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Dr. Kim Barrows Interviewed about Restorative Reproductive Medicine by ABC News in Grand Rapids, Michigan

Sat, 14 Jun 2025 14:28:55 GMT

Dr. Kim Barrows Interviewed about Restorative Reproductive Medicine by ABC News in Grand Rapids, Michigan

ABC News “13 On Your Side” in Grand Rapids, Michigan, included a report on restorative reproductive medicine (RRM) in their June 12, 2025, broadcast. The report featured Reply RRM clinician and Grand Rapids resident Dr. Kim Barrows, along with her former patient, Mary Kate Weeber, who overcame infertility with RRM care.

ABC News WZZM affiliate host Julia Gorman conducted the interview of Dr. Barrows and Mrs. Weeber as part of a feature during World Infertility Awareness Month. “Infertility awareness,” said Ms. Gorman as she opened her report, is “a topic that we can always be talking about more here in our community.” She included questions to Dr. Barrows about RRM and how RRM clinicians go about investigating “what the root cause might be of someone’s infertility.”

Dr. Barrows shared how we know infertility typically is multi-factor, with 4-6 underlying causes or contributors that can be female, male,

or both, and that one of the benefits of restorative reproductive medicine is that it can position a couple not only for one baby, but for improved health long-term for couples to build their families.

Mrs. Weeber, who is not a Reply patient but who saw Dr. Barrows prior to Dr. Barrows joining Reply, provided a thoughtful summary of her RRM experience, which included treatment for PCOS:

“A family member told me about Dr. Barrows. It was a learning curve and following the treatment plan of RRM, I think it was nine to ten months and we had a positive pregnancy test.”

The Weebers now have three children.“What would you say to other women out there,” Ms. Gorman asked, “who may be struggling with infertility like you were at one point?”

“I think it’s never too soon to learn about how your body works,” answered Mrs. Weeber, “and to seek out those answers if you feel like something is wrong.”

A transcript of the interview follows below, and the WZZM “13 on Your Side” story can be viewed here .

Host Julia Gorman

We're going to switch gears now and talk about infertility awareness, of course, a topic that we can always be talking about more here in our community. I'm joined by Dr. Kim Barrows and Mary Kate Weeber. Ladies, thank you so much for being here! We're talking about restorative reproductive medicine, and that is your cup of tea, Dr. Barrows?

Dr. Kim Barrows

Yes.

Host Julia Gorman

And Mary Kate, you have benefited from this kind of science. We're going to talk all about your success story and your growing family in just a moment. Dr. Barrows, you know, this is your thing—talk to me a little bit about if someone's never heard of RRM, what is it? What are we talking about here?

Dr. Kim Barrows

Yeah, restorative reproductive medicine is a new way, a very effective solution for couples facing infertility. So, it's taking a deep dive and looking at all the underlying factors that could be contributing to the infertility—both the man, the woman, and both. So, we have—I liken it to peeling back the layers of an onion—and we just want to leave no stone unturned.

Host Julia Gorman

And infertility is obviously, you know, a really challenging issue that so many couples can face. It can be so devastating, and challenging, and there's lots of different approaches out there. IVF is one that maybe some couples are familiar with. You know, when you're talking about peeling back the layers and looking at kind of what the root cause might be of someone's infertility, the man or the woman. What could some of the causes be here that you're talking about?

Dr. Kim Barrows

Some of the causes—we generally find about four to six—but PCOS, endometriosis, chronic endometritis is a big one, and then we have male factor infertility, that can be related to not just sperm count, but also the quality of the sperm. And so, the quality of your ovulation matters, the quality of all the things related to sperm, and metabolic health, anatomic health, all that matters.

Host Julia Gorman

Yeah, really, a wide span of different things that could be causing this issue that can be so challenging. And you know, as far as how you figure out what that cause may be, and then work to kind of resurrect it to ultimately, you know, enable someone to grow their family. What does that look like? I'm sure it's very complicated, but kind of in a nutshell, what does that look like?

Dr. Kim Barrows

We start with the woman charting her cycle because it's really important to use a fertility awareness-based method that's based in science with efficacy and a teacher actually training you. So then once you can confidently identify, “yes, you are ovulating,” or “no, you're not.” If you are, are you ovulating well? Then we can move forward. We also work with the husband and do lab work on both parts of the couple. And we also do a targeted, timed hormonal profile as well as their ultrasounds around her ovulation, so it's really key for her to be able to figure out when that is.

Host Julia Gorman

Really a detailed look at anything that could be impacting this process, which is really incredible. Mary Kate, you worked with Dr. Barrows—I don't want to leave you out here—you worked with Dr. Barrows, you're now a mom of three, three under five, which is incredible. Kudos to you! If you don't mind, tell us a little bit about your journey, how you got to working with her and what your experience was like.

Patient Mary Kate Weeber

Okay, well, my husband and I married in the spring of 2016, but even before that we spoke together and knew we wanted a family. And also with my history, I knew as a teenager and into my twenties, I had been told I have PCOS, so in the back of my head, that was there. But then as we were ready for a family, it was difficult, and about six months in—I didn't want to wait a full year—I wanted to figure out what was going on. There was, that's actually when a family member told me about Dr. Barrows. And we met with her. It was a learning curve, um, following the treatment plan of RRM, and then within, I think it was nine to ten months, and we had a positive pregnancy test, which was really amazing to finally see that. And our daughter Annie, was born in August of 2019.

Host Julia Gorman

Wow.

Patient Mary Kate Weeber

We're both so grateful for Dr. Barrows, working with us, we just don't know, you know, if we hadn't met with her then how long our journey to starting our family would've been.

Host Julia Gorman

And, you know, many are, and many aren't familiar with PCOS and the different problems that can cause when it comes to fertility and also just quality of life—that's another women's health issue that's just not talked about enough. And for you, knowing that early on, as a young person, and worrying about, you know, how that was going to impact growing your family, that's such a challenging experience, I'm sure. You know, being able to use this approach, what would you say to other women out there who may be struggling with infertility like you were at one point, and trying this approach compared to the others that are out there?

Patient Mary Kate Weeber

Yeah, I think it's never too soon to learn about how your body works, and to seek out those answers if you feel like something is wrong. Infertility is so isolating, so I think it's important to keep the communication open and really be kind to yourself.

Host Julia Gorman

And since Annie being born, you've welcomed two other children. Did you use RRM for that as well? Was that needed for those births?

Patient Mary Kate Weeber

That's a great question. I did actually, I worked with Dr. Barrows and her team into my pregnancies as well, and then postpartum. I wanted to meet with her again for a refresher and to talk about the spacing of our children. So, I have worked with her team for a while.

Host Julia Gorman

Oh, such, such incredible news. And we were showing some pictures just a moment ago of your absolutely adorable family, which is so exciting. Congratulations!

Patient Mary Kate Weeber

Thank you. Thank you.

Host Julia Gorman

Again, you are the hero here for “three under five!” You know, Dr. Barrows, as far as when it comes to this method and this approach, obviously there's others out there. Many people have heard of, you know, IVF or other sort of associated procedures. How does this compare? Is this kind of just another option? Does this work better for some people than other ways of conceiving?

Dr. Kim Barrows

Well, this is definitely a comparable option, the efficacy is comparable. It's definitely a lot less expensive. But the thing I really like about it is it's long-lasting. Once you heal those problems, you know, then a lot of times you don't need to do nearly as much to get pregnant the next time, or sometimes nothing at all, because the problems are fixed.

Host Julia Gorman

Gotcha. And for anyone who is hearing about this and wants to learn more and maybe wants to book an appointment with you—how can they do so? Where are you based? Tell us about that.

Dr. Kim Barrows

I'm based doing telemedicine through Reply Fertility, and we're actually in lots of states with lots more coming. So if you check out our website, replyfertility.com, you'll be able to find us and set up an appointment in your state.

Host Julia Gorman

Very cool. Anything I'm missing? Anything else you want folks who are watching right now to know, from either of you just about this process?

Dr. Kim B arrows

I would say “don't wait.” Learn as much as you can about your cycle, about your metabolic health, your hormonal health, and everything. And then work with a doctor that understands RRM because that's going to be a great option for most people.

Host Julia Gorman

Absolutely. Ladies, thanks so much for being here, talking about this vulnerable topic. I think as women, the more we can talk about these topics, the more de-stigmatized we can make them, and just a priority for women's health. So, I really appreciate both of your time and congratulations again!

Patient Mary Kate Weeber

Thank you.

Host Julia Gorman

We are going to take a quick break and we'll be back talking about a new life jacket initiative here in West Michigan.

Statement from the International Institute for Restorative Reproductive Medicine

cplican@replyobgyn.com (Carolyn Plican) — Fri, 30 May 2025 16:08:01 GMT

Statement from the International Institute for Restorative Reproductive Medicine

In anticipation of an announcement from the Trump administration regarding solutions for infertility, and in preparation for World Infertility Awareness Month in June, the International Institute for Restorative Reproductive Medicine (IIRRM) has issued a statement about the growing promise and prominence of restorative reproductive medicine (RRM).

“Couples struggling with infertility are best served when they receive a comprehensive evaluation, diagnosis, and restorative treatment to optimize their health and natural reproductive function," said IIRRM president, Dr. Phil Boyle, a dual U.S.-Irish citizen who is a leading provider of RRM through his Dublin, Ireland, Neo Fertility clinic.

In addition to effectiveness, advantages of RRM care cited in the statement include that:

patients become full partners in their own care
care is more affordable
accessibility increases since RRM can be managed via telehealth and does not require central laboratories
barriers decrease since RRM is universally ethically acceptable

Dr. Tracey Parnell, IIRRM Global Director of Communications & Development, points out the discrepancy in preterm birth rates between RRM and IVF as one of the most important benefits to RRM care for couples undergoing treatment for infertility: “The reduced preterm birth rates with RRM are vitally important to consider. Preterm birth can bring not only trauma to the premature babies and their families, but also additional cost.” RRM preterm birth rates in the U.S. are 8% compared to 14.1% for IVF and 10.4% for the U.S. overall. The March of Dimes estimates an average additional cost of approximately $65,000 per case of preterm birth. March of Dimes also issues a report card that assigns letter grades to different preterm birth rates, according to which IVF in the U.S. would score an F, the U.S. overall would score a D+, and RRM in the U.S. would score an A-. The difference in preterm birth rates “underscores how important it is to do everything we can to help patients conceive naturally,” said Dr. Parnell.

The IIRRM is the leading medical society for restorative reproductive medicine. It maintains an academic journal, Journal of Restorative Reproductive Medicine , and an international clinical practice registry, Surveillance of Treatment and Outcomes in Restorative Reproductive Medicine (STORRM), as well as an RRM Clinician Recognition program. The Reply clinic is a participating clinic in STORRM and the RRM Clinician Recognition program.

“We are grateful to see increasing awareness and discussion about infertility,” concluded Dr. Monica Minjeur, IIRRM U.S. Director of Communications & Development, “and hopeful for more options for patients and more improvements in the field of reproductive health.”

The full IIRRM press release can be viewed here.

UNEXPLAINED INFERTILITY, EXPLAINED

Sat, 24 May 2025 15:48:15 GMT

UNEXPLAINED INFERTILITY, EXPLAINED

Finding Answers with Restorative Reproductive Medicine (RRM)

Patients Erica and John found Reply following years of unexplained infertility and no results working with other specialists—“we just didn’t know there was anything else out there.” They followed the typical pattern of multiple underlying factors that could be identified and treated. With comprehensive RRM care they were able to conceive and gave birth to a healthy, beautiful baby girl. They emphasize that “if you can figure out ‘why,’ that’s half the battle.” Their testimonial below was recorded, transcribed, and edited for length.

We were working with an ART (assisted reproductive technology) clinic because we didn't know otherwise, we weren't aware that there were other options. We had been with an IVF clinic for 3 years and had no success, but we didn't do IVF. We just did just some light optimization, did some blood work and a couple of different little things, and then the biggest thing we ever did was a couple of rounds of IUI, but we were very uncomfortable with that idea. We just didn't know that there was anything else out there.

We decided to move to North Carolina and one of our friends who knew about our struggle—we have been struggling at that point probably for about four years—gave us a book called Catholic Infertility. In the back of the book, we found someone who used to work with Reply, and it led us to Reply's website and that's what jumpstarted the journey into a whole brand new world that is restorative reproductive medicine.

We had removed plastics from our life. We had really looked into the types of chemicals that we were putting on our bodies. So we were very open to the pillars and hallmarks that is restorative reproductive medicine. By the time we came to Reply, we were just really ready for what they were going to throw at us.

(Erica) I thought I was really aware of what my body was going through, but once I came to Reply, I realized that what I knew was just the tip of the iceberg. I think a lot of people I've talked to who are in this journey don't realize how much more there is to fertility…through the health coaching and the fertility coaching that I got at Reply, I learned so much more about just my health as a woman that I wish more women could receive that kind of education, not from a fertility perspective, but from just a health one.

My husband and I are both very data driven people. So it really appealed to me to have something that I could track on a monthly basis. After a couple of months, I was very surprised at how the data started to reveal things, even to me…there were certain markers of what was going on. When it came time, when I did get pregnant, it was almost as if the data was already telling me that before I had even taken the test and confirmed everything. It was really interesting to see the trends over those 18 months.

I would also add that one of the things that makes Reply such a unique place is that our fertility educator really was very hands-on. During the whole process, every time we connected, she would ask like, hey, do you want to review your chart together? Do you have any questions? One of the things that we discovered, she and I together, was the inflammation caused during a menstrual cycle. I could aggressively lessen the pain that I would go through on a month-to-month basis if the week before my cycle started, I ate at least 3 or 4 servings of Omega-3s. For me, that was a piece of salmon. As long as I did that, I did not experience any menstrual cramping; but the months where I did not have that, I would experience my regular sort of menstrual cramping. So, it was really interesting working with her to kind of figure out what worked for my body and what didn't, and making those discoveries together.

I don't say this lightly, but I just feel like Reply is such a special place because everyone is so invested in restorative, reproductive medicine. [With our health coach], we would talk about what meals we were eating, what are the kinds of minerals and vitamins we should be getting through our food, what are some exercises that we should be doing, how is our sleep, how is our stress? It was a concerted group effort. It was always, “how can we get you closer to your end goal?”

Barbara, our nurse, is just the most amazing person ever. I remember how excited she was when we called to tell her we were pregnant. It was so nice to have her just there as a cheerleader. And I don't think people realize how emotionally taxing this infertility journey can be and to have someone, medical personnel, who is just constantly cheering you on. And telling you that you're doing a good job and to keep at it and don't give up—that was Barbara for us. Really and truly, it was Emily, Lisa, and Barbara that we saw week after week after week for 18 months.

I would say, unlike traditional doctor's visits, Reply took a very diagnostic and data-driven approach with us, which we really appreciated because that's how we work. And that was something that I noticed Reply was very cognizant of, which is “Here are your options, here are the things that we found at the end of the day. This is your choice, your journey. We want you to feel comfortable.”

You're functioning off of a sliver of hope. There's no guarantee, even with assisted reproductive technologies there is no guarantee. There is no promise at the end of "X" number of months that you're going to be able to conceive. And so to be able to see data that backs up the fact that we're placing our hope into this program was really, really reassuring.

We were both very surprised by how affordable this was, and even more so at the end of it, because we got so much out of this program. Reply was a breath of fresh air in that, they wanted to try as many things as we wanted to. So, we felt like we had an equal partner.

Our journey took, from beginning to end, 18 months. Through that, we were able to identify four areas that needed work. And I think a lot of people who are in this journey also misinterpret, misalign, or blame themselves. And oftentimes it's like, “Oh, because I was on birth control,” or because, you know, “I'm being punished for something.” There's a lot of guilt and blame in all of this. And I want to just stress how incredibly freeing it was to work with Reply because we did discover “the why.” We discovered what my body was doing to cause infertility to be a symptom and that's something that Reply taught me. If you can figure out why, that's half the battle.

We were able to identify some issues that, one of them was something that I didn't even realize could be a thing and apparently it's very common. Another thing that we discovered is something that has something to do with my long-term health. Like, it's not just fertility. It was something that, once I addressed it, I actually started feeling better and I had no idea that I had this issue. I just knew that I didn't feel good. Like, I just put up with it or maybe I didn't get enough sleep.

Once we figured out what those things were, the fixing took a lot longer than I anticipated. I think that's a misconception that, you know, oh, you identify what's going on, you start taking medication—everything will be fine. But your body needs time, whether it's reducing inflammation or addressing something that's been ongoing for probably a good part of your life. It takes time. So, it took some time to fix it and optimize it.

The other thing people don't realize too, is like the eggs that you have are dormant until three months (before they’re mature for ovulation) so if you're getting rid of the junk food in your body, you have to look three months ahead. That's another thing that I think I didn't realize until I was working with Reply that these things take some time. I think we probably took a good eight or nine months to get to a place where both my husband and I felt like, okay, we're finally in a place where we are eating well, sleeping well, exercising, and stress is under control. I would like to stress that Reply also doesn’t over medicate you, and of my four conditions, only two of them were under medications.

At our 11-month check in [our clinician Lisa] said, “you know, I'm really concerned that given everything that you're doing and how you're feeling and everything that we have found, that you're still not pregnant yet.” No one had ever said that to me, no provider, no medical professional. And when you're in an infertility journey--I mentioned the isolation--oftentimes you feel like you're the only one rushing. You're the only one trying to get to this finish line and you're doing it alone. And when Lisa said that to me, I felt so heard, and so supported. And I felt like for the first time there was someone else on my side who was just as concerned as I was.

So that jumpstarted two things: they took my data to a national conference and one of the doctors there, who has been in this industry for four decades looked at my data and basically said, “I think she has X.” And so what I was really grateful for was Reply didn't just stay insular. They were willing to admit, “we don't have all the answers, let's go consult other experts.” That is a breath of fresh air to me. As a result of that consult, Lisa said “you know, this would be my recommendation, but we have no way to prove this diagnosis without surgery.” The ball was in my court. Ultimately, I had the surgery, and the surgeon was able to identify and verify things that would not have been found, or addressed, without it. And again, I really appreciated it.

My husband was a part of this journey with me from beginning to end. And I think that because infertility is so isolating and so challenging, you don't often realize the toll it takes on the husband. We always talk about what we women go through, but he was as much grieving the fact that we weren't able to conceive as much as I was. In some ways it was a lot harder for him because it wasn't his body that was experiencing all the issues. It was mine. So, we were very blessed and very grateful. I conceived and our baby is a month old now. It was a lovely birth.

To the friends I currently have who are going through infertility, first of all, I tell them my story and then oftentimes I'll say, there is more to infertility than you can ever know and you're not alone. There are places that can help and which is why I am so glad that Reply is trying to get certified in all 50 states because I have friends all over the country that could use the experience that I had. More than anything, the reason why I'm eager to tell my story and eager to get the word out is because I know that there are millions of people who, if they knew that there was more options, it would be life changing.

So, “hang in there” is what I would say and get a second opinion from someone else who has other tools. I definitely feel that there's a reason why we went through this journey. I can now tell the story and I hope that wherever the story goes, whether it's through this platform or my telling it to friends, and friends telling it to their friends, that people can get help that they need.

I guess I should say this: our baby would not be here if it weren't for Reply. Full stop.

RRM Presidential Chair Established at University of Utah

Sat, 24 May 2025 15:40:06 GMT

RRM Presidential Chair Established at University of Utah

In a first of its kind, a presidential chair in restorative reproductive medicine (RRM) has been established at the University of Utah Spencer Fox Eccles School of Medicine in Salt Lake City, Utah. This new academic chair, the “Joseph B. Stanford, M.D., and Kathleen B. Stanford Presidential Chair in Restorative Reproductive Medicine,” honors the pioneering work and commitment of Dr. and Mrs. Stanford to the RRM medical discipline.

“I am honored and most grateful,” said Dr. Stanford of the tribute. “I look forward to continuing to contribute research and enhancing health care in this field.” Dr. Stanford offered his “profound thanks to Kathleen for her encouragement and fundamental support over my entire career.”

In an April 18, 2025, press release, the University of Utah indicated that the inaugural holder of the chair position will be announced “in the coming weeks.”

Dr. Stanford has served as a clinician and researcher at the University of Utah since 1993 where he is a tenured Professor of Family and Preventive Medicine and Vice-Chair of Research for that department, as well as adjunct professor in the Departments of Obstetrics & Gynecology and Pediatrics. He also serves as director of research for the International Institute for Restorative Reproductive Medicine (IIRRM), inaugural editor-in-chief of the Journal of Restorative Reproductive Medicine, and principal investigator of the clinical practice registry, Surveillance of Treatment and Outcomes in Restorative Reproductive Medicine (STORRM). Dr. Stanford’s research in reproductive epidemiology, fertility, and child health has been funded by the U.S. National Institutes of Health, the Centers for Disease Co ntrol, and the U.S. Office of Family Planning.

Among his many trailblazing contributions and collaborations, Dr. Stanford’s work set the stage more than a decade ago for the founding of the Reply clinic. It was during a year-long sabbatical at UNC Chapel Hill that discussions formulated the idea for an RRM-focused clinic in the Triangle, and Reply Ob/Gyn & Fertility opened following more than a year of intensive development among a team that included Dr. Stanford and an inter-disciplinary team from UNC. As part of that development Dr. Stanford was part of a team that visited Dr. Erik Odeblad in Umea, Sweden, to discuss Dr. Odeblad’s groundbreaking work into the function of the cervix and characteristics of cervical fluid.

Dr. Stanford also was part of the team who produced the landmark study of fertility awareness methods for avoiding pregnancy, “ Effectiveness of Fertility Awareness-Based Methods for Pregnancy Prevention: A Systematic Review. ” The study was notable for bringing together a group of scientific contributors from diverse organizations in support of creating well-researched information on the topic of natural fertility management.

Deborah Colloton, founder of the Women’s Reproductive Health Foundation , which is financially supporting the Stanford RRM Chair, praised Dr. Stanford for his “impeccable professionalism, his courage in blazing new medical trails, and his great empathy for patients facing fertility struggles.” Ms. Colloton, who also is a co-founder of the Reply clinic, expressed gratitude as well to the entire Stanford family: “Dr. and Mrs. Stanford are known for their devotion to family and community, as well as their love for the natural world. Naming the chair for the Stanfords sets the bar high for RRM and will serve as a great inspiration to others.”

The full University of Utah press release about the Stanford Presidential Chair can be accessed here .

New RRM Medical Journal Launches

Sat, 24 May 2025 15:26:11 GMT

New RRM Medical Journal Launches

A major milestone for restorative reproductive medicine has been achieved with the launch of the new medical journal, Journal of Restorative Reproductive Medicine (JRRM)

“ Our vision is that JRRM will disseminate and promote evidence-based information to support and restore human fertility and reproductive health, ” wrote editor-in-chief Dr. Joseph B. Stanford in a welcome commentary. The peer-reviewed, open-access journal is published by the International Institute for Restorative Reproductive Medicine (IIRRM) , and will provide the opportunity to expand and deepen the knowledge base for restorative reproductive medicine (RRM).

The IIRRM, founded in London, UK, in 2002, is the lead medical society for RRM with members representing 52 countries.In one of the first published JRRM commentaries, Dr. Jose Arraztoa from Clinica de los Andes in Santiago, Chile, provides a history and overview on infertility and RRM. He describes the foundational pillars of RRM care for infertility as: “a commitment to respecting healthy physiological processes, comprehensive health care for both the couple and the potential embryo, and the provision of education and continuous support throughout the therapeutic process.”

One of the more noteworthy points in Dr. Arraztoa’s commentary underscores how RRM differentiates itself from current conventional assessments for infertility: in summarizing the first published study on RRM outcomes for patients facing infertility [1] he reports that findings included “decreased estrogenic cervical mucus production, intermenstrual bleeding, luteal phase defects, and suboptimal estrogen and progesterone levels,” none of which had been previously considered in the patients assessed prior to their RRM care. This is consistent with the experience at Reply Fertility and other RRM clinics, where the use of fertility tracking provides a more precise understanding of female hormonal status and reproductive function, and where hormone levels are recommended to be balanced not merely “within range” but optimized for healthy conception and pregnancy.

The use of cycle tracking to record medically meaningful female biomarkers is a hallmark of RRM and sure to be a topic in future JRRM studies. IIRRM president Dr. Phil Boyle has remarked that “it is inconceivable that an RRM fertility clinic would assess and treat infertility without clinically-integrated tracking of the woman’s fertility cycle . Without this information, the clinical team and the patients are operating in the dark when it comes to assessment of female reproductive function.” Indeed, many patients and medical professionals now refer to cycle tracking as a female “vital sign” that can be used for assessment, treatment, and monitoring of female reproductive health, and many predict that not including such cycle tracking as part of female reproductive healthcare soon will come to be regarded as an omission on par with not checking blood pressure for someone with a heart condition.

Other contributions to JRRM include a Commentary on Surgery in Restorative Reproductive Medicine and an original research paper on Menstrual Cycle Heat Maps.

The editorial board of JRRM features medical experts from Australia, Canada, Chile, France, Germany, Ukraine, and the United States, and includes, in addition to Dr. Stanford , Reply medical director Dr. John Thorp and former Reply obstetrician-gynecologist Dr. Rachel Urrutia.

The Journal of Restorative Reproductive Medicine can be accessed at rrmjournal.org .

1. Stanford JB, Parnell TA, Boyle, PC. Outcomes from treatment of infertility with natural procreative technology in an Irish general practice. J Am Board Fam Med. 2008 Sep-Oct;2(5):375-84.

Response to Trump Executive Order on IVF

cplican@replyobgyn.com (Carolyn Plican) — Fri, 21 Feb 2025 18:31:05 GMT

Response to Trump Executive Order on IVF: Reply Fertility Urges Restorative Reproductive Medicine for Patients Facing Infertility

Durham, NC – President Donald J. Trump issued the executive order “Expanding Access to In Vitro Fertilization” on February 18, 2025. As a clinic that champions care for those facing infertility, Reply Fertility echoes President Trump’s call for attention to this growing problem, however we urge reconsideration of the President’s singular focus on in vitro fertilization (“IVF”) as the preferred solution.

Rather, there is a growing, compelling record that suggests couples are better served by the emerging medical discipline of restorative reproductive medicine (“RRM”). Whereas IVF is designed to circumvent underlying causes and contributors to infertility to try to force a pregnancy, RRM is designed to identify and treat the underlying factors so couples can conceive naturally and have a healthy pregnancy.

“Couples struggling with infertility deserve comprehensive evaluation, diagnosis, and restorative treatment to optimize their health and natural reproductive function,” says Reply Fertility founder Deborah Colloton, who herself suffered from infertility. “Patients are short-changed when they are raced into assisted reproductive technology such as IVF, which is not focused on restoring health and in fact can be detrimental to the health of moms and babies.”

RRM is emerging globally as a preferred new treatment solution. Compared to IVF, RRM is at least as effective and is:

less invasive
less expensive
much healthier for moms and babies

“By nearly every metric other than time to conceive, RRM outperforms IVF,” notes Colloton . “President Trump’s Executive Order runs contrary to the spirit of Make American Healthy Again (MAHA) and contrary to the spirit of the Department of Government Efficiency (DOGE). It is time to rethink how we address this challenge that is devastating for millions of couples in the U.S. and for tens of millions throughout the world, and we encourage a shift in attention and resources toward restorative reproductive medicine.”

Nowhere is the data for RRM more compelling than when it comes to preterm birth. Preterm birth can be traumatic for families and have a lasting impact on newborn babies; it is an issue of major national concern with the U.S. rate at 10.4% and an estimated average cost of $50,000+ per case, not including possible lifetime expenses. IVF nearly doubles the national preterm birth rate to 19.7%, which means the risk for preterm birth for patients using IVF is greater than for moms who smoke throughout pregnancy . In comparison, RRM care reduces the preterm birth rate to only 5.7%, representing a 71% reduction compared to IVF.

RRM is gaining traction globally and is represented by the medical professional organization, International Institute for Restorative Reproduction Medicine (IIRRM). IIRRM president, Phil Boyle, MD, reminds us, “This is about getting pregnant as healthily as you can, not as fast as you can.” The IIRRM launched a new medical journal on February 2, 2025 ( Journal of Restorative Reproductive Medicine ). Journal editor-in-chief Joseph B. Stanford, MD, who serves as Professor and Vice Chair for Research in the Department of Family and Preventive Medicine at the University of Utah School of Medicine, explains that RRM “is about understanding what the human body is designed to do, and when things aren’t healthy, how to get back to a normal, healthy physiology.” Dr. Stanford also serves as principal investigator for the international research registry, Surveillance of Outcomes for Restorative Reproductive Medicine ( STORRM ), in which Reply Fertility participates.

