#Reproductive Medicine

[eveshmeve]

ode to iuds

[oupacademic]

Time-lapse imaging of embryos has been widely introduced to fertility laboratories worldwide with the aim of identifying the best quality embryos to transfer that will ultimately improve IVF success rates.

But there can be ethical, financial, and safety implications when it comes to hastily adopting time-lapse monitoring of embryo development.

Image: ICSI by Eugene Ermolovich (CRMI). CC BY-SA 3.0 via Wikimedia Commons.

[queen-esther]

Early pregnancy tests are both a blessing and a curse, especially for women actively trying to conceive.

They’re a blessing in that they are helping women discover pregnancy earlier than ever before in history, usually before a period is even missed. This is great for women who are wanting to take precautions as soon as possible and avoid things like alcohol or too much caffeine early on in pregnancy, and there’s also an element of fun in knowing so soon. My first pregnancy was detected only three weeks on the dot after my period started, and it was because I used one of those First Response early tests.

However, they’re also a curse in that more women are beginning to actively recognize chemical pregnancies/early miscarriages. Most pregnancy failures happen in the first few weeks of pregnancy, but they were often not noticed until recently, since this usually happened before a classic pregnancy test could even pick a pregnancy up. Women who experienced chemical pregnancies typically wrote off the end of that cycle as a “heavy period” that was just a couple days late, since they had no way of knowing they were actually briefly pregnant.

I don’t know if I posted about it here, but during a cycle a few months after my miscarriage, I was getting very faint positives on early tests. I knew these weren’t just indent lines, because they were very clearly pink and consistent for a couple days before I started bleeding, like, a couple days after my period was due. I weirdly enough didn’t get heartbroken over this one, I guess because the fact that the lines never got darker clued me in that the pregnancy wasn’t going to stick. Anyway, the cycle following this fiasco was the one my son was conceived in, so had I not used any early tests, I probably would’ve been none the wiser that anything had even happened down there.

I think we’re going to get a lot more data in the coming years about just how common chemical pregnancies are as more and more women decide to test before their periods are due. We could see it become more common to openly discuss failed pregnancies, as well as experience more acceptance over the fact that miscarriages, while tragic, are a common part of the reproductive process, and they’re nothing for mothers to be ashamed of or necessarily panic over in relation to their chances of successfully carrying a pregnancy to term in the future.

[wowbright]

I learned yesterday on Sawbones podcast that the recommended dose of Plan B is less effective has unknown efficacy for people 165 lbs or more, but also no because insufficient data is available for what was gathered in clinical trials to determine what the effective dose is based on weight above 165 lbs.

Which is just wild to me. A lot of people weigh more than 165 lbs. Tall people, fat people, muscular people, people who are neither fat nor remarkably muscular nor remarkably tall.

This is not a recommendation to not take Plan B if you are over 165 lbs. This is a recommendation to demand that pharmaceutical companies consistently include people of a variety of weights in their dosing trials.

[ineffectualdemon]

So there is post further down about pregnancy tests and I have learned that the average charge for a pregnancy test in the hospital is 30 dollars

Friends.

That's the same fucking test that you do at home.

I have literally been told by doctors on the NHS it's the same test.

If you tell them that you're pregnant and you know from taking a test they are just "cool." And move on with your pregnancy taken as fact.

Don't do the 30 dollar pee test.

But I know sometimes they insist and force you to take the test before you receive actual treatment

So here's my suggestion

Keep an over the counter pregnancy test in your bag and of they insist on a pee test before a procedure insist on using your own

[sir-crocodile-slut]

Just got back from my doc appointment. I was honestly expecting a bigger fight about sterilization tbh. I told them that’s what I wanted, doc asked a couple questions, informed of the risks and such, and said surgery dept will contact me for a procedure opening.

I’m like that’s it? That easy? 👁👄👁

I had the state code, reproduction laws, fuckin everything ready to argue over it but they’re like “Yeah, it’s your choice we can’t decide for you. Just know the risks are there as any general surgery and anesthesia-necessary procedure. Some women have regrets but that’s not for me to decide for you, so I will talk with surgery and they’ll call you with a time slot. Bookings are usually a month or so out.”

I’m like… IT WAS THAT EASY THE WHOLE TIME??

[youreverycolor]

I haven’t really talked much about what’s been going on with me physically. But I guess I need to now.

After three weeks of severe pelvic and back pain plus months long nipple pain, last week, I had a transvaginal ultrasound that showed thickened endometrial lining and excess fluid in my cervix. My uterus is also retroverted and retroflexed (see below image).

Basically my uterus looks like the bottom right photo. It also has pushed my cervix so that it sits right on top of the vagina - so basically whenever I have sex, the guy hits my cervix.

