<?xml version="1.0" encoding="UTF-8"?><rss version="2.0" xmlns:content="http://purl.org/rss/1.0/modules/content/" xmlns:wfw="http://wellformedweb.org/CommentAPI/" xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:atom="http://www.w3.org/2005/Atom" xmlns:sy="http://purl.org/rss/1.0/modules/syndication/" xmlns:slash="http://purl.org/rss/1.0/modules/slash/" > <channel> <title>Pregnancy Archives - goldsteinmd</title> <atom:link href="https://www.goldsteinmd.com/category/pregnancy/feed/" rel="self" type="application/rss+xml" /> <link>https://www.goldsteinmd.com/category/pregnancy/</link> <description></description> <lastBuildDate>Wed, 22 Jan 2025 23:01:52 +0000</lastBuildDate> <language>en-US</language> <sy:updatePeriod> hourly </sy:updatePeriod> <sy:updateFrequency> 1 </sy:updateFrequency> <image> <url>https://www.goldsteinmd.com/wp-content/uploads/2017/12/cropped-header-logo-2-1-32x32.png</url> <title>Pregnancy Archives - goldsteinmd</title> <link>https://www.goldsteinmd.com/category/pregnancy/</link> <width>32</width> <height>32</height> </image> <item> <title>Fertility decline, freezing eggs: myths and realities</title> <link>https://www.goldsteinmd.com/blog/fertility-decline-freezing-eggs-myths-and-realities</link> <comments>https://www.goldsteinmd.com/blog/fertility-decline-freezing-eggs-myths-and-realities#respond</comments> <dc:creator><![CDATA[GoldsteinMD]]></dc:creator> <pubDate>Wed, 05 Sep 2018 13:53:50 +0000</pubDate> <category><![CDATA[Fertility]]></category> <category><![CDATA[Pregnancy]]></category> <guid isPermaLink="false">https://www.goldsteinmd.com/?p=2522</guid> <description><![CDATA[<p>Fertility decline, freezing eggs: myths and realities In last week’s New York Times, just before the holiday weekend, there was an article about a 22-year-old single woman who decided to freeze her eggs. In that article it said that fertility was declining by age 20. This is extremely inaccurate and unfair. According the American College … <a href="https://www.goldsteinmd.com/blog/fertility-decline-freezing-eggs-myths-and-realities" class="more-link">Continue reading<span class="screen-reader-text"> "Fertility decline, freezing eggs: myths and realities"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/fertility-decline-freezing-eggs-myths-and-realities">Fertility decline, freezing eggs: myths and realities</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p><strong>Fertility decline, freezing eggs: myths and realities</strong></p> <p>In last week’s New York Times, just before the holiday weekend, there was an article about a 22-year-old single woman who decided to freeze her eggs. In that article it said that fertility was declining by age 20. This is extremely inaccurate and unfair. According the American College of Obstetricians and Gynecologists, fertility remains <u>relatively</u> constant until about age 30 then begins to decline and there is a <u>sharper</u> falling off after age 35 and especially after age 40. I have dealt with this issue of the “biological clock” with my patients for more than 25 years.</p> <p>The ability to freeze eggs rather than embryos is now an option if one has not identified a <u>partner</u> with whom one wants to have their children. When first introduced into this country (it was developed in Italy) NYU was one the pioneers in the United States. I was, however, somewhat in an awkward position serving on the Gynecologic Practice Committee of the American College of Obstetrician and Gynecologists when, initially, this was meant to be offered on an experimental basis to patients who had cancer and were about to undergo chemotherapy. There was an opinion by the American College of Obstetricians and Gynecologists as well as the American Society of Reproductive Medicine that this should be done on an experimental basis without charge. In those early days, NYU was offering this as a clinical service and charging patients and, as all of you are probably aware, it is not covered by insurance.</p> <p>Those times have changed, however. This is no longer experimental. It has been around long enough to have proven that it is virtually as successful as frozen embryos can be. I have begun to discuss with my single patients who are not engaged or married and/or have no intention of being pregnant in the next several years to consider consultation with fertility experts and to <u>consider</u> freezing eggs. I do so not because I am so concerned that they will not be able to have a baby. I have seen so many women in my career who have had successful pregnancies at 37, 38, even 39. But so many of them have come back at 42 or 43 and say, “you never told me how great this was,” and now they are trying to have a <u>second</u> baby and that does not come so easily.</p> <p>It is very interesting that virtually no one have ever come to me worrying about their fertility and said, “can I have <u>two</u> babies.” Thus, when I speak to patients now at 32, 33, 34 about the possibility of freezing eggs, it is often with the idea that that may be for the <u>second</u> child, obviously depending on their individual circumstances. I do feel, however, that 22, as talked about in the New York Times article, is much too young to be subjecting one’s self to the treatment involved in terms of medication, procedures, and cost to freeze eggs simply because of a fear of declining fertility.