Proper evaluation of fertility challenges takes months as the issues often are multi-factor, chronic, and complex. There are dozens of possible factors that can be anatomical, metabolic, hormonal, autoimmune/inflammatory, infectious, ovulatory/gamete, or lifestyle related. The medical literature shows infertility typically is multi-factor with 4-6 factors that can be female, male, or both. At Reply Fertility, patients receive written diagnoses, personalized treatment recommendations, and continuing care to optimize their reproductive health. “Unexplained infertility” is virtually non-existent in the field of RRM.

“I am fighting now for others to receive the care I wish I’d known about earlier in my infertility journey,” says Colloton, whose two daughters were born when she was 39 and 40 after she discovered RRM and finally received proper treatment. “I was told I needed IVF to have children. This was untrue, and the evidence now demonstrates that couples should be offered the opportunity for RRM care to address their fertility struggles.”

###

About Reply Fertility

Reply Ob/Gyn & Fertility was founded in 2015 in the Triangle in North Carolina with a mission of developing the evidence base for RRM and increasing patient access to RRM. The clinic currently is scaling its fertility program, Reply Fertility, throughout all 50 states. For more information visit www.replyfertility.com.

THE RRM DIFFERENCE

Wed, 03 Jul 2024 00:30:35 GMT

The RRM Difference

Restorative Reproductive Medicine (RRM)

“After over a year of trying and a miscarriage, it just felt like there was no hope and no way out of this situation.

It seemed like there was no solution, that I would always be sick, and that we would never get to hold any of our

children in this life.”

I've had reproductive issues since my teenage years, and after 12 years of talking to doctors about it, nothing was ever really done. I met with a prominent reproductive endocrinologist before finding RRM, and I remember just feeling so hopeless after that conversation. I sat on my back porch, and I cried and I called a friend. They consoled me, and I remember sitting there and thinking, ‘One more doctor's appointment, I'll meet with one more doctor and then that's it, that's all I can do.’ That next meeting was with Reply, and it changed my life. Not only was I able to conceive and carry my daughter to term, but I had several major health issues which were discovered and treated. My quality of life and the quality of life of my husband have improved so drastically through this process. Working with a practitioner in restorative reproductive medicine was one of the single best things we've ever done for our health.

I had never heard of RRM before working with Reply. It was a shock because I had been a high school biology teacher and was pre-med at a prominent local university, but no one had ever talked about a method which uncovers the underlying diseases causing infertility. Working with Reply was amazing because for the first time I had practitioners I felt like I could trust. I had experienced very negative encounters with ob/gyns over the years—my symptoms had not been believed, and by this point I had really given up on the idea that anyone wanted to fix what was wrong with me or that anyone knew how. When Reply explained that my menstrual cycle was a vital sign and an indicator of my overall health, it was so clear and naturally scientific, I was shocked I had never heard that before. Having a health coach was super helpful because I needed the emotional support as well as the accountability to really make progress on overall healthy goals. I never felt abandoned with Reply, I never felt like I had been forgotten, and I knew they actually cared about my desire to become a mother. When I found out I was pregnant, it was incredible to call them and celebrate. They were some of the first people I sent baby photos to. Reply changed my life forever.”

-- Rose W.

THE CASE FOR RESTORATIVE REPRODUCTIVE MEDICINE

Tue, 30 Apr 2024 10:27:51 GMT

The Case for Restorative Reproductive Medicine

By Deborah Colloton

Two things struck me during reflections surrounding 2024 “National Infertility Awareness Week”:

1. The argument for restorative reproductive medicine (RRM) over in vitro fertilization (IVF) is so compelling. For couples for whom RRM is a fit (most couples experiencing infertility), it’s hard to see why RRM shouldn’t be considered the essential first step: RRM is less invasive, less expensive, and far healthier than IVF, and is at least as effective (compared to autologous IVF). Moreover, it carries none of the vexing ethical issues attached to IVF.

2. There is a surprising range of voices expressing concern about the patient experience and patient outcomes with IVF. The Economist recently characterized IVF as “grueling and costly” and “failing most women,” and numerous academic articles have warned against overuse of IVF and suggest we hew more closely to nature.

I reflect further on these issues in A New Solution for Infertility at Real Clear Science .

The Reply clinic for years has championed RRM, and advocated for more attention and more research for improved understanding and treatment of reproductive health problems. Exciting progress is being made with the establishment of the new international research registry, Surveillance of Treatment Outcomes for Restorative Reproductive Medicine (STORRM), a collaborative effort of the International Institute for Restorative Reproductive Medicine (IIRRM) and the University of Utah School of Medicine. Reply is a participant in the STORRM research, which currently is evaluating outcomes for couples facing infertility or recurrent miscarriage.

Advancement of RRM cannot happen soon enough. In the meantime, patients deserve greater awareness of options as they work to navigate what can be confusing and even devastating circumstances of facing a fertility challenge.

What is RRM and why have I never heard of it?

Thu, 24 Aug 2023 12:31:29 GMT

Why don’t more couples know about restorative reproductive medicine?

By Amanda Naramore, APRN

Most women have never heard the words Restorative Reproductive Medicine but many of the 13% of women struggling with infertility(1) do often ask themselves very important questions: Why hasn’t my doctor offered natural way to achieve pregnancy that cooperates with my reproductive system? or Why aren't my doctors working to explain my "unexplained infertility?" These are appropriate questions, but unfortunately they are not answered because most medical providers have never heard of RRM or fertility awareness charting.(2)

Restorative reproductive medicine is a growing practice that has helped countless women restore their reproductive health. The International Institute of Reproductive Medicine defines RRM as a “medical discipline that identifies and treats the root cause of reproductive problems, aiming to treat, optimize and restore the patient’s health"(4). Most medical schools offering OBGYN residency programs do not teach students about RRM or even introduce them to the possibility of its existence (2). As a graduate of a women’s health nurse practitioner program, I was never exposed to the notion of health restoration. The curriculum identified the female medical abnormalities and went directly to treatment with birth control or in the case of infertility, referral to artificial reproductive technology (ART). There were no natural alternatives to treatment discussed or suggested. In fact, infertility is often referred to as a disease state instead of a symptom of a bigger problem.

The lack of exposure a medical student or OB/GYN resident receives to RRM and fertility awareness charting will directly affect their ability to offer a positive alternative to ART. Providers simply do not know there is an entire medical community devoted to a unique fertility restoration approach. This knowledge deficit leaves many women frustrated with their options to improve their fertility and even suspicious of the medical community. Medical providers can also become discouraged. It seems like such a glaring inadequacy in medicine, yet the answer has been available for over 20 years.

Here at Reply, we utilize RRM not only to repair the couple’s overall health and optimize their fertility but also to teach them about the female’s reproductive system by utilizing fertility awareness charting. This practice is backed by years of medical research and evidence-based medicine. RRM has excellent success rates in achieving pregnancy, especially in cases where IVF has failed, and women were of advanced reproductive age.(3) Another reassuring fact is that the RRM success rates for pregnancy are comparable to ART, excluding the use of donor eggs.(4) Our Reply team is working to educate couples about a healthier and more natural alternative to ART. We feel this approach respects the couple, as it helps them optimize their health while trying to conceive a healthy pregnancy.

1. Datta, J., Palmer, M., Tanton, C., Gibson, L., Jones, K. G., Macdowall, W., Glasier, A., Sonnenberg, P., Field, N., Mercer, C. H., Johnson, A., & Wellings, K. (2016). Prevalence of infertility and help seeking among 15 000 women and men. Human Reproduction, 31(9), 2108–2118. https://doi.org/10.1093/humrep/dew123

2. Roberts, L.M., Kudesia, R., Zhao,H. et al. A cross-sectional survey of fertility knowledge in obstetrics and gynecology residents. Fertil Res and Pract 6, 22 (2020). https://doi.org/10.1186/s40738-020-00091-2 General FAQ – The Institute for Restorative Reproductive Medicine. (n.d.). https://iirrm.org/general-faq/

3. Stanford, J. B., Parnell, T. A., & Boyle, P. (2008). Outcomes from treatment of infertility with natural procreative technology in an Irish general practice. Journal of the American Board of Family Medicine, 21(5), 375–384. https://doi.org/10.3122/jabfm.2008.05.070239

4. Virtual Mentor. 2013;15(3):213-219. doi: 10.1001/virtualmentor.2013.15.3.stas1-1303.

PAMELA'S STORY

Tue, 22 Feb 2022 22:29:00 GMT

”Not until I found Reply, did I feel confident that I would ever have a child of my own.” Watch to learn how the Reply Fertility “Finding and Fixing” Program helped Pamela to address her PCOS, to conceive, and to have a happy and healthy pregnancy.

BREAST CANCER AND PREVENTION

Wed, 21 Oct 2020 22:54:11 GMT

In the case of breast cancer, there are some risk factors that cannot be changed such as your first period occurring before age 11, menopause arriving late, or the presence of particular genetic mutations. However, there are a number of breast cancer risk factors that you can control, many of which can be discussed at your preventative annual well-woman visit!

Research continues to highlight the importance of focusing on the following key lifestyle factors to support breast health and prevent cancer:

1. Engage in physical activity

In women of all ages, regular physical activity has been shown to reduce the risk of breast cancer. In general, it is recommended to get at least 150-300 minutes (about 20-40 min per day) of moderate physical activity or 75-150 minutes (about 10-20 min per day) of vigorous physical activity each week. Physical activity influences hormone and blood sugar regulation, weight, and inflammation – all factors that may contribute to cancer risk.

2. Avoid or stop smoking

Recent research suggests that women who have ever smoked in their lifetime are 14% more likely to develop breast cancer. Those who smoke during adolescence, or who smoke and have a family history of breast cancer, seem to be at a higher risk of breast cancer than others who smoke. It is encouraging that if one chooses to quit smoking, the risk for breast cancer does slowly reduce over time.

3. Consume a nutritious diet

Diets full of colorful fruits and vegetables seem to have a positive effect in reducing the risk for breast cancer. Specifically, foods rich in beta-carotene and other carotenoids (think orange or red foods like yams, cantaloupe, carrots, squash, tomato, pumpkin, peaches, etc.) help to lower the risk of breast cancer. A good practice is to shop heavily in the fresh food section, and carve out a time to meal prep for the week ahead. This helps to have nutritious foods ready for the days when there isn’t much time for preparing nutrient-dense produce!

4. Maintain a healthy weight

Weight gain in adulthood is linked to an increased risk of breast cancer both before and after menopause. Though the relationship between weight gain, obesity, and breast cancer is not well understood, maintaining a healthy weight for your age and height through activity and quality nutrition is an important aspect of reducing breast cancer risk.

5. Use hormones with caution

Conflicting evidence exists regarding the risk of different forms of hormonal birth control and their role in breast cancer risk. However, studies consistently show that oral contraceptives (the pill) are linked with a slightly increased risk of breast cancer compared to no use of oral contraceptives. This risk seems to return to baseline about 10 years after discontinuing the pills. There is also a risk associated with certain hormone therapies after menopause. This is associated with the type of hormones used, the timing of hormone therapy initiation, and the length of time they are used for. It is important to talk with your healthcare provider about your hormonal medications and the risks that may be associated with them.

6. Limit alcohol consumption

Any alcohol consumption is linked with increased risk of breast cancer. However, research shows that women who consume one drink a day or less have a much smaller risk. Specifically, women who consume ≤1 alcoholic beverage daily have a 20% lower risk for breast cancer than those who have 2-3 drinks a day or more.

7. Attend your annual well-woman visit

The annual well-woman visit is a good time to discuss family history and other personal factors that play a role in your risk for breast cancer. You and your provider can plan appropriate screening strategies at the right time for you. You will also learn breast self-awareness, how to notice changes that could occur in your breasts and when you should report them to your provider. Beginning at age 21, it is recommended to consider a clinical breast exam at your well-woman visit. During this exam, the provider assesses the skin, breast tissue, lymph nodes, and any other concerns you may see or feel on your breasts.

8. Schedule regular mammograms

In women with an average risk of breast cancer , annual or every other year screening mammography is recommended to begin between the ages of 40-50. Talk with your provider at your well-woman visit to decide when you should begin screening mammograms. For some women with an increased risk of breast cancer based on genetic factors, screening mammograms or other imaging may begin earlier in life.

Remember, when protecting your health, it pays to follow the well-known advice: “an ounce of prevention is worth a pound of cure!”

Author Bio:

Samantha Ratcliffe is a board-certified nurse midwife at Reply Ob/Gyn & Fertility. She earned her Master of Science in Women’s Health and Nurse Midwifery from Georgetown University.

REFERENCES

American Cancer Society. 2020. Lifestyle-related Beast Cancer Risk Factors. [online]. Available at: https://www.cancer.org/cancer/breast-cancer/risk-and-prevention/lifestyle-related-breast-cancer-risk-factors.html

National Cancer Institute. 2018. Menopausal Hormone Therapy and Cancer. [online} National Institute of Health. Available at: https://www.cancer.gov/about-cancer/causes-prevention/risk/hormones/mht-fact-sheet#:~:text=Menopausal%20hormone%20therapy%20(MHT)%E2%80%94,of%20the%20natural%20hormones%20estrogen

LOOKING FOR PREGNANCY CARE?

Fri, 07 Aug 2020 18:40:58 GMT

How To Pick An Ob/gyn When You're Pregnant

Congratulations, you’re pregnant! What’s next?

It’s time to find a pregnancy care team who can provide the range of specialized services you need for yourself and your growing baby. You may be wondering how to choose an ob/gyn, or whether to consider a midwife. During this life-changing time, it’s important to find a provider who is the right fit for your prenatal care, labor & delivery, and any other services you may need to help ensure a healthy pregnancy and birth.

Here are 10 important things you may wish to consider when choosing an obstetrician or choosing a midwife at this exciting time in your life:

Check provider credentials
Think about your comfort level with the providers and staff. Is it a good fit?
Learn about the support team
Explore all the services offered
Consider CenteringPregnancy®
Take advantage of community and resources
Read patient reviews
Check insurance
Become familiar with practice and hospital locations
Know your rights

Reply offers new patient appointments for women at any stage of their pregnancy. If you have questions or would like to schedule an appointment, please contact us!

1. Check provider credentials

If you’re new to an area, or not yet established with a regular physician, you might be wondering how to find an obgyn, or how to find the right obgyn during pregnancy. Whether you’re looking for an obstetrician, a nurse midwife, or a team with both, a good place to start is with a provider’s credentials (their education and training information), which you should be able to find in an on-line bio. This information should include whether the provider is board-certified. Physicians and midwives have similar approaches to care; they also have unique differences. You can learn more about nurse midwives at our recent post Midwifery 101. Nurse midwives typically are able to spend more time with women during labor and provide statistically fewer interventions such as episiotomies, with equally good outcomes for moms and babies.

2. Think about your comfort level with the providers and staff

Once you have found an obstetrician or midwife who appears to be a good fit on paper, make an appointment to get to know them. You can always switch if you’re not comfortable for any reason. Some questions to think about:

Communication: were you comfortable asking questions and were you satisfied with the responses? Did you feel listened to?
Trust: did you feel good about trusting this team with your care?
Experience: does this provider/clinic have the experience and expertise you need?
Coverage: who will be providing your prenatal care and who may be present for your birth?
Your Labor & Delivery plan: do you feel like everyone is on the same page in developing your plans for labor & delivery?

3. Learn about the support team

From ultrasound technologists and health coaches, to doulas and lactation consultants, there are villages of support to help you along your pregnancy journey. Your provider can give you more information about which resources might be important for you throughout pregnancy and postpartum. At Reply, we are pleased to offer in-house ultrasonography, fertility education, health coaching, lactation support, and more, all in our Cary location. Visit our clinic team here.

4. Investigate services offered

It’s important to find a practice with services that match your needs. For example, the Reply clinic provides care for low-risk and most high-risk pregnancies, including for women seeking TOLAC/VBAC (“Trial of Labor after Cesarean”/”Vaginal Birth after Cesarean”), and our team includes a maternal-fetal medicine physician. In addition, Reply offers CenteringPregnancy, an evidence-based program of group prenatal care that offers extensive support and produces improved outcomes. Reply also specializes in advising women how to avoid pregnancy naturally, including use of LAM (“Lactational Amenorrhea Method”) or other fertility awareness-based methods (FABMs) following birth. Reply does not provide tubal ligations or contraception, as these services are not in keeping with our cooperative approach.

5. Consider CenteringPregnancy® (really!)

At Reply, we offer both traditional 1-on-1 prenatal care as well as CenteringPregnancy, an innovative, evidence-based program of prenatal care developed by the Centering Healthcare Institute in Boston. Centering consists of group prenatal care, where pregnant women are teamed with ~6-10 other patients of about the same gestational stage, and they learn together in sessions that run about two hours as an alternative to the much shorter private provider appointments. Each participant still has a private medical check at each session, but the group meeting allows for more access to your medical team, and fosters an environment of learning and support. Research has shown that women and babies have better outcomes with Centering, and patients report high levels of satisfaction with the program. Learn more about Reply’s Centering program here.

Note: at this time due to the coronavirus pandemic, we are working to maintain Centering groups via virtual gatherings through telehealth; feel free to ask our team for updates to this popular program.

6. Take advantage of community and resources

Friends and family often are a wealth of information, especially for first-time parents. There’s also a multitude of supportive resources, both free and for-cost, offered through clinics, hospitals, and independent consultants. These resources can be invaluable not only for the information provided, but also can serve as an introduction to other soon-to-be parents! Check out our list of Classes & Events, with everything from hospital tours and breastfeeding classes to Daddy Boot Camp!

7. Read patient reviews

Testimonials from past and current patients are another way to gain insight. Look for patient stories that mention situations like your own or factors that are important to you. Review both on-site and off-site patient testimonials–those listed on the provider’s website itself as well as those posted as reviews on Google, Facebook, or other sources.

At Reply, we promote patient education and encourage patients to be active participants in their care. Here are some examples of how we’ve helped with some unique patient situations, including during pregnancy.

“I went to a doctor who didn’t understand the philosophy behind Natural Family Planning. After [my] miscarriage, I felt like I needed to see somebody who was on the same page and who could speak the same language I was speaking … A friend told me about Reply and I made an appointment with Dr. Rachel Urrutia. I feel like I was meant to see her. She was perfect.” –Rachel R.

8. Check insurance

It’s important to understand your health plan benefits, and generally is recommended to choose a provider in-network to receive affordable care. You’ll want to understand what costs are covered and which costs you will be responsible for. If you don’t have insurance or are choosing to pay privately for any reason, you may want to inquire about payment plans.

Information about which insurance is accepted is usually available on clinic websites; Reply’s accepted insurance plans can be found here and our billing director can answer any questions about costs of services.

9. Become familiar with practice and hospital locations

You might have a strong preference to give birth at a certain hospital—if so, you can check to see which ob/gyn practices deliver there. Or you might do the reverse and find a provider/practice you like, and then have your baby at the hospital they are affiliated with. Either way is fine. Ideally you will not have a long commute, but you may also decide it’s worth a short drive to get what you’re looking for. In addition, some visits can be covered by telehealth, especially during the coronavirus pandemic, eliminating much travel time!

10. Know your rights

Don’t ever forget that you, the patient, are the customer. You deserve competent and respectful care, and you have privacy rights, the right to informed consent, and rights to your own medical records. You may always change your mind about a provider or practice, and arrange to transfer your care elsewhere.

Author Bio:

Samantha Ratcliffe is a board-certified nurse midwife at Reply Ob/Gyn & Fertility. She earned her Master of Science in Women’s Health and Nurse Midwifery from Georgetown University, and completed her residency with AYA Healthcare in San Diego, CA, where she gained experience in labor and delivery as well as high-risk antepartum and intrapartum units. She is passionate about international outreach and has worked to provide gynecologic services to women in several locations including Cuzco, Peru. Mrs. Ratcliffe holds certifications in ALCS, BLS, NRP (Neonatal Resuscitation Program), and Advanced Fetal Monitoring, and is also a licensed fertility educator and breastfeeding counselor.

MEN'S HEALTH AND FERTILITY

Wed, 10 Jun 2020 19:28:35 GMT

1. Are there signs or symptoms of male infertility?

Unfortunately, there is no routine way to monitor male fertility similar to how we can with cycle charting for women. That being said, we can monitor for signs of low testosterone such as low libido, hair loss, fatigue, and increased body fat, especially around the midsection. Erectile dysfunction, premature ejaculation, or pain with intercourse would be other reasons to seek care as these may be related both to health and fertility concerns.

2. Are there different kinds of male factor fertility problems?

There are similar categories of male fertility issues as there are for female fertility, including hormonal abnormalities, anatomic abnormalities, genetic abnormalities and unexplained infertility.

3. What kind of tests look at male fertility?

All men who are part of a couple experiencing subfertility/infertility should complete a full health screening with a healthcare professional and have a semen analysis ordered. The semen analysis will report on sperm count, motility (movement) and morphology (shape). If any of these are abnormal, or if a physical exam or health history suggests a concern, this patient should be seen by a urologist. Ideally, this in-depth investigation should be with a urologist who has additional fellowship training in male fertility (known as a reproductive urologist). Additional testing may be considered depending on the nature of any problems. For example, not all men need hormone testing, but those who have abnormal semen parameters and signs of low testosterone will likely have blood tests ordered. Other men may need a testicular ultrasound or biopsy.

4. How do I know when to have a semen analysis ordered?

For all couples who are undergoing a fertility evaluation and having difficulty conceiving for six cycles or longer, the male partner should have a semen analysis.

We recommend considering repeating a normal semen analysis every year while undergoing fertility treatment, as results can change. For mildly abnormal semen analyses, we recommend repeating these in 3-6 months to confirm if there was a true, consistent abnormality.

5. If my semen analysis is abnormal, how often should we be having intercourse to try to conceive?

As frequently as every day during the window of peak quality cervical fluid. There is a popular myth that daily intercourse should not be recommended for men with impaired fertility. This has never been proven. In fact, in all the studies we have of intercourse, more frequent (e.g. daily) intercourse is just as likely, if not more likely, to lead to conception.

6. Does male fertility begin declining at a certain age?

Yes, we know a bit less about this, but fertility rate does appear to decline in men in their 30s and 40s, though at a slower rate than for women. Men typically remain potentially fertile their entire lifetime, unlike women, even though their actual fertility declines. At the same time, the rates of erectile dysfunction and the frequency of intercourse also decline. Finally, the risk of chromosome problems for pregnancies conceived as fathers age also rises.

7. Are there things in my lifestyle to consider for fertility health?

We would recommend avoiding heat exposure like saunas and hot tubs, and avoiding prolonged bike riding and tight-fitting pants. We would recommend avoiding any use of marijuana or tobacco. Moderate alcohol consumption is generally considered safe. Avoiding environmental toxins like hormone-disrupting chemicals also is a good idea. As far as weight goes, the worst weight for fertility is belly fat, so trying to keep your waist as trim as possible is a good thing. Heavy body building and use of body-building supplements may affect testosterone levels and sperm counts; these should be avoided if you are having difficulty conceiving.

8. Are there things that we can do together as a couple to improve our health, wellness, and fertility?

Improving communication and caring for one another can be very important. Consider taking a course together with Organic Conceptions, which helps with relationship building. Learn to identify your female partner’s most fertile times so that you can try to plan intercourse accordingly if you are trying to get pregnant. Improving dietary choices is also something couples can do together to benefit health and wellness, and that can have an impact on fertility as well. For example, men’s testes are an important producer of omega-3 fatty acids and omega-3s are essential for many bodily functions including sperm production. Research from Dr. Jorge Chavarro and his team at Harvard’s School of Public Health suggests that men who eat more good polyunsaturated fats from fish, seafood, and nuts have higher sperm counts then men who eat more trans fats from items like store-bought cookies, crackers, cakes, fast food, coffee creamers, vegetable shortening and margarine.

Here are a few quick ideas for working more omega-3s and healthy snacks into your diet.

Need a quick lesson on cooking fish? Check out this pan-seared trout video.
Try this healthy Lemon Garlic Salmon from The Stay at Home Chef, easy enough for weeknights!
For more recipes (Peri Peri Shrimp, yum!) and information on fish, seafood and fertility check out this blog article.
20-minute DIY Spiced Nuts

2 1/2 T (total) mixed spices (can be anything you like – cinnamon, turmeric, ginger, cayenne, cumin, garlic powder, pepper, etc.)

2 T Olive Oil

2 C Mixed Nuts – walnuts, cashews, almonds, pistachios, hazelnuts, pecans, etc. (again choose what you like!)

Preheat oven to 325 degrees F.
Line a small baking sheet with parchment paper or a silicone mat.
Combine all your spices in a bowl that will hold the nuts too. Add the oil. Mix until combined.
Dump the nuts into the bowl. Stir until they are evenly coated then spread evenly on the prepared baking sheet in a single layer.
Bake nuts for 12-15 minutes, stirring halfway through.
Remove from oven. Stir once more then let them cool for about an hour.
Store in an airtight container.

Reply is welcoming new patients for fertility evaluation and we offer health coaching to help with lifestyle factors. To schedule an appointment, please call us at 919.230.2100 or visit our Become a Patient page .

MIGRAINES & PREGNANCY

Tue, 09 Jun 2020 20:38:02 GMT

For women who experience chronic or acute migraine, changes associated with pregnancy and postpartum can present new challenges to a difficult diagnosis. Variations in sleep, infant behavior such as crying or feeding schedules, and maternal hormone fluctuations can feel like unavoidable migraine triggers. For migraineurs, facing the thought of migraine headache without a plan can be scary. Let’s parse through fact and fiction about migraines and childbearing to determine how to prepare well for conception, pregnancy, and postpartum in a healthy and confident way.

The Facts

Roughly one in four women will suffer from a migraine attack during her lifetime. Most women will experience their first migraine before a pregnancy, although for some this will occur during a pregnancy. In general, there are two main migraine triggers to prepare for in pregnancy and postpartum: 1) sensitizing lifestyle factors (e.g. pregnancy symptoms and lifestyle changes with a newborn) and 2) hormonal shifts.

The good news is that 80-85% of women who suffer from migraines will experience some or total relief during pregnancy. Many women are able to comfortably discontinue previous migraine medications during pregnancy and postpartum. However, there are some things to be aware of. Some women who have migraine with aura notice the same frequency or severity in pregnancy. For others, common first trimester symptoms might trigger migraines:

Nausea, vomiting (leading to dehydration)
Appetite changes, food aversions (leading to skipping meals or change in nutrition)
Fatigue
Rapid changes in circulating hormones, particularly estrogen
Nighttime awakenings due to increased urinary frequency

Most of these symptoms can be well-managed with lifestyle changes or therapies that are safe in pregnancy. With the transition to second and third trimester, estrogen levels stabilize in the body, early pregnancy symptoms often resolve, and migraine attacks generally reduce greatly.

Migraines with and without aura can both be associated with changing levels of estrogen. So the postpartum period is the next moment of susceptibility to migraine headaches. Some women experience this within the first week postpartum, with the prominent shift in hormones following labor and birth. Others don’t experience a shift that triggers migraine unless they discontinue breastfeeding or until regular periods return. However, some migraine medications and other therapies that weren’t safe in pregnancy can safely be resumed during postpartum and breastfeeding, which can help to alleviate returning migraine attacks.

Planning Before Pregnancy

While all migraine sufferers know that lifestyle factors such as nutrition, exercise, sleep, and stress play a role in migraines, many also rely on medication or other therapies to reduce the frequency and severity of migraine attacks. The two most common types of medications are preventive therapy medications and acute therapy medications. It is important to review all migraine medications with a healthcare professional prior to pregnancy. For instance, some of the preventive medications like topiramate and valproate are considered dangerous to a growing baby, even in the earliest days.

Once you’ve identified the medications to discontinue or to change, take some time to become aware of migraine triggers if you haven’t already. This will help you to know how to optimize your lifestyle and to have the most control over preventing migraines in your daily life. Consider working with a health coach to plan for physical activity, eliminate triggers you have found in your food and drink, and to implement other supportive daily choices for your nutrition, sleep, stress-management, and mood.

I’m Pregnant And I’m Still Having Migraines

The majority of women find that migraine intensity and frequency decrease during the second and third trimesters of pregnancy. Women who suffer from migraine have a higher tendency to experience a migraine attack in the week or so prior to their period when estrogen levels drop. So the thought is that this is due to the relatively high and stable level of circulating estrogen in the woman’s body in mid to late pregnancy, the body is less susceptible to migraine attack.

If migraine attacks are still occurring, or they are not responding to your treatment plan, talk with your healthcare professional. There are some options for acute therapies and preventive therapies that are safe in pregnancy. Additionally, your healthcare professional may discuss other options like supplements or complementary therapies.

