Preggie Pals
Getting Pregnant: Common Fertility Treatments

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Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was required which may alter the accuracy of the transcription

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DR. SUSANNA JUNG-A PARK: If you’re having a hard time conceiving a child you may want to consider fertility treatments to help with the process. So, what are your options? And what’s involved with each procedure? I’m Dr. Susanna Park, a Reproductive Endocrinologist and Infertility Specialist with the San Diego Fertility Center, and today we’re learning all about the standard treatments used to overcome common fertility issues. This is Preggie Pals, episode 88.

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SUNNY GAULT: Welcome to Preggie Pals broadcasting from the Birth Education Center of San Diego. Preggie Pals is your weekly online, on-the-go support group for expecting parents and those hoping to become pregnant. I’m your host Sunny Gault, would you like bonus content after each show, great giveaways and discounts? Then join our Preggie Pals Club. You can visit our website at www.preggiepals.com for more information and another way for you to stay connected is by downloading our free Preggie pals apps, they’re available in the Android and iTunes market place.

You can also subscribe to our monthly newsletter. If you do not live in the San Diego area where we record but you would like to be a panelist on our show, you can still participate thru our virtual panelist program. You need to like our facebook page, you can follow us on twitter, use the hash tag #preggiepalsvp, and we’re going to be posting interview questions in advance. We’d love for you to participate and join in on our online conversation. You can even ask experts questions that way and just be part of all the fun that happens here in the studio. One lucky listener will even win a one month subscription to the Preggie Pals Club for participating.

Okay, so let’s meet some of the people here in the studio today, Gabby let’s start with you, a new panelist on the show.

GABBY OSUNA: I am! Thank you so much for having me.

SUNNY GAULT: Sure!

GABBY OSUNA: My name is Gabrielle Osuna, I’m 28, and I’m currently a law student. My expected due date is December 12th, 2013, I’m hoping he’s going to come a little bit late. It’s a little baby boy named Maverick. He’s my first son and first child. And I just want to be having, I hope a natural birth

SUNNY GAULT: Okay, do you have any idea, do you want to have it in the hospital, any ideas on where you want to have the baby or?

GABBY OSUNA: You know what, I have it set for the hospital right now, but, the more that I learned, the more that I’m opening my eyes to the next one being the homebirth actually

SUNNY GAULT: Yeah? Yeah you have to talk to Annie because Annie’s had a couple of those and she’s our home birth pro

So you guys know me, I’m Sunny, I’m the host of the show, the current host of the show but I am handing over hosting responsibilities to Ms. Annie Laird here shortly. Just to tell you a little bit about myself, so I’ve got two little boys at home, Sayer is three years old, Urban is eighteen months and I’m pregnant with identical twin girls. So I had to even out the score there. Two boys; two girls. I’m also due in December, so by the time this show airs I will have my little girls with me at home. Very excited for that. It will be a C-section. I had some complications with my first born so, my second little boy was a cesarean and so we’re just following suit with that. And, yeah, I think that’s all about me. Ms Annie Laird, she’s coming back in the studio because she has her little one with her. She just had a baby less than a week ago and the woman is here in the studio today which is amazing. So Annie tell us a little bit about yourself.

ANNIE LAIRD: Hi! I’m Annie Laird, my day job is I’m a contracted Military Instructor and my night job is mom and my day job and my evening job and my morning job and yeah, so, it’s, taking over for as a hosting duties for Preggie Pals coming in 2014 and that way Sunny can spend more time with your babies and New Mommy media. She will be my boss. So, I’ll watch what I’ll say and then probably disregard that and just say it anyway. I have three little girls, an eight year old, a one year old and then breastfeeding does not work as birth control so now I have my five day old with me and so, that is all about me. And I’m very excited to learn more about fertility treatments today

SUNNY GAULT: Yes. And we’re excited to have Stella here in the studio. She’s just an absolute sweetheart.

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SUNNY GAULT: Okay. So, before we get started with today’s show. I do want to share a interesting headline. Yeah, you know when we’re pregnant we always talk about people touching our belly’s and stuff and I found this article online about a city in Pennsylvania who is hoping to change people’s abilities to touch pregnant bellies. They actually want to make it illegal. And this falls under the sexual harassment laws. And I don’t think it’s been passed yet, I think there is discussion about it and of course when something like this comes up everyone loves to chat about it and then talk about, well can they really do this and how can you even carry something like that out and you know we over stepping our boundaries here. So, I wanted to toss it up to you guys I know, you know living here in San Diego, you know, do you think something like that would fly here or in other places in the country that you’ve lived? What do you think about this law? We don’t know all the specifics of it but the general concept of touching people’s bellies, what do you think?