</p> <p>If this is not something that applies to you, perhaps you can pass this along to some friend or family member.</p> <p>Dr Steven R. Goldstein is an <a href="https://www.goldsteinmd.com/services/best-obgyn-manhattan/" target="_blank" rel="noopener">Obgyn in Manhattan</a> who may be able to assist couples with information on pregnancy.</p> <p>The post <a href="https://www.goldsteinmd.com/blog/fertility-decline-freezing-eggs-myths-and-realities">Fertility decline, freezing eggs: myths and realities</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/fertility-decline-freezing-eggs-myths-and-realities/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Contemporary Hormonal Contraception and the Risk of Breast Cancer</title> <link>https://www.goldsteinmd.com/blog/contemporary-hormonal-contraception-and-the-risk-of-breast-cancer</link> <comments>https://www.goldsteinmd.com/blog/contemporary-hormonal-contraception-and-the-risk-of-breast-cancer#respond</comments> <dc:creator><![CDATA[Steven Goldstein]]></dc:creator> <pubDate>Mon, 11 Dec 2017 17:09:01 +0000</pubDate> <category><![CDATA[Birth Control]]></category> <category><![CDATA[Pregnancy]]></category> <guid isPermaLink="false">https://www.goldsteinmd.com/?p=2217</guid> <description><![CDATA[<p>Last week a story broke in the News media about an article that appeared in the New England Journal of Medicine entitled, “Contemporary Hormonal Contraception and the Risk of Breast Cancer.” I received a number of queries about this news story and told patients that I needed to see the original article itself and spend … <a href="https://www.goldsteinmd.com/blog/contemporary-hormonal-contraception-and-the-risk-of-breast-cancer" class="more-link">Continue reading<span class="screen-reader-text"> "Contemporary Hormonal Contraception and the Risk of Breast Cancer"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/contemporary-hormonal-contraception-and-the-risk-of-breast-cancer">Contemporary Hormonal Contraception and the Risk of Breast Cancer</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p>Last week a story broke in the News media about an article that appeared in the New England Journal of Medicine entitled, “Contemporary Hormonal Contraception and the Risk of Breast Cancer.” I received a number of queries about this news story and told patients that I needed to see the original article itself and spend a good deal of time dissecting the “fine print.” It is a very long and complicated article but let me make the following observations:</p> <ul> <li>It was a study done on a registry of Danish women between 15 and 49 years of age. Denmark has a population of 5.3 million people, is relatively homogeneous, and has very good national health registries and statistics so that this kind of database mining is relatively easy. However, the population is not very heterogeneous nor very diverse. Many of these families have lived in the same village for many generations. One could facetiously say that if both your parents are Danish that the data derived from a Danish population would be more likely to apply to you and your genetic background.</li> <li>Overall, the study claimed a 20% increase in the risk of breast cancer in patients who had used any form of hormonal contraception including the newer levonorgestrel releasing IUDs (like Mirena). Levonorgestrel is a particular type of synthetic progesterone also known as a progestin.</li> <li>The New York Times article goes into great detail to try to make readers understand the difference between a relative risk and an absolute risk. To many people, a 20% increase in risk sounds formidable, although, if a risk to begin with is relatively small, an increase of 20% is still a very small risk. Overall, the data presented here would seem to indicate 1 extra breast cancer for every 8,000 women.</li> <li>There are some interesting points that they do not make in the article itself but are present in the Tables of the data. The percent of smokers for various groupings ranged from a low of 20% to a high in some groups of 60%!! This is certainly not typical of my patient population, whatsoever. In addition, there was no description of the amount of alcohol consumption, also a known risk factor for breast cancer, which is greater in the Danish population than most of my patients.</li> <li>One of the things that was most interesting and yet something I have known for quite some time was that the use of the levonorgestrel (synthetic progestin) releasing IUD resulted in a 21% statistically significant increase in breast cancer. The makers of that devise would have one believe that this only acts locally in the uterus but many of us have long know that there, in fact, is systemic absorption of the progestin.