Don’t Forget Postpartum

Whether or not a woman is breastfeeding, migraine attacks may reappear as early as the first week postpartum or when the menstrual period returns. Though not all reasons are known, both are often attributed to the shift in estrogen. Other postpartum changes that may result in sensitization and affect a woman’s migraine attacks include interruptions in sleep, stress changes, mood or anxiety disorders, skipped meals or change in diet, and any other personal factors that have been found to contribute to migraine. Anecdotally, some women report that postpartum migraines feel worse. It is unknown if this is due to the severity of the migraine, or due to the inability of being able to rest and recover as one usually would. Either way, it is important to find a way to approach migraine attack and find relief for the postpartum woman.

There are many safe migraine medications that you can take during breastfeeding, and other available alternative therapies as well. One resource to explore medications in pregnancy and postpartum is MothertoBaby. Additionally, plan for “baby breaks.” This is a common recommendation to prevent postpartum depression and anxiety, and it can also help prevent migraine. Occasional breaks of 1-2 hours to nap or exercise reduce triggers that may elicit migraine attack. Having a family member or friend “on-call” for at-home support will also allow you to take time to lie down in a dark room to begin recovery when migraine does occur.

Headache Warning Signs

One of the challenges of the headache in pregnancy and postpartum is to define if the headache is a migraine attack, or if it is caused by something else. There are two different kinds of migraine disorders:

Primary Headache Disorders: usually referring to migraine or tension headaches. Will often feel the same during pregnancy or postpartum as they usually do; not associated with new symptoms simply because of pregnancy.
Secondary Headache Disorders: Pregnant and newly postpartum women are at higher risk for various healthcare concerns that include headache as a symptom including preeclampsia or eclampsia, venous thromboembolism (VTE), stroke. Other symptoms may accompany secondary headache disorders

If you experience any of the following symptoms along with a headache, please seek medical attention: the worst headache of your life, accompanied by a stiff neck, fever, severe, lasting >24 hrs, doesn’t get better with medicine.

Questions About Migraine And Pregnancy?

Our Reply clinicians are here for you. Schedule a preconception or new pregnancy appointment with one of our physicians or nurse midwives online or by calling our office at 919-230-2100. If you have specific questions about migraines you may also click here to securely submit your question to our provider team. We will continue to answer them across our social media channels and here on our website.

Resources

https://www.uptodate.com/contents/pathophysiology-clinical-manifestations-and-diagnosis-of-migraine-in-adults

https://americanmigrainefoundation.org/

MIGRAINES

Sun, 07 Jun 2020 22:01:01 GMT

Migraine Headaches

Migraine headaches are a leading cause of disability worldwide, experienced by up to 12% of people in the United States. Many people inherit migraines due to genetics; in fact, 90% of those with migraine have family members who also suffer from this disorder. So, what is a migraine, and how does it differ from other common types of headaches?

What Makes A Migraine Different?

Migraine headaches often last 4-72 hours and are described as moderate to severe throbbing or pulsing pain on one side of the head. These headaches may not respond as easily to common over-the-counter medications like acetaminophen or ibuprofen, and many people with migraine find relief by lying down in a dark, quiet room Symptoms of a migraine include:

sensitivity to light, sound, smells
nausea and/or vomiting
pain worsens with exercise or physical activity
migraine interferes with work, school, or home life

One in four migraine sufferers experiences migraine with aura, which is a change in vision, hearing, speech, feeling, or movement before or during the headache. Many migraine attacks also can be associated with allodynia, the feeling of pain from something that is not usually painful like brushing their hair. Migraine attacks can be an emotional experience. If you’ve experienced two or more of the symptoms above during headaches, talk with your healthcare professional about whether you may be experiencing migraine headaches.

Common Migraine Triggers

The majority of migraine sufferers identify specific triggers of migraine attacks. The most common triggers include emotional stress, hormonal fluctuations (in women), skipping meals, alcohol consumption, sleep changes or disturbances, strong odors, weather changes, and specific foods.

In one study, 65% of female participants identified menstrual cycle or hormonal changes associated with puberty, pregnancy, postpartum, or menopause as a migraine trigger.1 This is significant since 80-85% of people who suffer from migraines are women. While hormone changes may seem like an “uncontrollable” trigger, this is actually a very helpful piece of information to share with your healthcare professional. This is true especially if you are noticing irregular patterns in your menstrual cycles, planning to become pregnant, or approaching menopause. Recording specific migraine triggers will help create the most appropriate plan for you, including lifestyle changes and therapies that work for your migraine type and frequency.

How Can I Tell If A Headache Is Not A Migraine?

The most commonly distinguishing factors between migraines and other types of headaches, like cluster headaches or tension headaches, are:

other headaches tend to improve with some level of activity
other headaches may more often be bilateral, not as commonly throbbing
other headaches are less associated with nausea/vomiting, sensitivity to light or sound

If you are unsure about what kind of headache you are experiencing, or if you are experiencing new headache symptoms, schedule an appointment to review your symptoms.

How Are Migraine Headaches Treated?

Migraine headaches may be treated in a number of ways. It is important to find therapies that work well with a person’s life and reduce both the frequency and severity of migraine attacks. Some therapies are listed below.

Lifestyle changes : Lifestyle changes may not eliminate migraines completely, but instead prevent more frequent attacks. Health coaching is a great way to implement these changes. Things to consider: hydration, sleep, caffeine intake, personal food triggers, daily or chronic stress, exercise, and mood and mental health. Consider keeping a diary of personal migraine triggers. Examples of triggers may include drinking red wine, smelling certain perfumes, or looking at car headlights at night.

Preventive medication therapy : Some medications are taken or administered to prevent migraines from occurring. Many preventive medications are off-label, meaning they are indicated for other disorders such as seizure or depression, but are found to be effective for migraine. These can take a few weeks to become effective in preventing migraine frequency.

Acute medication therapy: Some medications work to stop the migraine in its tracks. There are many classes of acute medications. Well-known medications include over-the-counter-medications like acetaminophen or ibuprofen, and the many different triptans.

Supplementation : There is some evidence that daily supplementation with magnesium oxide can help prevent migraine headaches. Additionally, recent evidence shows that daily supplementation with riboflavin (vitamin B2) can also be helpful for preventing migraines. Of note, high dosing of riboflavin is not considered safe while breastfeeding.

Complementary therapies : There is growing data that other complementary therapies help to prevent migraine attacks, though not all are safe in pregnancy and breastfeeding. Some of these therapies include Botox injections, acupuncture, and routine massage therapy.

Are Migraine Medications Safe During Pregnancy Or If I Am Trying To Conceive?

About 80-85% of women experience improvement in migraine frequency and severity during pregnancy. However, some women continue to experience migraines during pregnancy. Some migraine medications are not safe if you are trying to get pregnant. These include topiramate, valproate, and the newer antibody therapies, among others. If you are taking a preventive medication or other migraine medication, discuss this with your healthcare professional before getting pregnant. Click here to learn more about migraines in pregnancy.

Migraines And Menstruation

Not every woman who experiences migraine will experience menstrual-related migraines. Some women are more prone to migraine in the few days leading up to their period, or in the few days following when the period begins. Menstrual-related migraines are thought to be due to fluctuating levels of estrogen in the body. They may or not be accompanied by aura, which is defined as visual, hearing, speech, feeling, or movement changes associated with migraine headache.

A great way to plan ahead for menstrual migraines is to begin cycle charting with a fertility awareness based method.Some women find this helpful because they can begin preventive medications during the luteal phase (phase following ovulation) and stop these medications a few days after their period starts.

There is growing evidence that nutrition may also contribute to a woman’s experience of menstrual migraine. If menstrual migraines are associated with constipation, diarrhea, or a diagnosis of IBS, consider keeping a food diary and working with a nutritionist to work on ways to promote better overall health.

Migraines And Menopause

1. The average age of menopause, defined as one full year without a menstrual period, in the United States is 51 years old. The average age that migraine attacks discontinue in migraine sufferers is 50! Coincidence? Likely not. Around the age of menopause, women experience both hormone and lifestyle changes that may play a role in the reduction or cessation of migraine headaches. However, some women do experience an increase in migraines in the time period just before menopause known as perimenopause. Here’s what you need to know:

2. The severity of hot flashes, flushes, and night sweats in menopause may predict migraine severity in menopause. Hormone therapy (previously known as hormone replacement therapy) for perimenopausal symptoms may be considered, even in women with migraine! It is a myth that women who experience migraine cannot consider hormone therapy.

3. Similarly to during puberty, perimenopause may mark a period of irregular menstrual cycles and increased premenstrual syndrome symptoms. If a woman experiences menstrual migraine, perimenopause can make migraine attacks challenging to predict.

4. Cycle charting can help target migraine therapies during this period of time.

5. Lifestyle factors are always an important element of managing migraine, no matter age and stage of life.

If you experience the first migraine of your life after 50 years old, it is important to schedule an appointment with your physician or other healthcare professional! This is not common and may warrant further investigation.

Final Note

There are some red flags associated with headaches for every person to be aware of. Some of these include experiencing the “worst headache of your life,” changing symptoms or patterns of your headache, headaches no longer responding to your treatment or medication, or new or severe headaches in pregnancy. At Reply, we are available to discuss your questions and concerns. Schedule an appointment with us online or call us at 919-230-2100 to connect with one of our physicians or nurse midwives.

Do you have specific questions about migraines? Click here to securely submit your question to our provider team. We will continue to answer them across our social media channels and here on our website.

Resources

The Triggers or Precipitants of Acute Migraine Attack, L. Kelman https://pubmed.ncbi.nlm.nih.gov/17403039/?from_single_result=17403039&show_create_notification_links=False

UpToDate https://www.uptodate.com/contents/pathophysiology-clinical-manifestations-and-diagnosis-of-migraine-in-adults

American Migraine Foundation https://americanmigrainefoundation.org/

Move Against Migraine: A Podcast by the American Migraine Foundation, Dr. Larry Newman

THE FIRST POSTPARTUM PERIOD

Tue, 19 May 2020 22:37:56 GMT

When Does The First Postpartum Period Usually Return?

The first postpartum period can be elusive – and this is sometimes puzzling for women after having a baby. The first postpartum period, called return to menses, is largely determined by infant feeding. Women who exclusively breastfeed or who breastfeed and pump generally find that menses usually returns no earlier than 6-8 months after the birth of the baby.

For these women, daytime windows between feeding or pumping are usually no longer than 4 hours, and nighttime windows are usually no longer than 6 hours. For women who are exclusively pumping, have encountered periods of breastfeeding interruption, or are formula supplementing or fully formula feeding, menses may return much earlier. The average time to first menses for women who do not breastfeed is 42-45 days.

My Bleeding Stopped After Birth, But Now I Have Noticed Some New Bleeding, Is It My Period?

We are looking at a range of 6 weeks to 6 months (or beyond) for a return to menses after birth. How can you tell if the bleeding you are experiencing at 3 weeks or 3 months is a period? Let’s review some postpartum bleeding basics and a few tips for period vs. other bleeding comparisons.

Postpartum Bleeding Basics

Immediately after a baby is born either by vaginal or c-section birth, bright red (sometimes dark red) bleeding immediately follows. This is called lochia. Lochia may continue for up to 6 weeks, but it changes in character rapidly. The bright red bleeding usually begins tapering down by the end of week one, and is sometimes accompanied by occasional small clots. Lochia begins to lessen after the first 1-2 weeks. The color lightens from bright red to rustier red to pink. Eventually it will change brown/tan spotting, then yellow-white discharge. The flow decreases from moderate or heavy in the first week (I.e. needing a maxi-pad) to light (regular pads) to spotting (only needing liners). Other normal changes women may notice in postpartum bleeding patterns may include:

a feeling of a small “gush” after sitting or laying for long periods of time, this shouldn’t persist once standing up for awhile.
possible increase in bleeding flow on day 6-14 when the placenta “scab” is shed. This shouldn’t last more than 1-2 hours.
another normal variant is noticing increases in bleeding when doing too much activity, and noticing that the bleeding decreases with rest.

Experiencing bleeding after lochia has ended can be surprising – especially when not expecting a period yet! Let’s review some of the tell-tale signs of a period vs. other postpartum bleeding:

First Postpartum Period

Most likely 6 weeks postpartum or beyond
Bright red to dark red
Crescendo/decrescendo (increases then decreases) or decrescendo (starts heavy, then decreases) bleeding
Accompanied by cramping or other period symptoms
Proceeded by symptoms you usually experience before a period like mild back pain, mood changes, increased breast tenderness, mild PMS symptoms
May be heavier and last longer than menses you had before having a baby
Preceded by fertile signs ~6-14 days prior such as increase in peak type cervical fluid
Some women feel ovulation pain (mittleschmerz) more acutely after having a baby. It is not known why this happens. From what we know, about 1/3 of women will ovulate prior to their first postpartum menses.

Other bleeding

Occurs within first 6 weeks postpartum
Dripping or spotting for days in a row or on and off
Light spotting that is only pink or brown and goes away
Only occurs with exertion
Accompanies urinary symptoms such as irritation or pain with urination
Bleeding within first 6-12 weeks postpartum associated with tender abdomen, fever, chills, malaise
Return of bleeding after lochia has ended among exclusively breastfeeding women within first 6-8 weeks.

What Are Other Causes Of Postpartum Bleeding?

One of the most obvious causes of postpartum bleeding is that the body hasn’t recovered fully from birth yet. This is usually noticed as bleeding with increase in activity in the first 6 weeks. However, some women experience what is known as late postpartum hemorrhage, read more about this below.

Other causes of bleeding or spotting in the postpartum phase may include urinary tract infection, thyroid abnormalities, infection or inflammation of the uterine lining, or a piece of the placenta or amniotic fluid sac that hasn’t yet come out. If you notice bleeding that doesn’t seem to be your period, contact your doctor or nurse midwife to discuss this further.

When To Seek Emergency Attention

5% of women experience what is known as a postpartum hemorrhage, and this can happen at birth up until 12 weeks postpartum. Here are the signs to watch for, and if you are experiencing these, seek medical attention right away:

Bleeding that soaks through 1 pad an hour and is not slowing down
Blood clots bigger than a golf ball
Feeling faint, dizzy, chills, sweaty, nauseous with bleeding
Bright red bleeding persisting at or beyond week 1 of delivery

Special Note For Fabm Charters

If you’re charting with a FABM and you haven’t charted postpartum before, it’s important to know that your first 3-4 cycles postpartum may not resemble your other cycles before having a baby. The luteal phase will often be shorter, and extend back to your normal length with each subsequent cycle. You may notice that periods are different too, either in flow amount or length. If this persists beyond 3-4 cycles, contact your Reply fertility educator or clinician through your patient portal or call to schedule an appointment at 919-230-2100.

References

https://www.aafp.org/afp/2007/0315/p875.html
https://www.webmd.com/women/vaginal-bleeding-after-birth-when-to-call-doctor
https://www.whattoexpect.com/pregnancy/symptoms-and-solutions/postpartum-bleeding.aspx

WHAT DOES A DOULA DO?

Tue, 19 May 2020 22:18:08 GMT

What Does A Doula Do?

Donna Zubrod, is a Certified Doula, Fertility Educator at Reply, and a multi-faceted health professional committed to educating and empowering women at all stages of life.

“What does a doula do?” is a commonly asked question. Read more to learn what doulas do and don’t do, the benefits of working with a doula as supported by evidence-based research, where you can get additional information about doulas, how to find a doula that meets your needs, and how to work with a doula given the current COVID-19 restrictions.

What Is A Doula?

The word Doula originates from ancient Greek and means “someone who serves.” A birth doula is a companion who supports a birthing person and couple during pregnancy, labor, and birth. Doulas are trained to provide continuous, one-on-one care, as well as evidence-based information, physical support, and emotional support to birthing persons and their partners. There are also postpartum doulas who are trained in assisting families during the immediate months after birth, known as the 4th trimester.

What Do Birth Doulas Do?

A birth doula nurtures and supports a birthing person and their partner throughout labor and birth, providing continuous labor support to the birthing person, no matter what decisions they make or how they give birth. A birth doula’s role and agenda are tied solely to the birthing person’s agenda, and their responsibility is to the birthing person—not to a hospital administrator, nurse, midwife, or physician.

It is worth noting that many doulas provide support during pregnancy to help the birthing couple prepare for their birthing time. Additional services vary and are delivered in a variety of ways depending on the training of each birth doula. For example, some doulas may offer childbirth education, prenatal massage and bodywork, or relaxation therapy. Pregnancy is an important time for the birthing couple to build connection with the person who will be supporting you at your birthing time. Through that process you are able to review additional services that some doulas provide in addition to labor support and determine if those add-ons are something that is relevant for you.

What a birth doula offers in terms of birth support can be summarized into 4 areas, each designed to provide comfort, confidence, and empowerment:

Informational

Helping the couple find/offer evidence-based information about different options in childbirth
Helping explain medical procedures before or as they occur
Keeping birthing person and partner informed about what is going on during their birthing time
Suggesting techniques, such as breathing, relaxation, movement, and positioning
Helping the partner understand what’s going on during labor (for example, interpreting the different sounds the birthing person makes)

Emotional

Helping the birthing person to feel cared for, and to feel a sense of pride and empowerment before, during and after birth
Continuous presence
Reassurance, Encouragement, Praise
Helping the birthing person see themselves or their situation more positively
Helping the birthing person and partner work through fears and self-doubt
Debriefing after the birth—listening to the mother with empathy

Physical

Soothing with touch through massage, counter pressure
Assisting with positioning for comfort and labor effectiveness
Helping to create a calm environment, like dimming lights and arranging curtains, music, aromatherapy
Assisting with hydrotherapy (shower, tub)
Applying warmth or cold

Advocacy

Often, we think of the word advocacy to mean speaking on behalf of someone, but in the doula world, advocacy means helping the birthing person and couple to find their voice. It means supporting the birthing person in their right to make decisions about their own body and baby. This can take many forms. Some examples of advocacy that doulas have described include:

Encouraging the birthing person or their partner to ask questions and verbalize preferences
Asking the birthing person what they want and supporting their decision
Teaching the birthing person and partner positive communication techniques
Creating space and time for the birthing family so that they can ask questions, gather evidence-based information, and make decisions without feeling pressured
Facilitating communication between the birthing couple and care providers

What Does A Birth Doula Not Do?

Doulas are NOT medical professionals.
They do not perform clinical tasks such as vaginal exams or fetal heart monitoring and they do not “catch” the baby
They do not give medical advice or diagnose conditions
They do not make decisions for the client (medical or otherwise)
They do not pressure the birthing person into certain choices just because that’s what the doula prefers
They do not take over the role of the partner – instead they facilitate the couple to work effectively together

What Training Do Doulas Have?

Doulas don’t need to be certified, but many are. The largest and best-known certification program is provided by DONA International. DONA-approved workshops provide a minimum of 16 hours of instruction time, with an emphasis on practical hands-on techniques, the history of birth, benefits of doula support and the significance of doula support for families.

What Is The Evidence On Doulas?

Can the benefit of having a birth doula be measured? What does the research say?

It is important to note that in our culture’s current conventional care model, most births are in hospitals, where a continuous labor support person is not provided. Of course, there are nurses, midwives, and physicians present, but these professionals are not in the birthing room 100% of the time. Doulas however, provide continuous and knowledgeable labor support.

Various research studies have been published around continuous support during labor and the evidence suggests that if a birthing person receives continuous labor support, both mothers and babies are statistically more likely to have better outcomes. To learn more visit https://evidencebasedbirth.com/the-evidence-for-doulas/.

To summarize the research findings, those who received continuous labor support:

Were more likely to have spontaneous vaginal births
Were less likely to have any pain medication, epidurals, negative feelings about childbirth, vacuum or forceps-assisted births, and Cesarean sections
In addition, their labors were shorter by about 40 minutes and their babies were less likely to have low Apgar scores at birth
There is no evidence for negative consequences to continuous labor support

My Partner Will Be With Me Continuously During Labor. Do I Still Need A Doula?

Some people think that they do not need a doula because their partner will be with them continuously throughout labor.It is true that the birth partner is an essential support person for a birthing person to have by their side. However, the birth partner will need to eat and use the bathroom at times, and they are having their own emotional journey that requires support.

Also, many partners have limited knowledge about birth, medical procedures, or what goes on in a hospital, while doulas have knowledge and experience about all of these things that they can use to inform and support both the partner and birthing person. Ideally, doulas and partners can work together to make up a labor support team.

What Does The Research Say About Doulas Working Alongside Partners?

A landmark study in 2008 evaluated the effects of doulas and partners working together and researchers found:

Specifically, reduction in C section rates for first time mothers, even in cases where labor was medically induced.

Also, fewer birthing people required epidural pain management

Specifically, reduction in C section rates for first time mothers, even in cases where labor was medically induced.

Also, fewer birthing people required epidural pain management

Given The Current Covid-19 Restrictions At Our Local Hospitals, It May Be That Only One Support Person Is Allowed. How Can I Have Both My Partner And My Doula Present At My Birth?

It’s unfortunate that COVID-19 is causing birthing couples to have to consider this question – partner vs doula? COVID-19 is definitely changing how doulas are offering their services at this time for hospital births. Many doulas are getting creative at how they offer their support and we are seeing many situations where doulas are offering online support during labor.

It is important to keep in mind that most if not all doulas don’t just offer support during the birthing time, but a lot of time is actually spent supporting the birthing couple during pregnancy, prior to going into labor.

Birthing couples often find that time spent with their doula during their pregnancy was very valuable in preparing them mentally, physically and emotionally for their birthing time. When you are interviewing doulas, you should ask them how they can support you during this unprecedented time.

How Do I Find A Doula?

If you’re considering learning more about doulas or hiring one, you may want to interview several doulas with your partner. Below are some resources you may find helpful as well as some questions you may choose to ask prospective doulas.

What inspired you to enter this field of work?
What certifications do you hold?
What additional pregnancy and birth related services do you offer as a doula?
How long have you been a doula and how many births have you attended?
What types of births have you attended — home, hospital, birth center?
How do I get in touch with you when labor begins? Are you always on call? When and where will you join me?
If you are unavailable when I go into labor, do you have backups?
What is your philosophy on childbirth? (Make sure your birth preferences are compatible with the doula’s practices and beliefs.)
What techniques will you use to help me move through labor?
How long will you stay with me after labor?
What happens if I need a C-section?
Do you provide postpartum services? Do you have experience helping nursing mothers?
What’s your fee and refund policy? What does it cover?

Childbirth Connection also has a great list of questions that you can ask when interviewing doulas.

The website DoulaMatch.net has a great search function for finding birth doulas.

Also, specific birth doula certifying organizations may list their birth professionals; for example, doulas who trained with DONA International.

The Bottom Line

A doula’s duty is to provide a continuous source of comfort, encouragement and support (both emotional and physical) during pregnancy and labor. Ultimately, they are support coaches who are there to carry out your vision to the best of their ability, given the circumstances that arise, and help you and your birth partner make it a day to remember. You and your birth partner’s personalities along with your birth preferences will help you ultimately decide if a birth doula is right for you. Research cited above shows that if you’re preparing and planning for an unmedicated natural birth, a doula may just be your best bet.

PMADS

Sun, 10 May 2020 23:28:12 GMT

What are PMADs?

PMADs are Perinatal Mood and Anxiety Disorders. They affect 1 out of every 5-7 women and may occur anytime during pregnancy or the first year postpartum. Often, PMADs peak around 3-4 months postpartum, or may be triggered when your period returns or when weaning from breastfeeding. While postpartum depression (PPD) is the best-known, there are several recognized PMADs to be aware of:

Perinatal or Postpartum Depression (PPD) up to 20%, possibly higher
Perinatal or Postpartum Anxiety (PPA) or Panic Disorder 5-7%
Perinatal Obsessive Compulsive Disorder (OCD) up to 1-11%
Postpartum Post Traumatic Stress Disorder (PTSD) 2-9%
Perinatal Bipolar Disorder
Postpartum Psychosis 1-2/1000 births

Symptoms of a PMAD can feel scary during pregnancy or the postpartum period, but know that there is help available and you do not need to suffer alone.

What is PPD?

Perinatal or Postpartum Depression (PPD) is one possible mood disorder under the umbrella term of PMADs. Because Baby Blues is a common experience in the first two weeks after birth for new mothers, it is often assumed that depressive disorders are bound to happen if you experience the Baby Blues. This is not always the case.

How are PMADs diagnosed?

We rely on specific screening tools and personal discussions for assessment of a person’s symptoms. One of the key factors in symptom assessment for each respective disorder is the duration of symptoms.

Why is mental health and wellness important in pregnancy and postpartum?

Perinatal mood and anxiety disorders affect the health of both the mother and the baby during pregnancy, and there are some implications for the baby as they grow up later in life. Anxiety or depression may have implications such as low birth weight and difficulty bonding between the mother and infant. Because of this, it’s important to find supportive treatment strategies for PMADs that occur in pregnancy.

Why might I be susceptible to PMADs?

There are many reasons that a parent may be susceptible to a perinatal mood or anxiety disorder. Some of the risk factors include:

History of perinatal mood or anxiety disorder
Personal or family history of mood or anxiety disorder
Endocrine disorder like thyroid disorder or diabetes
Pregnancy complications or traumatic birth experience
Challenging adjustment due to baby’s needs or temperament, NICU stay, special needs
History of PMS or PMDD
Poverty, loss of income, financial challenges, access to food/shelter
Lack of social support or support from partner
History of abuse
Unexpected or unplanned pregnancy
History of infertility
History of child loss, miscarriage
Multiple pregnancy (twins, triplets, etc)
Big life changes: new home, job, city

What are some symptoms of various PMADs?

One of the key signs of needing support for a mood or anxiety disorder is that symptoms do not resolve within a short period of time or with simple interventions such as increased social support, nutrient-dense diet, or uninterrupted sleep.

If you are ever concerned about symptoms, have thoughts about harming yourself or your baby, or that harm to self or baby are imminent, immediately contact your clinician and another trusted individual so you can be safe.

Symptoms to discuss in confidentiality with your healthcare provider include:
Irritability or persistent unsettled feeling
Guilt, shame
Hopelessness, worthlessness
Tearfulness, sadness
Consistent worrying and racing thoughts
Changes in bowel movements, stomach pains
Chest pain, palpitations, shortness of breath
Thoughts of harming self or baby
Feeling flat, unable to bond with baby
Intrusive thoughts that harm will come to baby that interferes with ability to sleep or participate in daily activity
Loss of interest, joy, pleasure
Rage, angry or scary thoughts
Lack of appetite
Inability to sleep
Inability to let others see, hold the baby

What is considered “normal” and what isn’t? PPD vs Baby Blues

Sometimes it can be difficult to distinguish between the baby blues and postpartum depression, or between the normal worries of parenthood vs. intrusive anxiety or OCD.

Specifically, postpartum depression usually does not resolve without treatment, and lasts beyond a period of two weeks. In contrast, 40-80% of women will experience a period of the Baby Blues which lasts for about 1-2 weeks shortly after a baby is born. Common symptoms include sadness, worry, fatigue, tearfulness. Intervention is usually not necessary, symptoms do not worsen, and the Baby Blues resolve with time and positive coping mechanisms.

If symptoms begin to feel severe, are recurring, or extend beyond a two week period, it may be wise to have a honest conversation with someone you trust and to talk with your healthcare clinician.

Is it possible to develop symptoms if I haven’t had them in previous pregnancies?

While PMADs are more common if you have experienced one before, they may also emerge for the first time in a new pregnancy. For example, the circumstances surrounding a second birth may be entirely different from the first – maybe you’ve moved, experienced a birth trauma or NICU stay, are encountering a difficult transition. We recommend that all pregnant women create a plan in case unwanted symptoms arise. Have someone you trust that will check in with you on a regular basis to review how you are adjusting, and to remind you to schedule a visit with your healthcare professional if you aren’t feeling yourself.

If I had these symptoms in previous pregnancies am I more likely to get them again?

It is common for women to experience postpartum mental health mood or anxiety disorders in subsequent pregnancies. Research shows that preparation is key in planning for a positive experience. Ways to do this include:

Setting up additional appointments for mood checks during pregnancy and the postpartum period
Plan ahead for psychotherapy or other talk therapy appointments
Establish social support early
If medication was a helpful management strategy before, you and your clinician may consider a time to begin this either during pregnancy or postpartum that is effective for you

How can I be screened for each? When does screening happen?

You can expect to see screening questionnaires during both pregnancy and postpartum visits. If you are experiencing concerning symptoms and having difficulty talking about them, you can always request a screening test. Screening tests are confidential and are designed to help find the next best steps for your plan of care. They also help to evaluate if your current plan of care is working well for you, or if something different would be better.

What are possible treatments?

