Reproductive Medicine and Gynecology
Fertility
Couples trying to conceive should be in good health, eat a well-balanced diet, and avoid cigarette smoke, recreational drugs, and alcohol consumption. It is also important to ensure that a couple is having intercourse when the woman is most fertile, the days surrounding ovulation. Both basal body temperature charts and ovulation predictor kits can be used to determine a woman's most fertile period and help couples plan well-timed intercourse.Before Treatment: The Complete Fertility Work-up
The specific treatment you receive will depend on many factors and the results of your fertility work-up. The complete fertility work-up will address the following six factors.- Ovarian factor: Are you ovulating regularly and predictably?
- Age factor: Are your ovaries getting too old?
- Cervical factor: Is your cervix allowing sperm to be appropriately passed into the uterus?
- Uterine factor: Is the uterus capable of receiving and supporting embryo development?
- Tubal factor: Are your tubes open and capable of transporting egg and sperm?
- Male factor: Are there enough, normal, motile sperm?
Fertility Treatments
Intrauterine Insemination
Intrauterine insemination (IUI) is a procedure that places specially prepared sperm into the uterus using a small, flexible tube attached to a syringe. By washing the sperm, IUI ensures that only those sperm capable of fertilizing an egg are used. IUI also places the washed sperm closer to the ovulated egg by inserting them through the cervix directly into the uterus. IUI can be performed with sperm from a male partner or a donor. IUI is used when there is a problem with the male partner's sperm, the female partner's cervix, or when a pregnancy is desired without a male partner.Ovulation Induction
Ovulation induction involves using medications to stimulate ovulation. The medication may be in a pill form or an injection. Ovulation induction may be used if a woman has ovulatory dysfunction (such as polycystic ovarian syndrome) and needs a medication to help her ovulate. Women with normal ovulation who want to release more than one egg per cycle in order to increase their chances of getting pregnant may also use ovulation induction.Ultrasound Monitoring
Ultrasound monitoring is used to evaluate ovulation, follicle growth, endometrial thickness, endometriosis, polyps, fibroids, and cysts. Depending on the reason indicated, an ultrasound will be performed during menstruation or right before ovulation. The ultrasounds are performed transvaginally.Complete Hormone and Metabolic Assessment
The complete hormone and metabolic assessment is appropriate testing for any woman who feels she has a hormonal imbalance such as peri-menopause, menopause, or polycystic ovarian syndrome. The assessment entails checking the following hormones: follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol, thyroid stimulating hormone (TSH), prolactin, and progesterone. Metabolic function is assessed through complete lipid profile (HDL and LDL cholesterol and triglycerides), insulin levels, fasting glucose levels, kidney and liver function, and hemoglobin A1C.Polycystic Ovarian Syndrome (PCOS) Management
We provide complete diagnostic assessment, laboratory studies, ultrasound studies and treatment for this common reproductive endocrine disorder. PCOS can affect 5% of all women and common symptoms include irregular menstrual cycles, increased growth of hair on the body, loss of hair on the head, acne, and weight gain. Based on the 2003 ESHRE/ASRM sponsored Consensus Workshop Group, PCOS is diagnosed in women who meet two of the three following criteria: ovarian dysfunction (not ovulating regularly), hyperandrogenism (increased male type hormones on lab testing or clinically increased hair growth), or polycystic ovaries on ultrasound (ovaries which show multiple small cysts on ultrasound). PCOS is a common cause of infertility and puts women at an increased risk of developing Type 2 diabetes. There is also increased risk of insulin resistance, hypertension, and abnormalities of cholesterol and triglycerides in women with PCOS. Due to these risks, we advise our patients with PCOS to have the complete metabolic assessment with complete lipid panel testing and a two hour glucose tolerance test.In addition to conventional management of PCOS, our clinic offers integrative approaches such as acupuncture, herbal medicine, and counseling in nutrition, weight loss, exercise, and stress reduction. These services can be especially beneficial as studies have shown that women with PCOS suffer higher rates of depression than women without PCOS (Rason et al., Depression in women with polycystic ovary syndrome: clinical and biochemical correlates. Journal of Affective Disorders. Vol. 74, No. 3, May 2003). We strive to support our patients and provide referrals to counselors and mental health professionals specially trained to work with women managing endocrine disorders.
