to techniques such as IVF-ICSI with either Microsurgical Epididymal Sperm Aspiration (MESA) or Testicular Sperm Extraction (TESE). (Be advised that these procedures may also be utilized in instances where a man has undergone a vasectomy.)

With a MESA procedure, under local anesthesia and general sedation, an incision is made in the scrotum, exposing the epididymus, the tubules immediately adjacent to the testicles that collect the sperm. Using an operating microscope, an incision is made into these tubules and sperm is aspirated. Although millions of motile sperm can often be collected, this sperm has not acquired the ability to penetrate an egg and must be injected into eggs via the IVF-ICSI technique. The advantage of MESA over TESE for men with obstructive azoospermia is that sperm collected in this manner can usually be frozen, and even if his partner has to undergo more than one IVF procedure, the MESA should provide adequate sperm for all subsequent IVF procedures.
A TESE or testicular sperm extraction is a procedure that involves directly aspirating the sperm from the testes or obtaining sperm from a testicular biopsy. It is usually performed under local anesthesia block and can be done as an office surgical procedure. The disadvantage is that in many cases, testicular sperm is much more scarce and therefore difficult to freeze. Usually, there is only enough sperm recovered for one IVF case and if further IVF attempts are needed, the TESE procedure needs to be repeated.


ICSI or intracytoplasmic sperm injection is a new procedure that allows couples with sperm problems to have IVF treatment. Developed in Belgium in 1992, ICSI is the process of injecting a single sperm into an egg. It is a remarkable procedure since it allows men with only very few sperm to have a chance of having their own children.

If you or someone you know has questions about these male factor infertility treatments or wants to know the way of getting started with them, please drop me a line. I’d love to hear from you!

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Reproductive Medicine in the Gay & Lesbian Community

One of the wonderful aspects of reproductive medicine is that it creates family building opportunities to a wide patient population—extending beyond just those with an infertility diagnosis. The gay and lesbian community is a primary beneficiary of reproductive technologies such as intrauterine insemination (artificial insemination), in-vitro-fertilization, and egg donation. I’ve taken the liberty of highlighting some of the services that my clinic provides to the gay and lesbian community.


For lesbian intended parents, procedures such as intrauterine insemination (known as “artificial insemination”) require the use of donor sperm and insemination via a catheter. In-vitro fertilization (or “IVF”)—the process by which a woman’s eggs are extracted from the ovaries and fertilized in a petri dish—is also a commonplace treatment for lesbian and gay intended parents. For lesbians, IVF may be used in cases of infertility, where one female partner provides the egg, which is fertilized with donor sperm, and then transferred to the womb of the other female partner. For gay men, IVF is performed in instances where a donor provides eggs, the eggs are fertilized with sperm in a petri dish, and then transferred to the womb of a gestational carrier.

As background, the demand for assisted reproductive technology (ART) is underscored by the fact that a substantial percentage of gay and lesbian couples and individuals are becoming parents. In fact, according to the 2000 U.S. Census, 34 percent of lesbian couples and 22 percent of gay male couples have at least one child under 18 years of age living in their home. Lesbian couples parent at about 75 percent the rate of married heterosexual couples and gay male couples parent at about half the rate of married heterosexual couples. (Source: http://www.census.gov/prod/2003pubs/censr-5.pdf.)

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The IVF Dilemma: Optimizing Pregnancy Rates, Minimizing Multiples

One of the challenges in reproductive medicine is giving patients the best chance of conceiving while avoiding multiple births. After all, it is our experience that singleton births are the healthiest for both baby and mother. However, with an IVF cycle, fertility clinics typically transfer multiple embryos to give patients the greatest chance of conceiving…a practice that can result in multiple births. (This is quite different than natural fertilization wherein one embryo is fertilized during a natural cycle.) Thankfully, fertility clinics are making use of state-of-the-art techniques such as embryo freezing and the day 5 embryo transfer to help address this dilemma. With regard to embryo freezing, patients can avoid multiple pregnancies by transferring fewer fresh embryos and successfully freezing the remaining embryos. The frozen embryos can be thawed and transferred at a later date should the patient choose to have another IVF cycle.

Additionally, performing the day 5 embryo transfer as opposed to the standard day 3 embryo transfer enables us to assess which are the most chromosomally normal embryos as well as those most likely to develop in the womb following embryo transfer. Subsequently, fewer embryos are transferred (minimizing multiples). We are also seeing a small but growing number of couples interested in the day 5 transfer of only one embryo because they wish to avoid the risks of having a twin pregnancy. In fact, there is a recent article on use of single embryo transfer to help reduce multiple births. The article can be read here. These procedures are not appropriate for all patients and we encourage you to speak to your physician or drop me a line to discuss your individual case.