Research shows us that psychotherapy and a strong social network are two of the most helpful interventions for preventing and treating PMADs. However, sometimes medications or other tools may need to be integrate. The best care plans for PMADs are often created with an interdisciplinary approach which may include:

Focus on positive lifestyle factors
Cognitive behavioral therapy or other therapeutic modalities
Medications as determined by your obstetrician, nurse midwife, psychiatrist, or other clinician
Supplements, often focused on reaching adequate RDA of micronutrients as recommended by the NIH

Are there things I can do to prevent PMADs?

While there is no guaranteed preventative strategy, there are things you can do to support your mental health before, during, and after pregnancy. One strategy is delineated by the acronym SNOWBALL from the Utah Maternal Mental Health Collaborative. Practice these to the best of your ability to ensure that they become positive habits in your life.

Sleep: ideally 4-6 uninterrupted hours daily
Nutrition: take a high quality prenatal vitamin, make half your plate fruits and vegetables, consume both protein and high-fiber carbohydrates
Omega 3s: fish oil plays a positive role in preventing and treating anxiety and depression. Look for an omega 3 with EPA and DHA and review it with your provider.
Walk: if this is outside, even better!
Breaks, baby breaks: shoot for 2 hours, 3 days a week
Adult time: virtually or in person. Consider journaling.
Liquids: dehydration inhibits thought processes and may increase feelings of worry
Laughter: releases hormones in the brain that contribute to positive mood

https://www.postpartum.net/wp-content/uploads/2016/06/1E-White-and-Smith-Quick-Tips-for-Emotional-Wellness-Handout.pdf

How does Reply support me if I develop symptoms?

Please do not suffer alone, call us at 919.230.2100 or send a portal message if you are having unwanted symptoms. At Reply, we have developed a team-based approach to caring for mental health. We believe it is important to initiate more frequent communication and screening if you have experienced a PMAD in the past or share that you are experiencing symptoms of a PMAD. We offer screening and discussion to every woman at least once during both pregnancy and the postpartum period, and then as frequently as needed.

We also believe in finding the best approach to support your mental health, and each individual will respond to a different treatment plan. We will work one-on-one with you to find something that best supports your health and lifestyle.

Some situations are emergent, and if you are experiencing symptoms like thoughts of harming yourself or your baby, please know that there is support immediately available and call 911.

———-

References
https://www.npjournal.org/article/S1555-4155(18)30134-X/fulltext
https://www.postpartum.net/wp-content/uploads/2016/06/1E-White-and-Smith-Quick-Tips-for-Emotional-Wellness-Handout.pdf
https://www.med.unc.edu/ncmatters/files/2019/12/MATTERS_Toolkit-Brief-Nov-2019.pdf

HBP & PREECLAMPSIA

Sun, 10 May 2020 23:05:38 GMT

National High Blood Pressure Education Month Preeclampsia Awareness Month

Have you ever wondered what makes high blood pressure so dangerous? May is high blood pressure education month, and it’s a good time to review the facts about a condition that affects so many women.

Why worry about high blood pressure?

High blood pressure, also called hypertension, is so deadly because it increases the risk for heart disease (which is the leading cause of death in women in the US). Hypertension usually develops gradually and silently over many years, so most people have no symptoms. That’s why it’s so important to schedule a well woman exam with a healthcare professional that includes a blood pressure check at least once a year. You can also measure your own blood pressure at home with an automated blood pressure cuff.

What blood pressure reading is considered high?

A blood pressure reading of 120/80 is no longer considered normal. Recent 2017 guidelines define normal blood pressure as less than 120 systolic (the top number) and less than 80 diastolic (the bottom number). Elevated blood pressure is diagnosed when the systolic is between 120–129 and diastolic is less than 80. The diagnosis of hypertension is made when blood pressure is consistently 130/80 or higher. With these newer guidelines, a lot more people have been diagnosed with hypertension.

What can I do to lower my blood pressure?

If you have hypertension, the good news is that there are many things you can do to improve your blood pressure. Eating a heart healthy diet, daily exercise, and maintaining a healthy weight are important lifestyle habits that can make a big difference. It’s also important to take BP medication if it’s been prescribed for you. If you notice any side effects when starting the medication, it’s better to contact your healthcare provider about this instead of stopping the medication on your own.

It can be especially important to make sure your blood pressure is well controlled before pregnancy. If hypertension is present before pregnancy, called chronic hypertension, it is considered a high-risk condition. If it develops during pregnancy or even after delivery, it could be a sign of a condition called preeclampsia.

What is preeclampsia?

Preeclampsia is a pregnancy complication that involves hypertension and protein in the urine (proteinuria). It typically occurs after 20 weeks of pregnancy, and it usually develops in the 3rd trimester of pregnancy or during the postpartum period. In many cases there are no symptoms, but it can often be detected during routine prenatal appointments.

What causes preeclampsia?

The cause is not fully understood. Experts believe preeclampsia may be caused by abnormal development of a pregnant woman’s placenta, the organ that supplies oxygen and nourishment to the baby during pregnancy. During the early stages of pregnancy, new blood vessels begin to form as the developing placenta attaches itself to the mother’s uterus. However, these new blood vessels can develop abnormally, sometimes due to blood vessel damage from uncontrolled diabetes or hypertension. These placental vessels can later release substances into the blood stream that cause blood vessel dysfunction throughout the woman’s body. This eventually leads to high blood pressure

If left untreated, preeclampsia can be life-threatening to both the mother and her baby. When preeclampsia worsens to affect multiple organs in the mother’s body, certain “severe features” may develop:

severe headache
pain over the upper abdomen
changes in vision
HELLP syndrome (red blood cell destruction,
abnormal liver function, low platelets in the blood)
abnormal kidney function
fluid in the lungs
severe elevations in blood pressure (which can lead to stroke if not medically treated with intravenous medication to lower the blood pressure)

In a small number of cases, worsening preeclampsia can develop into a more serious illness called eclampsia, which involves seizures or convulsions.

What symptoms should I look for?

Symptoms typically occur later in pregnancy but can also occur for the first time after birth. If you experience any of the following symptoms during pregnancy or after delivery, you should call your doctor or midwife right away. Having symptoms doesn’t necessarily mean you have preeclampsia, but they may be cause for concern and require medical evaluation.

Some symptoms of preeclampsia include:

Headache that won’t go away, even after taking Tylenol
Changes in vision like seeing spots or flashing lights; partial or total loss of eyesight
Nausea or throwing up, especially suddenly, after 20 weeks (not the morning sickness of early pregnancy)
Upper or right-sided belly pain that doesn’t go away after taking antacid medication
It’s also important to note that some women with preeclampsia have NO symptoms or they “just don’t feel right.” If you have a sense that something’s wrong, even without symptoms, trust your instincts and contact your healthcare provider.

How is preeclampsia treated?

Thankfully, there are ways to carefully monitor mothers who have developed preeclampsia, and treatments are available to help both a mother and her baby stay safe. Women who develop severe features are given medication to lower their blood pressure and a medication to reduce the risk of seizures called magnesium sulfate. Since the underlying cause of the disease involves the placenta, the only real cure is delivery. Labor induction is often recommended, and mothers can still have a vaginal delivery in many cases. In some cases, doctors must perform a caesarean delivery to stop preeclampsia from progressing.

What happens after my baby is born?

Preeclampsia usually goes away after birth. However, in severe cases, complications may still occur following birth. Preeclampsia may even develop for the first time during the postpartum period (called postpartum preeclampsia), and it can occur up to 6 weeks after delivery.

Postpartum, you may need to continue monitoring your blood pressure and taking medication to lower your blood pressure. The medication should not affect your ability to breastfeed. If you are still on medication to treat your blood pressure 6 weeks following birth, or there is still protein in your urine on testing, you may be referred to a specialist.

Will I get preeclampsia in my next pregnancy?

Overall, women who have had preeclampsia are 7 times more likely than other women to get it again in a future pregnancy. For women with a history of preeclampsia, daily aspirin is now recommended for preeclampsia prevention starting at 12 weeks of pregnancy until the day of delivery.

Who is at highest risk for preeclampsia?

Women with a history of preeclampsia in a past pregnancy
Twins/multiple gestation
chronic hypertension
kidney disease
diabetes mellitus
autoimmune conditions (like lupus)

Moderate risk factors:

African American
first pregnancy
body mass index (BMI) over 30
mother or sister with preeclampsia
age over 35

What can I do to prevent preeclampsia?

It’s important to know whether you have risk factors for preeclampsia so you can take steps to reduce your risk. If you have hypertension and are thinking about getting pregnant, see your ob-gyn or other health care professional to make sure that your hypertension is well controlled before pregnancy. If you are overweight, weight loss can help to reduce your risk. If you have diabetes, it is very important to make sure it is well controlled before pregnancy.

Thankfully, we are learning more and more about how to prevent and manage hypertensive disorders throughout a woman’s lifespan. Please share these facts about high blood pressure with the women in your life throughout the month of May and beyond!

Monitoring your own blood pressure? Learn the proper procedure here.

References

https://www.cdc.gov/bloodpressure/hbp_education_month.htm

https://www.preeclampsia.org/

https://www.nichd.nih.gov/health/topics/preeclampsia

https://www.acog.org/Patients/FAQs/Preeclampsia-and-High-Blood-Pressure-During-Pregnancy

https://replyobgyn.com/any-woman-any-pregnancy/

INFERTILITY

Wed, 22 Apr 2020 23:37:38 GMT

Infertility And You

Infertility can be challenging – what often begins as a hopeful, excited path to family building can quickly become lined with worry and unanswered questions. Infertility is recognized when a couple has been trying unsuccessfully to conceive for at least 12 months. In the US, 1 in 8 couples experience difficulty conceiving.

At Reply we use the term “Subfertility” which we define as the inability to conceive after 6 months of trying. Taking this approach allows us to begin earlier into the investigation of possible causes of subfertility. Our subfertility program is designed around a “Finding and Fixing” model of care; one that seeks to identify, diagnose, and treat underlying conditions in an attempt to optimize health and allow couples to conceive naturally. Cycle charting is an important tool we use in our subfertility program. The information from your cycle chart sheds light on potential health issues and the patterns unique to your body. Gathering this information allows us to create more targeted treatment plans. Click here to listen as Dr. Amina White describes the program in more detail.

I think we have a fertility problem… who should I tell?

As you begin an infertility journey, deciding who to turn to for support becomes an important part of the equation. It can feel very isolating to experience infertility alone. However, these are hard conversations to navigate! Opening up with friends and loved ones who have not experienced infertility comes with its own considerations. Likewise, choosing to begin fertility education or to see a fertility clinician can be tough, as parsing through what to share and what to keep to yourself can feel awkward.

Planning Before Pregnancy

Here are 7 thoughtful considerations to guide conversation with the people that will be supporting you while you are trying to conceive.

When speaking with fertile friends and loved ones, offer direct advice. Share things that you’d like them to say or not say to you. For example: “On Mother’s/Father’s day, it would be encouraging to hear that you’re thinking of us while we wait!” or “I know you’re trying for pregnancy too, if you do get pregnant, would you share with me personally before putting on social media?”
Boundaries are important, so if don’t know if you want to keep something private, a good practice is to keep it private until you are sure. You can’t un-share, but you can share when you feel more comfortable and ready.
Seek like-minded community to learn how others are connecting. Resolve offers virtual and in-person groups around the country. Organic Conceptions is a self-guided program that includes membership with an online infertility community and monthly group calls.
Sometimes, others won’t understand new health or lifestyle choices that may accompany infertility. Practice responses ahead of time. If you have chosen to stay home, or abstain from alcohol, or your dinner plate looks different than it used to, find the response type that fits your style – an honest answer, making light of the situation, or changing the topic.
When speaking with your Reply clinician, remember that they know an understand both the physical and emotional toll of infertility. There is no expectation for you to feel hopeful at every appointment. Likewise, there’s no expectation for you to feel grief at every turn.
If you’re unsure about sharing something with your Reply fertility clinician or fertility educator, err on the side of sharing if you feel comfortable. Often, personal things you share play a role in your care because your physical health is not separated from the rest of your life.
In all conversations, keep hopes high and set reasonable expectations. Remember, the things you are sharing have been in your thoughts for a long time, but they are new to the person you are sharing them with. Expect that their initial reaction might not be what you expected, but in the long run, it might be exactly what you need.

If you’ve been trying to conceive or are concerned about your chances for conception, Reply can help. Our health coaches are available to help you set achievable nutritional and lifestyle goals designed to improve your overall preconception health. Our fertility educators are available to schedule one-on-one appointments (available by telehealth too!) to help you understand and track your menstrual cycles and learn about cycle charting. And our fertility case management team is available to discuss the details of our subfertility program and next steps for getting started.

If this sounds interesting to you, please call us at 919.230.2100 or click here to schedule an appointment.

C-SECTION RECOVERY

Mon, 20 Apr 2020 15:33:11 GMT

C-section Recovery – 4 Quick Tips To Help You Prepare

Many women and couples who have experienced Cesarean birth verbalize that they wish they’d been prepared with more resources for recovery before their C-section, especially if it was unplanned.

Here are 4 ways to prepare ahead of time for C-section recovery

1. Stock up on padsicles

If you labor or have a vaginal birth, these are essential for reducing perineal swelling. If you have a C-section, place these over the incision a few times a day for a couple of weeks to a couple of months to facilitate healing. A great time to do this is while feeding your baby! Get the padsicle recipe here.

2. Practice the 3 key postpartum movements while still pregnant:

the squat, the hip hinge, and the log roll.
While it isn’t recommended to exercise until cleared by your clinician after birth, let’s imagine where these movements are useful.

• Use leg muscles to squat into and out of the car rather than curling the back.
• Hinge at the hips to lift light objects or carry your baby.
• Log roll when turning in the bed or sitting up from the couch.

Learning proper movements eases discomfort and protects your core, your trunk, and your pelvic floor as the C-section site heals. This also prevents injury down the road because you’re using the right muscles for the job rather than compensating out of discomfort. Practicing the key movements before birth can help with muscle memory! Ask a clinician or physical therapist if you need instruction.

3. Choose some postpartum compression pants and a nursing pillow for bracing.

You will likely experience some pain with coughing, sneezing, or straining for a few weeks. Compression against the scar will help with day-to-day straining as well as keeping clothes from rubbing against the healing incision.

4. Find a fragrance-free soap that you know won’t irritate your skin.

You will be advised to start cleaning around the incision pretty early on. It can take some getting used to!

Even a few small preparations can be empowering in the process of recovery! As always, remember that whether or not you are planning a C-section, your Reply clinician is available to address all of your questions or concerns.

ALPHABET SOUP

Fri, 17 Apr 2020 15:01:29 GMT

Fertility Awareness Alphabet Soup

Are you TTC checking BBT with STM and wondering if your OPK caught LH this cycle?

Or perhaps you’re new to FABMs and TTA, and you recall your LMP but can’t tell on which CD your LP began.

If you decoded both of those sentences, consider yourself fertility awareness user level: EXPERT.

Medical jargon has long been known to include a wide array of cryptic acronyms, yet a quick google search will reveal the meaning of most of them. However, many women find themselves wading through a similar alphabet soup in the world of cycle charting – and the same internet search won’t always yield helpful results!

New and seasoned cycle charters alike may engage in classes, webinars, or internet based groups seeking advice and support. But sometimes, it can be difficult to keep up with clinicians or peers when the language seems to be spoken or written in code. If acronyms have been a roadblock to understanding these discussions in the past, we’ve complied a comprehensive list of commonly used and important acronyms to navigate the world of fertility awareness based methods. The best part about this guide? It’s universal – it isn’t method or user specific.

So the next time, you will be the first to answer when someone asks, “What CD does AF start on?”

Common Abbreviations Discussed In Cycle Charting

ART : assisted reproductive technology

BC : birth control

Beta : pregnancy test from blood draw

BF : breastfeeding

BIP : base/basic infertile pattern of cervical fluid

CD : cycle day when day 1 (CD1) refers to the first day of the last menstrual period

CF/CM : cervical fluid, cervical mucus

CL : coverline, horizontal line in a basal body temperature chart – used as a pre-ovulatory baseline to help identify a temperature shift

CP : cervical position

DPO : days past ovulation

Dx : diagnosis

E : estrogen, hormone that is released from growing follicle (egg) before ovulation

EBF : exclusive breastfeeding

EDD : estimated due date

ENDO : endometriosis, a disorder where endometrial tissue exists in other places beyond the endometrium (uterine lining) and may contribute to pain, bleeding, or other symptoms

EWCF/EWCM : egg-white cervical fluid

FAM : fertility awareness methods

FABM : Fertility Awareness Based Method(s)

FP : follicular phase, the first of two phases of the menstrual cycle, it begins with the first day of the period and lasts through ovulation. This phase of the cycle may vary in length from cycle to cycle.

FSH : follicle-stimulating hormone, hormone released from the brain that stimulates follicle (egg) to grow before ovulation

HcG : Human chorionic gonadotropin (early pregnancy hormone detected with home and lab draw pregnancy tests)

HPT : home pregnancy test

Hx : history

I/IC : intercourse

IF : infertility

LH : luteinizing hormone, hormone released from the brain responsible for rupture of the follicle in the event of ovulation

LMP : last menstrual period (usually referring to the first day of your last menstrual period)

MF : male factor infertility

LAP : laparoscopy, a minimally-invasive procedure in the abdomen or pelvis for diagnosis or treatment performed through small incisions in the abdominal wall and aided by a camera

LP : luteal phase, this is the second of the two phases of the menstrual cycle, it lasts from ovulation until the first day of the next period. This phase is generally stable in length.

NFP : Natural Family Planning

O/Ov : ovulation

OPK, OPT : ovulation predictor kit, test, these strips detect the presence of LH in concentrated urine

P : Peak day. The last day of highest quality cervical fluid. This term is associated with the mucus sign.

PCOS : polycystic ovary syndrome, and endocrine disorder. Women with PCOS may have irregular cycles, evidence of elevated androgen hormones, and/or a higher than normal number of small follicles (cysts) on their ovaries.

PG : pregnant

PGN : progesterone, hormone that rises after ovulation and falls before menses, or remains elevated if a woman is pregnant

PMS : premenstrual symptoms/syndrome

PP : postpartum

POAS: pee on a stick, usually either referring to a pregnancy test or a symptohormonal method monitor strip or OPK

RRM : Restorative Reproductive Medicine, an application of medical and/or surgical health care that focuses on restoring optimal health and function

SF : seminal fluid

TTA : trying to avoid pregnancy

TTC : trying to conceive

US, U/S : ultrasound

VD : vaginal discharge

Common Method Name Abbreviations

BCC : Boston Cross Check

BOM : Billings Ovulation Method

CrMS : Creighton Model Fertility Care System

FEMM : Fertility Education and Medical Management

FF : fertility friend

LAM : Lactational Amenorrhea Method

MM : Marquette Method

NC : Natural Cycles

SDM : Standard Days Method

SHM : sympto-hormonal methods

STM : sympto-thermal methods

Common Online Discussion Thread Terms

AF : Aunt Flo (your monthly menstrual flow)

BFN : big fat negative (pregnancy test)

BFP : big fat positive (pregnancy test)

DTD : do the deed (referring to intercourse)

DH : dear husband (W, S, D… wife, son, daughter…)

LO : little one

OP : original poster

SO : significant other

TCOYF : Taking Charge of Your Fertility, one of the first well-known books about fertility awareness, written by Toni Weschler

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6079215/#!po=8.82353

COVID-19 – SURVIVING SOCIAL ISOLATION AND MANAGING STRESS

Wed, 08 Apr 2020 15:49:56 GMT

Surviving Social Isolation and Managing Stress

Many individuals and families are trying to cope with ongoing social distancing requirements – separation from friends, neighbors, peers, and their extended families. We are finding new ways to work, to school, and to communicate. In addition, families may be dealing with increasing financial pressures as so many jobs have been affected by social distancing requirements.

As stress rises, it’s important to take time for self-care to stay happy, healthy, and sane. Below are some basic tips to keep in mind and some resources to tap into as you move through the days and weeks ahead.

The Basics

1. Take time to exercise

Even though gyms are closed, try to get in 30 minutes of aerobic exercise every day
Enjoy running or brisk walking (at least 6 feet away from others if you do this outside)
Try stretching and aerobic exercises at home
If it’s hard to exercise with kids around, try these tips to get the most out of your workout

2.Eat healthy

Aim for 5 servings of fruits and vegetables every day (Ex. 2 fruits + 3 servings of veggies to keep that vitamin C level up!)
Try making smoothies with your blender – it’s a great way to get in all those servings
Be aware of the common tendency to begin stress eating. Keep only healthy snacks around the house like baby carrots, almonds, popcorn (without all the butter and salt), and dark chocolate. And, check out this list from TasteofHome.com with 40 great and easy ideas for healthy, kid-friendly snacks.
Vitamin C is critical in times of stress. During stress, our adrenal glands release stress hormones that trigger our “fight or flight” response so we can cope. Vitamin C is a co-factor in the production of these critical adrenal stress hormones. Lack of vitamin C may compromise our ability to deal with stress. Other nutrients key in times of stress include: protein, magnesium, and other antioxidants like vitamins E and A. The daily vitamin C requirement for women (75 mg) can be found in just 1 kiwi, 3/4 cup of raw green bell pepper, 1/2 cup raw red bell pepper, 1 cup cooked broccoli, or 1 medium orange.

3. Disconnect from the news

While it’s important to stay up to date on current recommendations, tuning in for hours can be overwhelming and heighten stress
Try limiting your news consumption and taking a break from devices
Spend some time in prayer, meditation, or deep breathing during the day
If you can’t eliminate the news, balance it out with Some Good News from John Krasinski or subscribe to the GoodGoodGoodCo, a weekly delivery of very good news. News that will make you smile.

4. Connect with others

Reach out to friends and family members by phone, text, or FaceTime
Take time to play board games or do puzzles as a family. You can even play with family and friends from afar through online apps – check out these options from Refinery29.com. UNO anyone?
Try to eat dinner together as a family if you can. Better still, try to prepare dinner together as a family if you can. Great teachable moment and a chance for everyone to pitch in. Food Network has a great section devoted to getting kids involved in the kitchen.

5. Get restful sleep

It’s important to get enough sleep for your age group, especially during times of stress
If you have trouble sleeping, check out these tips for improving restful sleep

6. Maintain a routine

The consistency of sticking to a routine at least during the weekdays can be especially important for kids. Having no set routine can be very overwhelming for both adults and children, exacerbating anxiety/stress levels and decreasing productivity. Consistency will also help reinforce the foundational pillars of health — sleep, exercise, nutrition, etc.

Working From Home

For those facing the new challenge of working from home, distractions are plenty and can disrupt your productivity. Many things in your personal environment will be trying to capture your attention – your kids, the dog, laundry and dirty dishes, etc…

It’s important to have a defined schedule and stick to it. Avoid sleeping in or lingering over breakfast, and get to work just as if you’re driving across town to your office, although you might just be walking into the next room. This Forbes.com article offers some great tips for working from home.

Helping The Kids Adjust

We need to talk to our children about the coronavirus and its effects, but finding the right words can leave us stammering, and struggling to explain terrible things to our children. This article from PBS can help.

We also know this is a difficult time as parents are trying to adjust their routines while simultaneously attending to the daily needs of their children in the absence of childcare and school. This tip sheet has some great ideas for creating and maintaining the structure that will make everyone’s day flow a bit more smoothly. Brookings.edu also offers some good strategies for keeping your kids (and you) sane during this time.

Be Kind To Yourself

Lastly, it’s important to remember this too shall pass and that in these times of uncertainty and stress it is essential that we take care of ourselves and our mental health. And, it’s OK to laugh – in fact, it’s recommended. Although these are serious issues we face, laughter can help us relax and maintain perspective on our circumstances. And if you really need a quick and corny laugh, you can always check out the Dad Joke Generator.

We Will Get Through This Together.

If you are a current Reply patient, you may always reach out to your Reply provider via the patient portal. You may also call us at 919.230.2100 during regular business hours or at 984.207.3739 after hours for urgent concerns. We also encourage you to visit the YouAskWeReply page where you can submit your questions and concerns to the Reply team.

https://health.clevelandclinic.org/5-ways-to-manage-stress-during-the-coronavirus-outbreak/

ENDOMETRIOSIS

Wed, 11 Mar 2020 16:05:57 GMT

What You Need To Know

March is Endometriosis Awareness Month.

Endometriosis can have a profound impact on women’s lives, including associated pain, infertility, decreased quality of life, and interference with daily life, relationships, and livelihood. The first step in alleviating these adverse effects is to diagnose the underlying condition. For many women, the journey to endometriosis diagnosis is long and fraught with barriers and misdiagnoses. [i]

How many women are affected?

A paper last year in the Journal of Obstetrics and Gynecology found that an estimated 4 million women of reproductive age in the US have been diagnosed with endometriosis. The true prevalence of endometriosis, however, is unknown because so many cases go undiagnosed, but studies estimate that it affects roughly 1 in 10 women.

How is endometriosis diagnosed and why it is sometimes misdiagnosed?

Laparoscopic surgery is the gold standard diagnostic method. Lapraroscopy allows a gynecologic surgeon to insert a camera into the abdomen to visualize and biopsy implants that may be embedded on the surface of pelvic organs including the ovaries, fallopian tubes, inner lining of the abdominal cavity (called the peritoneum) and sometimes even the intestines. Yet surgery can be risky, impractical, and costly. So, researchers have been investigating other ways to make the diagnosis. Although multiple studies have attempted to identify blood tests that can diagnose endometriosis without surgery, no blood tests are reliable enough for making the diagnosis. Imaging studies like ultrasound and MRI can give clues to make the diagnosis if they show large endometriotic implants, but smaller implants often go undetected. The continued lack of a safe, reliable, non-invasive test for making the diagnosis is one reason that women often experience frustrating delays before being diagnosed. A large study across 10 countries found that for women aged 18–45 years, the average delay in diagnosis was 6.7 years (7-11 years in the US).

Lack of clinician awareness about endometriosis is another reason for delays in diagnosis. In the same study referenced above, women reported an average of 7 primary care visits before being referred to a gynecologist. Symptoms can take many forms, including painful periods, pelvic pain outside of menstrual periods, pain or problems with bowel movements or urination, pain with intercourse, and difficulty getting pregnant. Primary care providers unaware of the range of symptoms may not think of a connection between bowel or bladder symptoms and a gynecologic condition like endometriosis.

How “charting” may aid in diagnosis

Fertility awareness cycle tracking can reveal signs and symptoms that may aid in diagnosis:

1) An abnormal bleeding pattern may be a clue about underlying endometriosis. A study by Heitmann and colleagues showed that premenstrual spotting is linked to endometriosis in women with subfertility. [ii] Cycle tracking makes it easier to notice premenstrual spotting and bleeding abnormalities in general.

2) Cycle tracking can identify abnormal cervical fluid patterns that are sometimes seen in women with endometriosis. Emerging evidence suggests that more inflammatory proteins may be present in the cervical fluid of women with endometriosis. Cervical fluid plays an integral role in fertility. Many studies report lower fertility rates in women with endometriosis compared to patients free from this disease suggesting a link between the two. However, more research is needed to better understand how endometriosis may affect cervical fluid and how cycle tracking can help make the diagnosis of endometriosis.

How is endometriosis treated and managed?

There is no cure for endometriosis — it is a chronic condition. However, it can be treated to manage symptoms and restore healthy reproductive function in many cases. It is important to address both inflammation and pain early to avoid long term consequences like scar tissue formation (adhesions) in the pelvis and central pain sensitization, when the brain begins to process pain signals even when inflammation is not present.

Treatments generally involve surgery, medication, or a combination of both. While a common conventional treatment is hormonal suppression with contraceptives like birth control pills, other hormonal and non-hormonal treatment options are also available. Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce both pain and inflammation, progesterone therapy, estrogen-reducing medications called aromatase inhibitors, and other treatments may help to treat symptoms and block further growth of implants. This overview from the Mayo Clinic is a helpful resource for understanding diagnosis and treatment protocols.

Aside from su rgery and medication, there is ongoing research on the benefits of maintaining a healthy lifestyle that limits exposure to inflammatory chemicals and foods.

Endometriosis and infertility

In the hands of an experienced endometriosis surgeon, excision surgery to remove visible areas of endometriosis, especially deep infiltrating lesions, can improve a woman’s chance of conceiving naturally. In many cases, surgery can restore anatomy that has been distorted by scar tissue and remove inflammatory tissue that may be suppressing normal ovarian and fallopian tube function. Pregnancy rates have been shown to improve following endometriosis surgery. A recent study of women with moderate to severe endometriosis and impaired fertility reported a 63% live birth rate after surgery, the majority without using assisted reproductive technologies.

