Friday, October 29, 2010

Fertility Issues – Giving You Hope to Overcome

Even though there are still mysteries about conception, there is a 95% chance you will conceive

By Rami Kaldas, MD

When I was doing my studies in gynecology and infertility in Palo Alto, California, there was a lab that was researching the biology of reproduction of the human cell. It was an illustrious group of scientists from Stanford. They were studying the fluid inside of unfertilized eggs. It was fascinating what they were discovering, but even more fascinating was what they didn’t discover and what they still do not understand – why it is when the sperm enters an egg and fertilization happens, the symphony of activity that ultimately develops into a baby occurs. 

In the meantime, it has been discovered that about 4 out of 5 conceptions end up not progressing, that there is something not quite right about either the egg or the sperm or them getting together.  It is, on a very microscopic scale, the workings as complicated as the biggest city in the world or more. It is a humbling thought. Nonetheless, humans have not gone extinct.

The point is, while the infinite number of details that go into making a human baby are mostly not understood, there are things that we do understand. Most of the time if a couple is unable to have a baby, we can figure out why and do something about it. 

That is why I tell my patients with confidence when I see them that there is a 95% chance, knowing nothing about them, that they will have whatever children they want to have. It is a matter of simply, what is it going to take? 

• After trying for about a year, 85% of couples are pregnant. 
• After two years, that goes up to 93%. 

That means that between the first and second year of trying, a complete half of the people who didn’t succeed the first year end up succeeding during the second year. In any given month, however, when someone times it just right, there is only about a 15-20% chance of achieving a pregnancy. After a year of trying, the chance of success in any given month goes down to about 4% and then after two years about 1%.
That is why, after a year of trying, it is reasonable to come see a fertility specialist at Women’s Care of Wisconsin. 

• Half the time it has something to do with what is going on with the woman
• About 40% of the time it has something to do with what’s going on with the man
• 10-20% of the time, it is a combination of both.

The American Society for Reproductive Medicine (ASRM), also known as the American Fertility Society (AFS), sets out basic guidelines. For most people, it is pretty straightforward, figuring out why they are not getting pregnant. Steps you can take include:

• A simple semen analysis
• A tubal dye study to make sure the fallopian tubes are open 
• Lab tests
• An ultrasound

Most of the time a combination of the above will yield an answer – but not all the time. That doesn’t mean that there is no hope certainly. Even when we can’t find anything wrong, treating with some tried and proven fertility drugs that have been around for decades will succeed for most people.

Frequently, a drug called Clomid is utilized to help a woman to ovulate better so she can become pregnant. Clomid has been around since the late 50’s. It was developed at the University of California as a contraceptive pill. Imagine the surprise they had when the people who were testing it were all getting pregnant instead of not getting pregnant! 

The way Clomid works is that it binds estrogen receptors in the body and it fools the part of the brain that makes the hormone that stimulates the ovaries to make eggs into thinking that there is a low estrogen environment, or, in other words, that eggs are not being made. Therefore, the female brain, being the very smart entity that it is, makes more of that follicle-stimulating hormone that makes more eggs be produced and mature. However, since more eggs are made, you might end up with more than one baby…Clomid does cause a higher rate of multiple gestation, usually twins or triplets.

After several cycles of Clomid, which should not exceed six cycles because it is unlikely to work after that if it hasn’t yet, there are other stronger drugs that actually are the same thing that the female brain makes to make the eggs happen and mature in the ovaries. Those are given by injection through a very tiny needle that goes right under the skin. Those drugs, being more powerful and more direct, end up yielding twins or triplets or more about 25% of the time and are used usually in conjunction with intrauterine (artificial) insemination, or when the male partner agrees to donate a specimen for the sake of procreation and his progeny. We put the A+ scholars high up into the uterus, shortening the journey for the sperm. It isn’t always a slam dunk with an intrauterine insemination, but it typically does better than just medicine alone.

After a few months, if that doesn’t work, then it is reasonable to consider in vitro fertilization, where the egg is withdrawn from the ovary and put with the sperm in the lab. That involves a little more cost, inconvenience and discomfort, but if nothing else has worked it will usually achieve its goal.

That, in a nutshell, is Fertility 101. Most of the time, your hard work will pay off. Please remember that 85% of the time in the first year, your hard work at home will pay off with never seeing the doctor. But when you are facing infertility issues, realize that there are many options for you, and we are here to talk you through the options and help you achieve your family goals. 

Join me at a talk I’m giving for women who are trying to get pregnant for the first time and are struggling with fertility issues, Wishing Upon a Baby, on November 2nd at 6:30pm, at the Bariatric Conference Room in Theda Clark Medical Center in Neenah. Hope to see you there!

