Managing chocolate cysts in infertile women

Endometriosis is a disease that affects the conception ability of many women.  This disease is defined as the abnormal growth of the endometrial lining in various locations within the pelvis.  The endometrial tissue is actually the inner lining of the uterus and that’s where it belongs.  We do not know why this tissue spreads throughout the abdomen of some women.  When the endometrioma or endometrial cyst grows in a woman’s ovary  it is called a chocolate cyst.  Undoubtedly named by a man because what woman would associate their favorite sweet with an entity that can cause infertility and pain?

During the normal cycle of menstruation, the uterine lining swells and thickens in preparation for conception.  Unfortunately, the aberrant tissue within the ovary does the same thing.  This process is driven by hormonal changes.  Just as with normal menstruation in the uterus, this tissue grows, bleeds and then sloughs off.  This is when menstrual bleeding occurs in the uterus.  The discharge from the endometrial tissue in the cyst has no place to go; therefore, it is encapsulated within the ovary and a cyst is formed.  The contents of this type of cyst are black, tarry and thick, resembling dark chocolate in appearance; hence the name, chocolate cyst.  This can cause painful periods.

An experienced physician like Dr. Malpani may suspect this diagnosis in a woman with complaints of infertility and progressively painful periods; however, some women have no symptoms.  That’s when an incidental finding of endometrious can be found in an infertility workup or routine pelvic examination.  Manual assessment of the abdomen may reveal large cysts that the physician can feel, but many of these cysts are too small to palpate and cannot be detected during a wellness exam.  That is why your IVF physician will order a pelvic ultrasound. 

For additional information please read http://blog.drmalpani.com/2011/01/chocolate-cysts-how-we-manage-them-at.html

What does my HCG level mean during my IVF pregnancy?

The Human Chorionic gonadotropin hormone (HCG) is an amazing molecule.  It is only produced during pregnancy by cells that are earmarked to develop into the placenta after conception occurs.  These specialized cells are called trophoblasts.  Upon implantation of the embryo into the uterine lining, these cells begin to produce HCG.  The level of the HCG hormone in the blood rises slowly over the first few days.  It takes about 2 weeks for the HCG level to be high enough to be detected in a woman’s blood and urine.  This is why the first blood pregnancy test is performed 14 days after the embryo transfer.  Throughout the first 2 weeks of pregnancy , the IVF clinic monitors your HCG level frequently.

A successful implantation of the embryo will result in a positive pregnancy test.  The HCG level will continue to increase, doubling every 48 to 72 hours.  If the doubling of the level is continuous and consistent, this means that the cells of the embryo are dividing well.  This suggests that the pregnancy is progressing well and the embryo is healthy.  Reviews of the HCG level during the first few weeks of pregnancy gives IVF specialists like Dr. Malpani an idea of how well your pregnancy is growing.  Should there be a drop in the HCG level during this time, it may be an indication that the pregnancy has failed.  To ensure continuity of monitoring, it’s important that women have their HCG levels tested in the same lab each time.  This will prevent discrepancies in the results associated with varied lab procedures and standards.

Read more at http://www.drmalpani.com/hcg-levels-after-ivf.htm

Bed rest no longer advised for IVF patients

If there’s a time for a woman to question every move she makes, it’s during the 2ww.  Overwhelming concern about the success of the embryo transplant makes her question even the most routine daily activity.  Women frequently ask questions about limiting physical activity or even being commissioned to complete bed rest.  These concerns stem from a fear that physical activity and exertion will affect the outcome of her IVF cycle.  Do not let these fears turn into complaints about IVF cycling.

Many IVF specialists advocate the restriction of women to bed rest after the embryo transfer.  The advancement of the science of IVF now questions the restriction of normal activities and the adage of bed rest.  Reviews of several reliable scientific publications are available that address this concern.

These studies confirm that continuing normal activity does not have an adverse effect on the implantation of the embryo.  There appears to be no correlation with activity level restriction and failed vs. successful embryo implantation.  Recent research identified facts that suggest strict bed rest after embryo transfer may actually decrease the chance of conception.  Dr. Malpani suggests that women carry on with their normal routine and activities and not cheat themselves out of a wonderful experience.  Using prudence and common sense will prevent women from doing something that they then will blame themselves for should the cycle fail. 

Read more at http://www.drmalpani.com/is-bed-rest-after-embryo-transfer-necessary.htm

Surviving the 2ww

During the 2 week wait between embryo transfer and the pregnancy test (called the 2ww), a frequently overwhelming concern with patients is the fate of the embryos transferred into the uterus.  It’s natural for every woman to want to know the outcome of her IVF cycle.  Once the 2ww commences, every minute can feel like hours so it’s understandable for women to feel that the 2ww is the longest 2 weeks of their lives.

It’s not uncommon for women in the 2ww phase to become hypersensitive to even the slightest changes or sensations in their body.  Many women have complaints of symptoms such as tingling in the breast, nipple soreness, a sensation of pulling of the pelvic muscles, frequent urination, vaginal discharge and nausea.  With each new sensation, the question returns to her mind. “Am I pregnant?”  This all important question lingers whether acknowledged or not.  Her endearing spouse adds fuel to the fire by daily queries about how she feels.

Some women find themselves drawn to the vast knowledge of the internet and become almost obsessed with reading reviews and articles about other women and the symptoms they developed during the 2ww.  This behavior can mitigate some of the wait time and it can alleviate some of the anxiety for some women.  Dr. Malpani recommends against this however, because many women will panic if they are not experiencing the same symptoms.  Others imagine that they are pregnant, or at least that they are having the same symptoms they read about.  The IVF clinic is available to help with concerns and should be your first source of information.

Is it possible to experience symptoms so early in the pregnancy that a woman will know she is pregnant before the pregnancy test is performed?  For further information, please read more at http://www.drmalpani.com/the-2-ww-and-ivf.htm  

Who safeguards your embryos? A look behind the scenes into the IVF lab

The IVF lab is the keeper of your precious embryos.  That is why the lab is considered to be the heart of the IVF clinic.  The cherished embryos are grown and safeguarded there with state of the art equipment and by highly skilled embryologists. This behind the scenes setting is a very important part of IVF treatment but most patients do not have a clue about the process of the IVF lab.  Dr. Malpani and Dr. Gundeti welcome patients to take a look behind the scenes of the IVF lab to see exactly what an embryologist does. 

Why bother?  It’s very important that IVF patients have a solid foundation of knowledge in order to understand which of several progressive assisted reproductive technologies is best for them.  It’s important that patients select the very best IVF clinic to optimize their chance of success with conception.  The clinic’s success is intertwined with the quality of the lab so all patients are encouraged to be proactive and do some research for themselves.  Dr. Malpani suggests that patients do not cheat themselves out of a knowledgeable experience when involved in the process of IVF care.  Reviews are available on line for patient perusal. A good foundation of knowledge will prevent complaints later in the process.

Read more at http://www.drmalpani.com/every-patient-needs-to-know-about-the-ivf-lab.htm