Endometriosis diagnosis and treatment at Reply

If you have been diagnosed with endometriosis or are struggling with undiagnosed pain or symptoms, Reply physicians can help. Our clinicians are highly experienced in using fertility awareness cycle tracking to aid in the diagnosis of this disease. They are also expert in performing endometriosis excision surgery, offering non-surgical options, and providing subfertility treatment and support for couples having difficulty conceiving as a result of endometriosis. To learn more or to schedule an appointment, call us at 919.230.2100 or visit https://replyobgyn.com/become-a-patient/.

References

[i] Am J Obstet Gynecol. 2019 Apr;220(4):354.e1-354.e12. doi: 10.1016/j.ajog.2018.12.039. Epub 2019 Jan 6. Clinical diagnosis of endometriosis: a call to action. www.ncbi.nlm.nih.gov

[ii] Heitmann et al. Am J Obstet Gynecol. 2014;211(4):358.e1-6.

PREVENTIVE HEALTH AND WELL WOMAN VISITS

Thu, 17 Oct 2019 16:14:16 GMT

It’s Always A Good Time To Focus On Health And Wellness!

Regular exams and recommended screenings are especially important for women. By scheduling your annual exam, you are making an important decision to take responsibility for your health and overall quality of life. Rather than treating a condition after it has progressed, proactive and preventive care focuses on preventing disease and maintaining proper health. These visits also help you track your progress toward individual health goals.

In addition to screening for cancer, your annual exam will assess your overall health, allow you to update your vaccinations and medical records, and help you establish a strong relationship with your healthcare provider.

Essential health screenings are recommended dependent on your overall health, your family and personal medical history, and your age. Your healthcare provider will be able to recommend preventive care steps and treatment plans based on these factors. Recommended screenings may include:

Annual Physical Exam
Pap Smear
Pelvic Exam
Mammogram
Blood Pressure
Lipid Panel Blood Test
Bone Density Test
Diabetes
Colonoscopy
Other Colorectal Cancer Screening Tests
Skin Cancer Screening
Heart Exam

*Click below for a more detailed look at these procedures.

Recommended for Women ages 18-39

Recommended for Women ages 40-65

IT’S ALWAYS A GOOD TIME TO FOCUS ON HEALTH AND WELLNESS!

Reply Physicians and Certified Nurse Practitioners are welcoming new patients. And remember, many visits can be done via telehealth from the comfort of your home. Call us today and take control of your overall health! 919.230.2100.

* https://medlineplus.gov/ MedlinePlus is the National Institutes of Health’s Web site for patients and their families and friends. Produced by the National Library of Medicine, the world’s largest medical library, it brings you information about diseases, conditions, and wellness issues in language you can understand. MedlinePlus offers reliable, up-to-date health information, anytime, anywhere, for free.

HEART HEALTH FOR WOMEN

Tue, 05 Feb 2019 16:47:20 GMT

February Is National Heart Health Month ♥

FEBRUARY IS NATIONAL HEART HEALTH MONTH ♥

Cardiovascular disease (CVD) is the leading cause of death among women, killing 1 in 3 women worldwide and 1 in 4 in the US. Several risk factors for CVD are unique to women, and the risk of CVD increases markedly after ovarian function stops at menopause. Other risk factors for CVD–including genetics, lifestyle, and environmental conditions–should also be taken into consideration. While some risk factors cannot be changed, others can be altered through lifestyle changes or treatment of certain medical conditions. Frequently asked questions about heart health and how it relates specifically to women are highlighted below.

What Are The Risk Factors For Cvd?

Age – As people age, their risk of CVD increases. Women see an increase in risk once they go through menopause.
High blood pressure – Blood pressure is the force the heart uses to move blood through the blood vessels to the organs and tissues. When blood pressure is too high (a condition called hypertension), it can damage the vessel walls. Damaged areas provide an ideal place for plaque to form. High blood pressure is a key risk factor for CVD in women and is the most common risk factor for stroke. Women should have their blood pressure checked by a health care provider at least yearly and get treatment if it is high. Lifestyle changes as well as medications are used to treat high blood pressure.
Abnormal triglyceride and cholesterol levels – Triglycerides are the most common form of fat in the body and provide energy to power the body’s activities. Cholesterol is a building block for cells and hormones. High-density lipoprotein (HDL or “good cholesterol”) helps prevent heart disease. It picks up cholesterol in the bloodstream and takes it to the liver where it is broken down. Low-density lipoprotein (LDL or “bad cholesterol”) can collect in the walls of blood vessels. Too much LDL in the walls of the arteries can trigger a response by the body’s immune system called inflammation. Inflammation can lead to a buildup of plaque in the arteries and eventually to atherosclerosis (hardening and narrowing of the arteries, putting blood flow at risk). Women who are at increased risk of heart disease should have their cholesterol measured periodically.
Diabetes mellitus – Diabetes causes high levels of glucose in the blood. Health problems, including CVD, can arise if blood glucose levels are not controlled. Risk factors for type 2 diabetes include being overweight or obese, history of polycystic ovaries or gestational diabetes, lack of exercise, strong family history of diabetes, and a higher-than-normal level of glucose in the blood (a condition called prediabetes).
Lifestyle factors – Smoking, lack of exercise, and being overweight are risk factors for CVD.

What Are The Risk Factors For Cvd That Are Unique To Women?

Several risk factors for CVD are unique to women throughout their reproductive lives and include the following:

Gestational hypertension (including preeclampsia) – Having high blood pressure during pregnancy increases the risk of having CVD and high blood pressure later in life. The risk of serious blood pressure-related complications with a future pregnancy also is increased.
Gestational diabetes – Diabetes that first appears during pregnancy increases the risk of developing diabetes and CVD after pregnancy. Women who have had gestational diabetes should be tested for diabetes 6–12 weeks after childbirth and then every 3 years or more frequently if they are prediabetic.
Polycystic ovary syndrome (PCOS) – PCOS is a leading cause of infertility that can affect all areas of the body, not just the reproductive system. Having PCOS increases the risk of diabetes and may increase the risk of CVD. Women with PCOS should be screened for diabetes at least every 3 years.
Certain autoimmune disorders – Diseases such as lupus or rheumatoid arthritis, which are more common in women, are associated with an increased risk of CVD. Screening for CVD is recommended for women with these disorders.
Hormonal birth control methods – Combined hormonal birth control methods contain both estrogen and progestin. They include the birth control pill, patch, and vaginal ring. Women using these methods have a small increased risk of stroke compared with non-users. This risk is higher for women 35 and older who smoke; women with additional risk factors for stroke, such as high blood pressure; and women who have migraine headaches with aura. These methods are not recommended for women with these risk factors.
Hormone therapy for menopause – Combined hormone therapy (estrogen and progestin) is linked to a small increased risk of heart attack. For this reason, combined hormone therapy should not be used solely to protect against heart disease. Both combined hormone therapy and estrogen-only therapy are associated with a small increased risk of stroke.

It is important to note that generally estrogen does a lot of good for your cardiovascular system. It can:

Decrease LDL (bad) cholesterol
Increase HDL (good) cholesterol
Dilate blood vessels
Protect against blood vessel injury
Prevent plaque from building up in arteries
Aid the formation of new blood vessels

Evidence shows that estrogen may play a protective role in young women. Premenopausal women rarely develop coronary artery disease. And, after menopause, your risk for heart disease increases dramatically. That’s because your heart becomes quite vulnerable when your ovaries stop making estrogen, especially if you have other heart disease risk factors, such as diabetes, smoking and obesity. This is why it is not recommended that women have their ovaries removed prior to 50 years old unless medically necessary.

However, giving women prescribed hormone replacement therapy has not been shown to be helpful to prevent these changes once women go through menopause. In fact, in some women this could actually be harmful. It is important to have an individualized conversation with your health care provider about the benefits and risks of hormone replacement.

How Can I Lower My Risk Of Cvd?

While the use of HRT and its ability to reduce CVD risk in menopausal women many still be controversial, there are some conclusive ways to reduce your risk of heart disease during and after menopause. They will likely sound familiar as they are good advice for anyone at any age!

Don’t smoke . Smokers have more than twice the risk of a heart attack than nonsmokers. Even one to two cigarettes a day greatly increase the risk of heart attack, stroke, and other cardiovascular conditions. Nonsmokers who are constantly exposed to secondhand smoke also have an increased risk.
Treat and manage medical conditions . If you have diabetes, high cholesterol, or high blood pressure, you are at a higher risk for heart disease. Work with your doctor to keep these conditions under control.
Maintain a healthy body weight . The more you weigh, the harder your heart has to work to give your body nutrients. Research has shown that being overweight contributes to the onset of heart disease.
Exercise throughout the week . The heart is like any other muscle — it needs a workout to stay strong. Exercising helps improve how well the heart pumps blood through your body. Try to do at least moderate exercise for at least 150 minutes per week.
Eat a heart-healthy diet . Enjoy plenty of plant-based foods, such as fruit, vegetables, nuts, and whole grains. Limit trans fat (partially hydrogenated fats) and refined sugar. Omega-3 fatty acids are good fats and come from tuna, salmon, flaxseed, almonds, and walnuts. Monounsaturated fats also are good for you and are found in olive and peanut oils.
Schedule regular appointments with your healthcare provider . All women need to have yearly annual exams (preventive visits) to discuss your individual risks with your health care provider and do any recommended screenings. If you are at risk of CVD, or even if you are not, lifestyle changes usually are recommended first. If lifestyle changes alone are not enough, or if you are at high risk of CVD, your doctor or other health care professional may suggest medications to treat high blood pressure or lower your cholesterol levels.

________________________

At Reply we do preventive visits that can help you understand your risk of CVD, and offer health coaching for patients who are exploring lifestyle modifications to treat risk factors for CVD. If you wish to schedule an appointment with one of our providers, please contact us at 919.230.2100 .

Portions of this post have been excerpted from The American College of Obstetricians and Gynecologists (ACOG). and from the Cleveland Clinic’s speakingofwomenshealth.com .

LANDMARK FABM STUDY: AN UPDATE

Tue, 05 Feb 2019 16:28:00 GMT

In September 2018, Dr. Rachel Urrutia along with five colleagues in the field of women’s reproductive health published a systematic review of studies looking at effectiveness of Fertility Awareness-Based Methods (“FABMs”) for preventing pregnancy. Read more about this landmark study on the Reply blog here. Since the study was published, some online responses have raised questions that are addressed in the letter below by Dr. Urrutia and her co-authors.

July 22, 2019

Since the publication of our systematic review in August 2018, several internet critiques have been published (FACTS and Natural Womanhood blogs) which may misrepresent the specifics of our methodology and our findings. Our goal in conducting and publishing our review was to advance the science of fertility awareness-based methods. We wanted to acknowledge and summarize the body of work that had been previously conducted, as well as facilitate better understanding of the science, both within and beyond the scientific community. As such, we would like to respond to some of the critiques outlined by the above Internet publications.

In preparation for our work, we read numerous key articles and reviews of FABM effectiveness. With respect to the review by Manhart et al. (the FACTS group), there were multiple differences in how we designed our review as compared to the Manhart review. First, the Manhart et al. review used one database and limited the years of the search as well as the language of the articles to English. Our goal was to try to be as comprehensive as possible, so we evaluated studies from 5 databases, and in 4 different languages. We looked at studies as far back as the inception of the databases and were also able to evaluate several studies published subsequent to the Manhart et al. review. We also reviewed the reference list of key articles to identify additional studies. This resulted in 53 included studies (versus 29 in the Manhart review).

A second difference was in the overall design of our quality framework. Though we shared some quality indicators (or partial quality indicators) in common with the review of Manhart et al., our framework was different in several, key ways. The Manhart et al. review ranked studies according to a SORT taxonomy and then summarized the findings from only the 10 studies that met “SORT criteria of evidence Level 1 (score of 40 or more out of 56 points).” By contrast, we developed our quality ranking tool on a framework from the U.S. Preventive Services Task Force in which studies needed to adhere to a level of quality in order to be ranked high, moderate, or low quality. This means that if no studies adhered to the quality framework, it would be possible for there to be no studies ranked high quality. This is in fact what happened. None of the studies that we subsequently evaluated were ranked “high quality,” and 21 of 53 were ranked “moderate.” We are pleased that our quality ranking could be considered “extremely rigorous,” and we spent a great deal of time creating a ranking system that we thought was relevant and attainable. Though studies had to meet multiple criteria to be considered high quality, we did not expect that the studies would be perfect. We chose to exclude several additional criteria which we thought might make a high ranking unattainable. For example, we felt studies should measure emergency contraceptive use and take account of this in the analysis. However, since emergency contraception is a relatively new phenomenon, we did not want to hold studies to this standard. Also, it’s important to note that our review recommends that clinicians advising patients interested in FABMs share the effectiveness estimates identified in the “moderate quality” studies in this review, with appropriate cautions.

Third, we described the effectiveness estimates from all of the “moderate” or higher quality studies. This allowed, for most methods, opportunity to present a range of effectiveness estimates, and not just focus on one effectiveness estimate for each method from one high quality study. This is important because typical use pregnancy rates vary extensively by population differences (e.g. age, motivation, education, etc.). Therefore, presenting only one typical use estimate from each method could be misleading. It is more useful for women and couples to understand that there is a range of typical use effectiveness that can vary between populations and individuals. As an extension of the initial review, we are currently working on an analysis to investigate the impact of population characteristics on pregnancy rates in more detail.

Regarding statements made about how our study will be interpreted by others: our brief overview statement in the systematic review—that “Prospective studies evaluating the effectiveness of specific fertility awareness-based methods to avoid pregnancy are of low to moderate quality; effectiveness estimates vary between and among methods”—was required by the editors of our paper. This is an accurate statement. The purpose of our article was not to convince more people to use FABMS. Our goal was to provide the most transparent information about effectiveness possible to support people in making their own informed decisions. We hope that our review will give more people the information needed to decide whether or not to use an FABM, and which one would be most suitable for them. In the meantime, we believe more data is needed in diverse populations before we can fully understand effectiveness, particularly in comparisons of effectiveness between FABMs and other contraceptive methods. Because of this, we are concerned about the critique appearing in the online FACTS commentary stating, “After all, about 10 ‘moderate-quality’ studies consistently demonstrate the potential for effectiveness rates rivaling hormonal contraceptives with none of the side effects and at significantly lower costs to users and insurers.” The comparison to effectiveness rates for hormonal contraceptives is not accurate or appropriate, nor is it one we made in our review. The most recent pregnancy estimates per 100 woman for one year for hormonal methods (implants, hormonal IUDs, DMPA, ring, patch, and pills) range from 0.1 to 7 in typical use, and from 0.1 to 0.3 in perfect use—based on a large body of evidence for each. More importantly, these estimates triangulate with those from retrospective population-based studies like the National Survey of Family Growth. These studies have limitations but do provide “real world experience” estimates that may be more generalizable. This type of triangulation to population-based data is currently impossible for specific FABMs because the number of users for each method is so low. However, most FABMs (setting aside sympto-thermal and Marquette) in the moderate quality studies in our review ranged from 9 to 33.6 in typical use, and from 1.1-12.1 in perfect use. The estimates from Marquette and Sensiplan are lower, and our review clearly states that these methods may be more promising, but they need to be triangulated with additional data before definitive statements can be made. Therefore, we believe that comparisons between FABMs and other methods at this stage must be done with appropriate caution and nuance. The cost argument also is incomplete and inappropriate–some FABMs are quite costly and, under ACA, many contraceptive methods are free. To make an evidence-based statement on cost, a cost-benefit analysis would need to be done, which was outside the scope of our review.

Regarding the specific criteria of excluding cycles with no intercourse, leading experts in the field have recommended this quality criterion for nearly 3 decades. Trussell and Grummer-Strawn stated in their 1990 publication, “Women simply are not exposed to the risk of contraceptive failure unless they have intercourse, so cycles characterized by no exposure to the risk of pregnancy should be removed.” Not adhering to this criterion can lead to “immortal time bias.” If a criterion like this is not used, a contraceptive method with the exact same effectiveness would appear to be far more effective in a sample of women or couples who have sex 6 times a year than it would in a sample of women or couples who have sex 6 times a month due to the fact that the baseline chance of pregnancy in each group is very different. Therefore, using this criterion helps to establish a more accurate baseline when comparing different studies. The authors in this landmark publication advocate for using this approach of removing cycles with no intercourse from the analysis for all methods of contraception or family planning, and not just FABMs. Systematically reviewing whether studies of other methods excluded all cycles where intercourse does not occur would be another enormous project that was not part of the scope of our review. If we were tasked with ranking quality of studies for another method, we would certainly hold them to the same standard as we held FABMs to in this study. We are aware of several studies of other contraceptive methods where this process has been followed. More importantly, the FDA has recently required investigators to exclude cycles without intercourse for other types of family planning methods. For FABMs, particularly in the context in which we can’t triangulate estimates with generalizable data such as that from the National Survey of Family Growth, we maintain that studies should have excluded cycles with no intercourse in order to produce estimates that could be as comparable as possible with those from other studies that have done the same. We acknowledge that many users of an FABM might abstain from intercourse during a subset of days during each menstrual cycle (in which case their information would not be excluded from calculations) and, in a small proportion of cases, may abstain from intercourse for an entire cycle or a few consecutive cycles at the start of using the method. We look forward to continued academic discussion about this unique feature of FABMs versus other contraceptive methods. However, for the purposes of estimating effectiveness, we feel that it is important to follow the methodology recommended by the FDA and contraceptive effectiveness experts for the reasons described above.

Regarding the ranking of specific studies in our review, at least one critique stated that only one study met the criterion of excluding cycles with no intercourse (WHO Trussell reanalysis). However, several other studies did meet that specific part of the quality criterion, including Arevalo 2002, Arevalo 2004, Bonnar 1999, as well as the Trussell reanalysis of WHO 1981. Furthermore, giving credence to the idea that this criterion was important, a few other studies (which didn’t meet our criteria) gave a nod to this concern: Johnston 1979 did a risk-based adjustment for cycles of low risk, Bartzen 1967 excluded cycles of women whose husbands were away with the military, Doring 1967 implies (but did not explicitly state) that cycles without sexual intercourse were excluded. Finally, several studies took care to exclude people who identified themselves as not sexually active, but never stated clearly if this applied on a cycle-by-cycle basis, while still indicating that this is a criterion that should be considered. Perhaps most importantly, failing to meet this criterion did not “disqualify” ANY remaining studies from consideration as high quality. All of the studies ranked moderate quality failed to meet the “high” quality bar due to at least 2 quality criteria and, in most cases, more than 2 criteria. This is an important point that seems to have been misrepresented by the FACTS blog and in further coverage of the FACTS blog by Natural Womanhood .

We recognize that there can be legitimate differences of opinion about interpreting the body of evidence regarding the effectiveness of FABMs, and we welcome continued scientific discourse. At the same time, we desire for our work and positions be represented accurately, which was the impetus for this letter.

Sincerely,

Rachel Peragallo Urrutia, MD, MS

Chelsea Polis, PhD

Elizabeth Jensen, PhD

Margaret Greene, PhD

Emily Kennedy, MA

Joseph Stanford, MD, MSPH

PCOS: A PATIENT'S STORY

Thu, 25 Oct 2018 17:08:39 GMT

Polycystic Ovarian Syndrome (PCOS) is a gynecological problem that affects 1 in 10 women. Symptoms include irregular cycles, weight gain, excessive growth of facial or body hair, severe acne, and metabolic problems. In honor of PCOS Awareness Month, one of our patients decided to share her story in the hope that others will benefit from learning about the condition. Patient “Julie T.” had been struggling with symptoms for more than a decade before coming to Reply with concerns about her health.

When Julie T. was first diagnosed with PCOS, her doctor advised her to go on the birth control pill or risk becoming infertile. It is very common for women to be prescribed the birth control pill for PCOS, and the Pill can improve symptoms like acne and hair growth. Ultimately, though, this course of treatment doesn’t help cure the underlying medical problem and can mask disease progression. In this case, it left Julie feeling unsure about her options and the best course of action:

“It’s a lonely diagnosis be cause every woman is different with her symptoms, and different doctors have different opinions on how to treat it…I felt like for 10 years I had to piece together things about PCOS from ob/gyn appointments, books, and the internet.”

By the time Julie came to Reply she had additional motivation for getting to the bottom of her health questions. She had been trying to conceive for a year and a half without becoming pregnant, and she was concerned about possible impact on her fertility. Through consultation with Dr. Rachel Urrutia, Julie made a plan of action for medical management and lifestyle changes:

“I really appreciated on the initial visit that Dr. Urrutia let me have a voice in my care that I would be receiving. She gave me the option of starting medication, or I could do lifestyle changes first. I truly felt empowered with the autonomy and knowledge to choose what I thought would work best for me. I decided to try to lose a little bit of

weight by working with Emily (Reply Health Coach Emily Kennedy), rather than trying medications first. I really appreciated that I didn’t feel pressured into a certain kind of treatment right away, and that she took the time to help me understand all the options. Dr. Urrutia was very thorough and ordered a lot of blood tests and also an ultrasound to rule out other issues. She was checking in to every possible area that could be a concern. I didn’t feel like I had to do my own research to make sure my doctor was covering all the right bases–I felt confident that she was already doing that. I can trust her. She gave me options and her recommendations, and I felt empowered me to make my own choices.”

Julie began working with Reply Health Coach Emily Kennedy on lifestyle changes, and Reply fertility educator Lori Hartley in order to learn fertility awareness cycle tracking, a tool that can help women with medical management and with family planning. In this case, Julie learned to identify her fertile window—the days during each cycle when intercourse could lead to pregnancy.

From previous experiences of cycle charting on her own, Julie had noticed that when she experienced a 7-10 pound weight gain, her cycles became more irregular. Even those few pounds seemed to have had an effect, and so she decided an important goal for her was to reduce her weight even by a few pounds. Weekly telehealth sessions were a convenient way to connect with her health coach to discuss specific ways for improvement: “Emily was able to help me see unhealthy food habits that I had developed without making me feel guilty or bad about it.”

The happy ending? Julie conceived within three cycles and is now expecting her first baby! “I am so grateful,” says Julie, who says she now encourages others, “keep looking until you find a practice where you can feel confident because it is worth it.”

At Reply, our mission is to help women optimize their health as much as possible. Sometimes women are surprised to learn that even a small weight loss like Julie’s of 10 pounds or less can significantly improve hormone balance. Rather than take a “band-aid” approach such as prescribing the birth control pill, we pursue treatments that promote underlying health and fertility. This can include medical treatments and/or working on lifestyle factors like diet and exercise.

If you’ve ever struggled with irregular periods or bothersome symptoms, or been prescribed the pill for management of PCOS without being able to understand your underlying health, you may be interested in Reply’s Cooperative Approach to healthcare. To learn more about PCOS, click here .

SEAFOOD INTAKE AND PREGNANCY

Wed, 12 Sep 2018 18:24:33 GMT

NEW STUDY LINKS HIGHER SEAFOOD INTAKE TO SHORTER TIME TO PREGNANCY

By Emily Kennedy, MSc, Reply Fertility Educator & Health Coach

On the journey to parenthood couples often wonder if they could make any lifestyle changes to boost their fertility. A new study out of the Harvard TH Chan School of Public Health has some advice:

Try eating more seafood.

Published in the May 2018 issue of Journal of Clinical Endocrinology & Metabolism , the Longitudinal Investigation of Fertility and the Environment (LIFE) study looked at 501 couples planning pregnancy to determine the effect of seafood intake on time to pregnancy. As the researchers followed these couples for up to a year or until they got pregnant, they started noticing a few trends. Couples who ate more

than 8 servings of seafood per menstrual cycle (about 2 servings per week) were found to have shorter time to pregnancy.

Specifically, within these couples, men who enjoyed this regular intake of seafood had 47% shorter time to pregnancy when compared to their peers who had only one or less than one serving per cycle. Women saw an even greater benefit with those who ate seafood an average of twice per week getting pregnant 60% faster than women who rarely ate seafood. As a couple, if both the man and the woman ate seafood at least 8 times per cycle, their time to pregnancy was found to be 61% shorter than couples who ate less seafood.

Like the researchers, you’re probably wondering why this might be. First of all, it is important to note that this type of study cannot prove that the seafood intake was the cause of the faster time to conception. It may be that women and men who ate seafood were different than women and men who do not eat seafood. Perhaps they ate a healthier diet in general, were more active, had less pesticide exposure, etc. One notable difference between the groups is that in the study, higher seafood intake was also linked to more frequent sex – 22% more frequent sex. It is possible that seafood increased sexual desire or that people who eat seafood more frequently have more sexual desire for other reasons. Seafood (think: oysters) is not the only food linked to greater interest in sex. A quick search reveals that everything from celery to pickled watermelon rind could be on a libido-enhancing menu. Of course, many factors influence how often a couple has sex but it never hurts to eat more fruits, vegetables and seafood. None of these studies, including the LIFE study, are conclusive but the findings are scintillating!

One limitation of this study is that it was done among couples with presumed normal fertility and so the findings have not been shown in a population who had difficulty conceiving at baseline. However, there is no harm in eating seafood and other health benefits to doing so.

Additional benefits of seafood

As a source of protein, minerals like zinc and selenium, and good fat, seafood has numerous benefits beyond fecundity (shorter time to pregnancy). For one, heart health professionals have long encouraged higher fish and seafood intake to boost intake of omega-3 fatty acids. Omega-3 fats are a key part of the structure of all cell membranes, particularly the structures in the retina, brain and sperm which contain a lot of omega-3 DHA.

Higher omega-3 intake has been associated with:

– lower triglyceride (blood fat) levels
– lower blood pressure. (Healthy blood pressure contributes to healthy erectile function.)
– lower susceptibility to irregular health rhythms
– decrease platelet aggregation (how sticky your blood is)

It’s no wonder why the American Heart Association recommends eating at least 2 servings of fish or seafood per week, just like the more fecund couples in the LIFE study.

Researchers are also looking into the link between omega-3 intake and cognitive function in children. For example, one British study published in the Lancet in 2007 found that women who ate seafood regularly during pregnancy gave birth to children with better fine motor, social and communication skills at age four. This potential benefit is still being investigated but it’s safe to say that eating more seafood will not hurt your chances of conception, nor will it harm your overall health.

How to eat low toxicant, high omega-3 seafood and fish

If you are concerned about toxicants like dioxins, PCBs and methylmercury in your fish and seafood, fear not. There’s a way to maximize benefits while minimizing risk. The following species are recommended by the Harvard Health Letter for this expressed purpose of safe, frequent fish and seafood consumption:

Salmon, farmed or wild (farmed is high in omega-3)
Trout
Light tuna (not albacore)
Mussels
Scallops
Shrimp

Eating a variety of different fish and seafood, instead of the same species all the time, also minimizes risk of toxicant exposure. Here are some meal ideas:

Smoked salmon and avocado toast
Open-faced light tuna sandwich melt
Seafood Medley and Rice Paella
Shrimp and potato omelet
Salmon or trout en papillote (baked in wax paper – easy clean up!)

Fish is fast food! Keep in mind, fresh fish takes only 10 minutes per inch of thickness to bake at 450 F. In a hot pan with oil, it’s just as fast – 4 to 5 minutes per side per inch of thickness.

If you’re still are not comfortable eating more fish, you can supplement with low mercury, low PCB fish oil to get your omega-3s in, just keep in mind that the benefits to eating fish are not limited to these good fats.

Feeling A Bit Spicy? Try This Easy And Delicious Recipe For Peri Peri Shrimp!

Ingredients

• 18-24 large shrimp (prawns)
• 1/3 cup + 2 T extra virgin olive oil
• 2 teaspoons crushed garlic
• 2 tablespoons lemon juice
• 2 tablespoons peri-peri sauce (recipe below)
• Salt, milled black pepper

Peri-Peri Sauce • 1 1/2 ounces red chilies, very finely chopped • 5 cloves garlic, crushed • 2 cups olive oil • Pared rind of 1 small lemon

Preparation

Peri-Peri Sauce

Mix the ingredients together in a bottle and shake well. You can make the sauce ahead and store it in the fridge; the flavor improves with age, reaching its peak at two weeks.

Shrimp

Slit shrimp down their backs and devein. Leave heads on, or remove them if you prefer. Depending on the size of your frying pan, cook them in one or two batches.

Heat the butter gently and add the garlic and lemon juice. Don’t let the garlic burn. Add shrimp and peri-peri sauce. (Shake first to make sure you get some of the chili and garlic as well.)

Sizzle for 4-5 minutes, turning frequently, until cooked. Season with salt and pepper and place into a warm serving bowl. Garnish, if you wish, with chopped fresh parsley. Serve with rice or bread and butter.

LANDMARK FABM STUDY

Fri, 17 Aug 2018 18:06:40 GMT

How Effective Are Fertility Awareness-based Methods (“fabms”) For Preventing Pregnancy?

