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Don't worry, I won't quit my day job...

Four months ago, I was just a doctor who loved his work. Two months ago, I was a doctor and a newbie blogger. Today? Well, that's still what I am today, for now anyway. I just finished attending the 2007 BLOGWORLD Expo in Vegas where I rubbed shoulders with some of the greatest bloggers in the world. Here were people, all with very different stories, but who shared one thing in common, a great love and ability for sharing their thoughts and emotions with their captive audiences throughout the internet world. The meeting ended with a stirring talk by Mark Cuban, passionately sharing his experience with his own blog. It was a humbling experience for me, and I loved it!

For years, I've been on the other side of the lectern, giving talks and sharing my knowledge and expertise on infertility with hundreds of doctors and medical students in my position as a faculty member of a medical school (now of TWO medical schools as of earlier this year). I also had gotten into the habit of doing a fair amount of informal teaching, complete with handouts and diagrams, to my own patients during their day-to-day care. So here I was at the Expo, no longer the teacher, now the newbie student, absorbing an overwhelming amount of information in a field I previously knew little about, realizing with excitement that there was a whole new world for me to explore.

So for now, I will keep on learning and improving this site for you. I love your feedback, so keep it coming!

Happy Halloween!

My staff and I love it when patients send us pictures of their babies. It is a happy reminder that the eggs, sperm and embryos that we see everyday grow up to be very real adorable little people. One of my favorite patients sent me these darling photos of her little girl in a pumpkin patch. Such creativity really stands out amidst all the hundreds of other pictures taken at the Sears studio. But we love those too!

These two pictures especially cheered me up just when I was starting to get a little disillusioned with Halloween lately. I recall how during my younger days in Indiana, we used to fearlessly go trick-or-treating by ourselves, unaccompanied by parents. It was such a time of carefree childhood fun. I'm not sure if those times were safer or if we were just more naive. Our biggest worry at the time was that some bully would steal our bags of candy. I remember one year going out dressed as a little surgeon (no I didn't have the foresight to be a little reproductive endocrinologist). After my younger sister had finished collecting a large pillowcase full of candy,  a delinquent gang of high school boys sped by on their bikes and did a drive-by snatching of all her hard work for the night. What I find most memorable about that night came afterwards, when we went back to the same houses with my sister in tears. When the candy-givers learned what had happened, their hearts opened up and they started giving her all their extra candy, even going back to the kitchen to get the "good stuff". That year, my sister wound up with ten times the candy that she usually got.

Nowadays, besides being just a reminder of how unsafe the world has become for children, Halloween seems to have grown into just another opportunity for girls to dress provocatively in public. I've attended a few parties these past few years where I noticed the recurring theme of girls dressed in actual lingerie, but then adding a pair of large wings so they could turn it into some sort of "slutty angel" outfit. Times have changed.

Still, I know that my cynical Halloween comments won't even faze those of you with kids one bit as you witness their little smiles today. As for those of you who are yet to have kids yet, this is why we in the fertility field work so hard doing what we do, so that hopefully, everyone who wants to be a parent will get their chance. Have a safe and happy Halloween, everyone.  =)

Learning Even Better Ways to Help Infertile Couples

I'm presently in our nation's capital for the 2007 ASRM meeting, an annual event when fertility doctors and personnel from all over the world meet to share information. I had posted a notice in my office a few weeks prior to this trip preparing my patients that we would arrange for them to go to my covering colleague's office while I was gone. A lot of them of gave me a supportive farewell saying something like "OK, doctor, go learn something that will help me get pregnant faster!"

Every year, our ability to help our patients improves. I think it's fair to say that if all the infertile couples from thirty years ago who ended up completely childless had full access to the medical treatments available today, over 90% would have gotten to enjoy the blessings of parenthood. Today, the focus has shifted from simply being able to help couples have a child to being able to do it in a safer, less inconvenient, less costly manner and with better obstetric outcomes and fewer complications. We might have also in some ways become TOO good, meaning some questions arise as to which cases are there in which we should NOT necessarily create pregnancies, even if we can.