This explains everything about why sex is ALWAYS painful for me. Every time. It’s NEVER ONCE been physically enjoyable. The best I’ve gotten is “not very painful.” All my adult life I’ve told doctors that I cry and can’t walk after sex and I’ve been told that I should change positions or that “sometimes women just don’t enjoy sex.” Nobody bothered to tell me that my tilted uterus could cause it, nor did they bother to do an ultrasound that showed that it’s also retroflexed. Apparently they can fix this with laparoscopic surgery if it’s determined there is enough pain to warrant it. I’m going to push to have it done. I want to enjoy sex and not have horrible back cramps.

So anyway. After the imaging came back, they recommended I get an appointment to have a pelvic exam done ASAP to find out exactly what things look like in there, which I have tomorrow, and then Tuesday I have to have a mammogram for the breast pain. The word cancer was mentioned. I’m sure it’s just a CYA thing, but hearing that word in any context ever is horrifying.

I am 35 years old this month. I want this to be fixable. I want it to be something stupid and normal. I want my body to not be broken. And I certainly would like to find out that this isn’t indicative of cancer. Please, if you’re the praying kind, pray that it’s all just hormonal and can be fixed with surgery or a pill or something. Because right now I’m scared and don’t know how not to be.

[vmoondev]

Hello everyone!

I am heading out to a protest in Indiana today. The state is ruling on an abortion ban today and we want to disrupt and make as much noise as possible. If you are in the area, check the ACLU twitter page for more details. Stay safe out there! 💕

[maybemamatobe]

Why I'm here.

Alright. So I actually I didn't want to do this blog, but I was so frustrated, upset and disappointed with the very little useful information I've been finding online about this journey that I felt I had to.

A little about me. I'm a 37 y.o. Black woman with a PhD in engineering. I'm married to the most amazing man who loves me for me (despite the crazy). I work in the tech industry and the nonprofit sector trying to build technology solutions that merge social justice interests and goals and teach people along the way. '

A lot of ish has been hard for me in my adult life. My kid life was pretty idyllic to be honest. Things got complicated and hard from college forward - ambition is pretty costly, but often the rewards are pretty good. I still have PTSD and anxiety from grad school and work challenges that were often influenced by race and sex - basically, being a Black woman is often a tough experience to live through. While I've figured out how to navigate with lots of different kinds of strategies and resources, I'm in a challenge now that I didn't anticipate and am struggling to figure out -infertility.

In May 2020, still early in the pandemic, my hubs and I were ready - IUD taken out, we're going to try to have a baby. For context, when we were dating and really up until then I was always an "eh if it happens great, if it doesn't no big deal" type of person about kids. My early adult life jaded me pretty quickly I guess. But we decided to try. At 36 I knew I was stepping into advanced maternal age, but I never had any reasons to worry as far as I knew.

By February of 2021 I had not a single late period, no hint of a positive test, just absolutely nothing. I called the office of my new doctor (we had just moved to TX in Feb 2020) and was hurried off the phone saying I needed to be trying a full year. Skkkrrttt!! - what? The ol' innanet says at 35+ six months. So, here I was a little not sure what to do because my new Black woman doctor's office wouldn't see me and it's a panorama out there, so getting a doctor's appointment is tough.

February 2021 through now have been a lot - pelvic physical therapy, getting a reproductive endocrinologist, new ob/gyn, hysteroscopic myomectomy, getting my hubs on board fully, 2.5 IUIs, and now recovery from an open myomectomy just a few days ago with 16 (!!!!!!) fibroids removed and at least a 3-month wait ahead to try to get pregnant I've figured out a bunch. I also have been disappointed, upset and frustrated with the lack of real or useful information out there about this experience, especially for Black women.

Yeah, I can read the scientific articles, but that doesn't tell you that you need to plan to not be able to do your hair for a few weeks. Checking out doctor's websites might help you get a sense of what is involved in fertility treatments, but don't explain how fibroids can be a silent enemy.

So, I'm here...I want to use this blog as a real, woman to woman, "here's what I've found out and learned on this journey" resource to share what I've newly learned and what I found out the hard way.

[ssogoodinblue]

I just saw someone try to argue that treating a miscarriage or ectopic pregnancy is a totally different thing than abortion and I think this is the one that finally broke me you guys bc I CANNOT stop laughing

No joke it’s been 45 minutes and I’m still walking around my house laughing to myself. Anyone else ever heard this argument?? Bc I have not and I cannot handle it lmao I’m crying

[oupacademic]

The next four hours passed slowly, slowly, but when I did examine the final Oocyte I felt as much excitement as I had ever experienced in my life. Excitement beyond belief. A living, ripening, human egg, unbombarded by any hormones, beginning its programme just as the mouse eggs had done. There, in one egg, in the last of the group, lay the whole secret of the human program.

We celebrate the life of Sir Robert Edwards, IVF pioneer, with this special tribute issue from MHR: Basic Science of Human Reproductive Medicine. Robert was awarded the Nobel Prize for Physiology or Medicine in 2010, and was the founder of three of OUP’s journals, including MHR.

