In vitro fertilization (IVF) allows physicians to fertilize eggs and create embryos outside the woman’s body. The process of choosing which embryo (or embryos) are going to be transferred back into the uterus is usually done by looking at the appearance of the embryos under the microscope. This is usually a good method to select the best quality embryos, but it does not tell us much about the genetic make-up of those embryos we are choosing. Preimplantation genetic diagnosis (PGD) allows physicians to analyze an embryo formed outside the mother’s uterus for genetic defects that would prevent that embryo from implanting, produce a miscarriage or cause an inherited disease upon birth. Many genetic diseases can be screened by this technology, including genetic disorders such as cystic fibrosis, or abnormal number of chromosomes like Down syndrome. Genetic testing of the embryos has been available for more than 2 decades, but recent advances in genetic testing have made PGD much more accurate. For example, for many years we could only test for a limited number of chromosomes. More recently, we can use computer chips that allow testing for all the chromosomes in the embryos.
PGD requires patients to use IVF to produce multiple eggs and embryos that will undergo genetic testing. In general, one cell from the embryo is removed and its genetic material is tested to identify possible defects. The PGD results are usually available within 24 hours. Once identified, a limited number of normal embryos are returned to the mother’s uterus to allow implantation and pregnancy to be established.
PGD can be used for diagnosis of gene defects or chromosomal abnormalities. Single-gene defects are classified into two categories: recessive and dominant. Recessive disorders (i.e. cystic fibrosis, sickle cell anemia, etc) require both parents to be carriers of the abnormal gene. These couples have a 25% risk of having a child affected by the disease. For dominant disorders (like myotonic dystrophy, Huntington’s disease, etc) only one parent is the carrier, and 50% of the couple’s children will be affected by the disease. Chromosomal abnormalities that can be diagnosed by PGD include abnormal number of chromosomes and specific rearrangements of the chromosomes called translocations. While most embryos with abnormal chromosomes don’t survive, some fetuses carrying an extra chromosome (like an extra chromosome 21 in Down syndrome) can survive to term. There is extensive evidence that the higher infertility rates in older women are due to an increase in embryos with abnormal number of chromosomes. PGD could be used to decrease the risk of these women having an abnormal fetus and reduce their risk of miscarriage.
PGD testing can be performed for couples aware of genetic disorders through family history or based on carrier testing to help them conceive a healthy child. In genetic disorders where the genetic mutation is known, the actual genes of the embryo are examined for presence of the condition. Chromosomal abnormalities due to advancing maternal age are more likely to occur in women over the age of 35. PGD testing can determine the number of the chromosomes and help select the embryos most likely to result in a healthy pregnancy. Revealing genetic defects before pregnancy can significantly reduce the risk of a fetus being affected. At present, nearly all-pregnant women are offered some form of prenatal screening and diagnosis. Since PGD allows for screening embryos before they are transferred into the uterus, many believe that it spares some couples from the emotionally wrenching ordeal of having to decide about a second trimester pregnancy termination if their baby has a genetic disorder.
In summary, PGD is an exciting technology that offers couples at risk an alternative to pregnancy termination of an affected fetus. In addition, PGD offers the promise to become an important tool in IVF by selecting a single embryo with the greatest potential for implantation, thereby maximizing pregnancy outcomes and at the same time reducing the risk of multiple births.
Don’t be late, don’t be late,” I repeated to myself as I pulled into the parking garage at San Francisco’s Pacific Fertility Center where I had planned to freeze my eggs. My lateness was surely a reflection of an ambivalence I had about the whole process. I was in too much of a rush to notice the “NOT AN ENTRANCE” sign on what appeared to be a front door. I then scurried up five flights and yanked on the 5th floor door. It didn’t budge. I raced down the stairs pulling on the doors at the 4th, 3rd, 2nd and 1st floors. I was locked out of all of them.
After four increasingly stressful phone calls to the reception desk, a building security guard found me in what I later learned was a back entrance no one used. When I finally arrived where I was meant to be, I couldn’t get my name out ahead of an unexpected rush of tears. My internal dialogue stirred up a mix of fearful emotions. “Why am I here? This is not the way I envisioned having a baby!” I provided name and address details to a receptionist who, seeing my fragile state, kindly escorted me to a private room to wait for my doctor. I was late for that appointment as well as a marriage and family that, in my mind, should have happened 10 years ago.