ANNIE LAIRD: Maybe we should ask a law student

SUNNY GAULT: Gabby it’s your professional point of view

GABBY OSUNA: I mean, I’m a part of a, like a baby bump forum online and they, this was brought up and you know it kind of came to the point as when is it really ever okay to touch anybody’s belly? I know I, we protrude a little bit more, I give you that, but, when do you ever walk up to somebody and just start touching them? So, I’m kind of on board, I’m not a big fan of random people touching my stomach nor am I a fan of people randomly touching my neck or my shoulders, you know

SUNNY GAULT: I think creepy

GABBY OSUNA: A little bit, it’s very creepy

SUNNY GAULT: Do you guys find that people are still doing this, I don’t know. In my own personal experience I feel like the word has kind of gotten out, that it’s not okay to do this. So, I don’t know, maybe it’s just the circles I go in, but, I find that most people who are just reaching out touching my belly, I don’t care. I wouldn’t care if they did it, you know but I don’t know, what’s your personal, Annie when you were pregnant, what did you experienced?

ANNIE LAIRD: Not as much, I think when I was pregnant 8, 9 years ago, then it was now, at least people are touching less I think. Like you said I think word has gotten out and you know it would be weird if I was just randomly shopping and target and would come up and touch my belly. I wonder if some of it too is area of the country that you’re in. I lived for a while up in the northeast and there like even saying “hello” to someone on the street was like “I’m sorry, hello stalker?”

You know like, but, if you’re in Southern California people are like a lot more friendly and open you know I’ve had random conversation with strangers all the time, not that I go around touching them but I wonder if some of it too is, if this law would fly less here in Southern California then it would somewhere say like in island where you know where it’s a little bit more upper crest there. People just tend to be kind of friendly around here so, I think if somebody did touch my belly just in random street trying, I kind of look at them a little weird if it was an elderly grandmother type I’m not going to bite their head off you know I mean she means well

SUNNY GAULT: So, Dr. Park, what do you think about this? I know you have a little boy at home, so you’ve been do the pregnancy thing before

DR. SUSANNA JUNG-A PARK: Well I will say that when I was pregnant I’ve had a few strangers ask me for permission and say if they could touch my belly. And I thought that was, I was surprised, that was very respectful. But I’ve also had elderly people and like you, I mean I would not get mad at them because you know their elderly and they really are just intrigued and I’m sure they missed those days

SUNNY GAULT: Yeah that’s true. I guess we got to cut them some slack sometimes. It’s when the weird people do it or they it’s like the dirty uncle that would do it. You know that’s kind of where I draw the line

ANNIE LAIRD: Those were the only people who want to touch my belly

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SUNNY GAULT: Today we’re continuing our ongoing series focused on getting pregnant. I know a lot of you guys out there listening are trying to get pregnant and not pregnant quite yet so hopefully this series will help. In our last episode we discussed basic infertility evaluations and what’s involved in determining whether or not you have fertility issues. And this episode takes it one step further to outline some of your options for overcoming infertility issues to help you get pregnant. And joining us here in the studio is Dr. Susanna Park, she’s an Infertility Specialist with the San Diego fertility center. Welcome back to Preggie Pals Dr. Park.

DR. SUSANNA JUNG-A PARK: Thank you for having me. It’s good to be back

SUNNY GAULT: So when we talk about fertility treatments, what exactly is a fertility treatment?

DR. SUSANNA JUNG-A PARK: So, fertility treatment is any treatment that a woman undergoes that will increase her probability she will conceive. And they can be super conservative with, let’s say just supplemental progesterone it could be acupuncture and herbs to of course the most super less of which is everybody thinks about the whole IVF.

SUNNY GAULT: So, it could be non-invasive or invasive?

DR. SUSANNA JUNG-A PARK: Absolutely

SUNNY GAULT: Okay. Now, how do you know if you need fertility treatments?

DR. SUSANNA JUNG-A PARK: So, there are criteria in place. So, if a woman is under the age of 35, it should be 12 months of intercourse without success. Once she’s 35 or older it should be six months of timed intercourse without getting pregnant. And the reason for that difference in time is because as a woman gets older her ovarian supply, the number of follicles in her ovaries diminishes. And so the older she is, the less eggs she will have, the harder it is for her to become pregnant. So, she should not wait this long to seek treatment.

SUNNY GAULT: Okay. It’s not that she should get pregnant faster, it’s the amount of eggs that she has left and you want to preserve as much as you can. Okay. And do you need, you know in our last episode we talked about those infertility evaluations, do you need to go through that, I’m assuming that’s part of the process, that would be kind of the first step that you take in determining if you need this stuff right?

DR. SUSANNA JUNG-A PARK: Once you conceive you don’t necessarily have to undergo fertility evaluation again. A lot of it really depends on why you can’t conceive. So if it’s, your test came back fine, and they’re mildly at normal but for the most they’re fine, you will likely conceive on your own without fertility treatment. Let’s say the test came back and there’s a significant infertility issue, you likely will need fertility treatment to conceive again.

