Fertility & Infertility

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Just Because You’re On the Pill, Doesn’t Mean You Won’t Get Pregnant

Monday, May 28th, 2012

With contraception so much in the news lately, it seems that we have heard all there is to say about it.  A recent study regarding birth control though, has something quite different to say that definitely deserves our attention.  It’s evident from the attention that political contraceptive debates received that there are a lot of women in the US who take the pill or some other form of birth control.  According to the American Journal of Obstetrics and Gynecology though, many of those women wrongly assume that their contraception is infallible.

According to the Guttmacher Institute, 99% of women of reproductive age who have had sex use contraception.  That’s a lot of women, but Researchers at Washington University in St. Louis found that a shocking 45% of those women believe that contraception can prevent pregnancy 100% of the time.  With so many people taking birth control under this false assumption, it’s obvious there’s a need for education and media exposure.  While the pill, which is the most popular form of contraception, is mostly successful at preventing pregnancy, it can indeed fail between 2%-9% of the time.  And that’s the failure rate if you remember to take it every single day.  The failure rate can increase when women miss pills, are in their first month of taking the pill, switching dosages, or taking medications like antibiotics, migraine medications, or antidepressants.  Condoms have an even bigger failure rate of 15%-24%. This is why it’s so important for women to discuss their birth control options with their physician, and that discussion should include how effective each option is.  The rates of contraception failure with respect to perfect use and average use are outlined in my health book, Inside Information for Women.  Hopefully, that chapter will give you a better understanding of the types of contraception offered, their effectiveness and their applicability to your lifestyle.

This information shouldn’t make anyone panic, because as a whole, birth control is fairly effective, especially when compared to not using any contraception at all, which has a failure rate is 85%! However, knowing more about failure rates should make people aware of the actual risk involved in being sexually active, even while taking birth control.  This information probably won’t cause people to think again before having sex, and it may not prevent unintended pregnancies.  At the very least though, it gives parents like me yet another reason to teach our children that sexual activity does have consequences and is better saved for a time in our lives when we are ready to be responsible for our actions.

 

– Yvonne S. Thornton, M. D., M. P. H.

Don’t Want Kids? Why Haven’t You Told Your OB/GYN?

Monday, May 14th, 2012

Back in my mother’s day, women were expected to grow up and raise a family.  Nowadays though, modern women view having kids as more of an option.  In fact, more and more often women are choosing to forgo the family experience in exchange for a demanding or prestigious career.  There is no longer a societal stigma for not having children.  It is truly a choice.  Oprah Winfrey, two recently-appointed female Supreme Court Justices, Condolezza Rice, and even our Surgeon General are childless.  While I can say firsthand that it is possible to have both a career and children, I can certainly relate to the ambitious young women out there who want different achievements than those of their mothers’ generation.  While these young women may have decided beyond a doubt that they don’t want children, for some reason, they’re not sharing this information with their OB/GYNs.

Many people see OB/GYNs as physicians who perform annual exams or take care of matters concerning pregnancy.  While these are important parts of our job, they’re not the sole aspects.  We are here to provide support and advice when it comes to a variety of women’s health issues.  Just because you’ve decided not to have kids, doesn’t mean we don’t have anything more to tell you.  In fact, OB/GYNs can give you valuable information concerning your permanent birth control options.  Although so many women are opting out of pregnancy, they continue to use contraception methods that are temporary, not always effective, and sometimes, risky to their health.  With average use, condoms have a failure rate of 17.4 percent and the pill has an 8.7 percent failure rate.  In addition to the pregnancy risk, hormonal birth control increases a woman’s risk for blood clots, strokes and heart attacks.  Yet, those who don’t want kids or those who don’t want any more kids, continue to take the risk.