These meetings are one of the ways in which our body of knowledge is advanced. During this meeting there were about 300 oral presentations and another 800+ presentations in the form of large posters detailing information that physicians, embryologists and other specialists want to share with the world. We listen critically to the presented talks, read the posters, discuss and debate the information and then we individually decide which information we choose to believe and incorporate into our own practices. One shouldn't automatically believe everything. In fact, we can't believe everything, because the information is often conflicting. For example, after many talks espousing the benefits of acupuncture in IVF patients, a controversial presentation this year out of the University of Washington reported that under certain conditions, acupuncture actually was associated with LOWER clinical pregnancy rates.

This is a good example of how new ideas presented from past years inspire the audience to go back home and follow up with their own investigations to present in future years. Over time, a relative consensus develops to persuade us to adopt the things that do work and do away with the things that don't work. This applies to decisions regarding many choices such as different treatments, different medications and different embryology protocols. Even so, you can easily find a dozen different doctors who do things a dozen different ways, all of which work.

For me personally, I will take home some new ideas to try and incorporate into my own practice. My eyes were opened to some new complex ethical considerations that are coming into play. I've met some really nice people with whom to correspond in the future. These include not only physicians, but also experts in nutrition, infertility counseling and alternative medicine. I also picked up the usual brochures and free pens from companies who offer services to help me care for my patients. All in all, it's looking to be a very successful trip! I hope to share some interesting stuff with all of you in future posts.

By the way, the next time you visit Washington DC, I strongly recommend you check out the International Spy Museum.

Just for the record...

I take my responsibility to my patients seriously. In order to give them the best care, I need to have access to specific information about their condition. This is obtained through taking time to discuss detailed questions with them on a regular basis and through direct examination and through the help of lab tests. This type of 1-on-1 care is the best kind. However, the finite number of hours in a give work week limit the number of patients who are able to get this type of special attention from me. In contrast, an unlimited number of people can get helpful information through this site without ever meeting me. The drawback is that without taking into consideration their specific situation, they can infer no individualized advice. In other words, you have to take the information here and make your own decisions. This may sound common sense, but I would hate for someone to misinterpret my words as being strict advice aimed directly towards them and thereby make a decision that might end up being wrong for them! Again, I hope it is common sense that people realize everybody is different and what might be the best advice for 99% of people, might end up being terrible advice for somebody in the remaining 1% because of circumstances that are unique to them.

Please take responsibility for your own fertility plans and do it conjunction with your own physician's recommendations. Meanwhile, you are certainly welcome to benefit from any information that this site can humbly provide.

I am heeding legal advice that in this day and age, it is necessary to put a disclaimer like this on this type of website, so there it is (oh well). =)

DISCLAIMER
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The Wisdom of Crowds

The happiness associated with helping couples have babies is one obvious great aspect of my particular field of work. Another great thing that is often overlooked is the chance to always keep learning. Working in infertility does not get stale because the pool of knowledge out there is always changing. In fact, the rate at which new discoveries are being made has continued to dramatically change this field every few years. The success rate of treatment is increasing. The available options for patients are increasing as well. I love the fact that the more I choose to increase my knowledge, the better job I can do for my patients. One way of learning is just through the experience of actually taking care of patients.  A second way to supplement that learning is by reading. A third way is what I did earlier this week.

Two nights ago I had dinner at Derek's Bistro in Pasadena with eight other reproductive endocrinologists and two embryologists along with some other people who work in the field of infertility. The atmosphere was relaxed and casual. The food was good.

This was our second Journal Club meeting. Assembled in the room were a group of us who collectively were responsible for well over 1000 IVF cycles in the past year. We had all taken time to gather together for the purpose of exchanging our knowledge. I'm not exactly sure how this started, but the others keep telling me that it was originally my idea. I had once mentioned to the other doctors how nice it would be if we could get together in a non-academic unstructured setting and just shoot the breeze, sharing our own tips and pearls of wisdom gleaned from our own professional experiences.