SUNNY GAULT: You know, and I know I mentioned this in our last episode, but my husband and I did do some basic infertility treatments with our first, now it seems like we just look at each other and we get pregnant. But in the beginning it was difficult. And you know we did some basic Clomid and eventually ended up on our third round of Clomid getting pregnant and I remember, you know. We’re not super young, we’re not super old, we’re kind of on that mid-range but we were planners you know and so going in to the second pregnancy and not being pregnant yet but wanting to get pregnant again.

We went back to the fertility doctor to you know look at getting back on Clomid and I know it was kind of comforting to me to know that we didn’t have to do all of that testing like the Fallopian tube testing and all that kind of stuff to get back to where we were. Because even though I knew we could conceive we did conceive on Clomid I thought there was a good chance. You know I’ve heard all this stuff about “Oh once your body realizes you can get pregnant then you’ll get pregnant much more easily” and I’d heard all this stuff, but in the back of my head there was still all this doubt because we had so much trouble the first time and I remember thinking, you know, it’s really nice that, you know we could get back on Clomid right away and do that.

And for us we didn’t end up really needing it, we actually did one round of Clomid the second time and then my husband and I just kind of look at each other and we’re just like “I think we can do this on our own” I don’t really think, you know, let’s just try this, you know, we’re not that pressed for time.

I mean, you know I think once you become a parent you know you realize that nothing is really in your hands anymore, so, everything’s out of your hands, including when you get pregnant, and then we ended up getting pregnant on our own, so it kind of worked out for us. But I remember, again, it was just nice knowing that you didn’t have to go through all of that. I could hop right back in to it.

Okay, so let’s talk about some of the common treatments for infertility and I want to talk about some of the problems you know first of all that women have and then what’s used to treat some of those. So, problems with ovulating what do we do about that?

DR. SUSANNA JUNG-A PARK: So that is probably one of the most common problems that I see. And the most common culprits is Polycystic Ovarian Syndrome which the acronym for which is PCOS, and that’s a condition they’re criteria it fine but such is the condition where you just don’t have a regular cycles. But another most common cause of irregular cycles is something as simple as your fibroid.

Common in women and it’s just a simple blood test. Other women don’t have regular cycles because they don’t have enough body fat right? So our ballerina dancers, the anorexics don’t ovulate because they just don’t have enough body fat and so the reproductive system is shutting down. Some people don’t have regular cycles because they’re just so stressed, it maybe because of infertility, it maybe because they’re stressed, overworked or over some other personal issue.

So there are many reasons why somebody does not ovulate. The remedy depends on the cause. So, for PCOS the number one answer for the overweight PCOS is weight loss. Okay, most PCOS women are overweight. There’s a sub set called thin PCOS. But, for the overweight, typical piece here was woman weight loss will do so much, so much to get you to be regular. But, if weight loss alone doesn’t work, because it’s hard, you can add pills such as Metformin, Clomid, for the woman who has a thyroid disorder, if you fixed the thyroid issue they will very likely to start ovulating regularly. For the woman who doesn’t ovulate because her body mass index is too low, she needs to put on weight. And often it’s not just weight, a lot of this also having to go see a therapist and sort of work out the issues as to why she is so underweight. That goes along with the stress related and ovulation as well.

SUNNY GAULT: So, one of our facebook friends Halie Haymore says “As I was diagnosed with PCOS, which is what you’re just talking about. In 2009, when we’ve first started trying, after three rounds of Clomid and one miscarriage, we had our son, we’ve been trying for almost two years for another baby and we’re planning to see an RE in January. What’s an RE?

DR. SUSANNA JUNG-A PARK: Reproductive Endocrinologist

SUNNY GAULT: Oh, okay. That’s the fancy technical term. Okay got it. So is this, you know kind of common this kind of thing that she’s talking about?

DR. SUSANNA JUNG-A PARK: Yes. I don’t know if I would have waited the two years, but certainly I think for her, especially if Clomid worked for her, I am sure Clomid would work again. Which is the great news is that she got pregnant with such conservative treatment before, I think she will get pregnant again with Clomid.

SUNNY GAULT: So, okay, let’s talk about , taking Clomid and there was another one Metformin, okay, so when we take these pills like what is involved in that?

DR. SUSANNA JUNG-A PARK: Okay, so, they work very differently. Metformin is a drug used for diabetes, and many people think it drops your sugar level, it does not. What Metformin does, it makes the insulin in your body work more efficiently it makes you more, the problem with PCOS is that you have insulin insensitivity so your insulin doesn’t work well. So, what happens is when you have higher circulating insulin levels because it doesn’t work efficiently your body has to put out more insulin, higher insulin levels confuses your ovaries and therefore you don’t ovulate.