As stated in my women’s health book, “Inside Information for Women”, the most common form of contraception among couples is sterilization.  While most have heard about invasive procedures like vasectomies and tubal ligations, only 12 percent were aware that other options existed.  Because, in the final analysis, whoever carries the child is the one who is going to be the one most concerned about birth control, it is more usually the female partner rather than her mate who elects sterilization. There is more than one type of sterilization for women though, including sealing fallopian tubes using an instrument with an electrical current, closing them with clips, clamps, or rings.  A new method of sterilization (Essure®) involves inserting spring-like coils into the tubes through the cervix around which tissue grows to block the tubes.  President of AAGL and practicing OB/GYN, Dr. Linda Bradley believes that more women would choose a permanent method if they were simply more educated on the matter.  She cites the insert procedure (Essure®) as being 99.8 percent effective and a lot less invasive than a tubal ligation.  She notes the insert method, for instance, as being a “non-surgical permanent birth control procedure [that] offers women the option of no incisions, no hormones, no general anesthesia and no slowing down to recover.”  It’s a fairly new procedure, just ten years old, but it is gaining in popularity among those who have learned about it.

Wherever you are in your reproductive plans, it’s important to share them with your OB/GYN.  They can give you information you may not have considered, guide you in your decision making, and help you make the healthiest and most informed choice regarding your reproductive health.  The next time you and your loved one debate over who should get that permanent birth control procedure, include your OB/GYN in the conversation.

– Yvonne S. Thornton, M. D., M. P. H.

Early Menopause is Bad News for Women and Their Bones

Monday, May 7th, 2012

Let’s face it.  None of us looks forward to getting old, but we try to do it with as much grace as possible.  For some women though, menopause, a hormonal change that should come later in life, comes sooner than expected.  Instead of dealing with hot flashes, night sweats, mood swings and all the other symptoms of menopause in their 50s, they’re facing it in their 40s or even younger.  And as if early menopause isn’t bad enough, studies now show that it increases their risk for osteoporosis and even shortens their life expectancy.

Swedish researchers from Skane University Hospital in Malmo conducted a study of almost 400 women over the course of just under 30 years.  They found that of the women who started menopause before the age of 47, 56 percent developed osteoporosis compared to just 30 percent in the women who started menopause later in life.  Women suffering from osteoporosis are at greater risk for bone fractures, bone pain, and loss of height due to bone loss.  Their findings also showed that women who had undergone early menopause had a greater risk of fragility fracture and death with a rate 17 percent higher than the women with later menopause.  The rate of fractures in women with early menopause was 44% compared to 31% in those women who entered menopause later.

The cause of early menopause is not yet clear, though there seems to be a link between it and premature ovarian failure, hysterectomies, chemotherapy, and possibly even stress.  Premature ovarian failure has been associated with Fragile X syndrome, so there may be a genetic link. Unfortunately, preventing and reversing early menopause is not yet possible, but there are ways to decrease your risk of osteoporosis.  The bone masses of most women peaks in their 20s.  You can increase yours by getting plenty of calcium, vitamin D and exercise.  A balanced diet and thirty minutes of weight training or other moderate exercise every day can make big difference when it comes to your bone health.

The association found between early menopause, osteoporosis, and death is causing some to call for more studies to determine a more definite correlation. The higher mortality rate in women with early menopause does need further study in order to address the confounding variables, such lifestyle, medications and smoking.  In the meantime, we should take the results as a warning to take care of our bodies, particularly our bones, as early as possible.

— Yvonne S. Thornton, M. D., M. P. H.

Childhood Obesity Speeds the Onset of Puberty in Girls

Tuesday, April 24th, 2012

When I was young, even though my Dad wanted to “plump up” me and my sisters so that we would be less attractive to boys, for the most part, sitting down at the family table meant eating a well-balanced meal and reconnecting with each other after a busy day.  This time wasn’t just important for the bonding opportunity it provided, but for the proper nutrition it allowed my sisters and I to receive.  It was there that we learned what a balanced diet was and to appreciate the food we had.  Snacking throughout the day was a privilege and eating snacks between meals was a luxury a poor person could ill afford. Unfortunately now days, it seems that many parents don’t have time for traditional dinners or are unwilling to make time for time them.  Snacks are cheap, ubiquitous and filled with carbohydrates. With so many people reaching for the quickest, easiest foods, families are moving to a culture of convenience and their kids are paying the price.

