Category Archives: Blogs

Blogs about infertility by the experts at F.I.R.M. or Florida Institute for Reproductive Medicine cover female infertility, male infertility, and IVF treatments based in Jacksonville, FL

Meet the Experts: A Family Building Expo

Saturday, November 19, 2011 8am – 11am, St. Luke’s Hospital Auditorium. Presented by Resolve, the National Infertility Association. Are you one of the 1 in 8 couples of childbearing age in the U.S. diagnosed with infertility? Are you interested in learning more about your family building options? This EXPO is for you. Door prizes include a free IVF cycle and other professional services. Cost: $10 per person / $15 per couple in advance or $15 per person / $20 per couple at the door. Register in advance at www.resolve.org/Jacksonvilleexpo.

Fertility Treatment and Ovarian Tumor Risk

Recent headlines have reported that IVF treatment is linked to ovarian tumors based on a recently published study. The findings are not different than was was reported over 10 years ago, and media coverage often misleads the public into making assumptions that may not be true. Many studies in the past have reported positive or no linkages with fertility treatment and ovarian stimulation and future risk of ovarian tumors. This study from the Netherlands was retrospective in nature, meaning that they started with women who had tumors, then looked to see what type of treatments they had. This type of study can possibly find causal linkages between a treatment and an outcome, but are in no way definitive as there are many biases that are introduced. You can breathe a sigh of relief that the study did find no link between IVF and ovarian cancer in a follow up of 15 years time. The only relationship was with possible “borderline” tumors, often called “low malignant potential” tumors. These are not invasive cancer and are not considered pre-cancer tumors, though they can grow like a tumor over time. The prognosis with this tumor is usually very good and tremendously different than with invasive ovarian cancer. Below is a blog from the American Fertility Association that helps to clarify a lot of this information.


Tumors of low malignant potential

Posted by Corey Whelan on Oct 27, 2011 with 1 Comments

http://www.theafa.org/blog/tumors-of-low-malignant-potential/

A new study out of the Netherlands and published in Human Reproduction is making the news today. It is entitled “Risk of borderline and invasive ovarian tumours after ovarian stimulation for in vitro fertilization in a large Dutch cohort”. Reuters picked it up as “Fertility treatment raises tumor risk in study”.

It is of course understandable that The AFA’s phones have been ringing off the hook. Women are alarmed by this report. Briefly, I wanted to share a few facts about the study and urge you to please relax while you read this.

This long term study compared women who had done in vitro fertilization (IVF) with two other groups of women; 1)the general population, and 2)sub fertile women who had not done IVF. The researchers reported an increased risk level for the IVF group of developing borderline ovarian tumors. The research also showed that the overall incidence of invasive ovarian cancer was not significantly elevated, but increased with longer follow up.

The important thing to note here is that borderline ovarian tumors are actually cysts of low malignant potential. I am not minimizing the value of this study However, the term as is being reported in Reuters and picked up by media outlets, that women are twice as likely to develop ovarian cancer after IVF, is misleading. Patient’s individual risk of getting ovarian cancer if they do IVF is not 50% higher than it would be were they not undergoing treatment. The increased risk of acquiring invasive ovarian cancer for this group is around 1.76% greater after 15 years. If you however, put together the statistics for borderline ovarian tumors along with the statistics for ovarian malignancies, the rate goes up to 4.23%. That being said, we don’t want women to wind up in either group if they can help it.

I reached out to Dan Potter, M.D. to get his opinion on the study. His comments, verbatim, were:

“This is no different than the study that was published here in the U.S. about 10 years ago. The lead author is an epidemiologist. Oftimes in studies such as this, the researcher starts with the conclusion they wish to arrive at and then they work backward to prove it. I’m not saying that’s what happened here, but these are the most problematic issues that I see in this study.