So they can take Metformin and make that insulin work more efficiently thereby you don’t need as much insulin thereby you’ll lower your circulating levels of insulin you tend to ovulate more regularly. And Metformin’s taken every day. Unlike Clomid is taken only for five days per menstrual cycle. And the way Clomid works is, naturally we all ovulate one egg a month but multiple eggs undergo cell death a month because your body only chooses one dominant egg per month, a group of eggs come out, one dominant egg wins the loser eggs undergo death every month. So multiple eggs die every month but you ovulate one egg. So Clomid prevents the death of the other eggs, not all of them, just a few, so that when you take Clomid and a load those will ovulate one egg and the PCOS person but a typical women who has regular cycles Clomid she will pop out two, three, four eggs at the same time.

SUNNY GAULT: Okay. Well how many eggs typically die, you say the handful of them kind of

DR. SUSANNA JUNG-A PARK: So depends how many your body puts out so if you’re 28 you’ve got a great egg supply, you can put out 15 to 30 eggs a month.

SUNNY GAULT: Really?

DR. SUSANNA JUNG-A PARK: The cold antral follicles, yeah. One ovulates, the rest undergo cell death. You are 43? You probably put out three eggs a month because you don’t have that many left, one ovulates and the other two undergo cell death

SUNNY GAULT: Now when it undergoes cell death like does it just get absorbed by the body

DR. SUSANNA JUNG-A PARK: Correct. It goes back into ovarian we call it stroma that tissue that makes up the ovary, yeah

SUNNY GAULT: Interesting

DR. SUSANNA JUNG-A PARK: And that’s how you are born with the million eggs but when we hit menopause, in the United States it’s 51 as the average age you are down to a thousand eggs. So the only way that could have happened in a span of 51 years is that if you’re losing more than one egg a month

SUNNY GAULT: You said that and my head immediately goes to, I’m pregnant with two girls does that mean there’s over two thousand whatever or two what? Two million like with the babies that I’m making now like you said what that means because they’re, well they have all the eggs in them right

DR. SUSANNA JUNG-A PARK: Oh your baby, oh yes as a matter of fact, yes a girl has her peak egg supply when she’s 20 weeks old on her mother’s uterus and then she has 67 million eggs at that time.

SUNNY GAULT: So how many eggs are in my body right now? From the point on?

DR. SUSANNA JUNG-A PARK: A female fetus undergoes egg death from the time she’s 20 weeks old in her mother’s womb.

SUNNY GAULT: Oh My Gosh!

DR. SUSANNA JUNG-A PARK: So that when she’s born she’s down to a million. Oh yeah, egg that starts in utero

ANNIE LAIRD: Isn’t that amazing that you’re carrying your grandchildren right now

SUNNY GAULT: That’s a good point Annie. Okay, alright, so that kind of covers problems with ovulating. Let’s talk about unexplained fertility.

DR. SUSANNA JUNG-A PARK: Yeah that’s a frustrating one. It’s a double edged sword

SUNNY GAULT: That’s what I was. They couldn’t tell me what was going on with us. So, that you tell a patient the good news is all your tests came back fine, the bad news is I don’t know why you’re not getting pregnant. Which is the whole reason I’m coming to see you

DR. SUSANNA JUNG-A PARK: Exactly. Exactly. So that one is tough, and the way, the way I treat such patients is I go based on their age. Like if they’re young I told them “you know what? Try a little Clomid with just sex, but nothing, nothing super aggressive. Try for a few months, I’m sure it’ll work you’ll be fine”. And if that doesn’t work, I give them 3 months, “Okay let’s come back let’s sit down again, back to the drawing board”, but I try to start very conservatively. However, if she’s older, I‘d move a little bit faster. Right. Because by the time I’m conservative I don’t want a year to go by and now she’s a year older and makes it that much harder to get her pregnant

SUNNY GAULT: Okay, so, when we’re talking about unexplained fertility, what are some of our options then for treating them?

DR. SUSANNA JUNG-A PARK: So, you can start from the most conservative to Clomid sex, you can advance to insemination of people know this artificial insemination or intro utero insemination which all means the same thing which basically means just getting your partner’s sperm into the uterus so when you have sex he ejaculates into the vagina. And you know after sex stuff comes out of you that’s normal right? But in that stuff in that liquid of sperm so in trying to not let the sperm come out you actually concentrated in the catheter and you deposit the sperm in the uterus so number of the sperm that actually enters your fallopian tube is much higher with insemination than just sex

SUNNY GAULT: Okay, I see

DR. SUSANNA JUNG-A PARK: And you can do that in a woman with regular cycles. You can even do it without Clomid. She’s got regular cycles let her make a one natural egg and then you just inseminate when she’s ovulating. Or you can do a combination of the two, you can do the Clomid with the insemination

ANNIE LAIRD: Looks like the woman that she did at , or the guy that she did in Boston marathon you know that took a bus to like mile 18, you know, so what’s going on, you just kind of you know bypassing the vagina

DR. SUSANNA JUNG-A PARK: That’s exactly right Annie

SUNNY GAULT: So, as a doctor then would you recommend which option to move forward with and how do you make that distinction?