Childhood obesity is on the rise and it’s having effects in some unexpected areas.  Studies are now suggesting that girls who are overweight start menstruation at much younger ages.  The average age of onset of menstruation (menarche) in the late 20th century was between 12.6 to 12.8 years.  Recently, that age has decreased to 12.43 years.   It has been argued that girls need to reach a critical weight (47.8 Kg) to initiate pubertal changes; it is more likely that what is needed is a shift of body composition, with an increase in the percentage of body fat. The percentage of body fat in children (16%) needs to rise to 23.5% to initiate puberty.  A 2011 study found that each 1 kg/m2 increase in childhood body-mass index (BMI) can be expected to result in a 6.5% higher absolute risk of early menarche (before age 12 years).

Normally, once a young woman reaches a particular body mass index, that tells her body she is of childbearing weight.  This starts the menstruation cycle.  If a young girl, say of about eight or nine, is overweight, she will reach this body mass index much sooner, triggering her body to go into early puberty.  While early childhood obesity is itself a problem, early puberty can also lead to a shortened growth span.  Most girls stop growing a few years after starting menstruation.  If they start this too soon, they will also stop growing much earlier than normal.  If childhood obesity continues to increase, the rise in early maturation is likely to follow.  In 1965, about 5% of kids were considered obese in the US.  Obesity in children has increased three-fold over the past 30 years.  In 1980 obesity in children, ages 6-11, was a mere 6.5% but by 2008 it increased to 19.6%.

Today, about 25 million children are either overweight or obese.  Researchers are finding that increases in the number of girls hitting puberty early seems to be in keeping with these obesity statistics.  The First Lady is even promoting a change in our habits that affect childhood obesity.

Although convenient, fattening foods have flooded the markets; there are still plenty of healthy foods out there.  Parents cannot expect their kids to make smart choices about their diets, especially at such young ages.  It’s up to them to teach their children how to eat, so they can grow up to make good choices for themselves and their own families.  There’s something to be said for those traditional sit-down dinners, because they truly benefit the health of our children in more ways than one.

— Yvonne S. Thornton, M. D., M. P. H.

Sources:

http://children.webmd.com/features/obesity

http://www.helium.com/items/1249193-delayed-puberty

 

 

 

Should you be worried about the blot clot risk with newer birth control pills?

Monday, November 21st, 2011

You might have read the news that YAZ and Yasmin, two newer birth control pills, are riskier to take than older contraceptives due to higher potential for blood clot formation.

But it’s important to put this into perspective. No matter what birth control pill you use, blood clots are a possibility, if an uncommon one. What you might not know is that blood clots are even more common in pregnancy. Fortunately, the vast majority of the millions of women who get pregnant and give birth each year don’t suffer blood clots. Just as millions of women take birth control pills with no such side effects.

So, is there a unique problem with YAZ? Yes, but not the one identified in the headlines. The problem is in the marketing.

YAZ was promoted to women as a pill for bloating and acne in addition to its contraceptive effects. While that might be a good marketing strategy, it’s not a good medical one. Contraceptives are for birth control, and the best one for you, based on your medical history, might have nothing to do with acne. People shouldn’t pick their birth control the way they pick their toothpaste—on the basis of consumer advertising. You should consult your doctor who will look at your history and decide what form of contraception meets your needs. If your family has a history of strokes, blood clots, or thrombophlebitis (a blood clot that causes swelling in a vein), your doctor will almost certainly order advanced testing due to the possibility that any birth control pill—YAZ, Yasmin, or older medicines—might be inappropriate for your condition.

But if your doctor has already determined that YAZ or Yasmin is a safe bet, and you’re on one of these now? Keep taking it unless your doctor says otherwise. The alternative could be unintended pregnancy. And pregnancy, ironically enough, is more likely to cause a blood clot than your birth control pills.