Dr. Rami Kaldas is an Obstetrician/Gynecologist at the Neenah and New London locations of Women’s Care of Wisconsin. Contact Dr. Kaldas at 920-729-7105 or meet him here.

About Women’s Care of Wisconsin 
The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at

Wednesday, October 27, 2010

Incontinence: More Common Than You Think

Did you know that 40% of women have incontinence at some point in their life? Here’s what you can do to take control.

By Eric Eberts, MD

Incontinence is the loss of urine in an uncontrollable fashion. There are many reasons as to why people have it. Some of them are very easy to treat successfully and are easily cured, and some of them are very challenging to cure. But we can usually get significant improvement with treatment. Incontinence is one of my favorite conditions to see a new patient with; I can often cure them outright and almost always make a big improvement for them with fairly little intervention.

Most people put up with it and hope that it’s going to get better, or put if off until tomorrow, only to realize that several years have passed and it’s only gotten worse.

In generations past, people have looked at the loss of urine as a normal part of aging or normal consequences of childbearing, both of which I think are mistakes. What I would encourage people to think about is the fact that although incontinence is not painful, it’s not normal. People really don’t like to deal with it because it’s embarrassing. But they should realize, it’s very common, and often very easy to treat.

However, correctly treating incontinence means also that you have an understanding of what the true diagnosis is, very much like a headache. There are many different causes for it and the headache itself is usually a symptom of an underlying abnormality of some type, just as incontinence can be caused by many different things. 

Relief for women dealing with bladder control issues typically takes one of three routes:
• It can be as simple as a 10-minute outpatient procedure or a prescription for  medication.
• It may require a combination of therapies to get someone to a much better function.
• Sometimes we need to treat an underlying, undiagnosed urinary tract infection, which should be evaluated further, as it could possibly be a sign of other diseases such as MS or diabetes. 

There are varying levels of incontinence, all of which can be diagnosed and treated to help you return to a normal, active lifestyle.

Spasm and bladder irritability:
  • Conditions where a person is urinating frequently and up a lot at night with a sudden 
  sense of urgency (similar to the television commercials you see)
  • Tends to be a neurologic, irritational aspect to the bladder
  • There are a handful of different medications that are typically used to treat this
Stress incontinence:
• People leak a small amount of predictable urine every time they cough, sneeze, lift or 
 • Will not get better with time
 • Often times this can be treated effectively with proper Kegel exercises, but a lot of times that treatment requires ongoing and continuous exercise by the person, and sometimes even then it won’t hold up over time
• Should that fail, we can proceed with a small, 15-minute, outpatient procedure that is very successful such as some type of sling procedure, which in the past was a very big surgery and nowadays really can be done quickly with a very fast return to full function status

For more challenging cases, treatment options are available and include:
  • Physical therapy and E-Stim or other pelvic floor strengthening
  • Relaxation techniques that need to be taught correctly and practiced by the patient
  • Periurethral bulking, which is an injection in the bladder neck to help strengthen the 
   closure ability of the bladder or injections into the bladder wall that keep the muscles  
   from contracting involuntarily and spasming, thus making the bladder leak when the
  patient doesn’t want to

When incontinence affects how you function, what you’re doing, your clothing choices or travel plans, it’s just a shame not to get an evaluation and treatment—because so often, it is actually fairly easy to fix with many different treatment modalities. 

Suffice it to say, there are many treatments for many different causes in the many unique types of patients out there. But I would encourage readers to not for a minute think that this is a normal part of aging and something they simply have to “put up with.”  I would encourage them to seek medical evaluation and intervention, because if you’re thinking about the fact that you’re leaking urine, then it is probably affecting you on a daily basis.

Join me at a talk I’m giving tonight, Fixing the Leak, at 6:30 in the Ironwood Conference Room at Appleton Medical Center. Hope to see you there!

Dr. Eric Eberts is an Obstetrician/Gynecologist at the Appleton and Oshkosh locations of Women’s Care of Wisconsin. Contact Dr. Eberts at 920-729-7105 or meet him here.

About Women’s Care of Wisconsin
The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at

Wednesday, October 20, 2010

Out in the Community: Women’s Care of Wisconsin Employees Giving Back

Women’s Care employees’ dedication to caring extends to entire community

By Katie Sharratt, Marketing Coordinator and Employee Committee Member

At Women’s Care of Wisconsin, we feel it is very important to support our community. Through our Women’s Care Employee Committee, we have been able to support many worthy causes that help women and their families. We’d like to highlight some of the organizations we’re involved with on this blog, and encourage you to join us in supporting them as well.

Heart Walk
Did you know the number one killer of women is heart disease? This year’s Heart Walk, benefitting the American Heart Association, was held on Saturday, Oct. 2 at Fox Valley Technical College in Appleton. Despite a very brisk and chilly morning, Women’s Care had a great team of employees who came out to support a fellow coworker, who happens to be a five-year survivor of Sudden Death Cardiac Arrest.