DR. SUSANNA JUNG-A PARK: So usually I give them the three most conservative options. And I tell them to go home and think about it, because they’re all, they don’t involve much time in our office at all. You know there’s some men who don’t feel comfortable thinking, “Wait, my baby got conceived by your catheter?” So for them they would probably come back to me and say “You know I think we wanted to do it with the sex thing and the Clomid” but I also have couples who honestly will tell me “You know what we have been trying to get pregnant for so long that honestly sex isn’t even fun anymore. And for couples like that I told them “I have the perfect solution, insemination. Just bring me the sperm and I will inseminate at the right time.

GABBY OSUNA: I have a question about insemination, does it hurt? Or is there, what is, I mean I’ve never done this.

SUNNY GAULT: That’s a good question.

DR. SUSANNA JUNG-A PARK: Yeah! It doesn’t hurt. The catheter’s really-really small and very pliable and it’s like a pap smear so a speculum goes inside so you can see the opening of the uterus which is a cervix and you just slide a really small catheter pass the cervix into the uterus and then just deposit the sperm there. It literally takes like a minute. It just takes an hour and a half to process the sperm. But the procedure itself takes like a minute

GABBY OSUNA: Oh okay perfect. Thank you

DR. SUSANNA JUNG-A PARK: You’re welcome

SUNNY GAULT: So then does your partner have to be there with you or is it one of those things that he needs to ejaculate and then it needs to go in immediately or can he bring that in

DR. SUSANNA JUNG-A PARK: He can bring it in. He doesn’t even have to come to the office. The female partner can actually bring it in. But we just let her know, you know, we need an hour and a half to process so you should go and get something to eat because you don’t have to be fasting for this and then we do the procedure. Because sometimes there are men who are embarrassed to walk into our office and tell them you don’t have to walk into our office at all

SUNNY GAULT: Okay. What is involved, you mention a hormone injections right? What’s involved with that?

DR. SUSANNA JUNG-A PARK: A lot, so let’s say you did the 3 months of Clomid and gosh, you know, I’m just not getting pregnant. Or there’s some women who just don’t respond that alone with the Clomid. The hormone injections, they’re called Ganadotropin they consist of two hormones the FSH and LH which we all make to make an egg it’s just the same hormone in like super high doses. And what it does is it really saves those eggs from cell death. Yeah, so instead of ovulating 2-4 eggs maybe you’ll add a little bit more maybe 5 or 6, or 7 so you’ve got to be very careful because you don’t want somebody ovulating 8 eggs especially if they have PCOS. So, do you guys remember the show Jon and Kate makes 8? She had PCOS and she did Ganadotropins insemination

SUNNY GAULT: Oh I didn’t realize that

DR. SUSANNA JUNG-A PARK: So you have to be very careful that you don’t over stimulate somebody because they’re so powerful and because those drugs are so powerful you have to come to the office almost every other day for blood work and ultrasound. It’s a very involved process

SUNNY GAULT: Okay, so you guys would give the hormone injection, it’s not something we would do?

DR. SUSANNA JUNG-A PARK: You do it yourself at home

SUNNY GAULT: Oh you do?

DR. SUSANNA JUNG-A PARK: It’s subcutaneous injection, the needles half an inch short and you put it on your abdomen or your thigh but most women, just inject it on the abdomen

SUNNY GAULT: I love it when you said half an inch short instead of half an inch long. She’s putting positive thoughts in our heads. Did you notice that? I knew that was going to be the next route for us, do you know, with our first, we did two rounds and then for some reason you know they didn’t ultrasound and there was something about I don’t know, if not all the eggs died or something happened where they didn’t want to do another round right then they wanted to wait a month.

And then we tried naturally, didn’t get pregnant on the month that we waited then did another round of Clomid and that was the one that took you know but I remember, I kind of think I was kind of a mental thing for me I’m like okay buddy I don’t want to get myself injections, I don’t want to get myself injections please work this time and that’s, that was next on our list was do hormone injections. Okay so let’s talk about blocked or damaged tubes, what can we do for that?

DR. SUSANNA JUNG-A PARK: So it depends, so if your tube is blocked at the end of the fallopian tubes we call it hydrosalpinx, you can try to get it open and you do it laproscopically so laproscopy means camera through the belly button and you make two other insicions on the lower part of your abdomen and then you put instruments through there and then looking up the camera you can fix somebody’s tube. If the blockage is at the start of your fallopian tube it’s called proximal blockage you can try to fix that as well but that needs to be fixed with a combination of laproscopy and historoscopy. Historoscopy is camera in the uterus because those blockages you cannot fix from the end of a tube you have to fix from the beginning which means you go through the vagina, through the uterus to try to fix that.