August 15, 2018

The most comprehensive look to date at this question has just been published in Obstetrics & Gynecology, the official publication of the American College of Obstetricians and Gynecologists. Dr. Rachel Urrutia, Assistant Professor in the Department of Obstetrics and Gynecology at UNC Chapel Hill and a clinician at Reply Ob/Gyn & Fertility, is lead author of the landmark study, “Effectiveness of Fertility Awareness-Based Methods for Pregnancy Prevention: A Systematic Review” (click here to download a PDF of the full study) .

Key Findings Of The Systematic Review Include:

Twelve methods were identified as having at least moderate quality scientific support in the peer-reviewed literature. They are the Standard Days Method, the Two-Day Method, the Billings Ovulation Method, Marquette Mucus Method, Marquette Monitor-based, a French Symptothermal Method, Sensiplan, Thyma, Natural Cycles, Bioself, and Persona.
Pregnancy rates vary among methods. While the U.S. Department of Health and Human Services publishes the single pregnancy rate of 24% for FABMs, the Systematic Review found rates ranging from 2-34% with typical use and from <1-12% with perfect use (pregnancy rates indicate the percentage of women out of 100 using a method who become pregnant in the first year of use).
Two methods may be more effective than the others. These are the Sensiplan symptothermal method (pregnancy rates were reported at 2-3% with typical use and <1% with perfect use) and the Marquette Monitor-based methods (pregnancy rates 2-7% with typical use and less than 1% with perfect use).

“Women and couples deserve accurate information about the effectiveness of FABMs for their personal use, and researchers and medical professionals need this information in order to counsel patients and conduct further research,” says Dr. Urrutia, a board-certified obstetrician-gynecologist, preventive medicine specialist, and women’s reproductive epidemiologist. “We have only just begun to understand the effectiveness of FABMs, and we hope that high quality research to understand these methods continues as millions of women worldwide currently use FABMs.”

Dr. Urrutia explains that many users of FABMs have not learned a specific method, which further complicates the question of effectiveness. She also cautions that published effectiveness rates cannot be used to definitively compare FABMs to methods of contraception such as the birth control pill, or even to compare one FABM to another: “We recognize that many people will want to directly compare methods. However, it is complicated to do this because there are a relatively small number of studies for each method and the studies were done in very specific populations with very few comparisons between methods. What we can say is that there are several FABMs with effectiveness similar to barrier methods and or oral contraceptive pills in specific populations, and that our findings underscore the need for more work in this area.”

The Systematic Review Research Team from L to R: Margaret Greene, PhD, Chelsea Polis, PhD, Joseph Stanford, MD, MSPH, Rachel Urrutia, MD, Elizabeth Jensen, MPH, PhD and Emily Kennedy, MSc.[/caption]

The Systematic Review was produced over a period of four years by a multidisciplinary team who evaluated the best available prospective data on typical and perfect use effectiveness rates of FABMs for avoiding pregnancy. Dr. Urrutia’s co-authors are Chelsea B. Polis, PhD, Senior Research Scientist at the Guttmacher Institute and Associate Professor in the Department of Epidemiology at the Johns Hopkins Bloomberg School of Public Health; Elizabeth T. Jensen, MPH, PhD, Assistant Professor, Epidemiology & Prevention Office of Women in Medicine & Science at Wake Forest School of Medicine; Margaret E. Greene, PhD, Principal at GreeneWorks LLC; Emily Kennedy, MSc, Fertility Educator and Health Coach at Reply Ob/Gyn & Fertility, PLLC, and Joseph B. Stanford, MD, MSPH at the University of Utah Health Hospitals and Clinics. The study was partially funded by USAID.

Reply Ob/Gyn & Fertility teaches fertility awareness education on-site at its Cary, North Carolina, clinic and to distance learners via video telehealth. Reply fertility educators teach three of the 12 methods identified in the Systematic Review as having at least moderate quality scientific support: Sensiplan™ , Marquette Model™ , and Billings Ovulation Method® .

For more information about fertility awareness and/or learning a method with Reply, click here. For the full PDF of the study, “Effectiveness of Fertility Awareness-Based Methods for Pregnancy Prevention: A Systematic Review,” click here .

A POSITIVE APPROACH TO GESTATIONAL DIABETES

Sat, 21 Apr 2018 21:10:43 GMT

Pregnancy is an exciting time full of rapid changes. In up to 10% of pregnant women, a condition called gestational diabetes mellitus (“GDM”) can develop because of hormonal changes and cause expectant women to feel discouraged or even guilty. This article seeks to help these women understand the condition, realize they are not at fault, and, most importantly, empower them with positive ways to have a healthy pregnancy. The diagnosis of GDM is an opportunity to become even healthier than you were before you became pregnant.

Please note : While aimed at women with GDM, the information below can be applied to many women in all stages of life. Blood sugar control is important for everyone!

What Is Insulin?

Let’s review what insulin is and how it works, because this is fundamental for understanding GDM.

When someone ingests any type of carbohydrate (bread, fruit, beans, rice, etc.) it is broken down into sugar, or glucose, in the bloodstream. This sugar travels through the bloodstream where it looks for an entry way into the cells so that it can be used as energy. However, for glucose to be let into a cell, insulin is needed to open the door to the cell. Imagine a glucose molecule standing outside a cell “door” asking to be let in, and insulin comes and acts as the “key” that opens the door.

Pregnancy hormones and excess body fat can block the “lock” of the cell where insulin usually fits. As a result, insulin is unable to open the “doors” as efficiently as needed.

If insulin is unable to open the “door,” then the body starts making more insulin to try to compensate. As a result, there is lots of insulin and lots of glucose in the bloodstream, but neither is working very efficiently, and very little glucose is actually getting into the cells.

This is called insulin resistance.

What Is Gdm? How Does It Develop?

When diabetes develops during pregnancy, this is largely (often?) due to normal hormonal changes that occur during pregnancy.

Let’s take a quick look at these normal hormonal changes:

1st trimester (0-12 weeks)

2nd & 3rd trimesters (13 weeks onward)

What causes insulin resistance (which again, in a mild state, is very normal in pregnancy) to turn into full-blown gestational diabetes? We have to ask the pancreas!

The pancreas is the organ in charge of making insulin. The pancreas has to work 2-3 times harder during pregnancy to overcome normal insulin resistance…so is it? If the pancreas is not making enough insulin, or if that insulin is not working effectively, and is unable to “open the door” to each cell, then a woman may develop GDM.

Who Is At Greater Risk?

Here’s an interesting fact: many cases of GDM occur with no pre-existing risk factors. Anyone who is pregnant can develop it. However, to help with early detection, anyone with any of the following risk factors will be screened for GDM as soon we know they are pregnant:

Early screening is so important because knowing early gives a woman more time to improve her blood sugar control.

How Is Gdm Diagnosed?

Diagnosis of gestational diabetes is a 2-step process:

1. Screening
Everyone gets screened at 24-28 weeks, which involves drinking 50 grams of glucose (the Glucola drink) then testing to see how much glucose is still in your blood after 1 hour. Those with risk factors are screened earlier in pregnancy.

2. 3-hr Glucose Tolerance Test
If the screening result is elevated, we bring patients back for another test that looks at how well glucose is used over a long period of time. Elevated results from this 3-hour test indicate gestational diabetes.

We ask that women not change their eating or exercise habits just prior to a screening or 3-hr glucose tolerance test. Discovering gestational diabetes is very important for the health of the baby and mother. Let’s not try to cover it up if it’s there.

If you have risk factors like previous GDM or strong family history, you will be screened at the time of pregnancy confirmation.

Why Is Diagnosis So Important?

As we will describe below, there are important changes that a woman must make after her GDM diagnosis. However, change is hard. Pregnancy is hard, even without gestational diabetes! Therefore, sometimes it helps to remember the potentially avoidable poor outcomes when you are running low on motivation.

Possible poor outcomes for mom if GDM is not managed well:

Possible poor outcomes for baby if GDM is not managed well:

Reply Certified Diabetes Educator Lori Hartley has more than 20 years’ experience as a labor & delivery nurse. Here’s how she explains the avoidable poor outcomes for baby:

“When a pregnant woman has gestational diabetes, the ‘doors’ to her cells don’t always allow glucose in, resulting in insulin resistance. When this occurs, the glucose is forced to continue traveling through her circulation searching for any ‘door’ that will allow it to enter. Unfortunately, a woman’s placenta and umbilical cord to the baby have huge ‘doors’ that allow all that excess glucose to be dumped.

When the baby’s little pancreas notices all this extra glucose coming towards it, it goes into overdrive and starts producing large amounts of insulin to combat all this extra sugar. Insulin is a growth hormone and causes babies to grow so this can cause high birthweight, difficult deliveries, and increased risk of stillbirth.

After delivery, the baby’s pancreas is still working overtime; however, the umbilical cord has been cut, so there is no longer an excess of blood sugar. This causes the baby to have too much insulin, and too little blood sugar, which can cause difficulties ‘normalizing’ after birth (jittery baby, rapid respirations, etc.). Often babies of moms with uncontrolled blood sugar will require admission to NICU.

I stress to moms over and over: it’s not the diagnosis that puts your baby at risk. It’s the uncontrolled sugars, which you can control! When sugar levels are controlled well, the baby has an excellent chance of being born healthy and without complications, equal to that of a non-GDM mom.”

Choose Your Response

After a woman is diagnosed with GDM, what’s next? We believe attitude and empowerment go along way in determining how the rest of the pregnancy goes. There are two ways to think about the diagnosis:

1. Focusing on the unhealthy, sad outcomes

OR – hopefully –

2. Focusing on the positive, healthy, happy outcomes that occur with well-managed blood sugar.

Let’s Think Positive!

Positive thoughts are healthy thoughts, and healthy thoughts lead to healthy habits!

Positive Thought #1:

GDM is very manageable!

Changing one’s diet, increasing physical activity, performing self-monitoring of glucose levels, and maintaining frequent contact with a knowledgeable healthcare team can have a major positive impact on blood sugar levels. This group of actions are the first line of treatment for GDM.

Sometimes, this may be all that is needed to manage blood sugar levels and have a healthy pregnancy. After one or two weeks, if blood sugars are not improving with changes to these habits, we will help the woman manage with oral medication in addition to continuing to work at food and fitness habits.

Working closely with a knowledgeable healthcare team is very important, including a Certified Diabetes Educator. It is important to understand how certain types and amounts of carbohydrates affect blood sugars. A knowledgeable healthcare team will help a woman learn how to choose low glycemic index (GI) carbs, what a glycemic load (GL) is, and why it is important.

Exercise is a great way to manage blood sugar issues because it speeds up use of any extra glucose floating around in the bloodstream and it helps to re-sensitize our cells to the action of insulin. The goal is 30 minutes of moderate intensity activity, 3 to 4 days per week. If this sounds like a lot, start by adding 10 minutes of extra movement to the day, perhaps after each meal.

It is important to note that blood sugar management during pregnancy is a moving target because hormones are constantly changing and hormones affect how insulin works. It is possible to make all the right changes and still need to adjust the treatment plan. Again, this highlights the need for good self-monitoring and frequent contact with a knowledgeable healthcare team.

POSITIVE THOUGHT #2:

The positive habits created after a GDM diagnosis can last a lifetime.

GDM can be a catalyst for change and blessing in disguise. For many women, after the initial hard work to master nutrition basics, these routines will become part of their “new normal.” Women discover how good they feel when their blood sugar is balanced, and never want to go back!

The same goes for key exercise basics like getting 30 minutes of brisk activity in most days per week. Working at this during pregnancy may turn swimming, dancing, or at-home workout DVDs into a healthy way to de-stress after a long but exciting day of caring for a newborn!

(Want tips on Exercise during Pregnancy? Click here.)

POSITIVE THOUGHT #3:

Most cases of GDM go away after baby is born.

No more pregnancy hormones, no more blood sugar issues. While the mother who had GDM will remain at elevated risk for diabetes, heart disease, and GDM in future pregnancies, in most cases GDM resolves after delivery. A healthcare provider should perform a secondary glucose test 6 weeks post-partum to ensure that levels have returned to normal.

Healthy Habits For Gdm Management

Plan your meals
Learn 7 easy, healthy recipes (see below for a couple of ideas) for go-to breakfast, lunch, or dinner
Make and stick to a shopping list
Check carb content on labels (15 grams = serving)
Eat a big, calorie-dense breakfast
Eat more of the day’s calories in the beginning of the day, rather than at the end of the day
Eat more fiber, protein, and healthy fats

2. Prepare for exercise

g. Get walking shoes with good support

h. Find something fun to do at home

3. Enlist help

i. Ask a friend or family member for support

j. Sign up for fitness coaching at a local gym

k. Sign up for health coaching at Reply

l. Join online support groups

4. Stay positive – No one is expected to be perfect!

Health Coaching For Change

It is possible for a woman with gestational diabetes to manage her blood sugar naturally, deliver a healthy baby, and continue to make healthy choices in the post-partum phase (and beyond!) to avoid the conditions associated with GDM.

Health coaching helps women map out the small changes they need to make for long-term health. Working with a health coach is all about setting goals, developing a personalized plan to achieve those goals, and developing personal strategies for overcoming barriers to the execution of that plan.

Bottom Line

Gestational diabetes happens because of hormonal changes that are natural to pregnancy. Thinking positive and learning to manage blood sugar during pregnancy can help an expecting mother achieve the best of health of her life as she navigates parenthood. Everyone should have blood sugar control on their health radar, and sometimes a GDM diagnosis is the blessing in disguise that helps us realize that.

References

American Diabetes Association. Gestational diabetes mellitus. Diabetes Care. 2003;26 Suppl 1:S103-S105.

Kim C, Berger DK, Chamany S. Recurrence of gestational diabetes mellitus: a systematic review. Diabetes Care. 2007;30(5):1314-1319.

Boinpally T, Jovanovic L. Management of type 2 diabetes and gestational diabetes in pregnancy. Mt Sinai J Med. 2009;76(3):269-280.

Gestational diabetes: prevention. Mayo Clinic website. https://www.mayoclinic.com/health/gestational-diabetes/DS00316/DSECTION=prevention . January 10, 2018.

Mottola MF. The role of exercise in the prevention and treatment of gestational diabetes mellitus. Curr Sports Med Rep. 2007;6(6):381-386.

________________________

Recipes

Quick (Leftover) Veggie Fritatta

• 4 eggs
• ¼ cup liquid such as whole milk, bone broth, or miso soup
• ¼ teaspoon herbs of your choice (parsley, oregano, thyme, basil, etc.)
• 1 cup leftover cooked vegetables (wilted spinach, collards, kale, roasted veggies, etc.)
• 2 teaspoons butter or coconut oil
• Salt and pepper to taste

Preheat oven to 350°. Beat all ingredients, except butter, together in a big bowl. Heat butter or coconut oil in a heavy, non-stick pan on medium high heat. Pour in egg mixture. Turn heat down to low medium and cook for 5-10 minutes then transfer to the oven for 2-3 minutes or until set. Transfer to cutting surface and serve with a salad for a full meal!

Overnight Vanilla Chia Pudding

• 1 cup milk (whole, organic whole, or unsweetened coconut milk if dairy intolerant)
• 3 tablespoons chia seeds
• 1 squirt of liquid stevia (optional)
• ¼ teaspoon vanilla extract (or cinnamon if you prefer)

Can be topped with unsweetened coconut, raw almonds, fresh fruit, etc.

Put everything into a jar. Put the lid on and give a shake. Put it in fridge. Ready in 30 minutes. Prep it before bed and wake up to a dessert-like breakfast.

Quick set method: Heat the milk before you add it to the seeds.

Chocolate Avocado Pudding

• 2 ripe avocados
• ¼ cup milk (whole, organic whole, or unsweetened coconut milk if dairy intolerant)
• ¼ cup unsweetened cocoa powder
• 1 tsp vanilla extract
• 1 squirt of liquid stevia (optional)
• A pinch of salt

Blend (electric blender is best) everything together until smooth.

ENJOY!

THE MYSTERY OF MENOPAUSE : EXPLAINED

Wed, 21 Feb 2018 22:48:02 GMT

THE MYSTERY OF MENOPAUSE

On February 6 we hosted the First Tuesdays! talk, The Mystery of Menopause: Explained. Reply’s own Tally Krienke, CNM led the presentation, which reviewed the stages of perimenopause and menopause. In addition, several Reply clinicians were on hand and provided insights on everything from nutrition to physical changes to libido. A summary is shared below.

After a woman begins the fertile period of her life at puberty, it can take a few years for her cycles to become regular. This is because hormones fluctuate during development, and then typically stabilize into a regular pattern.

As one approaches menopause, the body does the same thing, but in reverse. Here’s how the journey unfolds, beginning all the way back before birth!

When a woman has 12 consecutive months without a period, she is officially in menopause. Fifty-one is the average age of menopause.

SYMPTOMS AND TREATMENTS

The following are the primary symptoms of perimenopause and menopause, and suggestions for management. When possible, we like to recommend the more conservative treatments and lifestyle modifications first, before moving to more invasive measures. Many women are relieved to learn that what they are experiencing is completely normal and that there often are effective ways to treat these issues.

1. Vaginal Dryness, Vaginal Weakness, Painful Intercourse

Developing eggs produce lots of estrogen. So as a woman enters perimenopause and menopause she has fewer and fewer eggs, and therefore less estrogen. Estrogen helps the skin cells of the vagina and other tissues by playing a role in the production of collagen. As estrogen decreases so does the level of collagen; this results in a loss of elasticity in skin, vaginal tissue, joints, and the walls of blood vessels. Without estrogen, the skin of the vagina begins to thin, leading to dryness, weakness, and potentially painful intercourse. Decreased estrogen also causes increased pH levels in the vagina, which may increase the risk for infection.

These physiological changes in the vagina may cause some women also to experience itching, burning, irritation, painful urination, vaginal bleeding, frequent urinary tract infections, or urgency and increased frequency in using the bathroom.

What can be done?

Water-based lubricants
Long-acting lubricants
Regular sexual activity
Increased foreplay with sexual activity
Vaginal moisturizers (daily vitamin E, olive oil, or coconut oil)
Vaginal pH balancing wash
Wash vaginal area with water only
Avoid douching

2. Hot Flashes, Night Sweats

Many women experience hot flashes or night sweats. These are extreme, sudden heat flashes of the upper body that can last 1-5 minutes and can result in perspiration, flushing, chills, clamminess, anxiety, and/or heart palpitations.

Prior to menopause, it takes a large shift in core body temperature to make you shiver or sweat. but as a woman reaches menopause, small shifts in temperature can result in these severe responses, like a hot flash in response to a small increase in our core body temperature.

This is partly because perimenopausal and menopausal women have less estrogen to help regulate hot flashes. Unfortunately, this process is not yet very well understood.
What can be done?

30 minutes of daily exercise
Weight loss
Decreased intake of sugar, caffeine, spicy food, and alcohol
Relaxation techniques like massage, meditation, aromatherapy, deep breathing
Vitamin E up to 800 units per day
Hypnosis
Soy isoflavones supplementation
Cognitive-behavioral therapy

What about Hormone Replacement Therapy?

Menopausal Hormone Therapy (HT) can be a great way to reduce symptoms of menopause that are affecting daily life and are not improved with lifestyle modifications. Other benefits of HT may include reduction of bone reabsorption, decreased risk of colorectal cancer and diabetes, and improved hot flash/night sweat symptoms. However, HT may come with an increased risk of conditions such as coronary heart disease, invasive breast cancer, stroke, and pulmonary embolism. Women should consult with their healthcare provider to consider possible HT plans.

3. Sleep Disturbances

Some women experience trouble sleeping, often due to night sweats/hot flashes. If you are experiencing sleep disturbances but not experiencing hot flashes/night sweats, further evaluation of other factors such as restless leg syndrome or sleep apnea should be completed.

Sleep disturbances also can be part of the normal aging process. As we age, we need less sleep and our bodies naturally decrease the time spent in each of the different stages of sleep; this process sometimes can be disruptive and difficult to adjust to.

What can be done?

Improve your sleep hygiene
Blue-light blockers
Put away electronics by a certain time every evening
Limit stimulants like caffeine, alcohol, sugar, nicotine
30 minutes of daily exercise
Relaxation techniques like massage, meditation, aromatherapy, deep breathing
Nutrition counseling (tips may include: light carbohydrate snack before bed like 1/2 a banana or a cup of warm milk, B12 supplementation)

4. Weight Gain

Muscle mass decreases as part of the normal aging process. Less muscle mass means a woman burns fewer calories, resulting in weight gain. This weight gain is often in the waist, creating an apple shape. Apple-shaped women tend to have more insulin resistance, which may increase the risk of cardiovascular disease and diabetes.

Although not the only contributor, lower estrogen may also play a factor in weight gain. Animal studies have shown that less estrogen may lead to more eating and less physical activity. Lack of estrogen may also make carbohydrate usage less efficient, thereby increasing fat storage. Some studies have shown that estrogen replacement therapy (HT) can increase a menopausal woman’s metabolic rate, although HT has not been medically approved for weight loss. Bottom line: Weight gain during menopause is multifactorial, not strictly because of less muscle mass or less estrogen.

What can be done?

30 minutes of daily exercise including weight training
Consult with a nutritionist or health coach who is knowledgeable about perimenopause and menopause
Reduce refined carbohydrate intake

5. Mood Changes and Depression

The physical changes happening in the body, coupled with the emotional effects of this life transition, may cause mood changes or depression. There may be added psychological elements related to loss of fertility, empty nests, becoming a grandparent, or other unrelated health issues. For some women, mood is improved with hormone replacement therapy, indicating the role that hormone balancing may play in this condition. For others, an anti-depressant or other treatment may work. There is not enough scientific evidence to state that mood changes and depression that may accompany perimenopause and menopause are purely or even partly caused by hormonal changes.

What can be done?

30 minutes of daily exercise
Limit stimulants
Cognitive-behavioral therapy
Antidepressants

Please note : in the Triangle region we are fortunate to have local resources for mood change problems. For example, the UNC Women’s Mood Disorder Center recently opened their Perimenopause Evaluation and Treatment Program . Please visit their website to learn more.

MANY SYMPTOMS CAN BE INTERRELATED

You may have already observed that many of these symptoms are interrelated. In an extreme example, sleep disturbances are often related to hot flashes and night sweats. With less sleep comes an increase in daytime fatigue, which can cause mood disturbances. Mood disturbances can decrease desire to exercise, which can lead to weight gain, which can lead to depression, which in turn can lead to more sleep disturbances, and so on.

While every woman is different and may experience her own unique symptoms,most symptoms typically decrease significantly by 3-4 years after menopause (after you’ve already gone 12 months without a period).

RISK FACTORS

Some risk factors may increase the likelihood of developing symptoms or having more severe symptoms. Women should consult their healthcare provider to identify individual risk factors.

High BMI
Depression/anxiety
Genetic factors
Smoking
Alcohol consumption
Vegetarian diet
Poor nutrition
Hysterectomy
Cancer treatment

Ruling out other issues

Please keep in mind that if a woman in her 40s or 50s has menopause-like symptoms, we don’t assume menopause is happening just because a woman is a certain age. Your healthcare provider should first rule out other issues like thyroid problems, cancer, diabetes, depression, medication use, alcohol and drug use, or other factors.

Increased risk for other conditions

Breast cancer – The increased risk of breast cancer in the menopausal woman is not fully understood. Evidence shows that women with higher BMIs in the perimenopause/post-menopause life stage have higher rates of breast cancer. This may be related to the overall high estrogen stores within the adipose tissue, and/or the higher insulin levels associated with a high BMI. Your provider may use a Breast Cancer Risk Assessment Tool to calculate your 5-10 year risk of developing breast cancer.

Colon cancer – The risk of colon cancer, like many cancers, increases with age. However, in some women Hormone Replacement Therapy may decrease the risk of colon cancer. Though the use of HRT as treatment is promising, this link has not been fully studied.

Heart disease – The increased weight gain that created the apple shape also increases women’s risk of heart disease. Lower estrogen levels also make blood vessels less flexible, or less capable of accommodating blood flow.

Osteoporosis – Osteoporosis–when the body loses bone mass ormakes too little bone, or both– increases with age in both men and women. However, post-menopausal women are more at risk because of decreased estrogen. The highest amount of bone loss occurs in the first year after menopause. Weighing less than 127 pounds or having a BMI less than 22, never having had children, cigarette smoking, excessive alcohol or caffeine use, a sedentary lifestyle, or inadequate calcium intake increase the risk of osteoporosis.

You should see your healthcare provider if you:

Have your period more often than every 3 weeks
Have very heavy bleeding during your period
Have spotting between your periods
Have been through menopause (12 months without a period) and start bleeding again, even if it is only one spot of blood

QUESTIONS & ANSWERS

Questions from our February First Tuesdays! event included:

How can a health coach or nutritionist helping me during this time?

Working with a health coach or nutritionist can help with some of the lifestyle adjustments. It is often recommended that patients keep a written log/food diary to try to identify what triggers certain symptoms. Much can be unveiled by this one simple technique – and a professional health coach or nutritionist can help you see connections you may not otherwise be aware of.

What can be done to help with brain fog?

Getting adequate choline from foods like egg yolks, liver, Brewer’s yeast, peanuts and green peas may help with memory and brain fog issues attributed to perimenopause and menopause.

Are Kegels still important during perimenopause?

Yes! Thinning of the skin and loss of muscle tone over time can contribute to a greater risk for uterine or bladder prolapse. Kegels help keep the pelvic floor muscles strong.

Are artificial sweeteners a good alternative to sugar to help with weight loss?

Artificial sweeteners can increase the risk of obesity. Stevia, Xylitol, and monk fruit are better alternatives to sugar or artificial sweeteners.

Is it normal for libido to decrease during perimenopause and menopause?

Yes, as mentioned previously, decreased estrogen can result in the vagina and vulva becoming dry and uncomfortable. Plus, how you feel about yourself may be changing. Increase foreplay, use water-based lubricants, practice lots of self-care to increase your confidence, and embrace this new phase of your sexuality.

As in all stages of life, it is of paramount importance during perimenopause/menopause for women to partner with a healthcare provider who listens to and treats each patient as an individual. And as our presenter, Tally Krienke, summed up:

“This can be a very powerful time in a woman’s life. A time for renewal and growth.
A time to harness the power of this new beginning!
If you’ve paid less attention to your health in previous years, now is the time to make
a renewed commitment to honor your body and protect your well being.”

___________________________________

REFERENCES

Committee on Practice bulletins- Gynecology (2016). Management of menopausal symptoms: Practice bulletin number 141.The American College of Obstetrics and Gynecologists.
Hall, J. E. (Sep 28, 2016). Understanding and treating menopausal symptoms. Retrieved from: https://www.med.unc.edu/obgyn/events/grand-rounds-45
North American Menopause Society (2015). Nonhormonal management of menopause-associated symptoms: 2015 position statement of The North American Menopause Society. The Journal of The North American Menopause Society. 22(11): 1155-1174. doi: 10.1097/GME.0000000000000546
The Women’s Health Initiative Steering Committee. Effects of conjugated estrogens in postmenopausal women with hysterectomy. The Women’s Health Initiative Randomized Trial. JAMA 2004;291:1701-1712.
Lizcano F, Guzmán G. Estrogen Deficiency and the Origin of Obesity during Menopause. BioMed Research International. 2014;2014:757461.
van Seumeren I. Weight gain and hormone replacement therapy: are women’s fears justified? Maturitas. 2000 Jan;34 Suppl 1:S3-8. Review.

PREGNANCY AND EXERCISE

Wed, 30 Aug 2017 20:23:49 GMT

There is a common misconception that exercise during pregnancy is unsafe. Fortunately, if you are healthy and your pregnancy is normal, it is safe to continue or start most types of exercise.

Why Be Active During Pregnancy?

Regular exercise during pregnancy benefits you and your baby in these key ways:

Reduces back pain
Eases constipation
May decrease your risk of gestational diabetes, preeclampsia (high blood pressure during pregnancy), and cesarean delivery
Promotes healthy weight gain during pregnancy
Improves your overall general fitness and strengthens your heart and blood vessels
Helps you to lose the baby weight after your baby is born

And benefits continue in the postpartum period: exercising after your baby is born may help improve mood and decreases the risk of deep vein thrombosis, a condition that can occur more frequently in women in the weeks after childbirth.

What Are The Best Choices For Physical Activity During Pregnancy?