Save 2nd Base
As part of Breast Cancer Awareness Month, The Bar held a fundraising walk on Oct. 2 at multiple locations across the Fox Valley. The turnout was phenomenal and we were proud to be part of this event to raise money to fund breast cancer research and help save 2nd base!

Women’s Care Cookbook for Causes
Women’s Care employees have been busy this summer putting together their favorite recipes into a cookbook containing 290 recipes. If you are a devoted cook/baker or are looking for the perfect Christmas gift, please consider purchasing a Women’s Care Cookbook. All cookbooks are $10; proceeds will be donated to the various local charities we contribute to throughout the year. Cookbooks are on sale in our Appleton and Neenah offices or by e-mailing us at

About the Women’s Care Employee Committee
Founded in 2009, the Women’s Care Employee Committee strives to make community a major focus of its employees’ passions by participating in and donating to charities, fundraisers and sponsorships throughout the Fox Cities and surrounding areas.

Meet our providers and learn more about women’s health, gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at

Tuesday, October 12, 2010

Five Things You Need to Know to Ensure a Healthy Pregnancy

The most important things you need to do to make sure you and your baby are healthy and happy

By Kristin Clark, MD

Patients frequently ask me “What can I do to ensure a healthy pregnancy and baby?” While there are multiple precautions one should take while pregnant, I will discuss five of the most important topics below. As always, if you have specific questions or concerns, it’s best to address these with your doctor. Keeping open lines of communication will be key to a healthy pregnancy and a healthy baby.

1. Get Prenatal Care.
This may seem basic, but getting regular, prenatal care is going to be the best way to detect any potential problems with your pregnancy or with your baby.

Prenatal care will allow you and your doctor to:
• Assess your vital signs including blood pressure and evaluate for any signs of toxemia or preeclampsia

• Measure your baby on a regular basis to assess whether he or she is growing too fast or too slow

• Discuss medications, answer specific questions or concerns about labor and delivery, and develop a birth plan

There are many “right ways” to have a baby, and ultimately your doctor wants you to have the safest experience possible for both you and your child.

2. Avoid Alcohol and Tobacco.

Patients frequently ask me if it is okay to have a glass of wine now and then. Whenever advising patients on the safety of certain substances in pregnancy, I always look to the American College of OB/GYN (ACOG) for recommendations. This governing body is the gold standard for recommendations on care during pregnancy.

• ACOG states that no amount of alcohol is considered safe while you are pregnant. While I have had patients who have had a glass of wine now and then and it has not been harmful, I cannot advise them that it is a safe practice, and therefore I tell my patients not to drink alcohol while they are pregnant.

• Further, tobacco use can be very detrimental to both you and your baby. There are over 100 different toxins in tobacco smoke, and most of these toxins will pass the placenta. This can put your child at risk for oxygen deprivation, growth restriction and possible long-term issues with asthma. It can also lead to pre-term birth, which in and of itself has many potential long-term consequences.

So bottom line, don’t drink or smoke while you are pregnant.

3. Make Sure You Are Up to Date on All Vaccines.

Pregnant women are often hesitant to take a medication or get a vaccine if it is not absolutely necessary for fear of harming the baby. I try to reassure my patients that vaccines, especially the flu vaccine, are of vital importance while you are pregnant because:

• Your immune system does not function like normal when you are pregnant, therefore you are more susceptible to infections.

• If you get an infection while pregnant, it is usually more severe and can last longer. This is especially true for influenza and H1N1 flu.

The CDC has confirmed that the flu vaccine (both containing thimerosal and the mercury flu vaccine) is safe for pregnant women to receive at any point in their pregnancy. It is also recommended for anyone who is going to be caring for an infant or around an infant less than 6 months of age. Therefore, I tell all my patients that they should get the flu vaccine while they are pregnant and if they are going to have a child during flu season, all of their family members should be vaccinated as well. 

Other vaccines that are not as routine are tetanus boosters (especially with any kind of puncture injury) if one has not been given in the last 5 years, pertussis vaccine following delivery (this should NOT be administered during pregnancy) in order to help prevent transmission of whooping cough to your newborn, and the rubella vaccine if you are not already immune (also given postpartum).

4. Make Sure You Are Taking a Prenatal Vitamin and Folic Acid. 

Some of my patients do have difficulty tolerating prenatal vitamins, especially in the first trimester, but I try to encourage at least a multivitamin supplement with at least 400 mcg of folic acid. In actuality, 800 mcg of folic acid is better in that it does definitely help prevent neural tube defects.

