Great.
I look forward to meeting you.
L. April Gago MD
Wednesday, December 9, 2009
Thursday, July 9, 2009
Hi Sylwia,
It sounds like you are describing congenital adrenal hyperplasia (CAH) , late onset. The symptoms can appear very similar to those of Polycystic Ovarian Syndrome (PCOS). CAH is an inherited disorder in the proteins (enzymes) responsible for the production of hormones. Women born with an abnormality of one of these proteins have decreased production of some hormones (usually cortisol) and an increase in others, 17-hydroxy progesterone and testosterone. With the elevation in testosterone, the symptoms that a patient experiences are similar to those of women with PCOS, with acne, excessive hair growth and weight issues being common. Because the origin of the problem is a bit different, the treatment is also slightly different. Patients with CAH are treated with cortisol or related steroids to supplement the hormones that are low, and this results in a decrease in the testosterone as well. Sometimes additional medications are also required for ovulation and fertility.
We can certainly repeat the diagnostic tests to reestablish the diagnosis, and initiate treatments that should help with ovulation and conception.
Some gynecologists are very comfortable making this diagnosis, and others prefer to have a reproductive endocrinologist assume the care for these types of conditions.
It sounds like it would be very reasonable for you to make an appointment with a reproductive endocrinologist at this point, because it is likely that you have CAH adult onset and will require their assistance for conception.
L. April Gago MD
It sounds like you are describing congenital adrenal hyperplasia (CAH) , late onset. The symptoms can appear very similar to those of Polycystic Ovarian Syndrome (PCOS). CAH is an inherited disorder in the proteins (enzymes) responsible for the production of hormones. Women born with an abnormality of one of these proteins have decreased production of some hormones (usually cortisol) and an increase in others, 17-hydroxy progesterone and testosterone. With the elevation in testosterone, the symptoms that a patient experiences are similar to those of women with PCOS, with acne, excessive hair growth and weight issues being common. Because the origin of the problem is a bit different, the treatment is also slightly different. Patients with CAH are treated with cortisol or related steroids to supplement the hormones that are low, and this results in a decrease in the testosterone as well. Sometimes additional medications are also required for ovulation and fertility.
We can certainly repeat the diagnostic tests to reestablish the diagnosis, and initiate treatments that should help with ovulation and conception.
Some gynecologists are very comfortable making this diagnosis, and others prefer to have a reproductive endocrinologist assume the care for these types of conditions.
It sounds like it would be very reasonable for you to make an appointment with a reproductive endocrinologist at this point, because it is likely that you have CAH adult onset and will require their assistance for conception.
L. April Gago MD
Wednesday, May 27, 2009
Acupuncture and IVF
Hello,
Published studies both support and refute acupuncture as beneficial for IVF success.
There are well done studies that support stress reduction techniques to be supportive of fertility as well as decreasing depression in infertility patients.
Some of my patients find acupuncture to be very good for stress reduction.
We work with excellent acupuncturists who can provide an evaluation and recommended treatment protocols.
Success with fertility treatments is built upon many things, usually not just one factor.
I wish you the best on your fertility journey.
L. April Gago MD
Published studies both support and refute acupuncture as beneficial for IVF success.
There are well done studies that support stress reduction techniques to be supportive of fertility as well as decreasing depression in infertility patients.
Some of my patients find acupuncture to be very good for stress reduction.
We work with excellent acupuncturists who can provide an evaluation and recommended treatment protocols.
Success with fertility treatments is built upon many things, usually not just one factor.
I wish you the best on your fertility journey.
L. April Gago MD
Hi Andrea,
Increased amounts of body fat can contribute to infertility through several mechanisms.
Adipose tissue (fat) secretes multiple hormones, and so, participates in the hormonal signaling in the body. Leptin is one of those hormones and inadequate and excessive levels can disrupt normal ovulation. Also, as adipose tissue increases, insulin levels increase which can create a PCOS like environment, and also disrupt ovulation. PCOS, of polycystic ovarian syndrome, is partly manifested as hyperandrogenism, or excessive levels of androgen hormones, which creates a poor environment for the developing oocytes, or eggs.
Women who are overweight can undergo IVF, but have decreased success rates and higher miscarriage rates.