SUNNY GAULT: That sounds so involved.

DR. SUSANNA JUNG-A PARK: It is. It’s actually easy to fix a distal block at the ends than to fix the beginning of a tube. But the problem is that whenever you do tubal surgery you are to increase risk for future scar tissue in the tube meaning for something called an ectopic pregnancy

SUNNY GAULT: Oh, I’ve heard of those, yeah

DR. SUSANNA JUNG-A PARK: A pregnancy that actually gets stuck in the fallopian tube and doesn’t make its way thru the uterus

SUNNY GAULT: So, it’s a fertilized egg that got stuck? Wow, okay. And then endometriosis

DR. SUSANNA JUNG-A PARK: Endometriosis is a condition where endometrial cells or cells inside the uterus which is the cells that build up every month to get ready for implantation and if you’re not pregnant the cells will come with your period. That those cells are actually found outside your uterus in your pelvis. So could be on your ovary on your fallopian tube on your uterus, behind the uterus, in front of the uterus, on your intestine, on your bladder. It can actually even be found far away like a meter long. And the problem with this condition is these cells will bleed every month because they’re endometrial cells but your pelvis does not like to have these aberrant bleeding and so in response you have this inflammatory state in your pelvis and so you tend to get scar tissue, painful periods and endometriosis makes it harder for a woman to become pregnant. So there are treatments for those medical treatments and there are surgical treatments for endometriosis

GABBY OSUNA: They would all be invasive then too right?

DR. SUSANNA JUNG-A PARK: The medical treatments, the easiest one’s birth control pill but obviously that’s for somebody who’s not trying to get pregnant. There’s a stronger medical treatment called Lupron but it has pretty bad side effects, very bad hot flashes. But is a short term treatment, it works very well

SUNNY GAULT: Alright so besides some of the big ones that we are going to get too after the break. I know we want to talk about IVF and some of the things like that, is there anything else that some common treatments

DR. SUSANNA JUNG-A PARK: Yes. There are some women who have abnormalities of the uterus. So, we check the uterus and we see, oh my goodness she’s got a big fibroid in there and that’s why she’s not getting pregnant. Simple solution hysteroscopy, which is camera in the uterus and you, can just fix that thru the vagina. Easy, so uterus or polyp or maybe she’s got scar tissue in the uterus from our prior, let’s say she had a D&C because she had a miscarriage. And then there’s also of course, the man, sperm issue. So for him it’s much easier, he can go to an eurologist and usually they’ll have some pills or some kind of supplements that they can use to try to improve the sperm. And if not then there treatments we offer to try to bypass the sperm issue

SUNNY GAULT: Okay. Alright well, ladies let’s take a quick break. When we come back we’ll discuss some of the more extensive procedures for conceiving a child. Like I mention In Vitro we hear a lot of about that in the news, so let’s break this down and talk about what exactly is involved. We’ll be right back.

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SUNNY GAULT: Welcome back, today we’re discussing your different treatment options if you’ve been diagnosed with having some infertility issues and Dr. Susanna Park is our special experts. So, Dr. Park we hear all about IVF. I feel like, gosh this is just like the trend now where I don’t know I feel like it’s getting so much publicity and everything. So when we talk about IVF In Vitro Fertilization, what the heck is it? What’s involved, what could we expect? How do we know if that’s right for us?

DR. SUSANNA JUNG-A PARK: Right. Okay so, let’s break it down, the word IVF stands for In Vitro and the word In Vitro means outside the human body and F means fertilization. So, the sperm and the egg literally become fertilized outside the body. So in order to do that, that means you’ve got to get a woman’s eggs and extract it from her and you have to get a man’s sperm and but he’s is easier he just ejaculates. So the way you get a woman’s mature eggs out of her is you take those Ganadotropins, those injections Sunny that you mentioned prior to the break.

You take those injections because you really want to save all those eggs from cell death that month. And that’s really important to understand because oftentimes I’[ll have patients say to me. Well if I do IVF, am I going to go through menopause earlier? And the answer is No. Because what I’m saving are eggs that were destined to die that month. I’m not going to exit by pulling out extra eggs. And sometimes I wish I could because sometimes I have patients who just don’t have a lot of eggs but I can’t. So these eggs were going to die anyway. So I’m just using them.

