People are so different. I love it! There was one time when in the same week, I performed intrauterine insemination procedures in my office on two different patients of extreme attitudes with regards to the level of emotional involvement in the process.

"Mrs. Total Experience" requested the room lights be dimmed. She brought a CD player and headphones to play meditation music. She wanted to bring aromatherapy candles, which I said was probably OK, although if it were an IVF procedure with delicate air-particle-sensitive embryos involved instead of an IUI with just hearty sperm involved, I would have said no. She wound up not bringing it anyway. I’m glad, because I had an afterthought that it might violate some fire code in our office. After I placed the speculum and gently threaded the catheter into her cervix, she had pre-requested that I let her husband depress the plunger on the syringe. He did so with his left hand while he held her hand with his right. It was actually kind of touching. Having husbands inject the syringe is not uncommon, but this entire ritual was definitely the most elaborate I’ve seen.

In contrast, "Mrs. All-Business" was already waiting in stirrups and fully ready when my assistant and I came into the room. She was on her cell phone having a heated business conversation and I politely waited for her to finish. Instead, without the slightest pause in her conversation, she waved her hand in a "go right ahead" motion followed by the curved index-finger-touching-thumb gesture, which I immediately understood from my scuba diving days to indicate "A-OK". So while she smilingly continued her conversation, I had to use some sign language myself. Waving both my gloved hands, I signaled "scoot down along the table a little". Then "let your knees go apart a little". Each time, I had to stand up from my exam stool so she could see me. I then held up the speculum for her to see and pointed towards the area where I would soon insert it. She nodded, all the while focusing on her conversation, which I couldn’t help but overhear. It apparently involved a transaction of more $$ than I would ever see in my lifetime. I did the insemination and stood up. Most other RE’s save time by not doing an ultrasound right after an insemination, but I do for several practical reasons. I confirmed that the sperm was in her uterine cavity. I was able to get a bonus image of her cavity to confirm the absence of polyps, sort of a no-cost poor-man’s saline-contrast ultrasound using the insemination fluid as distension medium. I also verified that her follicles had all ovulated. I adjusted our power exam table so that the patient was tilted head down at a 15 degree angle. She motioned for my assistant to give her her handbag which she had left on the chair on the other side of the room. As she pulled what looked like a small appointment book out her purse to write in, she smiled and casually waved to me as I left the room. I wondered if this superwoman will bring her laptop to work on while she is in labor pushing out her baby eight months from now.

I really enjoy my job. The day that I stop seeing things that surprise me is the day I will finally retire. I have a strong feeling that it won’t be any time soon.

• 6:30 am. I arrive at the surgery center. Two patients undergoing IVF procedures have been preparing for weeks to have their eggs harvested today. I greet the patients in the pre-op area and answer any last minute questions. I discuss any specific issues with the anesthesiologist and let her take over as she brings the patient into the OR. I finish some charting and then go scrub. The procedures are quick. Using ultrasound-guidance, I advance a needle through the vagina into each ovarian follicle. There is tubing hooked up with suction, so the follicular fluid flows into test tubes, which get handed off to the embryologist. He works quickly through the microscope, hunting for the eggs within each tube of follicular fluid. One patient (older) gets 5 eggs. The other patient gets 23 eggs. I make sure there is no bleeding and that each patient is doing well post-operatively. I discuss some matters with the embryologists.
• 7:40 am. I come back to my office and get an update from my staff. A pregnant patient called reporting having some spotting. Another patient is having bad morning sickness. We begin doing our scheduled ultrasounds. Each patient is in the middle of the ovulation stimulation process. Some of them have follicles that are almost mature. Others have only early ones. With each ultrasound, I measure the follicles and check the uterine lining. Some patients also have blood tests done. Using this information, I will make decisions on dosing changes and when to time the inseminations and egg retrievals. There are some inseminations this morning, as well. The husbands drop off the sperm that they produced at home, and one by one, their samples will be washed and processed. All in all, I do 16 ultrasounds and three inseminations and two mock embryo transfers this morning. In between seeing each patient, I go back to my desk and review the lab tests results that come in. I glance at the day’s news headlines online. I check Google Analytics to see how many hits my website got. I drink two glass of water. I compose treatment plans for the patients who will be doing cycles in the upcoming weeks. I return a few calls from referring doctors.
• 11:30 am. All the morning ultrasounds are done. The waiting room is empty. I go back to my desk and briefly check my fantasy basketball scores from last night. I hear my medical assistants screaming happily in the distance. I smile because this means the results of this morning’s pregnancy tests are finished running and the printouts are coming off the machines now. The happy cries from my clinical coordinators and medical assistants mean someone’s favorite patient with whom they especially bonded is now pregnant! I get the results. Five tests. Three pregnant. Two not. My staff fight over who gets to call the pregnant patients with the good news. The ones with the bad news will first be notified by my staff. Then, I will call them myself at the end of the day. I finish charting on the morning patients. I discuss all the patients with my staff to make sure we’re in sync with their treatment plans. No lunch today. I have a talk to give.
• 1:05 pm. I arrive at the medical school auditorium 5 minutes late for my lecture. The 3rd-year medical students are waiting to learn about infertility. I’ve given this type of lecture over 100 times, but each one is a little different because my lecture style consists of an interactive conversation, calling on students. So after covering the basic concepts, I never know where the rest of the talk will lead. This keeps it interesting for me. This is a particularly sharp and motivated group today. I stay a little later answering the many questions.
• 2:45 pm. I’m a little late getting to the radiology center to do a HSG test on my patient. It goes well. Good news. Her tubes are clear and her uterine cavity is normal.
• 3:20 pm. Back in my private office, I take a quick nap. With the help of advanced brain-wave technology, I have trained myself to be able to enter dream-state sleep very quickly. I wake up totally recharged after only 20 minutes, able to give my full alert attention to the next patient.
• 3:50 pm. One new patient to see. I love new patient visits. I never know what kind of interesting people with which types of interesting infertility problems I’ll see. This is a fairly routine case of a couple with suboptimal sperm. We discuss their situation, some tests we’ll be doing, their treatment options and what the next step is. We talk about their dogs and a little bit about my dogs as well. I do an ultrasound exam and go back to my office to dictate the consultation report. I call the two patients who had the negative pregnancy test. One failed her first insemination cycle. She is disappointed, but optimistic for the next time. The other one failed her first IVF cycle. Ouch. We’re both feeling devastated. They embryos had looked good, too. We schedule to talk in person next week. I review some more charts.
• 5:30 pm. Leave the office. Off to the gym before meeting some church friends for dinner. Hopefully, a big dinner.

