What You Need to Know About Subfertility

Deciding you are ready to add to your family—whether it is your first baby or maybe baby number two—is a big step for any couple. Then, your well-meaning friends and family tell you to “just relax and it will happen.” Unfortunately, now it has been a year of trying and it still hasn’t happened. It may feel like everyone else around you is getting their positive pregnancy tests, which can be a very devastating and isolating time for any couple.

First, let’s define subfertility: in a woman less than 35 years old, it is defined as failure to conceive after 12 months of regular intercourse. In a woman over 35, it is defined as failure to conceive after 6 months of regular intercourse. 15-20% of couples find out they are pregnant each month after regularly trying to conceive, and 80-85% of couples become pregnant after a year of trying. That leaves about one in five couples headed to their doctor for an evaluation of subfertility.

About 20% of subfertility is due to a problem with ovulation. A woman is likely ovulating if she gets regular periods. Other signs of ovulation are breast tenderness prior to a period, +LH surge, and a temperature spike on basal body temperature charting. If ovulation issues arise, medications can be given to help women ovulate. As we get older, our egg quality and quantity decline—there are blood tests that can determine egg quality and quantity.

Fallopian tubal damage accounts for about 15% of subfertility. Tubal damage can be caused by endometriosis, prior sexually transmitted infections, or pelvic adhesions. The fallopian tubes can be evaluated via different procedures. Male factor accounts for another 25% of subfertility. A semen analysis should be performed early in the evaluation of a subfertile couple.

Next, endometriosis and cervical factor each account for 6 % of subfertility. Some clues that a woman could have endometriosis are painful periods, pain days prior to a period, and pain with intercourse.

Finally, about 28% of couples are given the diagnosis of unexplained subfertility. This diagnosis is given after a thorough evaluation has been performed, but no cause has been found.

No matter the cause of a couple’s subfertility, there are treatment options that the fertility specialists at Women’s Care of Wisconsin can help with. Sometimes, a couple will get a positive pregnancy test with some education about timing of conception, medications to help a woman ovulate, or intrauterine insemination. Sometimes a couple needs a more specialized treatment plan with a fertility specialist (Reproductive Endocrinologist). No matter what your journey is to conceive a baby, Women’s Care of Wisconsin will be there every step of the way.

The physicians 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.

Meet our providers and learn more about infertility, gynecology, pregnancy care, midwifery services, procedures and surgery, incontinence, osteoporosis, menopause management and more at www.womenscareofwi.com. Or call or text us at 920.729.7105.

November is Prematurity Awareness Month

Pregnancy is one of the most exciting and vulnerable times of a woman's life. Most of us have thought about pregnancy and how our pregnancy would go long before we were actually pregnant. Most of the time, everything goes just right. However, almost one in ten women deliver preterm (defined as less than 37 weeks). These babies miss out on the important growth and development that happens in the final weeks. Preterm birth is a leading cause of infant mortality. Babies who survive can have health problems, both short- and long-term.

Some of the signs and symptoms of a preterm labor are:

• Contractions (the abdomen tightens like a fist) every 10 minutes or more often
• Pelvic pressure – the feeling that the baby is pushing down
• Low, dull backache
• Cramps that feel like a menstrual period
• Abdominal cramps with or without diarrhea

It is important to notify your doctor if you think you are experiencing preterm labor.

While we don’t understand all the reasons some babies are born too soon, we do know that some factors increase the risk of preterm birth: young or advanced age of the mother, cigarette or substance abuse, stress, depression, and carrying more than one baby. Socioeconomic factors also play a role, many of which are more common in African- American communities and threaten the health of pregnant women and their families.

The Centers for Disease Control (CDC) has identified five proven strategies to reduce preterm births:

• Prevent unintended pregnancies and achieve an ideal length of time between pregnancies
• Provide women ages 18–44 years access to health care before and between pregnancies to help manage chronic conditions and modify other risk behaviors
• Identify women at risk for giving birth too early and offer effective treatments to prevent preterm birth
• Discourage deliveries before 39 weeks without a medical need
• When in vitro fertilization is used, elect to transfer just one embryo, as appropriate, to reduce multiple births.