I had been married in my early 20s but divorced after the painful realization that I wasn’t ready to be a partner or a mom. After years of traveling, figuring out who I was and intermittent stretches of dating unavailable men, I hit 37 wondering where the time went. As a fellow single friend put it “It’s as if I forgot to set the alarm on my biological clock and slept through my 30s.” I woke up in a panic. What if I missed my chance to have a family?
I had always thought I may adopt a child one day, but the idea that time was taking away my opportunity to have one of my own seemed unfair. I started experiencing each of my failed relationships like I did the locked doors in the stairwell. Each unsuccessful attempt to make one work left me feeling increasingly stressed.
I sat still fighting tears in my doctor’s office when she walked in and welcomed me with a smile of a woman who had seen my strain of anxiety before. As she patiently and thoroughly explained the details of the egg freezing process I tried to wrestle my mind around a swirl of details involved. The idea of freezing the cells of babies-to-be in a $12,000 procedure was not part of my original life plan, but 40 minutes later there was one thing I was clear on: I would do this. I couldn’t control when I would meet a potential partner but I could control this. The peace of mind alone seemed worth the big chunk of my savings.
I sat through my injection class in a haze as Power Point images of needles and vials appeared. The class made it all seem so simple. “Fill, measure, inject.” It was simple. But on my first try I magically made several hundred dollars worth of liquid Menopur disappear by failing to load it into the correct syringe. I winced at the loss and the idea of injecting myself. I then held my breath, grabbed an inch of skin around my belly, and stuck the needle in.
I knew the hormones were kicking in when, on day three, I cried when someone cut me off in traffic. On day seven, a friend’s “I admire what you’re doing” sent tears streaming down my face.
But as each doctors visit allowed me to see ultrasound images of my little eggs multiplying, I was reminded of what my body was capable of. The truth is, while I was never confused about whether I wanted children, the thought that I might not get something I wanted so badly was painful. So, over the course of my many years being single, I slowly shut down my relationship with my fertility. And, like any difficult breakup, I wasn’t sure we’d ever be getting back together.
The morning of the extraction of my eggs, I walked my bloated belly into the procedure room and made small talk with the anesthesiologist. Before I knew what happened, I woke up to a nurse tapping me on the shoulder to congratulate me. In a drug-induced stupor I cried out “I’m soooo proud of myself!!!”
When a technician later arrived with a snapshot of the microscopic eggs, I studied the contours of each with pride and awe. Those that survived the process will be held for safe keeping until I choose to use or dispose of them. While there is no guarantee of their quality or that any will survive the many steps between being thawed and becoming a baby, I am relived to have them.
This year I went to my 15 year college reunion where, for the first time I can remember, the site of pregnant bellies and waddling toddlers didn’t trigger feelings of despair. Doing what I could to preserve my fertility has made me less afraid of losing it.
In the months since, I’ve been taking better care of my health and feeling less averse to being alone. Perhaps not surprisingly, I’m one of several women I know who started the best romantic relationship of their lives within months of her egg freeze. Maybe its like one of my dad’s favorite expressions: “Our ships come in on calm seas.”
I’m sure if I had been in a little less of a hurry the day of my first appointment I would have seen the “NOT AN ENTRANCE” sign, walked in the “correct” door and not been late. Still I can’t regret that 20-minute detour, nor the 10-year one that took me off track from the life I had planned. But I do believe that sometimes when we stop being in such a fear-driven hurry, life is far more likely to get us where we want to be. Right on time.
Follow Cara E. Jones on Twitter: www.twitter.com/@stories4good
What is egg donation?
Egg donation is when a woman (donor) gives her eggs to another woman (recipient) to allow the recipient to have a baby. To donate eggs, the donor must be given medications that will cause her to develop multiple eggs over a single cycle. The eggs are then removed from the donor by placing a needle that is attached to an ultrasound probe through the vaginal tissues. The eggs are then gently aspirated (suctioned) from the ovaries. Once the eggs are removed, they are evaluated by an embryologist. Then sperm from the male partner or a sperm bank is placed around or injected into each egg. This process is called in vitro fertilization (IVF).