Even 10% decrease in body weight can have a significant impact, and improve fertility. Excercise alone, even if there is not a large weight loss is also helpful. If you believe you are overweight, then try to get moderate levels of excercise, about 40 minutes of excercise which makes you moderately short of breath, 4-5 x /week.
Also, following a well balanced diet, such as Weight Watchers is also a helpful strategy.
Best of luck, and hope to meet you soon.
L. April Gago MD
Increased amounts of body fat can contribute to infertility through several mechanisms.
Adipose tissue (fat) secretes multiple hormones, and so, participates in the hormonal signaling in the body. Leptin is one of those hormones and inadequate and excessive levels can disrupt normal ovulation. Also, as adipose tissue increases, insulin levels increase which can create a PCOS like environment, and also disrupt ovulation. PCOS, of polycystic ovarian syndrome, is partly manifested as hyperandrogenism, or excessive levels of androgen hormones, which creates a poor environment for the developing oocytes, or eggs.
Women who are overweight can undergo IVF, but have decreased success rates and higher miscarriage rates.
Even 10% decrease in body weight can have a significant impact, and improve fertility. Excercise alone, even if there is not a large weight loss is also helpful. If you believe you are overweight, then try to get moderate levels of excercise, about 40 minutes of excercise which makes you moderately short of breath, 4-5 x /week.
Also, following a well balanced diet, such as Weight Watchers is also a helpful strategy.
Best of luck, and hope to meet you soon.
L. April Gago MD
Sunday, May 10, 2009
Saturday, April 25, 2009
Hello,
Sounds like you have a difficult situation with your current physician. There are many excellent gynecologists who can begin a thorough evaluation for you. Perhaps your current doctor has already done so. Seeing a reproductive endocrinologist at this point would make sense, since you have tried a few clomid cycles and have been on Metformin without success.
I would be very happy to see you, and my partner Dr. Kowalczyk has an office in Warren as well.
You can call the office at (810) 227-3232 to schedule an appointment at your convenience.
Also, if you can get copies of any bloodwork or testing that your doctor has already done, that would be helpful.
Good luck, and hoping to meet you.
L. April Gago MD
Sounds like you have a difficult situation with your current physician. There are many excellent gynecologists who can begin a thorough evaluation for you. Perhaps your current doctor has already done so. Seeing a reproductive endocrinologist at this point would make sense, since you have tried a few clomid cycles and have been on Metformin without success.
I would be very happy to see you, and my partner Dr. Kowalczyk has an office in Warren as well.
You can call the office at (810) 227-3232 to schedule an appointment at your convenience.
Also, if you can get copies of any bloodwork or testing that your doctor has already done, that would be helpful.
Good luck, and hoping to meet you.
L. April Gago MD
Sunday, April 5, 2009
Hello anonymous,
The Rotterdam criteria for the Diagnosis of PCOS require that a patient meet 2 of 3 features, which include irregular cycles, clinical or laboratory signs of hyperandrogenism (elevated androgens) which include excessive hair growth and acne, and PCOS ovaries on ultrasound. There are some women with stress or low body fat related hypothalamic dysfunction which can appear like PCOS, but are less likely to respond to Clomid or Femara and may require injectable gonadotropins (FSH and LH).
Some women with PCOS will not respond to 50 mg of Clomid, and can respond to Femara. Depending on your age, a trial of Femara may be a really good idea. If you do not respond to Femara, then a visit with a reproductive endocrinologist to discuss injectable gonadotropins or other options is a good idea. Unless your own physician is comfortable using injectable gonadotropins.
Best of luck with your fertility journey.
L. April Gago MD
The Rotterdam criteria for the Diagnosis of PCOS require that a patient meet 2 of 3 features, which include irregular cycles, clinical or laboratory signs of hyperandrogenism (elevated androgens) which include excessive hair growth and acne, and PCOS ovaries on ultrasound. There are some women with stress or low body fat related hypothalamic dysfunction which can appear like PCOS, but are less likely to respond to Clomid or Femara and may require injectable gonadotropins (FSH and LH).
Some women with PCOS will not respond to 50 mg of Clomid, and can respond to Femara. Depending on your age, a trial of Femara may be a really good idea. If you do not respond to Femara, then a visit with a reproductive endocrinologist to discuss injectable gonadotropins or other options is a good idea. Unless your own physician is comfortable using injectable gonadotropins.
Best of luck with your fertility journey.
L. April Gago MD
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