  1. They linked all of the ‘malignancies’ in the registry to patients in the two study groups (IVF and non-IVF) regardless of whether they returned the surveys or not. This creates a falsely high incidence. They compared them to ‘general population rates’ who basically have the equivalent of a survey return rate of 100%. See how they appeared to start at the conclusion and work backwards?
  2. Borderline tumors, also known as tumors of ‘low malignant potential’ or LMP are not malignancies. There is no such thing as ‘invasive cancer’ and ‘non-invasive cancer’. Cancer is invasive. Borderline tumors are not cancer and while not benign have low malignant potential. The 5 year survival rate of borderline serous tumors (the most common type) is ….…100%.
  3. They seem to speak of ‘invasive cancer’ and consider the borderline tumors ‘non-invasive’ cancer. The definition of malignancy is invasion so this simply does not make sense from a medical perspective.
  4. Their control group is women diagnosed with infertility that did not do IVF. They did not stratify these patients as to whether they became pregnant or whether they were on the birth control pill, both known protective factors. In fact, there is not control for whether the patient even had a hysterectomy or oophorectomy for endometriosis. It is hard to get ovarian cancer when you do not have ovaries. Prior use of fertility drugs in the controls may have led to pregnancy so that they did not pursue IVF. Pregnancy, BCPs, oophorectomy are all protective.
  5. There were 19,146 patients in the IVF group and 28 ‘invasive cancers’. Using their methodology they would have expected 21. Both of these number are very high compared to what we would expect in the US (about 10x higher). Not sure why they diagnose it more frequently there.”

So, to sum it up. You should absolutely discuss this study with your physician and weigh your own personal risk, based on medical and family history and genetic background. And, if you want to talk about it, please feel free to call.

Comments:
Great news about fertility treatment from the Netherlands!
The study, a large cohort of Dutch women with infertility, showed that
the incidence of invasive ovarian cancer was NOT increased in either IVF
treated women or Non-IVF subfertile women followed for up to 15 years
after treatment.

The study of 19,146 women who underwent IVF and 6,006 women treated with
lesser forms of fertility therapy over a period of 13 years, found 28
and 9 women respectively developed invasive ovarian cancer, (37 cases /
25,152 women) a rate that was the same as the general population in the
Netherlands.

9 of the 28 cases of invasive ovarian cancer found in IVF treated women
occurred beyond the initial 15 year observation period when the authors
would have expected to find approximately 3. No medical information
about other exposures that these women may have had during those
intervening years was accessible.

Borderline ovarian tumors, a non-lethal ovarian growth that may never
become cancer but may require surgery, were seen more frequently in
women who underwent IVF compared to Non-IVF subfertile women.

There are many risk factors for ovarian cancer and non-lethal borderline
ovarian tumors independent of treatment including infertility itself,
use of exogenous hormones; lifestyle factors; and family history of
cancer. The current study obtained this critical information by
questionnaire.

A limitation of the study is that while 71% of the subjects who
underwent IVF returned the 23 page questionnaire, less than half (48%)
of those who received lesser treatment responded.

Factors known to decrease the incidence of invasive ovarian cancer
including pregnancy and the use of oral contraceptives, now commonly
used in conjunction with IVF treatment, were not independently assessed.

Alan Penzias, MD

How to Evaluate an IVF Program with 5 Important Questions

Five of the Most Important Questions to Ask

1)  Ask to see the program’s official CDC pregnancy statistics.

The Wyden Bill requires that all IVF programs report their results to the CDC yearly.  While this is a law, it is not enforced by any significant penalty.  Treatment centers that do not report their data know they cannot be audited.  These clinics may be reporting erroneous data.  They may be transferring excessive numbers of embryos to achieve pregnancy.  Transferring excessive numbers of embryos leads to high rates of multiples, resulting in potentially serious morbidity and mortality to the babies and Mom.  Often programs have good fresh IVF transfer rates, but poor results with cryopreserved embryos.  Pregnancies from cryopreserved embryos can add a tremendous amount to a couple’s cumulative chance of having a baby.  Again, ask to see official CDC take home cryo IVF pregnancy rates.

2)  Ask if the clinic has regular office hours on Saturdays and Sundays.

