in this issue
Sonja Kristiansen, MD
Medical Director & co-founder
of
the Houston
Infertility Clinic, Dr. Kristiansen is double board certified
in
Reproductive
Endocrinology and Obstetrics & Gynecology and
specializes in surgical and IVF procedures.
She has
advanced training in hysteroscopy, laparoscopy, and
microtubal reconstruction. She also works with
female endocrine abnormalities relating to
menstrual and reproductive development.
Quick Links...
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Greetings,
A lot of patients pay close attention to anything
related to infertility in the news. You may have seen
even more in recent weeks, many of which came from
the 62nd Annual Meeting of the American Society for
Reproductive Medicine (ASRM), held in New Orleans this
year.
Like thousands of other fertility specialists from around
the world, I attended many presentations of research
findings at ASRM. These gatherings serve not only to
disseminate crucial information to other researchers
and clinicians like myself, but also to connect us as a
practitioner community.
I'm happy to note two particular conclusions that many
of my patients may find of personal interest:
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New Look at PCOS
Polycystic Ovary Syndrome is now often being
called "metabolic syndrome," a term that more
accurately reflects the whole picture of conditions that
affect women with PCOS. There was some surprising
information on treatment of PCOS-related infertility.
The drug Metformin has been used in recent years for
improving the insulin sensitivity aspects of PCOS. This
component of metabolic syndrome is linked to diabetes.
A large, multi-center study of over 600 women took a
look at just how effective Metformin is for PCOS with
infertility. To do this, the study authors compared the
fertility rates (measured by conceptions per ovulated
patient) of women using Metformin or placebo, Clomid
or placebo, or combined Metformin and Clomid.
To their surprise, not only was Clomid "superior to
metformin in achieving a live birth" in this group of
women, but Metformin used alone was found to
actually lower the rate of conceptions. There was
no "live birth advantage" to combining the therapies.
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Endometriosis Surgery Update
Another common cause of female infertility,
endometriosis, can not only affect fertility but can
render chronic pain that is often debilitating. For years,
the surgical removal of "stray" endometrial tissue was
thought to optimize treatment for women who were
having trouble getting pregnant because of
endometriosis. However, there's also been some
disagreement about the benefits versus costs of
surgery.
A debate among experts, informed by a number of
research studies and humorously entitled, "The
Obituary of Laparoscopy for Infertility Surgery Has Been
Written; Only Its Publication Remains!" arrived at the
conclusion that pregnancy rates are not improved by
endometriosis surgery. This conclusion holds true even
in cases of endometriomas, the largest and potentially
most fertility-impacting masses found in this disease.
There are still benefits for women who undergo such
surgery for treating severe pain and organ dysfunction.
But if fertility is the primary goal -- surgery does not
appear to be the best treatment. Endometriosis surgery
has not been found to improve pregnancy rates
whether conception is attempted post-surgery without
fertility treatment, with ovulation induction, or with
IVF. Specific to IVF attempts, surgery did not improve
rates of fertilization, implantation, pregnancy, or live
birth. Since most women who undergo endo surgery
often wait over a year afterward to try fertility
treatment, it's now believed that surgery may actually
lower pregnancy rates by way of lessening the woman's
chances over time.
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In Closing...
I find the field of reproductive medicine challenging and
exciting, and I enjoy bringing the most advanced
knowledge directly into my practice. As always, please
feel free to bring me things you've learned, and we'll
find out together whether or not new research findings
will have an impact on your own family-building efforts.
Sincerely,
Sonja B. Kristiansen, MD
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