And so you take these injections and you make them all grow and it’s usually they are daily injections but it’s usually for about ten days on average, sometimes it’s eleven, sometimes it’s nine but works it out to be about a week and a half. And then after that we do an egg retrieval and the way this is done is most centers in United States will put you to sleep and then the eggs are retrieved thru your vagina. So there is no incision on your abdomen and it takes about twenty minutes? You wake up and you hang out with us for forty five minutes, make sure your okay somebody takes you home and your back to work the next day so nobody even knows that you have this procedure.

And then the day we take the eggs out we need the sperm and then in the lab we combine the egg and the sperm together to create an embryo and then we, most centers in the United States will transfer the embryo back into the uterus when the embryo is five days old in which point it’s called the blastocyst. So the whole time you’re back at work, but when the embryo was five days old you come back and it’s just like the insemination, your wide awake and you just slide a little catheter into the uterus and it doesn’t hurt and you drop off a baby into the uterus, not sperm. Your dropping off a fertilized egg into the uterus.

SUNNY GAULT: Does the body ever rejected, I mean I know it’s coming from your body but it was outside of the body at some point

DR. SUSANNA JUNG-A PARK: Yes. So the highest IVF success rates are directly co-related to the egg quantity and the egg quality. So the younger the woman, the higher the IVF success rates. So at our center, let’s say you are twenty five years old your success with this is about 75 to 85 percent chance of it working. But that means that there’s 15 to 25 percent of these women, everything goes beautifully and for some whatever reason the embryo did not implant. So it’s not a hundred percent. But the older you are that success rates starts dropping very quickly because it’s co- related to how many eggs a woman has and the quality of the eggs.

SUNNY GAULT: Okay, so the older you get, the less quality your eggs would be so it may not take. So how old are we talking about? Like I mean

DR. SUSANNA JUNG-A PARK: It depends. Well, because typically one would say, Well if you’re let’s say over forty but we have had women in their early 30’s and whom we have done egg testing and we realized, gosh these numbers aren’t great like, she’s actually run out of eggs at a much earlier age than anticipated and her IVF success rates are actually much lower than that of another similarly aged thirty something year old woman. So it really depends on what your egg tests come back as. Now IVF was actually built to take care of blocked tubes and sperm issue so, before the break we had discussed, gosh what do you do if your tubes were blocked? Well you don’t have to have surgery you can say you know “I don’t want this surgery, okay, I don’t need your fallopian tubes to do IVF, so I just bypass the tubes, I need your ovary I need your uterus and I need your husband’s sperm. And as long as he has sperm we can actually fix those sperm abnormality in the lab, yep and address it yeah?

SUNNY GAULT: Well I know before in the previous episode about you know getting pregnant when we’re talking about the size and the shape of the sperm and all that, so do you mean to say that you can extract the best of the best and

DR. SUSANNA JUNG-A PARK: Correct. But the best of the best is based on visual inspection like I don’t know looking on that sperm, yes this sperm will create a baby that’s going to stand for, that I don’t know

SUNNY GAULT: Wait, but can you do gender?

DR. SUSANNA JUNG-A PARK: Yes. So, but that’s at a separate step. So, what you can do with your sperm so you look at the sperm and you only pick normally shaped sperm and you only pick moving sperm and then you manually inject the sperm into the egg and that is what ICSI is. Intracytoplasmic sperm injection, the sperm is injected into the cytoplasm of the egg. So you can do IVF without ICSI so you just take the egg you take the sperm you throw them all together in a dish, throw it in an incubator and I go home and the next day I look to see how many fertilized. Or I can maximize your fertilization by putting one sperm into one egg and that’s what ICSI is

SUNNY GAULT: Okay so, what are the rules or are there rules, there has to be something here that says you know, not every egg will probably take but how many do you insert do they get to their optimal start and everything right? So what are the rules here?

DR. SUSANNA JUNG-A PARK: Optimal was medical malpractice. So if you are generally in your 20’s or early 30’s and you’ve got great prognosis you should be discussing, putting in one or at the most two. But if you put in two you need to counsel the patient that there is in general a 30, 35 percent chance of twins. Not look alike twins because we put in two and both stick, they are not look alike, they came from separate eggs, separate sperm. But there’s also a 5 percent chance that when you put one embryo or even two embryo’s in

ANNIE LAIRD: It could split and then you get identical twins and then a fraternal triplet.

DR. SUSANNA JUNG-A PARK: That’s right

SUNNY GAULT: Look at you Annie, smarty pants

ANNIE LAIRD: I know. And this is going on newborn sleep too. I’m am impressed of myself.

DR. SUSANNA JUNG-A PARK: Right and so people feel well 5 percent that’s nothing. Okay but consider that naturally it occurs one percent of the time so that’s a five-fold relative risk, it’s a high relative risk. So somebody who is young with great prognosis, it should be one or two embryos you put back in. But the last prognosis IE the poor of the quality of the embryo because you don’t have such great eggs, you could put more in, because a likely hood that they’re all going to stick is pretty small

ANNIE LAIRD: But what you’re saying Dr. Park is that you would never put in even with the, you know, kind of crappy embryo. Or see now like not real high quality it was way too many to put in basically

DR. SUSANNA JUNG-A PARK: Not in the thirty two year old but I have in a 44 year old, I put 8 and and she didn’t become pregnant.