The first meeting several months ago was a great reminder of the art of medicine. While we did agree on many aspects of management, what was more striking was the great degree of disagreement. For example, different reproductive endocrinologists present at the meeting, all with a long solid track record of successfully helping patients get pregnant threw out very different opinions on controversies such as the effect of intramural fibroids on IVF success, the right indications for prescribing metformin, the importance of weight loss in obese infertility patients. The debates were fun and friendly.

This week's meeting was more structured as one of the other RE's did a great job finding three recent journal articles to discuss. There was still plenty of lively disagreement. I am always open-minded and hungry to learn alternative ways to do things. In future posts, I will share specific revelations that I learned at these meetings that might affect the specific strategies I use in my practice to help my patients.

Autism Incidence DECREASED in Babies born from Fertility Treatment

I was catching up on reading the July 2007 issue of the journal HUMAN REPRODUCTION during lunch and I found an interesting study out of Denmark that looked at the possibility of an increase in autism among babies born from fertility treatment. To the researchers' surprise, they discovered an actual DECREASE of autism risk in babies born from different fertility treatments (including hormonal treatment and technical treatment) as compared to babies conceived naturally.

To better understand the implications of these findings, let's look at how this data was obtained. The researchers started by reviewing the medical records of 461 babies born in Denmark between 1990-1999 who were later officially diagnosed with infantile autism. Next, they found 461 other non-autistic babies who matched the autistic ones in terms of gender, year of birth and county of birth. They then compared these two groups to look for any differences in the number of children who had been conceived from fertility treatment.

Of the babies in the autistic group 2.3% of them had been born from fertility treatment. Of the babies in the non-autistic group, 5.4% where born from fertility treatment. This was statistically significant and showed a lower risk of autism in the children who were conceived with some type of fertility treatment in comparison to those conceived naturally.

There could be some interesting factors that affect this. For example, one can imagine that women who are undergoing infertility treatment tend to be watched more closely by doctors and may also tend to be better about taking vitamins. Either of these alone could be the possible reason that the fertility babies did better in terms of avoiding autism. This initial study is promising and future research will serve to investigate this further.

UCLA In-Vitro Fertilization Conference

I just returned from the 20th Annual UCLA In-Vitro Fertilization review course held in Santa Barbara each year, where dozens of reproductive endocrinologists from around the world convene to review the latest on IVF.

During the drive there, I was rewarded with a soothing view of the Pacific Ocean on my left, as I looked forward to spending time at the Four Seasons Biltmore. I like these meetings for reasons besides getting to improve my knowledge about topics ranging from the optimal ovarian stimulation protocols, embryo transfer techiniques and patient management strategies. I like them for the chance to catch up with old friends and colleagues in the field from around the world. There's a lot to be learned, not only from the lectures, but also from trading tips and stories at night around the dinner table. I first attended this particular meeting when I was a UCLA Reproductive Endocrinology fellow, but find there's always plenty of new things to learn each year. It's helpful to see what other people are doing in their practices to help their patients get pregnant, meanwhile being respectful that there are many ways to accomplish the same goals.

Also present at these meetings are reps from the major companies that manufacture IVF equipment, embryo culture media and the medications that we use in our work.

The highlight for me this year came when I found myself in the auditorium watching a slide on the large screen showing a family with mom, dad and two lovely daughters in their late teens / early 20's. About 20 years ago at UCLA, one of the earlier IVF cases involved an egg retrieval done by ultrasound guidance through the bladder. One of the embryos that was created became the older daughter and another embryo was frozen and then transferred a few years later to give birth to the second daughter. The speaker at the lectern was Dr. David Meldrum, the physician who performed those procedures. He had just got done giving an excellent talk about the history of IVF. Afterwards, to the delight of the audience, one of the two daughters in the slide came on stage and gave him a plaque and a warm thank-you for helping bring her into this world. It was a touching reminder how all our work with sperm, eggs and catheters gives rise to very real babies and families!

This year, as always, I came back with a few new ideas to incorporate into my practice. I didn't bring my camera this time, but I hope to take pictures when I go to the next big conference, the annual meeting of the American Society for Reproductive Medicine, which will be in Washington DC this October.