As November is Prematurity Awareness Month, we invite everyone – future parents, pregnant women and everyone supporting them through their pregnancy, healthcare providers, public health professionals, and others – to learn about preterm birth and take action to prevent it.

The providers of Women’s Care of Wisconsin believe having a healthy pregnancy starts before a woman is pregnant. Healthy babies begin with healthy mothers. We promote a well-balanced lifestyle to our patients, which means preconception care, proper nutrition, routine exercise, a healthy, safe environment, as well as a daily prenatal vitamin with folic acid. With good guidance, avoidable conditions that may have everlasting consequences may be prevented. We would love the privilege to take care of you and answer any questions you might have about pregnancy care or preterm deliveries. Call or text us at 920.729.7105 if you have any questions or concerns.

A Visionary Program 100 Years in the Making

 

On October 18, 2022, ThedaCare announced the creation of an Obstetrical Emergency Department (OB-ED) and Hospitalist Program. Through the program, set to begin in 2023, women who are more than 16 weeks pregnant would bypass the emergency department and go directly to an obstetrical triage area located in the Family Birth Center at ThedaCare Regional Medical Center-Neenah. This program will supplement the care of a woman’s OB provider; her doctor will continue to provide care in the facility. The program ensures a highly specialized doctor to be available to evaluate a woman immediately, without waiting for the patient’s doctor to arrive on site, or providing a consultation over-the-phone.  

“The OB-ED and Hospitalist Program can redefine the standard of women’s care in the hospital setting to help continue safe patient care,” said Dr. Eric Eberts, Department Chair of Obstetrics at ThedaCare. “Because a trained physician evaluates every patient, our goal is that expectant mothers can leave the hospital with peace of mind, focusing on the health and well-being of their family.” 

The creation of an OB-ED and Hospitalist Program is an important milestone in ThedaCare’s history. For 113 years, ThedaCare has proudly provided care for the people in Northeast and Central Wisconsin, and that opportunity was made possible more than a century ago when Theda Clark Peters directed a significant portion of her estate to be used to build a hospital in Neenah so that people in the community would have local access to medical care.

Before her sudden passing at age 32 in 1903, just three days after giving birth to her only child, Theda Clark Peters directed a significant portion of her estate to be used to build a hospital in Neenah so that people in the community would have local access to medical care. On October 18, 1909, the sixth birthday for Theda’s daughter, ThedaCare opened its first doors.

“ThedaCare is honored to continue the vision of the Theda Clark Peters and her family by providing care to patients and families, and empowering each person to live their unique, best life,” said Lynn Detterman, Senior Vice President of the ThedaCare South Region. “The creation of the OB-ED and Hospitalist Program can help ensure mothers and babies have the most up-to-date technology, and facilities designed with patients in mind to allow care teams to continue to offer the right care, in the right place.”

Dr. Eberts noted that the program aims to provide support for ThedaCare’s other hospitals, including those in rural communities.

“The OB-ED and hospitalist program can help ensure that expectant mothers continue to receive timely, specialized care for themselves and their babies,” said Dr. Eberts. “We will have providers with the patient, ready to step in to provide care and help improve outcomes and peace of mind.”

Learn more via NBC 26’s exclusive report, which includes Dr. Eberts’ special connection to Theda Clark Peters.

Midwives: A Special Kind of Care

Midwives are best known for their care of women during pregnancy and childbirth, to make that journey as pure and natural as possible. Midwifery care is often described as having a “high touch, low tech” approach to medical care. Midwives are experts in supporting women in normal, healthy childbirth and focus heavily on building relationships with women and their families by listening and providing information, guidance, and counseling in a shared decision-making process.

Midwives are experts in pregnancy and health education, a combination that perfectly matches the needs of most women. They maintain and monitor the health of the woman and baby before, during and beyond pregnancy.