In a perfect world, we would always make the right decisions all the time. We would always make the choices that best increase the odds of us getting what we want. If you want to know the secret of how to get pregnant, you have to first recognize that the right answer is not the same for everybody. Think back to the times in your life that you wanted something to change. You wanted a new car, but didn’t yet have enough money to afford one. You wanted a good job, but had not found one yet. You wanted that boy in your calculus class to notice you and ask you out, buy he hadn’t yet. Whenever we are faced with wanting things to be different from the way they are now, it comes down to two alternative choices:

• Continue doing things the way you are doing and wait for it to happen.
• Change the way you are doing things.

This applies to everything in life including the question of how best to get pregnant. For some people, the best answer is to just keep doing what you’re doing (going about your daily life, having regular sex without using contraception) and wait patiently until you eventually get pregnant. For other people, the best answer is go see a doctor right away and get started on ovulation medications or have surgery to remove that fibroid from inside your uterus or get medical help to treat your hormonal abnormality.So, how do you know which choice is the best one for you? Well, not only is the right answer different for different people, the right answer is different for the same person at different times. For example, if you and your husband decided in October to stop birth control and to try and get pregnant, the right thing to do would be to just have sex two to three times a week and wait for pregnancy to come. For about 80% of you, pregnancy will come within eight months. So if you were to ask me back then, in October “What should I do to get pregnant?”, my advice would be to do what human beings have done for hundreds of generations, just have sex. However, suppose you follow this plan and next August comes around (ten months later) and you’re still not pregnant. Now if you were to ask me again “What should I do to get pregnant, the answer would change from “just have sex” to “consider getting medical help”. So what factors should you consider when deciding whether you continue the “BE PATIENT KEEP TRYING” strategy or switch to the “TAKE ACTION DO SOMETHING.” strategy? There are FOUR important factors:

• AGE: Because the health of a woman’s eggs changes over time, it is more acceptable to take the slow patient approach when you’re younger than when you are older.
• DURATION: The more time that has passed without you getting pregnant, the more you should consider taking action, rather than continuing to try on your own..
• SUSPICION: If you have abnormal periods, or if you suspect your husband has a sperm problem or if you have a history of gynecological issues such as endometriosis or pelvic infections or anything that makes you suspect that your fertility is impaired, then you should probably seek help sooner than later..
• PRIORITIES AND PERSONAL BELIEFS: On one extreme, if you absolutely insist on getting pregnant “naturally” and have vowed that you would rather remain childless than step foot into a doctor’s office or take a single pill, then your decision would differ from that of another woman who’s mindset is that her life cannot go on unless she has a baby NOW, even if she has to sell a kidney to afford the world’s best treatment.

In future posts, we’ll look at each of these factors in greater detail. Remember. You are always making a decision. If you are choosing to keep trying on your own, rather than see a doctor, that choice is itself a decision. Your are choosing between sacrificing some of you hard-earned money to have a baby vs sacrificing one more month passing by from your limited fertile years.

I’m a reproductive endocrinologist. People seek my help in order to get pregnant. However, I would prefer not to be thought of as just a baby-production technician. True, while the bulk of my job involves doing procedures to guide eggs and sperm together properly, there’s more that just that.

At times, my job requires being a DETECTIVE. Each patient brings new mysteries to solve of why they are not getting pregnant and new dilemmas to tackle of which treatment methods will serve them best with the least risks and cost. These challenges call into play many skills including using powers of observation, asking the right questions and employing appropriate lab tests. Logical thinking and a good grasp of the mathematics of probability are very helpful to have.

At times, my job requires being a MOTIVATIONAL COACH. Sometimes, the best solutions involve encouraging patients to quit smoking, to lose weight and to bravely deal with the huge stress associated with infertility.

At times, my job requires being a TEACHER, explaining complex medical concepts to patients so that they can understand their situation well enough to make the correct decisions that are right for them, based on their spiritual beliefs, their level of risk-taking, their sense of urgency and their financial priorities.

At other times, my job requires being a MARRIAGE COUNSELOR, when the stress of infertility causes conflicts between spouses which threaten to undermine both their treatment as well as their overall quality of life.

I also have the business and administrative duties of a program director, selecting the right team members and setting an environment that motivates them to continually sharpen their skills and to happily do the best job they can.

Looking at the bigger picture, I firmly believe that life challenges us with two primary purposes. One is to pursue our own personal happiness and spiritual growth. Most people would agree with that. The second, and arguably more important objective, is to do our part to contribute to the happiness and spiritual growth of OTHERS. I’m glad that you have found this site! I hope that I can share with you my thoughts and teach you something helpful. Likewise, I hope that by your comments and email you can teach me as well.