What is infertility and when should you consult a specialist? 

       According to the Resolve Website, the national infertility association, “Infertility is a disease of the reproductive system.  1/3 of infertility can be attributed to male factors, and about 1/3 can be attributed to female factors.  In about 20% of cases infertility is unexplained, and the remaining 10% of infertility is caused by a combination of problems in both partners. It is diagnosed after a couple has had one year of unprotected, well-timed intercourse, or if the woman has suffered from multiple miscarriages and the woman is under 35 years of age. If the woman is over 35 years old, it is diagnosed after 6 months of unprotected, well-timed intercourse."

What brought me to Abington Reproductive Medicine?

       Typically I avoid going to the doctor.  Everyone at work was required to have a physical with our family physicians and I thought to myself that I may as well quit procrastinating and bring it up.  At the time we were trying for well over a year.  She recommended University of Pennsylvania or Abington Reproductive Medicine, both of which are very reputable.  I chose Abington simply because that’s were my insurance dictated where I go.  According to US News and World Reports, at least two of their doctors (Dr. Schinfeld and Dr. Somkuti) are among one of 304 nationally recognized doctors in reproductive endocrinology. My doctor, Dr. Schinfeld, is also recognized in Philly Magazine as one of the top docs in the Philly area in reproductive endocrinology….not too shabby for my insurance coverage.  He completed his training at Boston Hospital for Women--Harvard Medical School.  He is the founder of Abington Reproductive Medicine, and is the Director of the Division of Reproductive Endocrinology and Infertility at Abington Memorial Hospital in Abington, PA.  He serves as Clinical Professor at Jefferson Medical College, and Adjunct Professor OB/GYN at Temple University School of Medicine.  Needless to say I feel I am in good hands.

My initial consultation:

            Prior to my appointment I was emailed a large amount of paper work including a very extensive medical history form.  It asks questions such as allergies, prescriptions drug use, illegal drug or alcohol history, ethnicity of both mother and father, a large section on family history including and genetic disorders such as Downs syndrome, history of STDs, and other embarrassing questions relating to sex and bodily functions I’m not at liberty to discuss.  They want to know it all.  From that moment I knew this was going to be quite the task to let a complete stranger know more about me than I know about myself.  In the end Chris and I  knew it was the only way.

            So I met with Dr. Shinfeld myself…Chris had to work.  Together we reviewed our history for accuracy.  We sat in this office, not in an exam room, and talked for a little over an hour.  He explained the general concepts of what they do.  He’s a bit quirky, but like most smart people, you’ve got to expect that.  He seemed to have good beside manner.  He then asked if I had any questions. Strangely, I couldn’t think of many.  I didn’t do my homework because somehow I thought this still really wasn’t happening and everything would work itself. But now I’m not so sure. 

            At the end of the consult they do an internal ultrasound to assess your ovaries and make sure you aren’t pregnant.  Believe it or not, it’s happened to some lucky women on their first consult. I couldn’t tell you how hopeful I was and then how disappointed I was to find out that was not the case. The final part of the appointment was a urine sample and drawing of about 15 vials of blood.  Anyone who knows me well, knows what I will do to avoid needles.  I can’t even begin to tell you how incredibly anxious I get.  From the blood, they check for STDS which could impact fertility and complete genetic testing. I swear they took enough to clone me.

         The first 2 weeks I visited the doctor 6 times for additional testing.  I can remember it being very stressful to rearrange my work schedule but luckily I am blessed with great co workers whom I consider good friends. It was crucial that certain testing was done on very specific days of my cycle for accurate results…times of appointment were not flexible due to the nature of the tests. 

Additional Testing:

       Since part of the reason for this blog is to help educate others, I’d like to share a synopsis of some of the tests.  I hope it gives you an appreciation for the science behind this technology as well as how hard some were to go through. 