Infertility is time specific.  If the clinic is not operating seven days a week, care, i.e. inseminations, IVF retrievals and transfers are often being compromised.

3)  Ask if the embryology lab is headed up by an embryologist certified as a highly complex lab director (HCLD).

This certification is given to embryologists who have obtained an advanced degree of training and equipment knowledge and have passed a rigorous certification exam.  Ask if the center has a secured facility for storage of your cryopreserved sperm, eggs, or embryos.  Ask how often liquid nitrogen tanks are filled and checked.  There should be documentation of these checks.  Ask if the program has a back up alarm system.

4)  Ask about cost for IVF.

Typically IVF costs range anywhere from $10,000 to $18,000 inclusive of medications.  Ask if there are additional charges for intracytoplasmic sperm injection (ICSI), typical cost $500 to $1000.  For assisted hatching, typically $500 to $1500, and whether cryopreservation, typically $500 to $1500, is included in the cost estimate.  Costs to do a subsequent cryo IVF transfer cycle range from $1000 to $3000.

5)  Ask if the physicians at the clinic are board certified or board eligible in Reproductive Endocrinology/Infertility.

Reproductive Endocrinology/Infertility subspecialists are OB/GYNs who have gone on to do two or three more years of subspecialty training in Reproductive Medicine.  To maintain board certification subspecialists must continue to keep up with important medical advances and take a re-certification exam yearly.

Answers to these five questions will go a long way in directing you to one of the better IVF programs in your area.  Do your homework – chances are your referring physician has no knowledge of these five issues.

Biological Clock

A female has the maximum number of eggs she will ever have as a fetus in utero at 20 weeks gestation, approximately 20 million.  During the last 20 weeks of in utero development, over 90% of the eggs will be lost, forming scars in the ovary.  At the time of birth, there are about a million eggs.  At puberty, when the brain-ovarian axis matures and ovulation begins, a few hundred thousand eggs remain.  The process of egg loss is known as atresia, and will continue until the last egg is released – menopause.

Each month when the menstrual cycle begins, a number of eggs start to develop – this group of eggs can vary in size from one to as many as thirty or forty eggs, depending on the number of eggs an individual is born with and her age.  With each reproductive cycle the entire group of eggs starts to develop; one egg out of this group develops to maturity and is released, i.e. ovulates, but the entire cohort of eggs is lost.  On rare occasions, more than one egg may ovulate, bringing about the opportunity for a multiple pregnancy.  This process of egg loss continues until menopause.  Typically, five to six years before menopause, cycles will become increasingly irregular as the quality of eggs that are released are often poor and may not produce enough estrogen to trigger ovulation.

Some individuals are born with much lower numbers of eggs.  These individuals are at risk for premature menopause – sometimes this occurs as early as the teenage years.  It is unknown why some women are born with fewer eggs, but likely is a function of genetics, i.e. menopause is often closely timed to maternal menopause.  The time of menopause can be influenced by a number of environmental factors, including surgeries, radiation, chemotherapy and smoking.  Starting your period early does not accelerate menopause.  Likewise, being on birth control pills, which prevents ovulation, does not delay menopause.  Again, there is a programmed loss of eggs each month.

Am I at risk for premature menopause?

It is important to identify those individuals that may be at risk for early menopause, not only for fertility concerns, but also for potential hormone replacement needs.  There are three primary means to guesstimate ovarian, i.e. egg, reserve:

Age

Age can be looked at as a rather crude guesstimate of remaining ovarian reserve, as some individuals are born with much greater numbers of eggs than others.  Certainly it is true that on average a 20-year-old is going to have far greater ovarian reserve than a 30-year-old, who would be expected to have far greater ovarian reserve than a 40-year-old.

Again, because of differences in the number of eggs someone is born with and potentially harmful environmental factors, there can be considerable variability in ovarian reserve at any age.  More accurate assessments of ovarian reserve include:

Hormonal Tests

Day 3 FSH/estradiol levels

Inhibin levels

Clomiphene citrate challenge tests

Antimullerian hormone

Ultrasound Assessment of Ovary

Counting the  number of egg/follicle units in the ovary, “antral follicle count” early in the cycle, typically days 2-4.