– Yvonne S. Thornton, MD, MPH

The new, several-mornings-after pill

Monday, August 16th, 2010

The FDA has just approved an emergency contraceptive that can prevent pregnancy if taken up to five days after intercourse.

The new drug, ulipristal acetate (ella), will be available by prescription only, unlike the so-called “morning-after pill,” levonorgestrel, which can be bought over-the-counter.

While ella is not the first emergency contraceptive to be approved, it gives women a wider window of opportunity to prevent pregnancy than previous emergency contraceptives such as levonorgestrel, which must be taken within 72 hours to be effective.

Although it’s been used in Europe for the past year, ella won’t be available here in the U.S. for another two to three months. And there are still risks and side-effects associated with it, as with all drugs. Still, the introduction of a new emergency alternative is good news for women and their doctors, in preventing unintended pregnancy.

– Yvonne S. Thornton, MD. MPH

Overweight or Obese? Don’t Count On Your Birth Control Pills.

Wednesday, July 14th, 2010

Since the pill first appeared on the scene, about 50 years ago, women have felt secure knowing that they had an almost foolproof way to avoid unwanted pregnancies. And that’s been mostly true.

But maybe not for all women.

If you’re overweight or obese, recent studies suggest that birth control pills might not be as effective for you as they are for more slender women:

“In one study of oral contraceptive pills, women with a body mass index (BMI) in the overweight range (a BMI of 25 or more) had a higher risk of pregnancy that those in the normal weight range. In another study of contraceptive skin patches, higher body weight — not higher BMI — was associated with higher risks of pregnancy.”

In addition to the sobering news about the lessened effectiveness of hormonal birth control, these birth control methods are thought to slightly increase a woman’s risks of heart disease, high blood pressure and other conditions. When you consider that overweight and obese women are already at increased risk of heart disease, diabetes and other ills, and that pregnancy is a riskier venture, overall, for obese women and their babies, you have a new incentive for getting your weight down.

I know it isn’t easy. I’ve struggled with weight myself and can attest to the fact that it’s a constant battle. But it’s a battle we must fight – and win. And now, we have one more reason to do it.

– Yvonne S. Thornton, MD, MPH

How late can you wait to have a baby?

Tuesday, April 13th, 2010

Today, many women are delaying starting families, most likely due to career and  economic concerns. Pregnancy rates are down in all age groups except for those 40 to 44 years of age, says the CDC, where pregnancy rates are up by 4 percent.

With all those over-40 women having babies, does this mean you can wait indefinitely if you hope to get pregnant? Not really.  A woman’s peak of fertility is about 25 years of age.  After that, “it’s all downhill.”  The likelihood of becoming pregnant drops dramatically well before you reach menopause, which is what many women think of as the end of their fertile years. A great number of those after-40 pregnancies are the results of medical interventions such as in vitro fertilization and donor eggs from 25 year olds.  Unlike our male counterparts who keep producing new sperm every 74 days, women are given their complement of eggs way before they are even born and there are no more new eggs to be produced.   Therefore, at 36 years of age, a woman’s eggs are 36+ years old with all the attendant risks that accompany any aging process.  According to the March of Dimes:

“At age 25, a woman has about a 1-in-1,250 chance of having a baby with Down syndrome; at age 40, the risk increases to 1-in-100 chance; and at 45, the risk  of carrying a child with a chromosomal anomaly such as Down syndrome, continues to rise to 1-in-30 chance.”

The advent of artificial reproductive technologies virtually transforms a woman’s “biological clock” into a perpetual calendar, but not without risks.  In studies, babies born via in vitro fertilization have been shown to have a higher risk of birth defects.

If an older woman doesn’t mind having a baby who carries none of her DNA, she may opt for a donor egg from a younger woman, which is then fertilized by her husband and the embryo transferred into her uterus.  Many of the older celebrities have chosen this route for their family planning.