Words from patients can give a sense of perspective to those considering the services of a midwife:

• A midwife was with me for all of my pregnancies. I could call for literally anything and I was never afraid to ask questions, and I had plenty. It was the same feeling that you have with a good friend, where you’re always comfortable.
• My midwife was so knowledgeable and advocated for me in every way possible. She listened to every concern of mine, never interrupted, never took anything for granted.
• I talked to the midwife about my husband a lot, and she got to know him and made the same connection with him as she did me. That was amazing and awesome.

For many women, having the same care provider that they saw during their entire pregnancy with them throughout their labor and delivery is very comforting.

“One of the reasons I became a midwife was because I really enjoyed the relationships and bonds I was able to form with my patients,” said Kay Weina, Certified Nurse Midwife at Women’s Care of Wisconsin. “To care for them throughout their pregnancy, to be there for the delivery, and then to see them for years to come and grow with them, it’s really special.”

What many women do not know is that midwives specialize in the health needs of women throughout life. Midwives listen to your concerns about health and sexuality, perform pap tests and breast exams, provide birth control methods and family planning, as well as a host of other services.

"As midwives, we can essentially provide for women's health across their lifespans,” said Elise Gessler, Certified Nurse Midwife at Women’s Care of Wisconsin. “We don't just do labor and birth. We take care of teenagers with contraception, we do STI testing, we do wellness exams, and we treat menopause."

If you’re interested in seeing Kay (Neenah, Oshkosh) or Elise (Appleton), you can schedule your first appointment by calling or texting 920.729.7105. Learn more about them by clicking here.

The Path to Pregnancy is Not Always Easy

Dealing with fertility problems is hard. About one in six couples are troubled with fertility issues, and it affects both men and women equally.

Simply put, a lot goes into the conception process. There’s the egg, sperm, fallopian tubes, fertilization, the women’s embryo, hormones, and not to mention each of those pieces needing to be in a healthy state. All but one of those parts could function properly and infertility could still be the result. We at Women’s Care of Wisconsin are here for those times. We specialize in the diagnosis and treatment of infertility and will help you navigate this journey to make your dreams come true.

In having a conversation about fertility, here are some common questions regarding the process, treatments, and how we’re here to help.

How long do you wait before speaking with a doctor about possible fertility issues?

Fertility can happen at many points within a lifetime, and infertility issues differ at each of those points as well. A general rule of thumb is if you are over or under the age of 35. Couples under the age of 35 statistically have better chances of conceiving, yet should look into additional options after a year of actively trying (actively trying means you are having intercourse around ovulatory times month by month). Patients over the age of 35 should intervene just after six months.

Can you explain the difference between IUI and IFV?

The big technical difference is where the fertilization of the egg and sperm takes place. During IUI, the doctor inserts the sperm directly into the uterus to fertilize. With IVF, the egg and sperm are manually combined in a laboratory dish and then transferred to the uterus. We can facilitate any IUI treatments by providing medication, tracking cycles, and stimulating the ovulation cycle while collecting and processing the sperm to be placed in the uterus in our own office. If you were to choose the IVF route, we would be the helping hand in that process of referring our best local clinics in the area to take care of you, then assisting once you choose your preferred facility.

When would you recommend IVF to a patient?

We recommend each individual go through the initial testing and treatment options, then work in a conversation about additional options following those. Usually, we would like to start an IVF discussion with a patient after 3-4 rounds of insemination. However, time frames will be individualized to each couple depending on a multitude of personal factors.

So, no matter if you’re just starting to think of the conception process or you are months or years in, Women’s Care of Wisconsin is here to provide education, diagnosis, and treatments, and be with you every step of the way. It’s our goal to make your dreams of having a baby a reality.

To schedule your own personal consultation, call or text 920.729.7105 to set up an appointment with one of our three fertility specialists. Click on their names to learn more about each.