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Intracervical Insemination vs. Intrauterine Insemination

Patients periodically inquire as to whether they can use washed sperm for both an intrauterine insemination (IUI) as well as an intracervical insemination (ICI).

For an intrauterine insemination (IUI), one would already be using washed sperm. Sperm washing is necessary when inserting sperm directly into the uterus because raw semen contains chemicals that cause it to contract. It also increases the probability of fertilization to place washed sperm directly into the uterus. This is because sperm washing sorts out lower quality and dead sperm, thus lowering the content of the sperm.

You could choose to buy washed sperm from a sperm bank for an intracervical insemination.

Although patients sometimes complain of cramping with IUI, it is usually short-lived. As background, IUI is the process of depositing washed sperm inside the uterine cavity. A thin catheter is used, connected to a syringe that contains the washed sperm. The catheter is introduced through the cervix and deep inside the uterus. Cramping sometimes does occur but is short-lived. Artificial insemination is commonly used with ovulation inducing medications when, for instance, there is abnormal cervical mucus.

However, due to the decreased sperm content, using washed sperm in ICI has not been shown to be effective enough to become commonly practiced. The choice is up to the patient and physician. If you have experience or questions using ICI or IUI, I’d love to hear from you.

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Embryo Adoption

One of the joys of being in assisted reproductive technology is the benefit we provide to those who might not been able to otherwise have a family. One of the wonderful programs that, we, as well as other fertility clinics provide is an embryo adoption program. Embryo adoption is the adoption of embryos that have been frozen by patients. These patients have decided not to use them, and instead chose to donate them to our embryo adoption program. Once adopted, these embryos are then treated as if they were the recipient couple or individual' own frozen embryos.

As far as cost goes, there are typically administrative and transfer fees associated with the process. Where I practice, we make these embryos available to our patients who have had unsuccessful in vitro fertilization cycles. Our embryo adoption process is limited to our patients, however, if you are not a PFC patient the following website may be able to assist you in finding an embryo from other locations: http://www.ihr.com/infertility/provider/embryo-adoption.html.

Often when patients have completed their IVF cycle, they have extra embryos. In addition to keeping the embryos frozen, patients have the option of discarding the embryos or donating them to research. Embryo disposition is a very interesting topic and there are many different scenarios. Please drop me a line if you would like to discuss this matter.

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Egg Freezing

One of the hot topics in the fertility field is Egg Freezing, and, once perfected this technology could revolutionize the field of reproductive medicine. It could allow a woman to freeze her eggs and, at a later date, those eggs would be thawed, fertilized, and transferred into her uterus in order for her to conceive. The potential benefits of this technology are substantial. For instance, it could allow a young woman embarking on her career to delay motherhood until she was ready to conceive, thus circumventing age-related fertility factors such as decreased ovarian reserve. Additionally, egg freezing could benefit women undergoing chemotherapy (which can render a woman infertile) as the eggs are retrieved and frozen prior to chemo. Egg freezing, however, is still in its infant stages (no pun intended) and is used in limited cases…primarily for women undergoing chemo. Nevertheless, it’s promising to note that more and more fertility clinics are pursuing egg freezing. In fact, where I practice, our IVF laboratory is involved in a research project working with the technology of the egg freezing process. When my physician colleagues and I feel that the results are sufficient to offer our patients such a service, we plan to add this procedure to our services.

As background, eggs are very delicate. They are the largest cell in the body and contain a great deal of water. In order to freeze eggs the water must be extracted and replaced with an anti-freeze type solution. Water expands when it is frozen, so if the water is not replaced before freezing, the expansion can cause the cell to burst. Once the water is removed there still remains an issue with the egg's chromosomes. Just prior to ovulation the chromosomes of the egg line up on "spindles." Half the chromosomes separate and move out of the cell in a “polar body” and the other half of the chromosomes remain organized on the spindles to be matched up with the sperm's contribution. The spindles are very delicate and subject to changes in pH, temperature, etc. When the egg is frozen and thawed what frequently occurs is that the spindles break apart and the chromosomes are dispersed randomly throughout the egg. When the time comes for the egg to be fertilized, the egg must organize the chromosomes to meet up with the sperm's contribution. The egg is not well equipped to do this reorganization and often there are resultant chromosomal problems. These chromosomal problems affect the ability of the embryo to fertilize and to continue into an ongoing pregnancy. The pregnancy rates of an embryo created from a fresh egg and sperm and then cryopreserved are much better than the success rates of an embryo created from an egg that has been previously cyropreserved. Currently the PFC lab freezes embryos. We have had good success with pregnancies from cyropreserved embryos.

Nevertheless, we are enthusiastic about our ongoing egg freezing program and the ultimate benefits that it could provide to patients with and without an infertility diagnosis.