</li> <li>Along those lines, it is interesting that the risk of a 50-microgram estrogen pill was similar to the risks of those pills that contain 20-40 micrograms of estrogen, if they employed the same progestin that they were paired with. In other words, this is very strong data pointing to it being the type of progesterone, not the estrogen dose that is most important for breast cancer risk. I have told many of you that the problem in the Women’s Health Initiative was not the estrogen employed (Premarin) but the progesterone (Provera) that it was matched with. This information from this article is very important in that many patients assume a lower dose of hormone would, in fact, be safer. This study would indicate that the choice of the progestin may be much more important that the dose of the estrogen. I’ve also told many of you that the lowest dose pills are too low for women under 30-35 years of age because they do not result in enough bone growth at a time when bone is growing geometrically. Thus, this data is reassuring that low dose pills need not be resorted to for women under 30-35 years of age, but rather, perhaps we should be thinking about which progesterones are being employed.</li> <li>As I have explained to many of you, virtually all pills contain the same type of estrogen. It is called ethinylestradiol. What differs in various pills is the synthetic progesterone (progestin) that the estrogen is paired with. More than half the women in this Danish study were taking pills whose progestin was one called gestodene. This is not marketed in any United States birth control pills. I find this reassuring in that, as mentioned, it accounted for more than half of the women in this entire study.</li> <li>Norethindrone as in the Lo Estrin family and its generics had no statistically significant increase in breast cancer. Drospirenone as in Yaz and Yasmin and its generics had no significant increase in breast cancer. Norgestimate as in the Ortho-Cyclen family and its generics did show a small increase as did levonorgestrel present in Seasonale, Nordette and its generics as well as the Mirena IUD did show a small increase in breast cancer. This amounted to approximately 1 case in every 5,600 women. It is important to note, however, that progestins like Norgestimate have other secondary benefits such as excellent control of acne.</li> <li>There was no information on Demulen and its generics (Kelnor, Zovia) for those formulations are not available in Europe.</li> <li>Furthermore, there are well known reductions in cancers of the ovary, uterus and colon in women who use birth control pills later in life. Thus, any small increase in breast cancer may well be totally offset.</li> <li>For those of my patients having good, annual radiologic surveillance of their breasts, I have seen no decrease in breast cancer over the last two decades but I have seen virtually no deaths in my practice. Many of you have heard me tell that I never want to “feel breast cancer again.” I expect the breast imagers to pick up early stage disease four to five years before anyone could possibly palpate it. Thus, currently, although, I see lots of breast cancer in hormone users as well as non-hormone users, virtually all that I see in my practice is Stage 1 disease where a simple lumpectomy and a single sentinel lymph node are all that are required and virtually all these patients survive with virtually no death rate.</li> </ul> <p>In summary, I still strongly believe that the short and long term benefits of hormonal cycle control far outweigh any potential risks. In some cases, this data may cause me to choose some formulations which appear to have less risk that other formulations. This appears to be related to the progestin in the pill rather than the dose of estrogen in the pill. I encourage everyone not to smoke, moderate your alcohol intake and continue your exercise program. Clearly, there are more deaths from the long- and short-term sequelae of hip fracture in patients as they age than breast cancers.</p> <p>As usual the devil is in the details and there was more to this paper than simply what the media reports. If you have any questions or concerns, do not hesitate to contact the office.</p> <p>Dr Steven R. Goldstein is a <a href="https://www.goldsteinmd.com/services/gynecologist-perimenopause-specialist/" target="_blank" rel="noopener">Perimenopause Specialist in NYC</a></p> <p> </p> <p>The post <a href="https://www.goldsteinmd.com/blog/contemporary-hormonal-contraception-and-the-risk-of-breast-cancer">Contemporary Hormonal Contraception and the Risk of Breast Cancer</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/contemporary-hormonal-contraception-and-the-risk-of-breast-cancer/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> <item> <title>Comments on Long Acting Reversible Contraception</title> <link>https://www.goldsteinmd.com/blog/another-front-page-article-in-todays-new-york-times</link> <comments>https://www.goldsteinmd.com/blog/another-front-page-article-in-todays-new-york-times#respond</comments> <dc:creator><![CDATA[Steven Goldstein]]></dc:creator> <pubDate>Tue, 