Dr. Allison Brubaker 

Dr. Amanda Reed 

Dr. Sara Swift

Therese Yarroch MD on Endometriosis

Are you doubling over in pain during your period? Do you have cramps you just can’t seem to shake throughout the month? For 1 in 10 women, these killer cramps are a symptom of endometriosis. Although endometriosis affects 190 million women worldwide, many go undiagnosed. Here’s what you need to know about this painful disease and how to find out if endometriosis could be affecting you.

What is Endometriosis?

"Endometrial cells are what make up the lining of the uterine cavity," Dr. Yarroch explains. "In women with endometriosis, these cells are found outside of the uterus where they cause inflammation."

Sometimes referred to as “endometrial implants,” they can be found on the ovaries, fallopian tubes, bladder, bowels and anywhere else in the pelvic region. This inflammation can result in pain and significant scarring to the surrounding tissue.

What Causes Endometriosis?

"We do have evidence that there is an increased risk of endometriosis in women with heavy menstrual bleeding and longer or more frequent menstrual cycles," Dr. Yarroch says.

Doctors also know that estrogen plays a role and women who have a close female relative with endometriosis are 5-7 times more likely to have it themselves.

Spotting the Symptoms

Although it’s a common misconception that endometriosis only occurs in women over the age of 20, the truth is that the disease can develop as soon as a girl gets her first period and can span the rest of a woman’s reproductive years.

"The most common symptom of endometriosis is pelvic pain," Dr. Yarroch says. “While this pain usually coincides with menstruation, some women can experience this symptom throughout their entire cycle.”

Other symptoms to look out for include:

• Pain during or after sex
• Severe cramps that do not go away with NSAIDs or that impede the activities of your everyday life
• A heavy menstrual flow
• Periods that last longer than 7 days
• Nausea or vomiting
• Urinary and bowel disorders
• Difficulty getting pregnant

Not every woman will experience all of these symptoms, but approximately 30%-40% of women who have endometriosis will experience issues with fertility.

Getting a Diagnosis

If you suspect that you may have endometriosis, we encourage you to speak with your doctor or make an appointment with one of the providers at Women’s Care. The only way to know for sure if you have endometriosis is through a surgical procedure called laparoscopy.

Treating the Symptoms

There are a wide range of treatment options for endometriosis and your doctor may suggest a few less invasive methods before ordering a biopsy. At Women’s Care, we work with you to choose a plan that fits your needs and your lifestyle. Some of the most common treatments include:

The use of NSAIDs, such as ibuprofen (advil, motrin) and naproxen sodium (aleve). NSAIDs can help relieve or lessen the pain caused by endometriosis by stopping the release of prostaglandins, one of the main chemicals responsible for painful periods. While NSAIDs can help manage the pain-related symptoms of endometriosis for some women, it’s not effective in every case.

Birth control methods such as the pill, the patch and the ring are often helpful to treat the pain associated with endometriosis because they reduce heavy bleeding. This method works best for women who only have severe pain during their period and not during the rest of their cycle.

Progestins are recommended for women who do not get pain relief from or who cannot take hormonal birth control that contains estrogen (such as smokers). This synthetic form of the natural hormone progesterone is available by prescription as a pill or an injection.

GnRH therapy uses medicines that work by causing temporary menopause. The treatment actually causes the ovaries to stop producing estrogen, which causes the endometriosis implants to shrink.

For some women, surgery may be the best treatment method. While there isn’t a cure for endometriosis yet, it is possible to remove some of the scar tissue and lesions with surgery.

If you have endometriosis, surgery could be an option if you:

• Have severe pain
• Have tried medications, but still have pain
• Have a growth or mass in the pelvic area that needs to be examined
• Are having trouble getting pregnant and endometriosis might be the cause

"It is important to note that there are other conditions that can cause many of the same symptoms as endometriosis," Dr. Yarroch explains. "An OB/GYN can help determine if endometriosis is the appropriate diagnosis."

So What Now?

"Endometriosis can have a significant impact on a woman's life. Fortunately, there are treatment options available to manage pain and minimize recurrence," Dr. Yarroch says.