The following activities are a few great ways to stay safely active for most healthy pregnant women:

Walking: Brisk walking gives a total body workout and is easy on the joints and muscles.
Swimming and water workouts: If you find brisk walking difficult because of low back pain, water exercise is a good way to stay active.
Stationary Bicycling: Because your growing belly can affect your balance and make you more prone to falls, riding a standard bicycle during pregnancy can be risky. Cycling on a stationary bike is a better choice.
Modified Yoga and Modified Pilates: Yoga reduces stress, improves flexibility, and encourages stretching and focused breathing. There are even classes designed especially for pregnant women! If taking a regular class, or doing yoga on your own, avoid poses that require you to be still or lie on your back for long periods.

When Is Exercise Unsafe During Pregnancy?

Women with the following conditions or pregnancy complications (which your doctor will tell you about) should not exercise during pregnancy:

Certain types of heart and lung diseases
Cervical insufficiency
Being pregnant with twins or triplets (or more) with risk factors for preterm labor
Placenta previa after 26 weeks of pregnancy
Preterm labor or ruptured membranes (your water has broken) during this pregnancy
Preeclampsia or pregnancy-induced high blood pressure
Severe anemia

Physical activity does not increase your risk of miscarriage, low birth weight, or early delivery – unless you have any of the above conditions. In a healthy pregnancy, being active is a good thing.

Working With A Health Coach

Before you begin, check with your ob/gyn to make sure exercise is safe for you. If you are having trouble sticking to your exercise goals, or want help in designing an exercise program that is right for you, you may consider working with a health coach. Reply Ob/Gyn & Fertility Health Coach Emily Kennedy has helped many of our patients achieve their health goals. Emily suggests the following tips for pregnancy workouts:

Drink plenty of water before, during, and after your workout.
Wear a sports bra that gives lots of support to help protect your back. Later in pregnancy, a belly support belt may reduce discomfort while walking or running.
Avoid becoming overheated. Wear loose-fitting clothing, and exercise in a temperature-controlled room. Do not exercise outside when it is very hot or humid.
Keep moving! To ensure adequate blood flow to your uterus, avoid standing still or lying flat on your back as much as possible.

“Expect your workout to feel different during pregnancy,” Emily advises. “Your balance, breathing and coordination are all different. So tune in, and go easy!”

ENDO WHAT ?

Wed, 30 Aug 2017 19:14:44 GMT

Join us Thursday, November 2, for an exclusive screening of Endo What? , a groundbreaking film about the devastating condition endometriosis. The event will be held on the UNC Campus and is presented by Reply Ob/Gyn & Fertility and Women’s Birth & Wellness Center. The presentation is FREE and open to the public, but space is limited so please register to reserve your spot.

“Shatters the myths surrounding endometriosis.” –The New York Times

“Hands down my pick for film of the year because its truth-telling is powerful & inspirational.” –The Guardian

“This film is the first step in a plan to educate & organize for change.” –Newsweek

“Gives real, straightforward information to shed the mystery surrounding the disease.” –Cosmopolitan

Endometriosis affects about 1 in 10 women worldwide. Yet, women with the condition see an average of 8 doctors for 10 years before they’re diagnosed. During that time, many are forced to abandon dreams of having children, to leave careers they love, and to watch their personal relationships suffer. They’re routinely told (erroneously) that pregnancy & hysterectomy are cures, and that pain is normal or in their heads. It’s time to break that cycle. It’s time for a normal that doesn’t mean multiple doctors, surgeries, misdiagnoses, and years of pain. The only film of its kind, Endo What? gives viewers an accurate, up-to-date base of knowledge straight from the experts – a vital resource missing until now.

We are pleased to have the following experts join us for a panel discussion and Q&A immediately following the movie:

Shannon Cohn: Director and Producer of Endo What? and Endometriosis Awareness Advocate
Dr. John M. Thorp, Jr.: Reply Ob/Gyn & Fertility Medical Director, and the McAllister Distinguished Professor in the Department of Obstetrics and Gynecology and Division Director for Women’s Primary Healthcare at the University of North Carolina at Chapel Hill
Dr. Rachel Urrutia: Reply Ob/Gyn & Fertility board-certified obstetrician-gynecologist, preventive medicine specialist, women’s reproductive epidemiologist, and Assistant Professor in the Department of Obstetrics and Gynecology at the University of North Carolina at Chapel Hill
Dr. Erin Carey: board-certified obstetrician-gynecologist, Division Director of UNC Minimally Invasive Gynecologic Surgery, and Assistant Professor in the Department of Obstetrics and Gynecology at the University of North Carolina at Chapel Hill
Dr. George Nowacek: board-certified obstetrician-gynecologist and Associate Professor in the Department of Obstetrics and Gynecology at the University of North Carolina at Chapel Hill
Dr. Jennifer Harrington: Women’s Health Physical Therapist, Founder of UNC’s Women’s & Men’s Health Physical Therapy program, and lecturer at the UNC School of Physical Therapy and UNC School of Medicine
Cherrelle Lawrence: Patient at Reply Ob/Gyn & Fertility, Endometriosis Awareness Advocate, and Founder of Her Yellow Ribbon

THURSDAY, NOVEMBER 2, 2017

5:30 pm Reception, featuring hors d’oeuvres from Green Planet Catering

6:30 pm Film screening of the groundbreaking new documentary, Endo What?

7:30 pm Expert panel and Q&A with the film director and physicians and medical experts from UNC and Reply Ob/Gyn & Fertility

Location: Room 2204 in the Medical Biomolecular Research Building (MBRB) at UNC-Chapel Hill (111 Mason Farm Road, Chapel Hill, NC 27599) – plug in to Google Maps, or see driving directions here

Parking: Ambulatory Care Center Parking Lot (open to the public beginning at 5:30 pm and FREE if you exit the parking lot after 7:00 pm) – 101 Mason Farm Road, Chapel Hill NC 27599 or in the Dogwood Deck ($1.75/hour) – 170 Manning Drive, Chapel Hill NC 27599

You may also click here for a general UNC parking map.

Tickets: The presentation is FREE and open to the public, but space is limited so please register here to reserve your spot.

This is an exclusive opportunity for the UNC and greater Triangle community.

We hope you’ll join us!

LIVING & LOVING, NATURALLY

Fri, 28 Jul 2017 20:36:28 GMT

LIVING & LOVING, NATURALLY – ONE COUPLE’S PERSPECTIVE

Kelsey and Eddie D. are a couple in their late 20s who love to live as naturally and sustainably as possible. They grow many of their own foods, shop local, and limit toxic chemicals in their cleaning and hygiene products. When it comes to their reproductive health, conversations with friends and their own research led them to Reply in 2015, where they learned to chart the signs of Kelsey’s fertility through the Sensiplan method in order to avoid pregnancy naturally. Eddie says: “We chose Sensiplan over other methods of family planning because of the opportunity to empower our decision making for intimacy with the knowledge of fertility cycles. Plus, Sensiplan is the only fertility awareness method taught in the Triangle area that is strictly evidence-based and has a strong foundation in European countries.”

Kelsey also appreciates that Sensiplan is a method of family planning that keeps Eddie involved. With Sensiplan, and any method of fertility awareness, you can’t simply “set it and forget it.” It requires daily communication and cooperation from both members of a couple. As a result, Kelsey says she feels that Eddie is more in tune with her. “The rewards of being disciplined and educated are enormous,” says Kelsey.

“Now, two years later, I can say that using the Sensiplan method has made our relationship stronger and each of us much smarter about our bodies. And bonus – I really appreciate not having to take drugs every day.” Eddie adds: “Being able to predict the fertility cycle in my wife has been an amazing experience and impacts our intimacy, fun, and health in a positive way.”

The only thing they wish is that more couples knew about fertility awareness! Kelsey says: “Learning how to observe the signs of your fertility should be a standard part of all sex education.”

We agree, Kelsey!

To learn more about fertility awareness and Sensiplan or to schedule an appointment, please call us at 919.230.2100 or visit our Become a Patient page .

APPRECIATING YOUR CYCLE

Wed, 26 Jul 2017 21:09:57 GMT

A Conversation with Emily Kennedy, MSc

Emily Kennedy, MSc, serves patients as both a Health Coach and a Fertility Educator at Reply. She also is a personal user of fertility awareness for natural family planning and health monitoring purposes:

“My husband and I learned about fertility awareness through friends who were also newly married. It was highly recommended by people we trusted, so we decided to learn more. And since then, we have used fertility awareness to both avoid pregnancy and become pregnant.”

Emily loves that tracking the signs of one’s fertility gives a woman a window into her overall health. However, before moving to the Triangle 3 years ago from Toronto, she did not have the support of local health professionals in this endeavor.

“I never had a doctor who was well versed in cycle tracking until I moved to Raleigh, so we’re really blessed to have some expertise right here in North Carolina! Through coordinating lab work to specific times during my cycle, I discovered I had a little bit of a thyroid issue. Finally, I had an answer as to why I was experiencing certain symptoms.”

As part of her health coaching practice at Reply, Emily has had wonderful experiences working with women to help them improve their health, body literacy, and body image through cycle tracking and making lifestyle changes.

“If a woman has cycle related issues, things like carb craving, water retention, or bloating – you may think, why is my body doing this? And she may have this love/hate relationship with her body. Until she comes to understand that – hey, this is happening because of my hormones! And learns that there are actually really good ways of managing hormones and good treatment. From knowing that, I’ve seen women gain greater self-respect for their bodies. They understand what’s going on with their bodies and are confident they can manage their symptoms.”

Emily encourages women to find a fertility educator they love and make cycle tracking part of their new daily routine. She says it will give you unprecedented insight into your body, your cycles, and what makes you unique:

“I love NFP because it is tailored to you as a very unique individual. No woman’s cycle is the same as the woman’s next to her!”

Call us at 919.230.2100 or click here to make an appointment with Emily today for health coaching sessions, or to learn Listen Fertility or Sensiplan for fertility awareness.

FERTILITY AWARENESS APPS

Tue, 25 Jul 2017 21:44:52 GMT

There’s an APP for that…

There are dozens (if not hundreds) of charting, fertility awareness, and period tracking apps out today, but their accuracy varies widely and very few of them are validated by evidence-based research. We sat down with our Director of Education, Lori Hartley, MPH, RN, who explained why learning a Fertility Awareness Based Method with a trained instructor is better than relying solely on an app. She says:

“Whether or not you decide to use a fertility app, establishing a relationship with a trained fertility educator is crucial to your success. A fertility educator will not only help you choose a method that’s right for you, but she will also help you maximize your learning in a way that’s meaningful to your specific needs.”

Read more from Lori below about fertility tracking and how apps can best be used to help you understand your cycle.

Why is it important for women to track their cycle?

Cycle tracking is important for every cycling woman, regardless of her age or regularity of her periods. Women who track their cycles have an advantage in that they become “in tune” with their bodies and can use that information to help make informed decisions about their health and wellness. A common misconception is that cycle tracking is only helpful for those wanting to get pregnant or avoid getting pregnant. What many women don’t realize is that cycle tracking can be used as a gauge of their overall health and be a tool to help informed healthcare practitioners diagnose and treat underlying health problems. Women sometimes even can detect underlying health issues on their cycle charts long before they have physical symptoms.

Our bodies give us signs of fertility (more specifically, ovulation). Ovulation is a sign of health; after puberty, women should cycle every 21-38 days as a sign of overall health. If a woman is not cycling at all, or having irregular cycles or irregular bleeding, she could have an underlying health problem that can be detected through cycle tracking. Finding a healthcare practitioner who is familiar with reading cycle charts is important so that he/she can create a treatment plan designed to address your specific needs.

Which apps (if any) do you recommend for cycle tracking?

There are more than 100 fertility apps on the market today. However, the majority are not founded on evidence-based fertility awareness methods. Although apps can be convenient to use and be a helpful supplement to fertility education, it’s important to know they are not created equally. Here are some factors to consider if choosing to use an app:

Choose an app that is backed by science. Has it been tested in a clinic setting?
Choose one according to your fertility intention. Not all apps are designed to be used for every intention. A couple wishing to avoid or delay pregnancy may use a different method (or app) than someone who simply wants to track for signs of health.
Use an app that asks you to input your unique signs of fertility. (May include last menstrual period, daily cervical fluid observations, basal body temperature)
Do not use an app that predicts your upcoming fertile days (or turn off that feature of the app). Your body is unique and much more complex than a simple mathematical equation.

What methods do you teach?

At Reply, we welcome patients using any method of natural family planning or fertility awareness. We understand not every method is right for every woman or every couple, and there are many factors to consider when choosing a method that is right for you. These factors include your intention for learning, your time and financial commitment, regularity of your sleep schedule and current ovulation cycles. At Reply, we offer in-person fertility education for several methods:

Listen Fertility is a simple, cervical-fluid-only tracking system for couples wanting to get pregnant or women monitoring their cycles for health maintenance. Sensiplan is an evidence-based, sympto-thermal method, meaning it uses physical symptoms including temperature. It can be used by women trying to get pregnant and also by women who are trying to avoid pregnancy.

Sensiplan has been used in Europe for more than 30 years, and I’m proud to say it’s been licensed for the first time in the United States at Reply. Also, this fall we’ll be introducing the Marquette method at Reply. Marquette is a symptom-hormonal method that uses a woman’s biomarkers of cervical fluid and urinary hormones to determine the beginning and end of her fertile window.

What do you love about each method you teach?

I love that regardless of language spoken, socio-economic status, or education level, there are modern methods of fertility awareness available for every woman.

What knowledge can be gained from learning how to track your cycle from a trained educator, rather than going by an app?

Whether or not you decide to use a fertility app, establishing a relationship with a trained fertility educator is crucial to your success. A fertility educator will not only help you choose a method that’s right for you, but she will also help you maximize your learning in a way that’s meaningful to your specific needs.

Do you recommend using an app AFTER you’ve learned how to chart from a trained educator?

EMPOWERED BY FERTILITY AWARENESS

Mon, 24 Jul 2017 21:49:03 GMT

By tracking information about their fertility women can become empowered to play an active role in not only their reproductive health, but in their health and well-being as a whole. Reply patient Sarah L., 27 years old, reflects on her choice to end hormonal contraception and learn Sensiplan, a German method of natural family planning/fertility awareness offered exclusively at Reply:

“I’ve been on a couple different birth controls. One of my doctors told me to do the shot and I gained a lot of weight following that. My hormones felt all over the place. The side effects for me were hard to shake.”

When she heard from a friend about Sensiplan being offered at Reply, Sarah decided to try it. She was shocked that she had never learned about her signs of fertility before: “These are things that I feel like I should have been taught as a young woman!”women are taught how to track the signs of their fertility: “It’s so, so important. I’ve told all my friends about it!”

Sarah now tracks her fertility, and she and her husband successfully avoid pregnancy using Sensiplan. They also have the knowledge to use fertility awareness to try to conceive in the future. She sees her use of the natural family planning element of fertility awareness as part of her overall strategy for a healthy lifestyle, including clean eating, exercise, and avoidance of toxins in the environment. She says she feels more in tune with her body and understands why she feels certain ways at certain points in her cycle.

“Reply has been so amazing and eye-opening, which is wonderful. It blows my mind that we aren’t taught this.” Her hope is that more women are taught how to track the signs of their fertility: “It’s so, so important. I’ve told all my friends about it!”

PCOS: TAKING ANOTHER LOOK

Wed, 28 Jun 2017 23:24:40 GMT

Do you experience more acne than most women your age, extra weight in your belly, unwanted hair growth or irregular periods? If so, you may be suffering from a condition called Polycystic Ovarian Syndrome (PCOS) .

PCOS is a gynecological issue that affects one in 10 women. Symptoms include unwanted excess hair growth, weight gain, painful acne, and metabolic problems. Women with PCOS often have longer cycles than average (35 days or more) due to delayed ovulation. Sometimes, women with PCOS do not ovulate at all for many months. Others may have regular bleeding but no actual ovulation (anovulatory cycles). Women with PCOS often have difficulty getting pregnant, and have more pregnancy complications such as miscarriage and gestational diabetes. They are also at higher risk to develop diabetes and heart disease later in life.

The symptoms of PCOS are commonly treated with combined hormonal pills (birth control pills). This may improve symptoms like acne and hair growth, but because the pills block ovulation, women taking them may have no idea what is going on with their underlying conditions. Ultimately, hormonal pills cannot cure the problem, and they do not reduce the risk of chronic diseases in pregnancy and later in life.

At Reply, we take a different approach. Our primary goal is to help women optimize their health as much as possible. For example, even a small weight loss (10-15 pounds) can significantly improve hormone balance in some women with PCOS. Rather than prescribe hormonal pills as the first line of treatment for PCOS, we recommend treatments that promote underlying health and fertility. This might include medical treatments and/or working on lifestyle factors like diet and exercise.

As part of our care, we work to understand each patient as an individual. PCOS manifests differently in different women. This is important as every woman has a unique body and a unique cycle. Often, we target treatments to certain days during a patient’s cycle. In order to do so, the patient must be tracking her cycle. At Reply we teach fertility awareness tracking to patients who are not already able to do this. This way, women are partners with their providers in their care, and are equipped with a health tool that can serve them in many ways throughout their lifetime.

If you’ve ever struggled with irregular periods or bothersome symptoms, or been prescribed the pill for management of PCOS without being able to understand your underlying health, you may be interested in the Reply approach. We are always happy to review your symptoms, cycle history, and any hormonal tests to help customize an approach that is best for you.

To schedule an appointment at Reply, call us at 919.230.2100
or visit our Become a Patient page.

ANY WOMAN. ANY PREGNANCY

Thu, 18 May 2017 22:35:22 GMT

Preeclampsia was a term I had frequently heard, but didn’t fully understand, until it affected our family. I had given birth to four children of my own, including twins following a high-risk pregnancy, but it wasn’t until I become a grandmother this spring that I learned exactly what preeclampsia is. May is Preeclampsia Awareness Month—please share this important information!

What is preeclampsia?

Preeclampsia is a complication of pregnancy characterized by elevated blood pressure (hypertension) and protein in the urine (proteinuria). It typically occurs after 20 weeks of pregnancy, but it can develop throughout gestation and even during the postpartum period. In many cases there are no symptoms, but it can often be detected during routine prenatal appointments.

Although studies have shown that certain risk factors may contribute to a higher likelihood of developing preeclampsia, the exact cause is not yet understood. And, the National Preeclampsia Foundation reminds us that the condition can affect any woman and any pregnancy.

Experts believe preeclampsia may be caused by problems with the early development of a pregnant woman’s placenta, the organ that supplies oxygen and nourishment to the baby during pregnancy. During the early stages of pregnancy, new blood vessels begin to form as the placenta attaches itself to the mother’s uterus. These new blood vessels may develop abnormally for several different reasons, including:

inadequate blood flow to the uterus

blood vessel damage

immune system problems

genetic factors

These abnormal blood vessels restrict the amount of blood that can flow to the placenta. If the placenta does not receiving enough blood flow, substances are released into the blood stream that can cause a mother’s blood pressure to increase.

If left untreated, preeclampsia can be life-threatening to both the mother and her baby. Because it involves problems with the placenta, the only real “cure” for a mother with preeclampsia is delivering her baby.

Why is it important to know if I have preeclampsia?

Preeclampsia is fairly common, affecting up to 8% of women during pregnancy. It is usually mild and normally has very little effect. However, it’s important to know if you have the condition because, in a small number of cases, it can develop into a more serious illness called Eclampsia, that can be life-threatening for both mother and baby..

What are the possible complications of preeclampsia?

Preeclampsia affects the development of the placenta, which may prevent your baby from growing as it should. There may also be less fluid around your baby in the womb. If the placenta is severely affected, your baby may become very ill. In the most severe cases, the baby may even fail to survive in the womb. Consistent monitoring works to identify those babies who are most at risk. A woman is more likely to have complications if she develops preeclampsia early in her pregnancy, and has noticeable symptoms. In some cases, doctors must perform induced labor and delivery or a caesarean section (C-section) to remove the baby. This will stop preeclampsia from progressing. If left untreated, complications may develop. If the condition continues to worsen, certain signs and symptoms known as “severe features” will develop. Some severe features and complications of preeclampsia include:

HELLP syndrome: causes hemolysis (loss of red blood cells), elevated liver enzymes, and low blood platelet count, resulting in organ damage
Very high blood pressure : can lead to hemorrhagic stroke (bleeding in the mother’s brain) if the level is very high
Eclampsia : A very serious condition causing seizures and possibly coma or death to mother and baby
Placental abruption : the separation of the placenta from the uterus wall, which can cause severe bleeding and damage to the placenta and be potentially life-threatening to both mother and baby
A lack of oxygen to the placenta : can cause slow growth, low birth weight, or preterm (early) birth of the baby

Women who develop preeclampsia face an increased risk of heart and blood vessel disease. Their risk of preeclampsia in future pregnancies also increases.

What symptoms should I look for?

Some symptoms of preeclampsia include:

Weight gain of more than five pounds in a week
Headache that won’t go away, even after taking medication
Changes in vision like seeing spots or flashing lights; partial or total loss of eyesight
Nausea or throwing up, especially suddenly, after 20 weeks (not the morning sickness that many women experience in early pregnancy)
Upper right belly pain, sometimes mistaken for indigestion or the flu
Heartburn that doesn’t go away with simple antacids
Difficulty breathing; gasping or panting
Muscle spasms or Hyperreflexia (overactive reflexes)
Swelling of the hands, face, and around the eyes sometimes occurs in preeclampsia, but it can also happen in normal pregnancy. It is good to discuss any noticeable changes in swelling with your doctor. (Swelling of the feet and ankles is more common in late pregnancy and probably not a sign of preeclampsia)

It’s also important to note that some women with preeclampsia have NO symptoms or they “just don’t feel right.” If you have a sense that something’s wrong, even without symptoms, trust your instincts and contact your healthcare provider.

In cases of preeclampsia with severe features, other organs — such as the liver or kidneys — can sometimes become affected. There can also be problems with blood clotting. Though rare, preeclampsia may also progress to convulsions or seizures before or just after the baby’s birth.

Who is most at risk for developing preeclampsia?

Preeclampsia can occur in any pregnancy but you are at higher risk if:

your blood pressure was high before you became pregnant
your blood pressure was high in a previous pregnancy
you have an existing medical problem such as kidney disease or diabetes or a condition that affects the immune system, such as lupus.

The importance of other factors is less defined, but some studies have shown you may be more likely to develop preeclampsia if more than one of the following applies:

this is your first pregnancy
you are over the age of 40
your last pregnancy was more than 10 years ago
you are very overweight – a BMI (body mass index) of 35 or more
your mother or sister had pre-eclampsia during pregnancy
you are carrying multiples

How is preeclampsia monitored?

Throughout your pregnancy, your healthcare provider will closely monitor you and your baby for signs of preeclampsia and you may have ultrasound scans to measure your baby’s growth and wellbeing. At each prenatal visit, your weight, blood pressure and baby’s heart rate will be monitored. If your blood pressure is high, a urine test will be done to check for the presence of protein. This may be done on an outpatient basis if you have mild preeclampsia. You may be advised to have your baby at about 37 weeks of pregnancy, or earlier if there are concerns about you or your baby.

What happens after my baby is born?

Preeclampsia usually goes away after birth. However, in severe cases complications may still occur following birth. You may need to continue taking medication to lower your blood pressure and you may need to continue monitoring of your blood pressure. The medication should not affect your ability to breastfeed. If you are still on medication to treat your blood pressure 6 weeks following birth, or there is still protein in your urine on testing, you may be referred to a specialist.

Will I get preeclampsia in my next pregnancy?

Overall, one in six women who have had preeclampsia will get it again in a future pregnancy.

Your practitioner can discuss with you your personal risk of getting preeclampsia in the future.

Are there any lasting effects of preeclampsia?

Women who have had preeclampsia have an increased risk of developing future problems such as high blood pressure, heart disease, stroke and possibly diabetes.

While it is still unknown whether the risk is caused by preeclampsia or if the woman was already predisposed, these increased risks may first emerge in the years following a complicated pregnancy.

Simple steps you can take to lower your risk for heart disease include:

Maintaining a healthy weight
Don’t smoke
Know and maintain healthy blood pressure, blood sugar and cholesterol levels.
Exercise regularly and eat a healthy diet
Regular check ups with your primary care physician to monitor your heart health

Lastly, research suggests that women who have experienced a traumatic pregnancy, with complications such as preeclampsia, are at an increased risk for postpartum depression and anxiety. Always share any concerns with your clinical team.

In our case, we were fortunate that my daughter-in-law’s preeclampsia developed very late in pregnancy – at 40 weeks. This meant that premature birth and development of the baby was not at issue. Physicians recognized immediately her elevated blood pressure and proteinuria, and moved quickly to begin labor and delivery–so quickly, in fact, that we really didn’t have much time to learn about this newly diagnosed condition and what to expect as a result. There were scary moments as she moved through labor and we watched her blood pressure spike to very dangerous levels as doctors tried to manage her symptoms and provide as “normal” a birth experience as possible. In the end, a C-section was necessary, as was the use of magnesium sulfate to minimize her risk of seizures. The immediate side effects were nausea, difficulty breathing, and extreme confusion. Certainly not how she had hoped to begin her life as a new mom. I am happy to report however that now, after 5 weeks, her blood pressure has returned to normal and any lasting side effects have disappeared.

We feel lucky to have a healthy mom and a healthy baby (who, by the way, is unprecedentedly spectacular – sorry, grandma moment)! But in hindsight, I wish we’d all known more going into this. For the benefit of others, please find references below.

References

RCOG guideline The Management of Severe Pre-eclampsia/Eclampsia (March 2006 and reviewed in January 2009) and the NICE guidance The Management of Hypertensive Disorders during Pregnancy (August 2010). https://www.nice.org.uk/cg107.

Preeclampsia and High Blood Pressure During Pregnancy (September 2014) https://www.acog.org/Patients/FAQs/Preeclampsia-and-High-Blood-Pressure-During-Pregnancy

https://www.preeclampsia.org/

https://www.emedicinehealth.com/preeclampsia/article_em.htm

https://www.healthline.com/health/pregnancy/preeclampsia-magnesium-sulfate-therapy#overview1

–Barri Burch is a healthcare marketing consultant and frequent contributor to the Reply Blog.

COMPLEMENTARY APPROACHES FOR FERTILITY ENHANCEMENT

Thu, 27 Apr 2017 14:45:10 GMT

Quite often our patients ask us about complementary natural approaches to fertility enhancement, such as acupuncture and abdominal-pelvic fertility massage.

Natural healing therapies focus on helping the body attain a state of balance from within. Key to this balance is proper blood circulation throughout the body. Optimizing circulation may help the body restore and repair itself.

Problems with blood flow

A number of things can negatively impact blood flow in the body: adhesions from accidents, previous infections or surgeries (internal scar tissue), organ displacement (yes, they can move out of position, especially the uterus), bony structural misalignment, and inflammation all can be factors. When blood flow is restricted, this may mean that oxygen and vital nutrients are not being properly delivered to all parts of the body.

Why is this important for fertility?

In addition to oxygen and vital nutrients, blood carries hormones throughout the body—including to and from the brain and reproductive organs. This means when blood flow is restricted, hormone imbalances may occur. This can happen in both men and women.

How can complementary therapies help?

Natural bodywork therapies such as acupuncture and abdominal-pelvic massage work to bring the flows in the body into balance. In keeping with the Reply’s Cooperative Approach to care, these natural therapies focus on finding and treating the root cause of the body’s imbalance. They may help increase blood circulation and transport of hormones, mobilize reproductive organs, and help balance the musculoskeletal system. A healthy, balanced body plays a vital role in fertility for both women and men.

Want to learn more? Join us at Reply’s First Tuesday event on May 2, “The Cooperative Approach to Infertility.” The presentation is free but space is limited; click here to RSVP.

Donna Zubrod MBA, MSc, LMBT, CD(DONA), Doula, Licensed Massage Therapist, & Certified Arvigo® Therapy Practitioner is a Reply Fertility Educator and frequent contributor to the Reply Blog.

INFERTILE OR SUBFERTILE?

Wed, 26 Apr 2017 15:09:16 GMT

We all think of infertile as the term that describes couples who can’t get pregnant.

But not so fast…

We have an important note for patients.

The medical definition of infertility is “the inability to become pregnant after one year of regular sexual intercourse.” But this definition is far from perfect. It does not take into account many related personal factors, and the truth is that many couples diagnosed with infertility eventually conceive and have healthy pregnancies and babies.

So why the label infertile?

At Reply, we do not categorize a couple as infertile just because a year has passed without a pregnancy. Instead, we use the term subfertile, which we believe is more accurate. Subfertile means less than normal fertility—in medical terms, “the inability to become pregnant after six months of regular intercourse.” We describe all couples who have not yet had a full fertility evaluation that uncovered a specific cause of infertility as subfertile, rather than infertile.

This terminology reinforces that our goal is to correct the underlying causes of fertility problems. Our cooperative approach at Reply means we work hard to look for, and treat, the root causes of the patient’s fertility problem, because we know that fertility problems often have multiple factors, and often require a thorough work-up.