Combining different ovarian reserve tests is likely to give a more accurate assessment of ovarian reserve. Ovarian reserve can decrease abruptly in some individuals, likely representing an accelerated period of atresia, much like what happens in the second half of intrauterine development.  This is relatively common and can be seen in patients whose mother had an early menopause or who have been exposed to chemotherapeutic drugs, radiation, or destructive ovarian surgeries.  For others there are no obvious causes.  If an individual is at increased risk for accelerated egg loss, it is important to do regular ovarian reserve testing, especially if future fertility is a concern.

Fertility Preservation Options

Oocyte Cryopreservation

Oocyte cryopreservation is a relatively new, exciting technology for those individuals who do not have a male partner or who are uncertain as to whether they will stay with their current partner.  Worldwide, there are approximately 1500 babies born from frozen eggs.  Because of the limited number of babies born and relatively short follow up on these children, this technology should still be considered research and therefore should be carried out under an IRB (Institutional Review Board) protocol.  The institutional review board serves to review results from oocyte cryopreservation both in terms of efficacy and safety.  There are many programs throughout the country advertising egg freezing.  Many of these programs have had little or no success.  It is, therefore, important to ask some key questions when trying to identify a competent institution.  Namely, the number of babies that have been born from that particular embryology lab, not an affiliated lab or program.  Ask the number of eggs that were frozen to achieve these pregnancies, thereby getting an idea of efficacy.  The number of eggs available to an individual less than age 35 years of age or younger, on average, will vary typically between 8 and 16 each month.  For those individuals 36 and above, the cohort size is likely to be reduced, averaging between 5 and 12.  Ovarian reserve testing, again, will give a better estimate of individual egg number.  Depending on the efficiency of the program and an individual’s ovarian reserve, more than one stimulation cycle may be necessary to have a realistic chance for pregnancy.  Programs involved with oocyte cryopreservation should maintain a registry as to any birth defects or any development problems.

Florida Institute for Reproductive Medicine has been involved with oocyte cryopreservation since 1998.  To date, we have had 63 babies born from frozen eggs.  On average, we have required ten mature eggs to produce a healthy ongoing pregnancy in mothers 35 years or less.  For individuals 36-38, we are requiring on average fourteen mature eggs.  We do not offer oocyte cryopreservation for individuals over the age of 38, as the great majority of these individuals will have low ovarian reserve and a very high percentage of poor quality eggs, i.e. they are unlikely to benefit from cryopreservation.

Pre-embryo or embryo fertility preservation

This is an appropriate option for those individuals who are in a stable relationship.  In general, if there is any concern about potentially discarding an embryo, the option of cryopreserving pre-embryos should be considered.  Freezing a pre-embryo is, in essence, freezing male and female nuclear material that are close to each other but have not combined to form an individual.  Pre-embryo and embryo cryopreservation have been available since the mid-1980’s.  There have been hundreds of thousands of babies born from both pre-embryos and embryos.  There is a large body of reassuring health data, on babies born from (pre)embryos.  Fertility rates with (pre)embryos vary tremendously depending on the reproductive medicine program.  Each advanced reproductive medicine program in the United States is required by law to report their data to the CDC; therefore, before considering an individual program, check with the CDC registry (www.cdc.gov/ART/ART2011) on the program’s cryo IVF data.

Costs for oocyte cryopreservation as well as (pre)embryo cryopreservation should mimic those of a typical IVF cycle; the steps are basically the same.  Ongoing storage costs will typically vary from $100 – $400 per year.

Video- How Much Does Infertility Treatment Cost?


In this video, Dr. Michael L. Freeman from the Florida Institute for Reproductive Medicine addresses the cost of infertility treatment.

FIRM Costs for IVF can be found here.


Before proceeding with infertility treatment, in particular with IVF, ask for all the costs to be given up front. We will provide you with a written statement of all associated costs, including fees such as anesthesia or cryopreservation, before treatment so that there are no hidden fees.