For more information on this topic, please drop me a line. I also recommend you read the article written by my colleague, Joe Conaghan, Phd, Pacific Fertility Center Laboratory Director, which is titled “Oocyte Freezing Hype.”

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Male Factor Infertility

More often than not, discussions of fertility treatments are centered around the woman…and for good reason. In the majority of IVF cases treated at my practice, it is typically the female partner who has the infertility diagnosis. In fact, according to the U.S. Department of Health and Human Services – Centers for Disease Control and Prevention, 56% of our IVF cases were for female infertility diagnoses such as tubal factor, ovulatory dysfunction, diminished ovarian reserve, and uterine factor.* That’s a significant percentage indeed.

Nevertheless, it’s also important to remember that infertility affects men as well. At my practice, 25% of diagnoses involved male factor infertility.* Again, these numbers reflect my practice and those numbers can vary from clinic to clinic. In fact, according to the American Urological Association (AUA), in up to 50 percent of couples having difficulty getting pregnant, the problem is at least in part related to male reproductive issues.

Bottom line—infertility is not a female issue and if a couple is having fertility issues it is imperative that the male partner undergo a semen analysis. Below is a guideline for what are defined as the normal values for the sperm analysis, as defined by the World Health Organization (WHO):

Semen Analysis-WHO Minimal Standards of Adequacy
Ejaculate volume----------1.5-5.0cc (milliliters)
Sperm Concentration----->20 million sperm per cc
Motility--------------------->50%
Forward Progression------2 (scale 1-4)
Morphology----------------30% normal forms (WHO criteria)
Morphology---------------->4% normal forms (Krueger criteria)

If you would like to learn more about male factor infertility as well as the diagnostic and treatment options available, please click

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This Weeks' Best of Health Matters

The Health Matters HealthBlog Network consists of a dozen independent and unfiltered medical professionals blogging about the topics that matter to you. Each week, Healthline's Editors select the three top posts from the network to share with all of our readers in one convenient post. We hope you'll enjoy them!

Infertility Stress Reduction Tips
If you, or someone you know, has struggled with infertility you know what a stressful time that can be. Visit The ART of Conception where expert Carl “Rusty” Herbert MD offers some tips for getting through these rough patches … read more

What Should Cancer Patients and Family Do About the Flu Vaccine?
Vaccinations can be a lifesaver. Most vaccines contain inactive viruses, but others contain a small amount of a live virus. Tune into Cyndy King’s Cancer Treatment and Survivorship blog to learn what people undergoing cancer treatment that can compromise their immunity should do…read more.

Throw a Stronger Punch (or Push a Car or Stroller)
People don’t always realize how many times a day they are hurting their backs. Read on to learn more about what Dr. Jolie Bookspan of the Fitness Fixer blog says is one of the most common misconceptions in fitness….read more.

Additionally, we're pleased to announce the launch of two new blogs this week! Freedom from Smoking with expert Lowell Kleinman, MD and Straight Talk from the ER with expert Robert L. Norris, MD.

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Avoiding Mix-Ups in the IVF Lab

It is difficult to imagine a circumstance where a mix-up in a medical situation could have a more damaging effect than in an IVF laboratory. For this reason, at my practice, we take this issue very seriously and devote considerable time and effort into designing a system in which a mistake cannot happen. Below is a list of items that should be assessed when choosing any fertility clinic.

Staff

Assembling the right team is the most important and fundamental part of running a good laboratory and each and every one of the Embryologists at Pacific Fertility Center (where I practice) is Board Certified and Licensed in their specialty. The State of California does not currently require licensure for Embryologists, but Pacific Fertility Center insists that all our staff are certified to the highest available standard. We are fortunate in having one of the most highly trained teams in the country and we pride ourselves on our honesty, diligence and thoroughness.

Preparing for a procedure

When a patient is scheduled for a procedure such as IVF or IUI, the laboratory receives at least 24 hours notice of the case. Notice is served in the form of a Requisition, a document submitted by a Physician detailing all procedures to be performed. Upon receipt of this document, an embryologist will begin the preparations for the case. This usually involves the preparation of test tubes and petri dishes containing a special fluid that will be used to incubate, sperm, eggs and/or embryos. Each item is carefully labeled with clear and unique identifying information that includes the patient's name, and the patient is also assigned a color to further code her tubes and dishes.

Once the preparation is complete, the labeled and colored tubes and dishes are assigned to an incubator where they will warm to body temperature and equilibrate until the patient reports for her procedure the following day. We are careful to avoid assigning 2 cases to a single incubator on the same day. Even though an incubator can accommodate up to 3 cases we never have a situation where the eggs from 2 patients are going into the same incubator on the same day. Also, each incubator has 2 doors and both doors are clearly labeled with your name and color code. This allows the embryologist to see your name twice, first on the main door and then on the inner door, before ever handling your specimen.