Insulin Sensitizing Agents
Given the association of increased insulin and insulin resistance in women with PCOS, proper nutrition, weight loss and exercise may also help in improving the condition. In addition, drugs used for women with diabetes may help improve the body's use of insulin. Metformin (Glucophage) is one insulin sensitizing agent that has been shown to reduce androgens and promote ovulation in women with PCOS. While there are some gastrointestinal side effects (up to 10% of women taking the drug experience stomach pain, nausea, and diarrhea), metformin is well tolerated when started slowly and the negative side effects almost always resolve. Women with PCOS who desire fertility may take metformin to help in ovulation, but a recent study indicates that the fertility pill clomiphene citrate is superior to metformin alone in achieving a live birth.Menopause Management
We provide complete assessment and management for menopause and perimenopause. We offer metabolic testing with a complete lipid profile in order to assess female hormone status and the risk of coronary artery disease. We also include a bone density scan to evaluate the risk of osteoporosis. Osteoporosis is a disease that causes bones to become weak and break easily due to a loss of calcium and decreased bone density. Menopausal and post-menopausal women are especially susceptible since the rate of bone loss speeds up when estrogen levels fall. Biomedical treatments for osteoporosis include selective estrogen receptor modulators (SERMs) like Raloxifene (Evista) which can prevent bone loss, and bisphosphonates such as Alendronate (Fosamax) and Ibandronate (Boniva) which increase bone mass and reduce the risk of fractures. A healthy diet, weight-bearing exercise, and increased consumption of calcium and vitamin D can also reduce the risk of osteoporosis.For some women with severe vasomotor symptoms (hot flashes or flushes), low dose hormone replacement therapy can be a short term treatment option (1-3 years). But given the increased risk of heart attack, breast cancer, blood clots, and stroke, non-hormone approaches may be a better option for most women. Non-hormone options for vasomotor symptoms include utilizing acupuncture which has recently been shown to significantly decrease nocturnal hot flash severity (Huang et al., A randomized controlled pilot study of acupuncture for postmenopausal hot flashes: effect on nocturnal hot flashes and sleep quality. Fertility and Sterility. Vol.86, No.3, September 2006).
Acupuncture for hot flashes is one example of our many integrative therapies to help women transition into what the Chinese call the "second spring."
Recurrent Pregnancy Loss
Women who have had two or more miscarriages can be seen in our clinic to be completely evaluated and treated for the various causes of recurrent pregnancy loss. Recurrent pregnancy loss can be attributed to many different causes. These causes include: genetic factors (e.g. abnormal fetal chromosomes, abnormal parental chromosomes); anatomic factors (e.g. structural abnormalities of the uterus such as scar tissue in the uterus, or congenital abnormalities of the uterus such as septate uterus); metabolic factors (e.g. diabetes); endocrine factors (e.g. abnormal thyroid, PCOS, diminished ovarian reserve); infectious factors (e.g. chlamydia, mycoplasma, ureaplasma); thrombotic factors (e.g. inherited thrombophilias); immunologic factors (e.g. anticardiolipin antibodies, autoimmune disorders, increased natural killer cell activity); male factors (e.g. sperm DNA fragmentation); and environmental factors (e.g. exposure to environmental toxins). We also offer collaboration with Dr. Joanne Kwak-Kim, an internationally renowned expert in the immunological and genetic causes for recurrent pregnancy loss.Traditional Chinese Medicine (TCM)
Acupuncture
Acupuncture is the therapeutic insertion of thin needles into specific points throughout the body in order to treat illness, prevent disease, and maintain health. According to TCM, qi (vital energy) circulates through the body in channels called meridians. Each meridian is linked to an organ or function. When qi flows freely through the meridians an individual feels healthy and balanced. When qi is blocked or depleted, an individual experiences illness. Points that lie on the meridians can be stimulated to balance qi and restore health.Acupressure
Like acupuncture, acupressure also stimulates specific points on the meridians in order to promote the balanced flow of qi. Instead of using needles, acupressure utilizes a gentle but firm pressure in order to access and release blocked or congested qi.Herbal Medicine
Herbal medicine is an integral part of TCM, serving to adjust and regulate qi. Each herb has four different properties: its nature (cooling, heating, relaxing, energizing), taste (sour, bitter, sweet, bland, spicy, salty), affinity (the meridians and organ networks that it connects to), and primary action (to dispel, astringe, purge, or tonify). Single herbs are rarely taken alone. Instead, combinations of herbs are specifically tailored to address each individual's health needs.Qigong
Qigong is a general term for the many systems of meditation and exercise that optimize the flow of qi in the body. Qigong incorporates breathing patterns, body postures, visualizations, and varied movements in order to regulate qi and harmonize the internal energy of the body. Dr. Kim promotes a simple approach to qigong called the ba duan chin which consists of eight simple movements to mobilize qi.Complementary Medicine
Natural Fertility
Natural fertility describes several methods to naturally monitor the most fertile days of your cycle. Methods include learning to check and interpret the changes in basal body temperature and cervical mucus associated with ovulation and charting them over the course of several months. Many couples find that directly learning about and discussing natural fertility methods is instrumental in achieving pregnancy.Mind/Body Approach
The mind/body approach emphasizes the connections between the mind, body, and behavior. It consists of any method wherein you use your mind to change your behavior or physiology in order to promote health or recover from illness. Mind/body approaches include techniques that induce the relaxation response (yoga, mindfulness, deep breathing, repetitive prayer, body scan, progressive relaxation), cognitive therapy either within a group or one-on-one with a therapist, and coping skills for stress management. Mind/body approaches and programs have proved highly successful at increasing pregnancy rates and decreasing distress for women struggling with infertility.- Meditation
- Relaxation Therapy
- Centering Prayer