Video- The Infertility Evaluation

Video- When is it time for infertility treatment?


In this video Dr. Michael L. Freeman from the Florida Institute for Reproductive Medicine discusses when it is appropriate to investigate and treat infertility.

Endometriosis Awareness Video

In connection with Endometriosis Awareness Week (7-13 March), the World Endometriosis Society (WES) launched a video to help women across the globe recognise symptoms of this painful and debilitating disease before their long-term health and quality of life are affected.

Endometriosis from Endometriosis.org on Vimeo.

One in 10 women of reproductive age worldwide are thought to have endometriosis, which is characterised by chronic pain: menstrual, pelvic, mid-cycle, during sex, during urination or bowel movements.
Significant effects

Lone Hummelshoj, secretary general of WES and well-known international campaigner for women with endometriosis, said:

    “We have created this video to help educate women about what is normal, and what isn’t when it comes to pain and help them to recognise the symptoms of endometriosis in order to seek treatment early, before their long-term health is affected.

Endometriosis indiscriminately affects women during the prime years of their lives. The pain associated with endometriosis significantly affects these women’s ability to finish an education, build a career, maintain a relationship, have a sex life and, for many, compromises their fertility.

Unfortunately, we still see that when a woman seeks professional help, low awareness and a long, unclear referral process means she will typically wait years for a diagnosis and proper treatment. This has to change. Endometriosis is not a life-style disease – there is no prevention, but it can be treated.”

Don’t take no for an answer

Diana Wallis MEP, Vice President of the European Parliament, is a sufferer herself and campaigns for increased awareness of endometriosis. Before her diagnosis, Diana struggled against the dismissive attitude towards her symptoms:

    “Over a period of 10 years, I was told ‘you’re working too hard as a professional woman –take it easy.’”

As a newly-wed Diana underwent a full hysterectomy, an operation that could have been avoided with earlier diagnosis and treatment of her endometriosis. She now calls for all young women who recognise symptoms described in the video to take action:

    “Don’t be like me. Don’t take no for an answer. If you feel something is wrong, you could have endometriosis. There are things that can be done to help you. Go and get advice, but also make others aware, because I don’t want you to end up like me”, said Wallis.

What is normal?

The video explains the prevalence, symptoms and treatments of the disease. WES President and Professor of Gynaecology at Maastricht University, Hans Evers, said:

    “It’s difficult to say what is normal and what is not normal, but as a general rule women know what is too much pain. There is a difference between menstrual discomfort, and pain that prevents you from going about your daily life.”

Professor Evers appealed directly to young women, and asks them:

“Endometriosis is a serious, chronic disease that requires treatment. I would like to invite women to take the initiative and see their doctor to have endometriosis diagnosed.”

Pregnant Women: Eating Well Means Eating Wisely

Taken from an article printed in Ob/Gyn News by Dr. E. ALBERT REECE, M.D., PH.D., M.B.A.
DR. REECE, who specializes in maternal-fetal medicine, is vice president for medical affairs at the University of Maryland, Baltimore, as well as the John Z. and Akiko K. Bowers Distinguished Professor and dean of its school of medicine. He said he had no relevant financial disclosures.

To help women control weight gain during pregnancy, I try to be both pragmatic and practical.

The latest Institute of Medicine guidelines on weight gain during pregnancy issued in 2009 recommend that women with a body mass index of 18.5-24.9 kg/m2, should gain between 25 and 35 pounds during pregnancy. Those who are underweight (with a BMI of less than 18.5 at the time they conceive) should gain more, between 28 and 40 pounds. However, for women who are already overweight at the beginning of pregnancy (with a BMI of 25–29.9), the weight gain recommendation is between 15 and 25 pounds.