Performing a procedure - General

In general, we have 2 embryologists performing procedures for the simple reason that we always know that we did it correctly. We are not required to assign 2 people to procedures, but we accept that a little redundancy eliminates the possibility of an error. When sperm are being added to eggs for example, one embryologist actually performs the procedure and another simply observes. Both embryologists sign off that they checked the paperwork, labeling, color code and performance of the procedure.

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Infertility Stress Reduction Tips

For most, if not all, infertility is a time of enormous stress and struggle. During this time many of us put off taking a new job, going back to school or any of a myriad of other decisions that get relegated to the back burner while pursuing pregnancy. Making a life becomes our life.

In order to feel as good as possible during your infertility experience, you will need to develop some good coping skills. Below is a list that my colleague, Peggy Orlin, MFT, came up with. I’m sure you will find it useful.

Coping is "developing the ability to manage in a difficult situation."

DO: Give up any and all feelings of guilt for how you are feeling. There is no right or wrong way to experience infertility. Your feelings may run the gamut from indifference to intense anger and despair and everywhere in between.

DO: Chose the gatherings you attend carefully. If being around children or babies upsets you, gracefully decline invitations to events where they are likely to be present. Know your limits and stick with them.

DO: Continue to get moderate amounts of exercise. Eat healthily and get plenty of rest. You will feel better if you treat your body with care.

DO: Reach out to childfree friends. Their company will be adult-focused.

DO: Think of non-child centered rituals. Take a vacation. Eat at a fancy restaurant.

DO: Shop from catalogs. You will avoid mall madness.

DO: Attend religious services at the time when there will be the least number of children. Or attend on a university campus, as those services tend to be more adult-focused.

DO: Volunteer at a nursing home or homeless shelter. It may help to help others who are having a difficult time.

DO: Plan for how you will answer uninvited questions about when you're going to have children. Remember, you are not required to tell them your entire "story!"

DO: Communicate with your partner to let him/her know of your feelings. Even if you and your partner are feeling differently it may help to share. If you are single, call a friend with whom you feel safe to share your feelings.

DO: Meet and talk with others who are experiencing similar feelings. Finding that you are not alone helps.

DO: Learn stress reduction techniques. At the best, they may help you get pregnant, at the least they will help you to feel better while you are in the process.

DO: Seek out a professional counselor if you have symptoms of depression for more than two weeks.

DO: Join us at our Mind/Body@PFC Weekend Workshops. Call 415-834-3000 for more information regarding fees and registration.

Use whatever of these suggestions seems helpful to you. Do what feels right for you.

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FSH Test Kits

(Contribution from Carolyn Givens, M.D. )

Periodically, patients in my practice have questions about FSH urine tests, as they have noticed that there are FSH urine test kits for sale over-the-counter to help women confirm the onset of menopause. Additionally, they wonder that since FSH testing is involved in determining fertility reserve, can they use this over-the-counter FSH test to help realize their fertility potential. My colleague, Carolyn Givens was kind enough to share her insight on this topic:

It appears as if a fair number of over-the-counter FSH test kits are indeed sold in drug stores and over the Internet. I am not going to comment on their efficacy for measuring hormonal changes that the pre menopausal body starts to undergo. But I can answer your question. These test kits are not useful tools to help you determine your fertility potential.

By way of background, human follicle stimulating hormone (FSH) produced by the pituitary gland stimulates primordial follicular growth and estrogen production by the emerging follicle that will mature into an egg.

The urine test kits provide a black or white - yes or no answer, not a glimpse of your FSH level in the context of a gray scale range of indicators. For accurate fertility potential diagnosis, we analyze FSH level in much more detail. On day two or day three of your cycle (following menses) we test your FSH level in conjunction with other tests including estradiol (E2) and an antral follicle count.

Most home urine tests, such as for pregnancy tests and ovulation predictor tests, use a threshold level of the hormone in the urine to detect a positive. With FSH test kits, only when the level reaches menopausal levels of FSH, equivalent to around 40-50 mIU/mL or higher in the bloodstream, will the test turn “positive.” For most women interested in testing for ovarian reserve, we would be looking for levels equivalent to 5-20 mIU/mL. So the sensitivity of the testing is set for menopausal and post-menopausal levels, not the levels seen in women with regular menstrual cycles. By the same token, they will not be able to discriminate normal from decreased ovarian reserve.

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The Best of the Medical Blogosphere

If you are familiar with blogs you know that many bloggers link to other bloggers. I wanted to give a note of thanks to the host of this week's “Grand Rounds" - an online forum that gathers interesting posts from other healthcare bloggers - for including my post about fertility and intercourse. To read this week's favorite posts click here:
RDoctor Medical

To learn more about Grand Rounds click here: http://blogborygmi.blogspot.com/2004/09/grand-rounds-submission-guidelines.html

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