As readers of this blog are well aware, Gordon men are completely unreasonable when it comes to their devotion to their 4 legged friends. My Dad was a perfect example of how problematic this behavior can become. Later in life, his Miniature Schnauzer, Chester, developed some rather unpleasant habits that involved his answering the “call of nature” in ways that are better left unsaid. Bleah….Suffice it to say that I have tried to be a good dog owner and if you are ever driving in my neighborhood late at night or early in the AM there is a good chance that you will see me walking our two shelter dogs: Lucky and Molly.

When we adopted Molly over 2 years ago I started feeding her a mix of dry and canned dog food that was not inexpensive and was “grain-free”….whatever that really means to a dog that was found in a ditch and rescued from a high-kill dog shelter in Pickens, SC. But in any case, she seemed to like the food. A lot.

Unfortunately, she and Lucky got into a tussle 2 months ago that result in hundreds of dollars of vet bills and Molly wearing a donut collar to ensure that the wound inflicted by her larger friend Lucky would heal correctly. Once the scab came off I cleaned the wound with chlorhexadine. Unfortunately, Molly did not listen to my admonition that chlorhexadine was for external use only and she licked off the excess in spite of my efforts to clean it off myself. It now appears to me in retrospect that chlorhexadine has powerful laxative-like properties and poor Molly was placed into a state of constant gastric/colonic distress. In order to break the cycle I resorted to the recipe suggested by another insane dog lover, my son Seth, who swears by the boiled chicken and white rice diet for these type of doggie issues. Since Seth is earning his PhD and I have a lowly MD, I deferred to his judgement.

So for the past six weeks or so Molly has existed on a diet restricted to boiled chicken and white rice (see other photo). Slowly her bowel functioned has returned to normal but in addition she has lost weight, has more energy and she no longer has eye goobers (that’s a technical veterinary medical term). I am impressed. In spite of the near-constant ridicule that I must endure from my wife and daughters, I am thinking that I should keep this new diet for Molly. If you see me with boxes of Uncle Ben’s Boil in a Bag Minute Rice, now you will know why…

But what in the world could this shaggy dog story have to do with infertility? Well, not a lot I guess except for this…

For many years, all of us REI types who did stimulated IVF performed embryo transfers in the same cycle as the egg retrieval. All patients were triggered with HCG and some ended up freezing all embryos to attempt to decrease the risk of ovarian hyperstimulation syndrome. We routinely transferred at least 2 and sometimes a lot more embryos. Many patients had success but some also had complications related to this approach including multiple pregnancies and severe hyperstimulation syndrome (occasionally even requiring hospitalization). Other patients failed to conceive with no understanding of why beautiful looking embryos had failed to generate a pregnancy. We were sticking with one recipe with no idea that there may be a better option out there.

10 years ago we introduced a radical concept to the Washington DC area…Natural Cycle IVF. Patients who had tried a traditional stimulated IVF recipe and had found it wanting could now try a markedly different approach. By allowing the follicle to grow on its own there was no risk of hyperstimulation and no problems with cycle cancellation for a poor response to medications either! Since 2007 we have helped many women succeed with this approach including a number who have had 2 and 3 children with us using NC IVF.

Since 2007 we have helped many women succeed with this approach including a number who have had 2 and 3 children with us using NC IVF.

Another seismic shift occurred a few years ago when we dropped HCG as a trigger shot for most IVF cycles and replaced it with GnRH-a (Lupron) trigger. Overnight we essentially eliminated ovarian hyperstimulation syndrome but also made the decision to go with a freeze-all approach and eliminate all fresh ET in stimulated IVF. We believed that the evidence strongly supported that the endometrial lining was not ideal in stimulated cycles and outcomes for babies and mothers were better in frozen embryo transfer cycles in which the hormone levels were more similar to natural cycle levels. Finally, as most patients were now electing to pursue Preimplantation Genetic Screening (PGS) on their embryos there was no reason not to pursue a freeze all strategy since PGS precluded a fresh ET while awaiting the results of the embryo biopsy.

… there was no reason not to pursue a freeze all strategy since PGS precluded a fresh ET while awaiting the results of the embryo biopsy.

Finally, we now have a tool to assess the precise timing of the embryo transfer in an FET cycle: the Endometrial Receptivity Assay (see my previous blog on this topic). All of these changes were clearly for the good. The old recipe and approach tossed out and the adoption of the new paradigm shown to improve outcomes ranging from the elimination of OHSS to the identification of the ideal embryo to pick for transfer.

…we now have a tool to assess the precise timing of the embryo transfer in an FET cycle

Change can be good …although I am not very good at handling change…just ask my wife why she has given up asking me to try new dishes at our favorite restaurants. But at Dominion we embraced these changes and our patients ended up benefiting in many ways. Just like Molly when I said “Good bye expensive grain free dog food and hello Uncle Ben’s white rice! “