Breaking the Link: PCOS and Autism

BREAKING THE LINK: PCOS AND AUTISM

A Swedish study released this month gained media attention for linking polycystic ovarian syndrome (PCOS) with autism spectrum disorder (ASD). The authors concluded that children of women with PCOS have a 59% higher risk of developing ASD compared to children of women without PCOS (0.7% vs. 0.4%) because of increased exposure to androgens (male hormones) before birth. This risk was further increased in obese women with PCOS. What does this mean for women who have PCOS? Let's go behind the numbers to provide reassurance. 

Reasons Why I decided to Get a MBA

There are many decisions that a physician has to make in 2015. What treatment plan is best, how to best manage time, and how to run a practice to name a few. Getting a MBA has been something I have been thinking about since I started fellowship and 3 years out, now is as good a time as any.

I thought I'd share my reasoning and what pushed me to do it. since many of my peers have had the same thought.

5 Questions...I get about IVF

Certain questions often come up when I discuss IVF with patients. Not surprisingly a simple google search of "myths and misunderstandings of IVF" provides easy access to many listicles some from Fertility clinics and others from special interest groups/patient support group blogs.

I am still waiting for Buzzfeed to make its list. Oh wait, they sort of did.

Some of the more common questions I get are listed below after the break. The most important piece of advice is to encourage patients to ask questions and make sure they are getting satisfactory answers from their providers.

Endometrial Exfoliation (i.e "Scratch Test") in patients prior to IVF: Answering a Medical Conundrum

Implantation, the act of the embryo adhering to the lining of the uterus or endometrium, is an essential part of a normal pregnancy. Implantation failure remains a major factor limiting the success of in vitro fertilization (IVF) cycles. As implantation depends on the cross talk between the embryo and the endometrium considerable research has been dedicated to understanding and optimizing this exchange. 

GENETICS of MALE INFERTILITY INITIATIVE (GEMINI)

Male infertility can be devastating for men and their partners. Despite that, an underlying cause of infertility cannot be identified in about half of infertile men. WUSM Fertility and Reproductive Medicine Center doctors and researchers are part of a large team working to uncover these likely genetic causes and work to find potential treatments.

Fertility Coverage or Bust for our Patients

The average cost of a cycle of IVF, including medications hovers around $15-16,000 (all costs). Cost is obviously a barrier to IVF which is unfortunate as it provides the highest chance of live birth. Approximately 50% of the patients I see have infertility treatment coverage. This is due to our close proximity to Illinois which has one of the more comprehensive fertility mandates in the US.

Many times insurance companies that cover IVF will not cover it unless there is a "medical necessity." Oftentimes we write letters and talk on the phone with insurance company MDs fighting for our patients to have coverage for IVF. This usually involves multiple levels of written letters, peer to peer phone conversations and in-person testimonies.

Sometimes we are successful and sometimes we come up short. Man, it feels good when we get a claim approved! I wanted to share a recent success story emphasizing that persistence pays off.

IVF is Firstline treatment for Women 38-42 struggling to conceive

If you have unexplained infertility (normal tubes, sperm and ovulatory cycles), and are between 38-42, IVF may be the first-line option for treatment. The Press release below is from an email that will become publically available on the ASRM website under Bulletins. I wanted to share it with the readership.

Credit: American Society of Reproductive Medicine

What is Mini IVF?

“Natural”, “gentle” fertility treatments seem appealing when it comes to in vitro fertilization. However, the evidence is not swayed by marketing. After performing a review of the literature, there are several points to be aware of when considering mini IVF.

National Infertility Awareness Week 4/20-4/26

In the spirit of National Infertility Awareness Week, I will be posting several articles on topics that seem to capture the interest of a lot of the readership. The topics will deal with fibroids, fertility preservation, egg freezing, mini IVF and IVF insurance coverage. There will be embedded links galore for further reading should you be interested. Stay Tuned

Changes to Fertility treatment in order to reduce multiples

A paper released in a joint collaboration between researchers at Yale and March of Dimes issued recommendations commenting on issues related to preterm births, multiple births and Fertility treatment titled: Recommendations for changes in policy and clinical practice. It is in press in Fertility and Sterility, a leading journal in reproductive medicine. Read on for the bulletin and view other bulletins from the American Society of Reproductive Medicine.

Got fibroids?

I have fibroids. Fibroids come many shapes and sizes and range in symptomatology from no symptoms to unbearable, pain and heavy bleeding. Not all fibroids are associated with infertility, but those that distort the cavity or cause symptoms in women who desire fertility should be evaluated by a gynecologist or reproductive endocrinologist/infertility specialist. The picture below shows all of the difference locations on the uterus that fibroids can appear.

IVF Outcomes in the United States: 2010

Since 1992, federal law requires all IVF clinics in the United States to report their outcomes regarding success rates and multiple births. This law has helped our field improve its standards and help lower the multiple birth rate but more work still needs to be done (i.e single embryo transfer). Keep in mind that the latest data is from 2010 because it takes 9-10 months to get live birth data and then another year to process and publish the data. You can read the latest report from the CDC past the jump.

Should I freeze my eggs?

To freeze or not to freeze… that is a popular question among modern, reproductive age women. Media coverage of egg freezing in an effort to defer childbearing is everywhere. A simple google search clues us in on our society's fascination with this technology. But who is using oocyte cryopreservation and should you learn more about it. 

Hyper-Hypo-and-anechoicity: a guide!