Although I typically recommend that pregnant women gain somewhere in the 20-pound range, many women find gaining so little quite a challenge. This is natural. After all, pregnancy is a time when most women are hungrier than usual and want to eat more often than usual. These new mothers also hear all kinds of “good” advice from their friends and other women in their family such as “You’re eating for two now,” and “You’re growing a baby; this is no time to start on a diet.” It can be very hard for a woman’s physician to counteract such messages from family and friends.

The truth is, the baby is probably going to weigh around 7 pounds or so. Therefore, if a woman is gaining 30 or 40 pounds, such a gain in weight is way in excess of the weight of the baby, the placenta, and all the extra fluid combined. Gaining that much weight makes it that much harder to lose after giving birth.

The group that usually gets the most attention with regard to weight gain is the group of women with diabetes or gestational diabetes. They usually get nutritional counseling, assistance in choosing an appropriate diet, and information about glucose control. The American Diabetes Association recommends that women with gestational diabetes – and women who are just gaining more weight than you’d like – restrict carbohydrate intake to 30%–40% of their daily intake. By doing this they will at least slow the trajectory of weight gain. For those women who are diabetic, restricting carbohydrate intake also will allow them to see a lowering of their blood glucose.

Every pregnant woman needs to eat well. What they may not recognize, however, is that eating well doesn’t mean eating more – it means eating wisely. Furthermore, most women come into pregnancy without healthy eating habits. These habits are already part of their nature, so the best we can do is to try to moderate them.

On the other hand, pregnancy is a very good time to try to improve a woman’s eating habits. Indeed, there are very few other times in a woman’s life when she will be so motivated to change her health habits as when she’s pregnant. Even smokers will quit then – although they may start back up after the baby is born. But during pregnancy, not only the mother, but the entire family is invested in bringing this child into the world as healthy as possible.

When it comes to this issue, I try to be practical. You can’t expect people to change their entire lifestyle immediately. Also, I try to take a pragmatic approach that focuses on changing a few things at a time.

Food

Instead of telling women to “eliminate, eliminate, eliminate,” I encourage them to be thinking all the time about what they do eat. Decreasing carbohydrates in line with the national recommendations of no more than one-third of the daily calories is a good idea for everyone. Protein, on the other hand, is food the body can’t store. So I advise women to increase their protein intake because it has a filling effect and lowers carbohydrate intake as well.

At the same time, they can significantly increase their intake of vegetables and fruits, including salads, while watching the salad dressing. Pregnancy is also a time of slower gastrointestinal motility and constipation. Eating more vegetables – in particular raw vegetables – can cut down on intestinal transit time and help with constipation.

Liquids

Water is the best drink for a pregnant woman. They may tell you they’re consuming a lot of fruit juice. However, most of these juice drinks are full of carbohydrates in the form of sugar. Even though “naturally” unsweetened juices are a better choice, they still have a lot of calories and carbohydrates in them.

As for soft drinks – the more pregnant women avoid them, the better. They are full of sugar and are really unhealthy for anyone, especially women with diabetes.

Again, if you only counsel women to “eliminate, eliminate, eliminate,” they probably won’t do it. My pragmatic approach is to have women limit, instead of eliminate. So I say, “Try to drink more water, less soda, and unsweetened fruit juice only in moderation.”

Exercise

Exercise can be beneficial for anyone, and any woman who has been in the habit of exercising can continue. But exercise should not be a new sport you take up when you get pregnant. If pregnant women are new to exercise, it’s better to concentrate on the upper body rather than the lower, because these women don’t have an exercise-related established physiology of improved blood flow. Intense lower body exercise for these women can compromise blood flow to the fetus.

I would say that the average woman with moderate exercise habits can continue to exercise for a moderate duration at a moderate intensity and without excessive fatigue. As far as when to stop as the pregnancy advances, I use my clinical judgment. As long as the baby is growing well and there are no signs of premature labor, exercise can continue. There really is no a priori time that she must stop.

Women who have exercised vigorously much of their life – athletes and dancers, for instance – can usually continue to do so until the time of delivery. If the pregnancy is showing any signs of not progressing well, however, they should stop exercising immediately. On the other end of the spectrum are women who should not be exercising at all during pregnancy. These are the women who have a history of preterm labor or are showing signs of it, as well as those with some underlying disease.