[squeeterbee]

the babies are coming the babies are coming

[autumngracy]

Hellscape, Hellscape, Hellscape

[madsdblake]

So they are offering $7,000 dollars to donate eggs.

If I'm desperate, thoughts?

[vmoondev]

if you are going to protests, please stay hyrdratred, don't be stupid and end up in the hospital

[fuguovaries]

Female Reproductive Anatomy + Physiology

*Cracks knuckles* alright, let's go (If there are any questions you want to be answered or any topics you want me to cover, just lmk!)

Righty-ho, can't get much explained without anatomy, so we'll start with that!

As in both sexes, the reproductive system is split into 2 sections, internal and external organs, for females, we generally split internal again into the vaginal canal and the uterus (referring to the fallopian tubes and ovaries as well) in everyday language.

External/Vulva - - Mons Pubis (In front of the pelvic bones) - Counts as part of the vulva, supposed to be for cushioning, or for pheromonal purposes, much like other areas that grow hair after puberty. - Labia Majora (Outer, larger skin folds of the vulva) - In most women, it covers and protects the other structures (for some, it's the labia minora, primarily). - Labia Minora (Inner, smaller skin folds of the vulva) - '' as above. Joins together at the top, forming the clitoral hood, and at the bottom forming the fourchette. - Clitoris (Erectile tissue [corpus cavernus]) - External part is the glans clitoris, the majority of it (the body) is internal, highly innervated and highly vascular (insert 8k nerve ending factoid here). - Vulvar Vestibule (Area bordered by the labia minora, below the glans clitoris) - Contains both the urethral and vaginal openings, - Vestibular Bulbs (Erectile tissue [corpus spongiosum]) - Due to its close proximity, it's supposed to exert pressure on the clitoris during arousal. - Bartholin's Glands (Greater vestibular glands) - Nearby the vaginal opening, secretes mucus into the vagina and the labia minora, primarily for lubrication or moisture (different to vaginal discharge btw!). - Skene's Glands (Lesser vestibular glands) - Nearby the urethral opening, similarly secretes mucus into the urethral opening, but rather than for lubrication, it's primarily for anti-microbial properties. - Vaginal corona (Folds of membrane at the entrance of the vagina) - Forms the opening of the vagina and helps with elasticity.

Internal -

Ovaries (Female Gonads) - Made of the outer cortex, and internal medulla. The cortex contains follicles (made from oocytes [premature egg] surrounded by granulosa cells [hormone releasing, surrounds the oocyte to form membranes when the follicle matures]) and the medulla contains blood vessels and nerves. - Epithelial (lining), granulosa, theca (present in prenatal follicles to also form membranes) and oocyte cells can all be present at various stages of the maturation process of follicles. - Follicles form as a type of vesicle, with granulosa and thecas surrounding an oocyte, before rupturing and releasing an ovum. The follicle then regresses as corpus luteum tissue before degenerating completely. - They primarily secrete estrogen and progesterone, alongside androgens. - Held in place lateral to the uterus by broad suspensory ligaments which contain the ovarian artery and vein, and nerve plexus.

Fallopian/uterine tubes - Made from flattened mesothelial (protective lining), epithelial, secretory (glands) and intercalated (like stem cells) cells, forming 2 tubes on either side of the uterus. - Fimbriae (the thin, finger-like tubes on the end) around the ovary leading onto infundibulum (wide section at the end, 'catches' released egg cells) ampulla (the longest section, where fertilisation usually occurs), and then into the uterine body through the fallopian isthmus. - Externally, they're covered by the peritoneum (which covers all your abdominal and pelvic organs and body wall), which is in turn supported by the way it's folded. Internally, they're lined with smooth muscle, ciliated (the little fleshy hairs) to sweep a zygote towards the uterus, with the mucosa providing nutrients to oocytes.

Uterus - Behind the bladder, with 4 'areas', the fundus (the top of it), uterine body, uterine isthmus (narrowing between the main body and the cervix), and the cervix (where only the external side dilates and thins during childbirth). - Anchored to the sacrum (ligaments) which help attach the uterus to the round ligaments of the body wall. - It's all supported in place and protected partly by the cardinal ligaments (which attach the uterus to the pelvic wall) and the mesometrium (protective lining). - The uterine wall is made from 3 tissue layers, the perimetrium, the myometrium (the smooth muscle layer that contracts during your period or childbirth), and the endometrium (a highly vascular mucosal layer that builds with the menstrual cycle).

Vagina - Extends from the uterus, and opens into the vulva - Split into 2 main tissues, the outer muscular wall containing rugae (folds in the tissue), and the inner mucosal membrane of the same cells as your skin (stratified squamous epithelium).

Refs: https: Zdilla MJ. What is a vulva? Nguyen JD, Duong H. Anatomy, Abdomen and Pelvis, Female External Genitalia. osms.it/female-reproductive-system R.S.F.U., Vaginal Corona - Myths around Virginity Utiger RD, "ovary". Encyclopedia Britannica