Physicians and medical researchers in Europe have used the term subfertile more widely than we in the U.S. have, and we suggest it’s time to think more carefully about terminology. For us, it’s “subfertile ‘til proven otherwise!”

If you or someone you know is concerned about issues of fertility, we encourage you to call us at 919.230.2100 to learn more or click to schedule an appointment.

WHAT IS ENDOMETRIOSIS?

Thu, 23 Mar 2017 15:35:53 GMT

What is Endometriosis?

March is National Endometriosis Awareness Month. Endometriosis affects about 1 in 10 women worldwide, yet many don’t know much about this condition. Shannon Cohn, producer of the documentary, Endo What? , states, “Women still go to an average of 6-8 doctors for 8-10 years before they are diagnosed. They are still told it’s in their heads, that pregnancy and hysterectomy are cures, and that pain is normal.” In her recent TEDx talk, she refers to the condition as “the most common disease you’ve never heard of.”

Symptoms of endometriosis may include:

painful periods
heavy bleeding
painful intercourse
discomfort urinating or having a bowel movement
difficulty becoming pregnant

It’s important to know that pain, or any other symptom, that disrupts your daily activities or causes you concern is something to discuss with a clinician.

Perhaps you’ve experienced some of these symptoms, but have never been told you may be suffering from this disorder.

“What causes it?

This is a common question from women with endometriosis. Although there are theories that suggest possible structural, hormonal, and even genetic abnormalities within a woman’s body, we don’t really know the precise cause of endometriosis. And, as unique as each woman’s body is, so are her symptoms, which can range from pelvic pain to infertility.

There are many unanswered questions about the causes of endometriosis, though research has shown that when diagnosis and treatment are delayed, its management becomes more difficult. Endometriosis is diagnosed through Laparoscopic surgery – doctors must look inside the body to actually see the evidence of endometrial growth. However, there are specific bleeding patterns women with endometriosis may observe to help doctors with their diagnosis before surgery. For example, according to Dr. Heitmann, et al., premenstrual spotting of greater than 2 days is strongly associated with endometriosis. At Reply, we teach fertility awareness cycle charting which helps women identify their unique patterns of bleeding and cervical fluid. A physician trained in fertility awareness can help you notice the signs of endometriosis, even before a diagnostic surgery.

Currently, there is no cure for endometriosis, but there are a variety of traditional and complementary treatment options that have promising results in reducing pain, slowing endometrial growth, and restoring fertility.

If you or someone you know is experiencing symptoms of endometriosis, we encourage you to speak with your physician about it, call us at 919.230.2100 to learn more or click to schedule an appointment .

References:

Socolov R, Socolov D, Sindilar A, Pavaleanu I. An update on the biological markers of endometriosis. Minerva Ginecol. 2017.

Heitmann RJ, Langan KL, Huang RR, Chow GE, Burney RO. Premenstrual spotting of ≥2 days is strongly associated with histologically confirmed endometriosis in women with infertility. Am J Obstet Gynecol. 2014;211(4):358.e1-6.

WITH HEARTFELT THANKS

Fri, 24 Feb 2017 16:12:28 GMT

“I WAS ENTERING THE UNCHARTED TERRITORY OF THE SPECIAL NEEDS WORLD, AND I WAS AFRAID.”

Read Rachel Geer’s heartfelt tribute to her physicians, including Reply’s Dr. Rachel Urrutia, as she and her newborn son began their journey with Down syndrome. This tribute is reprinted from https://themighty.com. Reply is proud and fortunate to have Dr. Urrutia as a founding member of our team.

To the Doctors Who Supported Us After My Son’s Down Syndrome Diagnosis

By Rachel Geer

Dr. Stamilio, Dr. Urrutia and Dr. McPherson,

You may not remember me. I might be just another pregnant mother in a sea of patients you care for regularly. But I remember the three of you.

Dr. Stamilio, I remember your kind and gentle voice when you told me that my unborn baby had a high probability of being born with trisomy 21, after a routine first trimester screening. You made sure I knew what all of my options were, but you didn’t tell me that my child would never be able to function and live within a normal society, words that are still too often heard by parents receiving a diagnosis. You provided me with pamphlets and materials and introduced me to Erin, the genetic counselor, who gave us very detailed information on our prognosis. We continued to see you at follow-up ultrasounds, and you remained positive throughout our pregnancy, every time you spoke to us, even when we told you we were keeping our son.

Dr. Urrutia, You were the first physician I saw upon returning to my regular OB appointments at the clinic. You were so positive and told me about your friend from med school who had authored books about siblings with Down syndrome. You gave me your cell number and you emailed me to check in on me and provide me with the titles of the books you had mentioned. You followed my case, and you sent me messages regarding our ultrasounds and test results and about how everything looked great. I always delete all of the appointment reminder emails I get in the UNC myChart system, but I haven’t been able to bring myself to delete your messages, almost 2 years later.

Dr. McPherson, You delivered my beautiful 7 pound 6 ounce baby boy, just after midnight on June 4, 2015. I was a wreck. My labor went so fast, and when I got to the hospital I was already 7cm. I made it to 10cm within the hour and felt the need to push while I was still in the triage room. I was scared, panicked, too late for an epidural and an all-around sloppy mess. I knew my life was about to change drastically.

I was entering the uncharted territory of the special needs world, and I was afraid. I was losing the ability to completely protect and shield my son from the outside world. There were so many people in the room, asking me so many questions and preparing for the unknown with my baby. And it was all happening faster than I could keep up with.

But you, well, you were calm. You were funny. You were amazing. And you seemed like someone I would want to hang out with outside of the hospital. I remember feeling disappointed that this would be the only time I was a patient of yours, and the imaginary friendship I had created in my head would soon be over. You may remember me saying how upset my sister would be that she missed the delivery because I waited until we checked in at the hospital to call her. She came bursting into the room about 15 minutes after the delivery, hysterically sobbing, and you looked at me, laughed and said, “This must be your sister.”

I have wanted to write this letter for a while now, but I wanted to make sure I adequately described my feelings throughout my pregnancy, and the impact each of you made on them. It makes me very emotional to think about. From the second Kendall was born, I threw myself into the Down syndrome community. I immediately joined the board of a just-formed non-profit organization called GiGi’s Playhouse and it changed my life. After a year of extremely hard work, we opened our doors on June 18, 2016. I hope you will take some time to check out the website.

Kendall’s picture has been up at all the local hospitals over the past 6 months to bring awareness to the amazing world of Down syndrome. I hope if you see it in the future, you will look at it with pride and think to yourself, you were part of bringing an amazing human being into this world. One who is going to make a difference for so many families, in addition to the numerous lives he has already changed.

We are always at UNC hospitals for various appointments, and Kendall goes to 4 different types of therapy per week. Kendall has had surgery for ear tubes, adenoid removal and hypospadius repair. He has been to the cardiologist, neurologist, ophthalmologist, urologist, pediatrician and ENT more times than I can count. But he is thriving. And he is happy. And he is the light of my life. I have loved every second of our “new normal,” and I have met too many wonderful people to list. I am so thankful I was chosen to be his mom, and I am so thankful I was given you as one of my providers. My heart is so fulfilled.

Thanks again for all that you have done for my family. I will never forget you.

PRE-CONCEPTION CHECKLIST

Thu, 12 Jan 2017 16:26:31 GMT

PRE-CONCEPTION CHECKLIST

By John M. Thorp Jr, MD

There are many steps prospective parents can take before they conceive to improve their health and that of their offspring.

Have a check-up and discuss pre-conception questions with your provider . Chronic health problems affect both fertility and pregnancy outcomes in men and women, and may be important to address. The CDC recommends regular check-ups for all adults, and the American College of Obsterician-Gynecologists recommends not only pre-natal but pre-conception exams for women planning a pregnancy. This is an important time to evaluate the overall health of prospective parents, and to address any issues that could affect the health of Mom or baby with a pregnancy. Health issues that are especially important to address include elevated blood sugar, mood disorders, chronic infections and hormone deficiencies. Ask your provider if there are any specific tests or treatments they would recommend in order to optimize your health before a pregnancy.
Review your immunizations, medications, and supplements. Women and men should have up-to-date information about how each of these may affect fertility and pregnancy outcomes before becoming pregnant. For example, the CDC recommends that all reproductive age women take folic acid supplementation. Folic acid intake improves pregnancy outcomes, and most strongly reduces birth defects when it is taken 6 months before conceiving. On the other hand, popular weightlifting supplements may decrease male fertility.
Learn fertility awareness. Patients educated in fertility awareness cycle charting may improve their chances of conception once they can identify the most fertile days of the woman’s cycle. Charting also provides an important a snapshot of a woman’s reproductive and overall health that can be used by women and their clinicians to detect potential problems and determine treatments. Women who chart their cycles also can provide a very important piece of data when they become pregnant—accurate information about their conception date! This may lead to a more accurate estimate of the due date. Standard of care is to rely on the first day of last menstrual period, but this may be inaccurate, particularly in women with long or irregular cycles.
Evaluate lifestyle factors and drop unhealthy habits . This is a great time to evaluate lifestyle factors and habits, and plan for healthy nutrition, fitness, sleep, and stress management. Use of tobacco, recreational drugs, and/or alcohol can have serious adverse effects for Mom, Dad, and baby, and these factors should be addressed openly with a clinical team. Pregnancy is a unique motivator—don’t miss this opportunity to tweak or revamp your personal wellness plan! Consider meeting with a health coach to develop a plan to meet the health and wellness goals you discuss with your physician or nurse midwife.
Reduce Stress. Lastly, it is important to be mindful that stress adds an extra layer of difficulty for couples struggling to conceive. With nearly 12% of couples having trouble becoming pregnant or sustaining a pregnancy, we need to raise awareness about subfertility and infertility, and carefully consider how to support loved ones in these circumstances. It is important to understand that subfertility and infertility may be symptoms of underlying disease or imbalance, and often these are chronic and multi-factorial. Couples in these circumstances can optimize their fertility in the ways listed above, and/or seek medical care to seek out the cause(s) of their difficulty conceiving.

John M. Thorp Jr., MD , is Division Director of General Obstetrics and Gynecology, and Vice Chair of Research in the Department of Obstetrics and Gynecology at the University of North Carolina at Chapel Hill. He also serves as the Medical Director of Reply Ob/Gyn & Fertility, and specializes in fertility awareness and a cooperative approach to treatments for couples with fertility impairment.

IMMUNITY SOUP

Wed, 11 Jan 2017 23:06:36 GMT

FIGHT OFF WINTER COLDS AND FLU WITH THIS IMMUNE-BOOSTING SOUP

Let food be your medicine with this flavorful, natural and healthful soup recipe from Dale Pinnick’s The Medicinal Chef*. This one-pot wonder of a soup is an absolute powerhouse when it comes to dealing with colds and flu. Don’t be put off by the goji berries — these sweet treats were once expensive and hard to find, they can now be found easily in any health food store.

IMMUNITY SOUP RECIPE

Ingredients:

1 red onion, minced

1 green chile, minced

4 garlic cloves, minced

2-inch piece fresh gingerroot, minced

2 tablespoons olive oil

2 medium sweet potatoes, diced, skins left on

4 ounces shiitake mushrooms, sliced

2 handfuls goji berries

vegetable stock, to cover

salt and black pepper

Instructions: Put the onion, chile, garlic, and ginger in a large pan with the olive oil. Cook over medium-high heat for about 5 minutes, until the onion softens. Add the sweet potatoes and mushrooms to the pan along with the goji berries. Stir well, then add enough vegetable stock to cover all the ingredients. Simmer well for 10 to 15 minutes, until the potato is soft. Season with salt and pepper. Carefully add the soup to a blender in batches, and blend into a smooth, vivid orange, spicy soup. Makes 4 servings. *Reprinted in part from https://www.motherearthnews.com/ and from The Medicinal Chef by Dale Pinnock, published by Ten Speed Press, 2013.

WHO'S YOUR DATA?

Wed, 11 Jan 2017 22:54:47 GMT

“Own Your Body’s Data” – a TED Talk by Talithia Williams

At Reply, we love this fantastic TED Talk from 2014. A self-professed math geek, Dr. Talithia Williams, gets personal in this piece about her own experience with cycle charting. She notes that one of the reasons she got a PhD in Statistics was because she “always wanted to know, what are people trying to hide with numbers? As a statistician, I want people to show me the data so I can decide for myself.”

With fertility awareness you can “own your body’s data”. And, as Dr. Williams points out in this talk, even the simplest markers can make a real difference if you only know how to look at them. “Just by taking daily measurements about yourself, you become the expert on your body. You become the authority. It’s not hard to do. You don’t have to have a Ph.D. in statistics to be an expert in yourself. You don’t have to have a medical degree to be your body’s expert. Medical doctors, they’re experts on the population, but you are the expert on yourself. And so when two of you come together, when two experts come together, the two of you are able to make a better decision than just your doctor alone.”

We say Amen to that.

MENOPAUSE AND FERTILITY

Wed, 11 Jan 2017 17:32:33 GMT

Here Are A Few Budget-friendly Ways To Support The New Mama In Your Life:

This past week, I had the privilege of training with some of the top fertility docs in the area, learning a new fertility awareness method from a pair of global experts from Germany. A lot of smart people, way smarter than me, but more importantly, they were all dedicated to more natural approaches to women’s reproductive health.

One report that stood out during the training was the story of a woman becoming pregnant and delivering a healthy baby at age 59. Isn’t the female body amazing? But hmmm, 59….good for her, but not an ideal age for motherhood, right?

Thus we begin our discussion of fertility awareness during the later years…

If you dread menopause, you’re not alone. Global pharmaceutical market analysis shows that peri- and post-menopausal women’s health continues to be a growing piece of the pie, with close to half (46%) of all women aged 45 to 60 being concerned with the effects of menopause on their health. Rightly so as declining estrogen may promote the development of heart disease and osteoporosis.

Arriving at menopause, defined as being without menstruation for a full 12 months, can take a long time and the peri-menopausal stage can make it feel even longer with unpredictable bleeding, hot flashes, mood changes and changes in libido.

How can the self-aware woman - who is into understanding her body, charting, and using as few drugs as possible - manage this inevitable life stage

Charting your biomarkers of fertility is critical during peri-menopause when you may go a few months without a period, or bleed every 3 weeks. As with the start of your cycles in your pre-teen or teenage years, ovulation is not occurring regularly but it’s important to know if and when you are ovulating. Most women who are peri-menopausal feel their family is complete and do not wish to conceive. However, at least according to my German teachers, libido does not decline but stays at a steady high from age 35 onwards.

The peri-menopausal woman is very busy with career, family, travel and household duties. She may also have developed chronic health problems like high blood pressure, poor blood sugar control, or even arthritis over the years. Aging gracefully is a key concern for her, when she’s not taking care of her own aging parents or making sure Johnny has clean laundry before he goes back to college.

Cycle charting is versatile and can be fit into this busy lifestyle using a phone app or a paper chart kept in the bedside drawer. Done once a day, charting is a few minutes of time to yourself and for yourself so that you can be aware of your times of fertility while gaining insight into the hormonal fluctuations that may be wreaking havoc on your relationships. It’s smart “me-time”.

How smart? Well, it’s definitely smarter than taking the Pill, which could mask and forestall the natural progression of menopause. Taking exogenous hormones at this stage of the game may also increase risk of breast cancer (did anyone in your family have breast cancer?) in addition to the aforementioned elevated heart risk.

Charting helps you understand your body and can help you gracefully pass through “the change” without increasing the chances of conception. By virtue of it not being the Pill, it may also may also improve your sex life by eliminating the risk of increased vaginal dryness.

What Might The Peri-menopausal Woman Learn From Her Chart?

Absence or presence of ovulation based on cervical fluid pattern or temperature shift (Keep in mind that ovulation is a sign of health and youth.)
Return of fertility based on presence of sperm-loving cervical fluid (marker of estrogen levels)
Length of post-ovulatory phase, or so called luteal phase (marker of progesterone levels)
Any “patterns” in irregular bleeding (You won’t know unless you chart!)
Any correlation of hot flashes with time in her cycle (i.e. Are they more frequent when estrogen is supposed to be rising?

If you are noting a correlation between phase of cycle and hot flashes, mental fogginess, mood swings, lethargy, low sex drive and other annoying symptoms of a natural process, here are some effective natural management tips that are recommended by both allopathic physicians as well as holistic practitioners because they have been shown to actually work.

Things To Decrease

Xenoestrogens – These are industrial compounds that bind to the same receptors as human estrogens, but disrupt natural reproductive functioning by acting as false messengers. They are also known to increase breast cancer growth. Xenoestrogens are found in: 4-MBC sunscreen lotions, BHA food preservative, FD&C Red No. 3, parabens in lotions and shampoos, along with the birth control pill.
Caffeine, alcohol, refined sugar and refined grains, spicy or greasy foods – all of these promote inflammation (you don’t need more heat!) and can increase stress, which is a trigger for hot flashes.
Red meat – Stick to 2-4 ounces of grass fed, hormone-free beef or bison every week.

FRUGAL GIFTS FOR NEW MOMS

Tue, 10 Jan 2017 17:29:10 GMT

Do you know a new mom or have a friend who is expecting? Are you looking for a creative, helpful way to support her without breaking the bank?

Here Are A Few Budget-friendly Ways To Support The New Mama In Your Life:

Run an errand. And rather than offering, “Let me know if you need anything,” call your friend and say, “I’m on the way to the store. What do you need?” If you tell her you are on your way to the store anyway, she will feel less like she is imposing on you or causing you to make a special trip.
Furry friends can feel a bit neglected when the baby arrives, so having someone come by after work and walk and play with the dog is a huge help. Mom guilt is bad enough – this will help alleviate any “dog guilt” while your friend focuses on her baby.
Arrange freezer meals for the new mother by soliciting friends and family. Organize this on her behalf, especially as many moms are unable or do not feel like cooking toward the end of their pregnancy.
Watch the other kids, if she has more than one, while they adjust to life with a newborn. Take them out of the house if you can, even if it is just to the back yard. If you are able, an outing to a park or to the movies is a special treat for the new older sibling(s).
Be a magical cleaning fairy and come clean the house while mom and baby sleep. Rather than saying, “Let me know if I can help clean,” offer specific windows of time when you are available. Without offering specific dates and times, it is less likely that your friend will take you up on your offer, as she may not want to impose. Be the one who initiates setting the date.
If you don’t have a lot of time, stop by before or after work and bring the family flowers to brighten their space. Sweet, simple, thoughtful.
Decorate their house as a surprise before the new mom comes home from the hospital. Raid the dollar store for fun, inexpensive decorations. And lots of balloons. Balloons are cheap and go a long way in making a room feel festive!
Take the family vehicle to get washed and vacuumed. Who doesn’t love a clean car? Something about a clean car makes you feel like you can conquer the world! That’s a feeling any new mom will greatly appreciate.

Ultimately, these are thoughtful things to do for any mom of young kids, not only parents of newborns. Have any ideas to add the list above? Let us know in the comments!

WHAT'S IN YOUR CART?

Tue, 10 Jan 2017 16:25:07 GMT

Top 4 Super Foods For Women

When you consider that the average woman goes through several periods of metamorphosis during which her body goes through a complete transformation that men and children can’t relate to, it’s no surprise that we have unique nutritional needs. Each stage of life from childhood to puberty, woman of child-bearing age to bonafide pregnant and lactating mother, to busy mother and, finally, menopausal womanhood requires specific nutrients to fuel a smooth transition. Here is a simple list of a few of the top foods you, being the superwoman you are, should be enjoying on a regular basis to meet the demands of your particular stage in life:

Cabbage

Both the red and green varieties cabbage contain indole-3-carbinol, sulphurous compounds and enzymes that detoxify the body and encourage the removal of excess estrogen. The enzymes in cabbage boosts production of antioxidants that deactivate carcinogens and prevent abnormal growth. For this reason, regular consumption of cabbage is linked to lower risk of colon cancer as well as estrogen-related cancers such as breast cancer, two cancers that often strike women approaching menopause. To get the most benefit out of the enzymes in cabbage, eat it raw by tossing your favourite vinaigrette into some shredded cabbage for a simple slaw.

Olive Oil

Olive oil is a signature component of one of the healthiest diet patterns in the world, the Mediterranean Diet. Studies have linked olive oil to decreased risk of breast cancer, heart disease and diabetes – all top killers of women – thanks in large part to the high concentration of plant phenols in olive oil. Plant phenols help keep blood vessels open and free of oxidative stress leading to better circulation, blood pressure and heart health. Swapping your saturated butter for monounsaturated EVOO also helps ensure that belly fat doesn’t creep up on you. Invest in a good quality extra-virgin olive oil, which is often a vibrant green, not yellow, to maximize the phenolic value of this healthy fat. Bonus, not only your heart and your waistline, but your hair and skin will love you for it too!

Quinoa

By now you’ve probably heard about the super-grain called quinoa (pronounced keen-wah) and perhaps you’ve even tried a recipe or two with it. Quinoa is a busy woman’s best friend because you can cook it up in large amounts and serve it up warm or cold as a quality source of protein, iron, calcium, zinc and essential fatty acids. Essential fatty acids are proven mood-boosters for bouts of depression that commonly plague women at various life stages and monthly cycle stages. The hefty dose of zinc in one cup of quinoa (15% of your daily requirement) helps to metabolize depression-busting essential fats while the protein supplies your body with tryptophan, the building block for serotonin. Hence, quinoa is the ultimate PMS, post-partum or peri-menopausal food.

Flaxseed

Want relief from hot flashes, PMS, endometriosis, constipation or acne related to hormonal changes? Grind up some flaxseeds instead of coffee beans as part of your morning wake-up routine. Sprinkling flaxseed on your cereal, yogurt or salad is an easy way to get anti-inflammatory omega-3 alpha linoleic acid(ALA) and hormone-balancing lignans into your body. Lignans bind to estrogen receptors taking the spot of estrogens your body has made, thereby diminishing it’s action on the ovaries and other estrogen-sensitive organs. A final word on flaxseed versus flaxseed oil: While both are beneficial for women’s health, flaxseed oil, while being higher in ALA, contains no lignans or fiber so if your goal is relief from PMS, hot flashes or constipation choose the seed.

5 POSTPARTUM ESSENTIALS

Mon, 11 Jan 2016 15:45:26 GMT

THE 5 POSTPARTUM ESSENTIALS (THAT NO ONE EVER TELLS YOU ABOUT!)

Last year supermodel Chrissy Teigen and her husband singer/songwriter John Legend welcomed a beautiful baby girl named Luna into the world. Days after giving birth, Chrissy tweeted the following image with the caption, “Buying myself a push present:”

Not a new diamond necklace, not a fancy Chanel bag? Her push present was a perineal irrigation bottle! If you’ve had a vaginal birth, then you know what this is. You fill the bottle with water and spray on your bottom before, during and after you pee. Why? To prevent urine from stinging your sore and possibly torn vaginal area. Having one of these on hand for each trip to the bathroom greatly improves your postpartum quality of life.

Thank you, Chrissy, for the very real, very raw reminder that motherhood is beautiful, but also messy and sometimes painful!

Even after labor is over, there are moments of awe and bliss mixed with moments of continued pain. Very few talk about the gritty details of that pain, though, or know how to handle it.

We spend a lot of time focusing on having a healthy pregnancy and easy labor, but not a lot of time talking about what happens to our bodies after delivery.

Fortunately, if you are preparing to give birth, there are a few items you can have on hand (in addition to a handy dandy perineal irrigation bottle!) that will make your early postpartum days a little better:

Depends – Depends! There are seriously not enough good things that can be said about Depends. Who cares that they are bulky and unflattering and not the sexiest underwear in the world? They are comfortable and soft and they absorb the lochia after delivery. At the hospital the nurses may give you mesh panties and large pads. Here’s a tip though – the mesh panties rip easily and the large pads move around too much! Buy some Depends for the days and even weeks after your delivery. You’ll be glad you did.
Padsicles – They may have a funny name, but padsicles are highly helpful, postpartum. Padsicles are made by concocting a mixture of aloe vera (for cooling), witch hazel (for inflammation), and essential oils, and spreading this mixture on a heavy duty overnight pad then freezing this pad in the freezer. Take a new pad out every time you use the bathroom. You can find various padsicle recipes online like this one.
Spray Solution – If you don’t have time to make padsicles or don’t feel like it, simply spray the padsicle solution you’ve concocted directly on your perineal area. Store your spray in the fridge for some extra cooling effects. Here’s another handy recipe for soothing spray.
Hemorrhoid Pads – Sometimes the pushing stage of labor can cause hemorrhoids. Not everyone gets hemorrhoids, but if you’re one of the lucky ladies who does, you’ll want to have some of these on hand. Buy some ahead of time just in case.
Sitz Bath – The warm water of a sitz bath will feel good and help heal your vaginal and perineal area!. Luckily, hospitals usually give you both a sitz bath and a perineal irrigation bottle when you’re in the hospital. Don’t forget to take them both home and spare yourself the trouble of having to buy them.

Motherhood. Not always glamorous, but oh-so-worth it. Be like Chrissy Teigen and arm yourself with a few items to make the pain of partum days a little more bearable!

replyfertility

Dr. Kim Barrows Interviewed about Restorative Reproductive Medicine by ABC News in Grand Rapids, Michigan

Dr. Kim Barrows Interviewed about Restorative Reproductive Medicine by ABC News in Grand Rapids, Michigan

﻿

Statement from the International Institute for Restorative Reproductive Medicine

Statement from the International Institute for Restorative Reproductive Medicine

UNEXPLAINED INFERTILITY, EXPLAINED

UNEXPLAINED INFERTILITY, EXPLAINED

Finding Answers with Restorative Reproductive Medicine (RRM)

RRM Presidential Chair Established at University of Utah

RRM Presidential Chair Established at University of Utah

New RRM Medical Journal Launches

New RRM Medical Journal Launches

Response to Trump Executive Order on IVF

Response to Trump Executive Order on IVF: Reply Fertility Urges Restorative Reproductive Medicine for Patients Facing Infertility

THE RRM DIFFERENCE

The RRM Difference

Restorative Reproductive Medicine (RRM)

THE CASE FOR RESTORATIVE REPRODUCTIVE MEDICINE

The Case for Restorative Reproductive Medicine

Two things struck me during reflections surrounding 2024 “National Infertility Awareness Week”:

What is RRM and why have I never heard of it?

Why don’t more couples know about restorative reproductive medicine?

PAMELA'S STORY

BREAST CANCER AND PREVENTION

LOOKING FOR PREGNANCY CARE?

How To Pick An Ob/gyn When You're Pregnant

MEN'S HEALTH AND FERTILITY

MIGRAINES & PREGNANCY

The Facts

Planning Before Pregnancy

I’m Pregnant And I’m Still Having Migraines

Don’t Forget Postpartum

Headache Warning Signs

Questions About Migraine And Pregnancy?

MIGRAINES

Migraine Headaches

What Makes A Migraine Different?

Common Migraine Triggers

How Can I Tell If A Headache Is Not A Migraine?

How Are Migraine Headaches Treated?

Are Migraine Medications Safe During Pregnancy Or If I Am Trying To Conceive?

Migraines And Menstruation

Migraines And Menopause

Final Note

THE FIRST POSTPARTUM PERIOD

When Does The First Postpartum Period Usually Return?

My Bleeding Stopped After Birth, But Now I Have Noticed Some New Bleeding, Is It My Period?

Postpartum Bleeding Basics

What Are Other Causes Of Postpartum Bleeding?

When To Seek Emergency Attention

Special Note For Fabm Charters

References

WHAT DOES A DOULA DO?

What Does A Doula Do?

What Is A Doula?

What Do Birth Doulas Do?

Informational

Emotional

Physical

Advocacy

What Does A Birth Doula Not Do?

What Training Do Doulas Have?

What Is The Evidence On Doulas?

My Partner Will Be With Me Continuously During Labor. Do I Still Need A Doula?

What Does The Research Say About Doulas Working Alongside Partners?

Given The Current Covid-19 Restrictions At Our Local Hospitals, It May Be That Only One Support Person Is Allowed. How Can I Have Both My Partner And My Doula Present At My Birth?

How Do I Find A Doula?

The Bottom Line

PMADS

What are PMADs?

What is PPD?

How are PMADs diagnosed?

Why is mental health and wellness important in pregnancy and postpartum?

Why might I be susceptible to PMADs?

What are some symptoms of various PMADs?

What is considered “normal” and what isn’t? PPD vs Baby Blues

Is it possible to develop symptoms if I haven’t had them in previous pregnancies?

If I had these symptoms in previous pregnancies am I more likely to get them again?

How can I be screened for each? When does screening happen?