Women with hypertension or some kind of vessel disease – like severe varicose veins or vasculitis – should not be exercising at all. With vessel disease, as the demands on the heart increase during exercise, blood will be shunted way from the fetus and could truly compromise the flow into the placenta. Sometimes these babies will experience decreased heart rates during exercise.

Some mothers have heard that certain exercises during pregnancy will make for an easier labor and delivery. There may be some truth to this, as women who are exercising before they get pregnant tend to have a lower incidence of large-for-gestational-age infants – and in that regard, they may have less difficult deliveries.

Is Robotic Surgery right for me?

The introduction of the da Vinci robot-assisted surgery for use in gynecologic surgery in the past few years has been of great benefit to many patients. It allows the use of a minimally invasive laparoscopic route to cases that would otherwise require an abdominal approach. In the field or reproductive surgery, this benefit most frequently pertains to the removal of uterine fibroids. In the past, the majority of fibroids could only be removed through laparotomy, or a large open incision. But with the use of robotic surgery, the vast majority of these procedures can be performed laparoscopically. This offers the patient a huge benefit. What usually required a 2-3 day hospital stay and 4-6 week recovery is now an outpatient procedure, with the patient going home the same day, and able to return to work in 7 days. There is significantly less blood loss, and less scar tissue formation around the uterus. Surgical outcomes are equal to those performed through an open procedure. With such great benefit, I strive to not perform on open procedure on patients. Even in very difficult settings, nearly all cases can be performed laparoscopically. The only cases which I consider laparotomy instead of a minimally invasive surgery is in those cases with large numbers of fibroids (more than 10), though even with large numbers, select cases may be robotic candidates. Fibroid size is not a limitation.

Another condition that can benefit from the use of robotic assistance is that of severe endometriosis. Particularly in the setting of pelvic pain, it is essential to remove all of the endometriosis. This can be done by standard laparoscopy, but if other organs such as intestines are involved, most surgeons under-treat the disease due to fear of injuring surrounding critical organs. Few surgeons treat it adequately due to the extended amount of time that such a surgery can take. The use of the da Vinci robotic system allows me to more thoroughly treat the disease, and perform a much more careful dissection around critical organs, and do all of this much faster than can be done by standard laparoscopy.

For women facing a hysterectomy, the use of robotic assistance allows for the performance of much more surgically challenging cases. These involve large fibroids, fibroids in difficult locations, endometriosis, and scar tissue. Well more than 90% of abdominal hysterectomies could and should be performed through a minimally invasive route.

You may ask, if this is of such benefit, why isn’t the procedure being done more often? There are several answers to this question. Many times, with general gynecologists, the patients aren’t truly given informed choices of their options. They are usually given the options that their physician can perform, but less often are they given other viable options. Many gynecologists lack the skills and/or training necessary to perform advanced laparoscopic surgery. Unfortunately, they often fail to consider what is in the best interest of the patient, as that may mean referring that patient to an advanced laparoscopic surgeon. Often, the patient may not know all of her options, or be told by the physician that it is not an option. These are situations in which doing your homework or seeking a second opinion can benefit you.

Is the robot necessary for these more difficult cases? No, as most of these above mentioned surgeries can be accomplished by a skilled laparoscopic surgeon. But with increasing complexity, comes the need for more advanced surgical skills, and longer operative times. To a skilled surgeon, the robot does expand what can be “easily” be done laparoscopically, which allows for a faster surgery, improving patient recovery.

If you might be facing a difficult surgery, and question whether the use of robotic assistance may benefit you, please call to arrange a meeting or phone consultation with Dr. Duffy

friends of F.I.R.M.

As a patient with PCOS, the dream of having a child may sometimes seem out of reach.  But with the help of Dr. Winslow and staff, that dream often becomes a reality. With the care, support and guidance given to me by all of those who helped me along this emotional journey, I am able […]

Read Full Testimonial »

Skip to content