07 Jul 2015 18:07:48 +0000</pubDate> <category><![CDATA[Pregnancy]]></category> <category><![CDATA[Other]]></category> <guid isPermaLink="false">http://goldsteinmd.com/?p=1812</guid> <description><![CDATA[<p>07/07/2015 There is an extremely interesting article on the front page of today’s New York Times entitled, “Colorado Finds Startling Success in Effort to Curb Teenage Births.” The article talks about a private grant that allowed free IUDs or subdermal implants to prevent pregnancy that was a six-year experiment in Colorado. During this period of … <a href="https://www.goldsteinmd.com/blog/another-front-page-article-in-todays-new-york-times" class="more-link">Continue reading<span class="screen-reader-text"> "Comments on Long Acting Reversible Contraception"</span></a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/another-front-page-article-in-todays-new-york-times">Comments on Long Acting Reversible Contraception</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></description> <content:encoded><![CDATA[<p style="text-align: right;"><strong><span style="color: #000000;">07/07/2015</span></strong></p> <p><strong><span style="color: #000000;">There is an extremely interesting article on the front page of today’s New York Times entitled, “Colorado Finds Startling Success in Effort to Curb Teenage Births.” The article talks about a private grant that allowed free IUDs or subdermal implants to prevent pregnancy that was a six-year experiment in Colorado. During this period of time, the birth rate among teenagers plunged 40% and the rate of abortions fell by 42%. Apparently, this was most evident in unmarried women under 25 who had not finished high school. In addition, the article talks about how the changes were “particularly pronounced in the poorest areas of the state… where many young women have unplanned pregnancies.” Understand, from a societal point of view, preventing unintended pregnancy, especially in women who would then have an unintended child, has merit. However, the endorsement of the American Academy of Pediatrics in the use of this type of LARC (long acting reversible contraception) for adolescents as a <u>blanket statement</u> is somewhat distressing to me.</span></strong></p> <p><strong><span style="color: #000000;">When I trained, we were taught that intrauterine devices (IUDs) were best suited for patients who had had a child (the uterus grows with child bearing) and those in a stable monogamous relationship. If one catches a sexually transmitted disease from a partner, the IUD can serve as a wick helping to spread it up through the uterus and into the fallopian tubes often causing pelvic inflammatory disease (PID) and often compromising the future fertility of these patients. Thus, while I agree that in patients who because of their lack of education or socio-economic status or lack of insight cannot be counted on for appropriate contraception without a device like an IUD or an implant that does not require any participation on their part—in such patients this may, in fact, make sense and as evidenced by the Colorado experiment will cut down on unintended births and abortions.</span></strong></p> <p><strong><span style="color: #000000;">However, recently, I’ve had two young women referred to me from the student health service at NYU downtown (Washington Square) who had two IUDs each that they expelled. Each of these young women was sent to me to evaluate her uterus to see if there was some abnormality causing her to expel the IUD. Evaluation with saline infusion sonohysterogram and 3-D ultrasound revealed they had absolutely normal uteri. However, the width at the top of the uterus was only 2.9 cm in each of them, whereas, the IUD devices are 3.2 cm wide. In other words, each woman’s uterus was too small to accommodate the intrauterine device.</span></strong></p> <p><strong><span style="color: #000000;">My overall point is that decisions should be made on a case-by-case basis and individualized. Most of my patients do not need to accept even the small risk of future tubal damage from an intrauterine device in order to prevent unintended pregnancy. These forms of LARC may be appropriate for some groups of patients but I have not routinely embraced them for young women in my practice who have not had children and are not in a stable, monogamous relationship. That is not to say that occasionally the rules may be broken, depending on the individual situation.</span></strong></p> <p>Dr Steven R. Goldstein is a leading <a href="https://www.goldsteinmd.com/services/best-obgyn-manhattan/" target="_blank" rel="noopener">Obgyn in Manhattan</a></p> <p>The post <a href="https://www.goldsteinmd.com/blog/another-front-page-article-in-todays-new-york-times">Comments on Long Acting Reversible Contraception</a> appeared first on <a href="https://www.goldsteinmd.com">goldsteinmd</a>.</p> ]]></content:encoded> <wfw:commentRss>https://www.goldsteinmd.com/blog/another-front-page-article-in-todays-new-york-times/feed/</wfw:commentRss> <slash:comments>0</slash:comments> </item> </channel> </rss>