If possible, a prenatal vitamin with folic acid supplement should be started at least 1 month before trying to become pregnant in order to build up certain vitamins and minerals in your body before conception. For example, the fetal neural tube or spine forms completely by 6 weeks gestation. Some patients do not even know that they are pregnant at this time, and could have a developmental problem before they even get a positive pregnancy test.

Taking a prenatal vitamin and folic acid supplement will also help prevent anemia, a common complication in pregnancy.

5. Eat Healthy and Exercise. 
Of course, pregnant women are entitled to dessert! That being said, try to avoid the mantra “I’m eating for two.” You really only need to add an extra 300 calories in your diet per day in order to ensure that you are getting enough calories to your developing baby.  

Try to eat a healthy diet balanced with whole grains, lean protein, fruits and vegetables. In the first trimester this can be difficult, especially if you are nauseated. I usually tell my patients not to worry too much about eating healthy in the first trimester if you are feeling sick; just eat what stays down and what tastes good. Once the nausea resolves, you can focus more on a balanced diet.

Also, I do encourage exercise in pregnancy in that it will increase endorphins, minimize nausea and make physical discomfort such as back pain less prominent. In general, you should not start a new type of exercise while you are pregnant, but you may continue to exercise and perform activities that you normally do in moderation.

I usually tell patients that they should not exercise beyond a level where they could have a conversation with someone and become breathless. I also tell them to try and keep their sustained heart rate less than 150.  It is okay to let a heart rate spike above 150 during exercise with interval work, but again, moderation is key with any type of activity while you are pregnant.

Above all, enjoy this time – this is one of the most exciting, wondrous, and fulfilling times of your life! Please make sure you are focusing on taking good care of yourself and getting the best care possible for a healthy pregnancy.

Dr. Kristin Clark is an Obstetrician/Gynecologist at the Neenah location of Women’s Care of Wisconsin, 200 Theda Clark Medical Plaza, Suite 130, Neenah, WI 54956. Contact Dr. Clark at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin
The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at our website by clicking here.

Monday, October 4, 2010

Obesity: A Concern for Fertility and Pregnancy

Talk to your provider about how exercise can help ensure healthy conception and pregnancy
By Michelle Landsverk, DPT

It’s October. Families are enjoying apple picking in the crisp, fresh fall air. Fall TV is going full speed ahead. Friday night lights bring cheers and football wins. The leaves are changing. It’s Healthy Babies Month and National Breast Cancer Awareness Month. And, did you know?  It’s National Physical Therapy Month.
This year physical therapists and physical therapist assistants are educating the general public on the dangers of obesity. The statistics on rising obesity rates, especially among children, are staggering.  Various health conditions arise directly as a result of obesity, namely:
            • Type II diabetes
            • Cardiovascular disease
            • Osteoarthritis
            • Many forms of cancer
            • The list goes on and on…
Why does this matter to us at Women’s Care of Wisconsin/PT Center for Women? Two critical reasons:
            1) infertility rates rise with obesity
            2) pregnancy is generally riskier in the overweight population
Early last month, a new Johns Hopkins Children’s Center study found a missing link from obesity to infertility, clarifying the relationship between being overweight and the inability to conceive.
Earlier in 2010, lead researchers at the Harvard School of Public Health conducted a study designed to look at the relationship between exercise both before and during pregnancy, and the onset of Gestational Diabetes Mellitus. The rationale behind the study was the fact that obesity and inactivity are related, and that obesity is a major risk factor for gestational diabetes. 

The results of this study are certainly encouraging. A positive relationship has been established between exercise both pre-pregnancy and during early pregnancy with a significantly lower risk of developing gestational diabetes, and thus hopefully breaking the cycle between gestational diabetes, childhood obesity, adult obesity and type II diabetes.

Both of these important recent studies confirm the importance of incorporating exercise into your daily routine and maintaining a healthy weight. Your provider can help advise you on the most appropriate diet and exercise regime to help you achieve a healthy conception and pregnancy.
>>Read more about the Johns Hopkins Children’s Center research linking obesity and infertility here

>>Read more about the Harvard School of Public Health’s research indicating obesity as a risk factor for gestational diabetes here

Michelle Landsverk is a Doctor of Physical Therapy at Women’s Care of Wisconsin/PT Center for Women, 3913 W Prospect Ave, Suite LL2, Appleton, WI 54914. Contact Michelle at 920-729-2982 or e-mail here.

About the PT Center for Women  At PT Center for Women, our focus is on helping women incorporate lifestyle changes that will improve the quality of their lives. This includes gentle therapeutic exercise to both improve and maintain muscle tone, to rehabilitative exercise designed to get you back to your previous level of function and activities. From managing crippling abdominal and pelvic pain, to teaching proper sleeping postures and body mechanics at home and at work, we’re here for women. Visit our web site here.