1)             Clomid challenge test:  A test to look at ovarian reserve (how many eggs do I have?). I was placed on oral medication (Clomid) for 5 days.  Clomid stimulates the ovaries to produce eggs.  Side effects are horrendous and numerous but glad to say I didn’t have any. After the medication is completed additional bloodwork is done to assess your FSH (follicle stimulating hormone) levels.  The lower the FSH level the better, meaning the more eggs you have.  FSH, secreted by the pituitary gland, promotes development of a follicle (the structure that houses and releases the egg each cycle).  If there is a large quantity of FSH, it is the brains way of saying…."you don’t have a lot of eggs left so hurry up and use them".  You’d think it would be the opposite.  

2)             Hysteroscopy-  Evaluates in inside of the uterine cavity (endometrium) for polyps, scar tissue, or fibroids with a hysteroscope (device with a telescopic camera).  These things often prevent a fertilized egg from implanting in the uterus.  Due to the invasive nature of the test, it must be completed early in the cycle to prevent miscarrying should you be pregnant.  Antibiotics are also taken for several days to prevent infection. I believe this is when I had a loud wake up call because I can honestly say this was the most traumatizing experience in my 33 years of existence.  I went by myself…the doctors say it’s pretty “routine” so I assumed it was no big deal.  I took their word and didn’t do my own homework.  Stupid.  Sure it’s routine for them because they do this everyday…not to mention none of them have a uterus.  I should’ve known then.  The test is performed in an outpatient surgical center.  After completing additional paperwork, I was taken to a room, dressed in a gown, placed in a bed and waited.  Nurses, dressed in surgical attire, wheeled me into the surgery room.  The hysteroscope (for those curious enough, you should google it to see this thing) is inserted through the cervix.  Fluid is injected into the uterus to help get a clearer picture with the camera.  They also scrape the uterine lining for a biopsy.   
                         25 years ago I had appendicitis and I remember that pain vividly.  I'm not a larger person but during the procedure a nurse had to physically hold me down.  I even remember the nurse "trying" to be helpful and keep me engaged by saying, "But look there's your fallopian tube."  Like I cared at the time! I didn’t expect that amount of pain because I wasn’t told to.  Later, I’ve read that this test can be more painful than natural childbirth.  Somehow, still in some pain, I managed to drive myself home, crying all the way.  The bad news was that the next day I had to have a similar procedure.  I was beside myself, crying for hours and contemplated calling all this quits.  In the morning, on my way to the next procedure, I was crying on the phone to the nurse.  Later I found out I had the option of receiving general anesthesia…I was so angry, and still am, that this was not disclosed to me. I literally had nightmares for days about that ordeal.

3)             Hysterosalpingogram (HSG) – In the radiology department,  dye is injected into the uterus via a catheter.  The dye fills the uterus and fallopian tubes.  A series of xrays is taken to assess if fallopian tubes are blocked, preventing sperm from reaching the egg.  Believe it or not, while this test was extremely uncomfortable, it was not painful.  Unlike the experience the previous day, the staff was very supportive.

4)             More bloodwork:The rest of the testing consisted of additional ultrasounds and blood work on specific cycle days to check certain hormone levels such as estradiol, luteinizing hormone (LH) and progesterone.  LH is the same hormone ovulation kits use to measure when you ovulate  Progesterone helps the uterine lining to prepare for the fertilized egg.  Some women miscarry due to low progesterone levels...the egg becomes fertilized, however is unable to implant due to insufficiencies in the lining.  For me, the science behind everything is amazing.

 Chris's Testing:                                                                                            

       Chris, being male, was the luckier one as he only had to visit the doctor for tests twice.  He was also required to provide a urine sample and blood samples.  In addition had to provide two semen specimens for analysis and also had a visit to a reproductive urologist.  In the semen samples they check for alot of different things including volume, total sperm count, motility, morphology (are the sperm normally shaped) and so on.  We have both learned more than we ever need to know about what a normal specimen should be as well as the human reproductive system in general. 

Is testing covered by insurance?                                                         

      It depends on your insurance carrier. Most cover testing, not treatment.  I believe my copays for the first few weeks of testing came to about $500.  I received the bill and was shocked to see that a 5 minute ultrasound charges the insurance company between $200 and $325.  A single blood test is about $145.  While expensive, I guess what these tests have the potential to find out is priceless.