How is the recipient prepared for the embryo transfer?
The recipient’s uterus (womb) must be synchronized with the donor’s stimulation so that they are ready at the same time. There are several ways to achieve this. If the woman still has regular menstrual cycles, a medication is often used to suppress her ovaries and her menstrual cycle. Once the donor starts the medication to stimulate her ovaries, the recipient begins taking estrogen to develop her uterine lining. Around the time of egg retrieval, the recipient will begin taking progesterone to enable implantation of the embryo (fertilized egg). The embryo(s) will be transferred to the recipient’s uterus three to five days after fertilization. Hormones continue to be given until the pregnancy test and then, if the test is positive, during the early part of the first trimester of the resulting pregnancy.
Who should consider using an egg donor?
Egg donation is used for a woman who wishes to have a child but cannot get pregnant with her own eggs. This may be because she was born without ovaries, is in menopause, did not respond adequately to hormonal stimulation of her ovaries in the past, or has had poor egg or embryo quality with previous IVF attempts. Women may also choose to use a donor if they have a genetic disease that they do not want to pass on to their children.
Who can become an egg donor?
Egg donors are women, usually between the ages of 21 and 34, who are willing to provide their eggs to a recipient. They may be anonymous (unknown) or known to the intended parents. Anonymous donors are recruited through egg donation programs or agencies and are not known to the recipient. However, some couples find donors through advertisements. Recipients should be cautious about recruiting donors without the use of an intermediary to screen the donors and should strongly consider seeking legal counsel. Known (also called directed) donors are generally a close friend or relative of the recipient.
What tests are performed on the donor?
The donor is tested for infections such as HIV, Hepatitis B and C, gonorrhea, chlamydia and syphilis. All donors should be tested to be sure that they are not carriers of the cystic fibrosis gene. Other genetic testing should be performed based on the donor’s history and ethnic background. Some programs perform chromosome analysis and test for Fragile X syndrome; however, this testing is not required. Psychometric testing is often done as part of the mental health screening.
How should the recipient be evaluated?
Evaluation of the recipient is similar to that of couples undergoing routine IVF. This should include a comprehensive medical history from both partners, including blood type and Rh factor, and testing for sexually transmitted diseases including HIV, hepatitis, gonorrhea, chlamydia, and syphilis. The couple should be counseled by a mental health professional about the complexity of the decision to use donor eggs.
The recipient should have a pelvic exam and an assessment of her uterus (womb). If she is over 45 years old, a more thorough evaluation should be done, including an assessment of heart function and risk of pregnancy-related diseases. She may also be advised to see a doctor who specializes in high-risk pregnancy. The male partner’s sperm should be analyzed and appropriate genetic screening should be obtained based on his history and ethnic background.
What is the chance that a donor egg cycle will result in pregnancy?
The success of egg donation depends on many factors but is not considered to be related to the age of the recipient. Success rates compiled by the Centers for Disease Control for the year 2010 show an average birth rate per embryo transfer of 55% for all egg donor programs.
Revised 2012 from Reproductivefacts.org
9 Nov 2013 21:12
The superstar singer had first treatment at 33 and is mother to three boys, Rene-Charles, 12, and three-year-old twins Nelson and Eddy
Celine Dion: Wants a baby girl – Getty
Celine Dion has told how she had IVF seven times to get pregnant – and hinted she may do it again.
The superstar singer, 45, is mother to three boys, Rene-Charles, 12, and three-year-old twins Nelson and Eddy.
Her first treatment, aged 33, was a success but she struggled to conceive a second time, the Sunday People reports.
Celine said: “For the twins I did IVF six times one after the other.
“I’d done five years at Caesars Palace and went half a year around the world on tour and it was finally time to get pregnant again.
“I thought as long as my health permitted me and unless my doctor thought physically I couldn’t do it, then I would go on with the IVF until someone told me to stop.
“With any pregnancy, whether it’s through IVF or not, you feel a danger. You have to remain positive and try to relax as much as possible.
“I always say my children’s first country is inside of me, so I try to make it a good one and be healthy.”