If you have endometriosis or believe you could have endometriosis, we strongly encourage you to speak with your doctor or one of our highly trained providers. We want you to know that at Women’s Care, we’re devoted to you and your health. We’re here to meet both your physical and your emotional needs each step of the way, from diagnosis to treatment and recovery.

Dr. Therese Yarroch sees patients in Appleton and Shawano. To schedule an appointment with her, please call or text 920.729.7105. Learn more about Dr. Yarroch here.

Meet Effie Siomos MD, Women’s Care of WI

Effie Siomos is a strong advocate for women taking steps to care for themselves.

“We need to do nice things for ourselves once in a while,” Siomos said. “Make time to meet a friend for lunch. Take a walk, ride a bike, sign up for a mud run. See your doctor.”

Wait, what?

“I know people don’t think of going to the doctor as something nice you can do for yourself, but just do it,” said the OB/GYN from Women’s Care of Wisconsin. “It will make your day-to-day life better.”

With special interests that include pregnancy care, performing in-office procedures and minimally invasive surgeries, and consults with moms and daughters to manage heavy periods or discuss birth control, Siomos has seen—countless times—women who have been dealing with issues for three, five seven years until they finally come in to see her.

In one classic exchange, a patient said she had been dealing with a problem in silence ever since the birth of her baby. Siomos asked how old her baby was.

“He’s going into high school,” was the reply.

“It’s easier to take care of our kids or our parents than it is to take care of ourselves,” said Siomos. “Just because your friend doesn’t have the issue doesn’t mean this is your lot in life. There are so many options to get you back to where you should be.”

Siomos loves good conversations with patients and feels that by paying close attention, she can make sure people are getting what they need at her office.

“Whatever the issue, there are physical symptoms that come with it, but there’s an emotional component as well, and paying attention to that really helps guide the treatment for what the patient wants or needs and what solution is best for them,” Siomos said.

Though a Chicagoland native, Siomos has spent her entire career practicing in rural communities, first in Beaver Dam following her residency, and now in Berlin.

“It’s a nice way to practice medicine,” said Siomos. “It just feels a little more personal. People look after each other.”

Such a perspective, said Siomos, dovetails perfectly with the culture at Women’s Care of Wisconsin, the organization she joined in 2019.

“A lot of times when you go to a doctor's office you're not just getting the doctor. You're getting the person at the front desk, you're getting the person who takes your blood pressure and puts you in a room, you’re talking to the nurse if you're calling with a question afterwards. There are all these layers to what makes a great experience, and that’s where Women’s Care of Wisconsin really stands out,” said Siomos. “It’s our people.”

With a family background in healthcare, it wasn’t surprising to see Siomos follow the path, as she weighed a university job against a more hands on career in the field. The latter solidified itself upon her first delivery, an experience she described as different from anything else she had experienced in med school.

“It was an amazing chance to be part of someone’s life at such a moment,” Siomos said. “It’s also an extraordinary opportunity to make an impact in ways that might not be typical for healthcare.”

Many days find Siomos in her Berlin clinic, spending time with patients discussing their concerns and healthcare goals and learning what’s important to them, while other days she’s in surgery for planned procedures such as a hysterectomy or the removal of cysts.

It’s a job with plenty of variety, which Siomos embraces.

“It’s a great way to get to know people, when you can sit down and talk to them about what decisions would be best in their life,” she said. “I get to teach and present what treatments are available and provide my patients with a clear understanding of their options,” said Siomos.

Gone are the days, she said, of patting someone on the knee and sending them on their way, often with the cursory (and demeaning) advice to just tough it out.

“There are so many different ways women want to interact with their health care,” said Siomos. “And we have so many ways to help.”

Dr. Effie Siomos sees patients at Women's Care of Wisconsin in Berlin, located at 225 Memorial Drive, Suite 2030. To schedule an appointment with Dr. Siomos, please call or text 920.729.7105.