I'm back in the blog game. Here is a nice piece from our ultrasonographers about ultrasound findings. Simple and straightforward. This is helpful for both practicing physicians and trainees. A refresher of sorts after the jump

Reflections of Presidential Elections Past

This is not intended to be a endorsement riddled post...so look elsewhere if that is what you were looking for. While being bombarded with all sorts of political adds from all sorts of media venues, I have spent the better half of the last several days reflecting on my memories of presidential elections past. The internet allows all voices to have a platform which expands the sources of information.

I was introduced to politics at a young age. When I was 4 or 5, my sisters asked me about what I thought of Ronald Reagan. Fortunately any proof of my response is gone forever (thankfully they couldn't record it on a phone and upload to YouTube)...unless of course that casette tape is lingering somewhere at my parents house!  

Eitherway, as we wrap up another election cycle (thankfully), I wanted to reflect my favorite memories from elections past.

My $0.02: The ART of Conference Chit Chat

Milestone: this is my first blog entry using my i pad. I got a keyboard and decided to give it a whirl. This works really well! Without further adieu...

I have been going to medical conferences regularly for the last 3 years. They are great venues for learning about our field and networking. In an effort to provide an observational take on networking at a conference (without sounding haughty) there are several things that, I think really work well for "meaningful" networking. Hit the jump for examples

What MNF fiasco tells us about character

I have been interviewing medical students and resident physicians for positions at my institution for a couple of years now. One thing I always like to look for in applicants is GRIT! When you get knocked down how do you respond? The MNF officiating fiasco (and how folks respond to officials in general) can open a door into one's personality.

Lost in translation: What the presenter's response really means at Grand Rounds

In the heat of an election we are constantly bombarded with "spin." But "spin" along with "evasion" are everywhere and anyone who has been to a scientific meeting, a grand rounds, or just a simple town hall Q&A has probably witnessed such tactics at play between presenter and audience. We are so accustomed to it though that we don't really think twice because we have learned to translate certain responses. In sports, for example, the post game press conference is where a player or coach serves up certain cliches for the media. New England Patriots Head Coach, Bill Belichick is notorious for this.

I was recently inspired by a sports talk show segment and a conversation I had with some peers about what is really meant by certain presenter responses. Sometimes people try to evade questions when they don't know or want to hide something. Thats fine. We have all done it too and for a variety of reasons: don't know answer, don't want to disclose specific information, protect 3rd parties, etc.

As a result, I have decided to translate such presenter responses from my experience as both audience member and presenter. This is meant purely for entertainment purposes. Note: 

Most of these are actual responses and some are actual TYPES of responses. Also the "TRANSLATIONS" are from the presenter's perspective

Onward after the jump

Paging Dr. Manners STAT to L & D: A guide for physicians and medical students

This blog has achieved 600 hits in a just over a week. In order to keep that momentum going, we are firing up another Dr. Manners post. It has quickly become apparent that there is a humorless void regarding residency, particularly in OBGYN, that we hope to fill.

Last week, we reviewed the decorum that can maximize the working/learning/teaching environment in the operating room. And just the other day, our guide to signout/handoff styles got some attention, so it got us thinking about doing a Dr. Manners guide for Labor and Delivery, possibly one of the most exciting and much-anticipated rotations in medical school. OBGYN rotations are usually spoofed magnificently at medical school class skits, but we digress.

I can remember being introduced to the concept of professionalism as a medical student and it quickly became apparent that it was becoming more and more of an issue because "how-one-should-act" on the wards was up to the examples set by the team the student was on.

Professionalism should not be taught to medical students/residents like a parent talking down to a child because lectures on professionalism quickly become "how-to-behave" lectures that quickly turn people off.

The purpose of Dr Manners is to provide a new paradigm, using humor and our collective real life experiences as medical student, resident and fellow to teach professionalism.

This week we break down what Blueprints OBGYN (mehh), First Aid OBGYN (not bad, decent for step 2/3), and CaseFiles Obstetrics and Gynecology (my favorite) fail to give advice on: professionalism (aka how-to-avoid-awkward-moments) on Labor and Delivery.

Please note that this is for Physicians of all levels too: residents, fellows, attendings, staff MDs, etc...and while the examples given below may be relevant for academic settings, just like the OR post, anyone who works on labor and delivery will appreciate the advice given here. Hit the jump for the guide on handling yourself on Labor and Delivery.

From the Residency Vault: L&D Sign Out Styles

The EMORY OBGYN Class of 2010 - Not shown because she is taking the picture (why?) is Martina Badell

As I gear up for the "Channeling Doctor Manners: L&D entry" I was reminded of my list of OBGYN signout styles and thought I would share.

As a 3rd year resident on L & D, you are in charge of "running" labor and delivery." Pretty much every patient is your responsibility and in the post-duty hours world of Graduate Medical Education (GME) communication is essential. But everyone has a unique style of communication.

I did my OBGYN residency at Grady Memorial Hospital - the GRADYs as the nurses like to call it. When you came on to start your shift, both day and night teams would sit (stands) and listen to the 3rd year resident present the board. 

The point is to provide "inventory," so-to-speak, on all the patients and their issues on Labor and Delivery. The goal is to be concise-yet thorough-logical, and coherent. Obviously, the more experienced one got, the smoother things were. 

Labor and delivery signout is where the true personalities of OBGYN residents shine. As a result I always tell medical students who are on away rotation sub-I's to spend time on labor delivery because the signout is one place where you can capture "the pulse" of the program.

While every obstetrician (and physician for that matter) has his/her own personality, it quickly became evident to me that there were certain signout styles that were common. Hit the jump for the most common L&D signout styles and let me know if I am missing one or need to qualify one further.