And the My Heart Will Go On singer, who married her manager René Angélil, 71, has not ruled out trying for a baby again.
Canadian Celine said: “There’s nothing that can top being a mother. I’d like more but I don’t know.
“It’s selfish to keep wanting more – although I would love a girl.”
Your reproductive system ages faster than you may realize. Some women, after completing college, settling into a career, or waiting for the right partner, find that they have problems getting pregnant due to age-related infertility. Other women are surprised when they begin developing symptoms of menopause, such as hot flashes, while they still feel young and healthy. Understanding the stages your reproductive system goes through is important in understanding these changes in your body.
What are the stages of reproduction?
The first menstrual period occurs around age 12. Periods (cycles) may be irregular at first but should become regular over the next few years. Contraception is needed if a woman is sexually active and doesn’t want to become pregnant. Fertility peaks from the late teens through the late 20s and then begins to decline. By age 30, the chance of miscarriage begins to increase, and the chance of becoming pregnant starts to decrease.
Usually in her 40s, a woman will begin the transition from reproductive years to menopause. The length of menstrual cycles will start to vary and she may begin to skip periods. She may experience hot flashes due to decreased estrogen production by the ovaries and may have difficulty sleeping. Pregnancy is rare but not impossible, so contraception is still needed to avoid pregnancy. The average age of the final menstrual period (menopause) is age 51.
After menopause, pregnancy is no longer possible and contraception is no longer needed. Ovaries produce very little estrogen, which results in vaginal dryness and bone loss. Hot flashes intensify and then begin to subside. Hormone therapy or other treatments may be appropriate for short-term use. If vaginal bleeding is noted during this stage, a physican should be consulted.
How does reproductive aging affect fertility?
By age 40, many women will not be able to have a successful pregnancy. By age 45, very few women will be able to have a successful pregnancy. This happens because both the quality and quantity of eggs remaining in your ovaries gradually declines throughout your life, and this decline accelerates beginning around age 35. Age is the best indicator of egg quality. The decreasing quantity of eggs in the ovaries is called “loss of ovarian reserve.” Women begin to lose ovarian reserve before they become infertile and before they stop having regular periods. There are medical tests for ovarian reserve. These tests do not indicate whether pregnancy is possible, but can give information about whether age-related changes of the ovaries have begun. Women with poor ovarian reserve have a lower chance of becoming pregnant than women with normal ovarian reserve in their same age group.
What are my options?
Women who wish to delay childbearing until their late 30s or early 40s may consider methods of fertility preservation such as egg retrieval either followed by freezing of the eggs or in vitro fertilization (IVF) followed by freezing of the embryos. The success of embryo freezing is well established, but it requires that the woman have a male partner or use donor sperm. Egg freezing for preservation of fertility is still experimental, but shows promise for success in the future. The only option for women who are already infertile due to age is to use eggs or embryos donated by a younger woman. Using donated eggs or embryos, the chance of successful pregnancy is the same as that for the woman who donated the eggs.
From Reproductivefacts.org; Revised 2012
Sep 30, 2013
Daniel Griffin, MD, has joined Boston IVF at The Women’s Hospital as a reproductive endocrinologist. He earned his medical degree from Indiana University School of Medicine in Indianapolis, Indiana, in 2006. Dr. Griffin completed his obstetrics and gynecology residency at St. Vincent Hospital in Indianapolis in 2010.
Dr. Griffin completed his reproductive endocrinology and infertility fellowship from the University of Connecticut Health Center in Farmington, Connecticut, in 2013. He is board certified with the American Board of Obstetrics and Gynecology.
Dr. Griffin is a fellow of the Society for Reproductive Endocrinology and Infertility, an associate member of both the American Society for Reproductive Medicine and the Society for Reproductive Surgeons and a fellow of the American Congress of Obstetrics and Gynecology. In addition, he is a member of the American Medical Association.
When asked about his passion for helping individuals and couples build and grow their families, Dr. Griffin stated, “I’ve always been interested in women’s health and infertility. The ability to help a couple fulfill their dream of having a family is what drives me.”
Boston IVF at The Women’s Hospital is proud to welcome Dr. Griffin as a full time physician to its state-of-the-art facility and lab. He is currently accepting appointments.
