My wife and I woke up this morning and watched the pilot show of “The Fertility Chase”. I felt the show did a wonderful job in portraying the emotional trauma that infertility patients go through. I thought the visual graphics, filming and editing was excellent. I applaud Exodus Productions for their very hard work in bringing this topic to others. Overall, they did a truly wonderful job.
The Reproductive Medicine Group, also here in Florida, did a great job discussing basic infertility. Dr. Goodman appeared extraordinarily comfortable in front of the camera. I have a high level of respect for these physicians and have asked their group to render a second opinion on a number of my patients.
I did agree with Dr. Lessey that it is very important to carefully evaluate the couple and search for the diseases that cause infertility. For my readers, the definition of unexplained infertility means that there has been a complete evaluation, including a normal laparoscopy, and that no diagnosis was found. It seemed as though many of Dr. Lessey’s patients really had not undergone the full evaluation so the term “unexplained infertility” in the segment may have better been termed “incompletely evaluated infertility”.
I feel that the usefulness of a laparoscopy in the treatment of endometriosis is controversial. There is (inconsistent) data that shows pregnancy rates do improve slightly following the diagnosis and treatment of stage I or II endometriosis with about 1/3rd of the patients conceiving within eight months of surgery. This would seem to differ slightly from the 50% in three months that was quoted by Dr. Lessey and I would encourage him to publish his data so we can all benefit from better his procedures and techniques.
It is uncertain that the surgical treatment of the more advanced stages of endometriosis (III & IV) improves overall pregnancy rates. I would absolutely agree that treatment of all stages decreases symptoms in the fast majority of the patients but fertility is a different issue. I feel there is room for discussion regarding the ultimate usefulness of laparoscopy in the infertile patient.
The comments regarding stress and holistic medicine were an intriguing segment. I agree that life is too short to be unhappy and/or stressed and that we should all seek methods to better cope with stress and try to be as happy as we can be. The effects of yoga, massage, acupuncture, exercise and other holistic treatments on fertility is a very complex issue. There is supporting data that stress management may reduce the number of miscarriages slightly but increasing pregnancy rates is a more challenging process. I wholeheartedly agree that all infertility patients should do what they can be become as healthy as they can and find a balance in their lives regarding work and family. To depend on a holistic approach as the only approach, however, may unintentionally delay diagnosis and treatment and potentially harm patients.
Remember that most infertility couples are getting pregnant on their own at a low 1-3% per month so anything that takes place during the month of conception is thought to have made the ultimate difference. The Internet, and even some published data, is full of “cures” that were most likely coincidence rather than truly causing a successful pregnancy. Since 1-3% of most infertility patients will get pregnant on their own every month, it becomes important to design studies that discover true cause and not just coincidence. These are complex issues and more carefully designed research needs to be done in this area before clear conclusions can be made.
I look forward to the next week’s segment on oocyte cryopreservation (egg freezing), a very important area of expanding research. Oocyte cryopreservation has tremendous potential for many women. It may provide women an unprecedented level of control regarding the timing of having children beating the biologic time clock through reproductive technologies.
Craig R. Sweet, M.D.