SUNNY GAULT: Oh my goodness, wow. That’s just the test of it on how things kind of declined

DR. SUSANNA JUNG-A PARK: So, if you’re on your mid late 30’s the rule generally is to maybe three of the number of great quality. Once your forty and above. There’s no ceiling because the qualities are so diminished.

SUNNY GAULT: Right. Okay so the patient can’t really dictate that kind of stuff can they?

DR. SUSANNA JUNG-A PARK: Well I think it depends on who the patient is. Well before I practicing for 8 years in New York City and we would have some celebrities and celebrities just have the way of getting things done their way. Do you know what I mean?

ANNIE LAIRD: Is there a discussion about the termination, type of thing?

DR. SUSANNA JUNG-A PARK: Oh absolutely.

ANNIE LAIRD: Of like, Hey! Are you open to this?

DR. SUSANNA JUNG-A PARK: Absolutely. Well it’s called selective termination or reflective reduction.

SUNNY GAULT: So that’s after conception and everything to the embryo’s implanted right.

DR. SUSANNA JUNG-A PARK: And it’s usually done about 11 to 12 weeks.

SUNNY GAULT: Oh really. Oh my goodness is it like having a medical abortion?

DR. SUSANNA JUNG-A PARK: Oh no it’s much. Well you do inject something into the sac of the embryo that you want to terminate so that you leave the other ones alone. There’s a five to ten percent chance that you can lose the entire pregnancy but in experienced hands it’s 95 percent of the time it goes without a problem. But I want to go back, you asked a great question about gender selection.

SUNNY GAULT: Okay, yeah.

DR. SUSANNA JUNG-A PARK: So, there is a way that you can sort out sperm such that the X and Y chromosomes are divided but the methods are not that great they’re usually about 70 to 80 percent accurate so if you wanted a more definitive way to say “Listen, I have three girls, right, hey I’d like a boy next time” Then what you can do is if you do the IVF process then once you create the embryos you can actually test all of them and you can test for gender but in addition to gender you’ll also test for down syndrome, which is trisomy 21 you can test for trisomy 13, 18 all the chromosomes so that you know ahead of time which of your embryos are chromosomally normal and the gender

SUNNY GAULT: It’s such a delicate thing, you know it’s finally got here. Interesting. Very good! Well Dr. Park, Thanks for joining us today it’s been a pleasure having you on our show again.

DR. SUSANNA JUNG-A PARK: Thank you for having me.

SUNNY GAULT: Absolutely! For more information about our expert and our panelist you can visit the episode page on our website www.preggiepals.com this conversation continues for members of our Preggie Pals club after the show Dr. Park will share the advice she typically gives patients considering fertility treatment. Should you do or should you not do it? How do you know if it’s right for you? To join our club visit our website www.preggiepals.com.

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SUNNY GAULT: We have a comment from one of our listeners and this comes from Leslie. Hi Leslie, she says:

“Hi preggie pals I’m one of the newest members of the preggie pals club. I also have your app on my phone. How do I unlock the archived episodes?

Yes, so if you just download the app, you’re going to see a little, that kind of looks like a lock next to a bunch of our episodes including the bonus content that’s part of each new show. The way to unlock that is thru your settings page so I have my app actually in front of me right now, so you’re going to go to the settings page, just look at the bottom, you’ll see settings, click on that and go to accounts, it’s the first option you see. You can log in through your premium log in information or even log in thru facebook, that’s an option as well. And you’re just going to enter your user name and your password that you created when you signed up for your account and once you do that boom! All the episodes including that great bonus content are in lot. So, Leslie thank you so much for your question.

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SUNNY GAULT: That wraps up our show for today, we appreciate you listening to Preggie Pals, don’t forget to check out our sister shows Parent Savers, for parents with newborns, infants and toddlers. The Boob Group; for moms who breastfeed their babies and Twin Talks; for parents of multiples. Next week, we’re continuing our series focused on Natural Ways to Overcome Pregnancy Discomforts and we are going to talk about Prenatal massage. So, this is Preggie Pals, your pregnancy, your way

[Disclaimer]
This has been a New Mommy Media production. Information and material contained in this episode are presented for educational purposes only. Statements and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Though information in which areas are related to be accurate, it is not intended to replace or substitute for professional, Medical or advisor care and should not be used for diagnosing or treating health care problem or disease or prescribing any medications. If you have questions or concerns regarding your physical or mental health or the health of your baby, please seek assistance from a qualified health care provider.

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