Medical interventions, while they seem miraculous when they work, aren’t guaranteed to be successful. Just as in getting pregnant the old-fashioned way, your chances of success drop the older you are.  In vitro fertilization will result in a live birth among women past 40 only 6 to 10 percent of the time versus a 30 to 35 percent success rate among women younger than 35.

Nature’s message is clear, and unfortunately, it doesn’t offer any leeway in difficult economic times or while you are working your way up the corporate ladder: if you want to start a family, you’re more likely to be successful if you begin well before you turn 40.

– Yvonne S. Thornton, MD, MPH

Should schools provide voluntary testing for STDs?

Friday, August 7th, 2009

Yesterday, I was on Dr. Nancy’s noontime show on MSNBC, as one of two medical expert guests, to discuss whether schools should be permitted to offer voluntary testing for sexually transmitted diseases (STDs) to their students.

As you’ll see from the video, we three physicians (who are also all mothers) — Dr. Nancy, myself, and a doctor from the Medical Institute for Sexual Health in Austin, Texas — agreed that this is a no-brainer. Of course, we should allow schools to offer voluntary testing for STDs.

Why should we test? Because, in a pilot program at eight high schools in the Washington, D.C. area, 13 percent of the teens who took advantage of voluntary testing were found to be infected, most often with chlamydia and gonorrhea. Chlamydia often causes no symptoms but, if left untreated, can lead to chronic pelvic pain due to pelvic inflammatory disease, an increase in ectopic (abnormal) pregnancy and infertility. Only by testing can we be certain to discover and treat it.

This does not mean we want our teens to be intimate at such a young age. But we must face the fact that, despite our best efforts, some are becoming intimate. And, because of this, some teens face the risk of sexually transmitted diseases that, if left untreated, can cause lifelong damage.

No one would be forced to get a test and no one is suggesting anything but that we make the tests available to kids who wish to know whether they’ve been exposed. If they fear that they are infected, we must give them a way to find out for sure so that they can get treatment.

– Yvonne S. Thornton, MD, MPH

Why your Ob-Gyn should be board-certified

Wednesday, July 22nd, 2009

It’s almost impossible to judge a professional’s skills if you’re not a member of that profession. Only a radiologist can say whether another radiologist accurately read a CT scan. Only a dentist can attest to the quality of the crown another dentist fits over a molar.

So how do you, a layperson, judge the qualifications of your doctor? If they drive fancy cars, wear designer clothes, and charge the highest fees in the community, you can be sure they’re successful. But does that mean they’re qualified? You can ask your girlfriends or your sister or mother to recommend someone. You can determine whether you have rapport with a physician. But that won’t tell you about qualifications, either.

If you want to know whether the kind, caring person you select has the minimum qualifications, there’s one way to determine that. Go here to see whether your doctor is board-certified.

Board certification isn’t mandatory. Once a doctor gets a medical degree and a state license to practice medicine and surgery, he or she can practice any specialty. No law requires a doctor to complete a four-year residency in a specialty, such as ob-gyn, in order to be called a specialist. Nothing prevents a doctor from giving him or herself the title of obstetrician or fertility expert or perinatal specialist or really, almost anything.

But only board certification assures you that the doctor has earned that title.

A board certified doctor has gone a giant step further than a physician who hasn’t passed her boards. After completing a residency program, passing a written test in the specialty, and practicing for a year or two, she’s gathered up all her cases and submitted them to an august body known as the American Board of Obstetrics and Gynecology. Before these distinguished university professors and chairs of departments, she’s been extensively questioned about real and hypothetical situations and asked about diagnoses, patient management and treatment.

As an oral examiner for the American Board of Ob-Gyn since 1997, I’ve certified hundreds of new ob-gyn candidates who have proven their capabilities under difficult circumstances. And there were some who did not pass because they didn’t meet those high standards.

So I speak from experience when I say that board certification is the minimum you should expect from your doctor.

Yvonne S. Thornton, MD, MPH