By: NEIL OSTERWEIL, Oncology Report Digital Network
BOSTON – Less than half of all women of child-bearing age who are diagnosed with cancer discuss with their physicians the potential effects of cancer therapy on fertility, and even fewer are referred to reproductive specialists, investigators reported at the conjoint meeting of the International Federation of Fertility Societies and the American Society for Reproductive Medicine.
A survey of 1,282 female survivors of various cancers showed that more than 50% did not have a discussion with their oncologists about the possible deleterious effects of chemotherapy or radiation on fertility, and few patients received referrals to reproductive specialists, said Penelope P. Howards, Ph.D., assistant professor of epidemiology at Emory University’s Rollins School of Public Health in Atlanta.
“In our cohort, which was women who were diagnosed between 1990 and 2009, a large proportion is not getting the message about how treatments may affect their fertility,” Dr. Howards said in an interview.
The likelihood that women would have been counseled about fertility varied by the type of cancer and by the typical treatment approach. For example, nearly 70% of women with cervical cancer said they had talked about fertility with their physicians, whereas women with cancers more typically managed by surgery – such as melanoma and thyroid cancer – were the least likely to be informed about potentially compromised fertility.
Only 60% of women with uterine cancers and 42% of women with ovarian cancers were told about the effects of treatment on fertility, despite having cancers of the reproductive system. Among women with breast cancer, the most common cancer type represented in the study, only 44% said they received fertility counseling.
Women who had at least one child by the time of diagnosis were less likely to be counseled than were women with no children (42% vs. 50%, respectively), and women aged 20-24 years were less likely to be informed about potentially compromised fertility than were women in their 30s, the investigators found.
Dr. Howards speculated that oncologists may assume that younger cancer patients are less likely to need counseling because they have a longer time to recover reproductive function than women who are approaching the age of menopause. Additionally, they may observe that young women who are rendered amenorrheic by cancer treatment may eventually resume menses, and wrongly assume that a return to menstruation indicates a return to full reproductive health.
Of those women who reported having a fertility discussion, 33% said they had initiated it themselves, 44% said that their oncologists had brought it up, and 23% said someone else initiated the discussion.
Dr. Howards and her colleagues searched the Georgia Cancer Registry to identify and interview women with a first diagnosis of cancer between the ages of 20 and 35 years. The interviews included questions about their reproductive histories, whether they had discussed with a clinician how cancer therapies might affect their fertility, and whether they had received a referral to a fertility specialist.
Factors that significantly predicted which women would be less likely to be counseled about infertility included having a child at diagnosis (adjusted odds ratio, 1.7), younger age at diagnosis (aOR, 1.5), being African American vs. white (aOR, 1.2), and not receiving chemotherapy or radiation (aOR, 3.1).
Of those women who did have a fertility discussion, only 6% of those with a child and 19% of those without children were referred to a fertility specialist.
An investigator who was not involved in the study said that the problem is not limited to women.
“With regard to men who get a diagnosis of cancer, we have seen that the discussion about their fertility status is not often had prior to getting a therapy that would affect their fertility status, such as chemotherapy, radiotherapy, or surgery,” said Dr. Anand Shridharani, a urologist at the Erlanger Health System in Chattanooga, Tenn.
The study was supported by a grant from the Eunice Kennedy Shriver National Institute for Child Health and Development. Dr. Howards and Dr. Shridharani reported having no relevant disclosures.
Dr. Claudio Benadiva, of The Center for Advanced Reproductive Services at the University of Connecticut Health Center, is interviewed by Mary Anderson for “Connecticut Spotlight” on NBC Channel 30 news.
Photo courtesy Dr. Claudio Benadiva
By Lisa S. Lenkiewicz
Argentine native Dr. Claudio Benadiva is a nationally known lecturer on infertility. He is director of the IVF (In Vitro Fertilization) Laboratory at The Center for Advanced Reproductive Services at the University of Connecticut Health Center in Farmington, board certified specialist in endocrinology and infertility, and clinical professor of obstetrics and gynecology. He has a special interest in ovulation induction for IVF and pre-implantation genetic diagnosis.
Benadiva is one of the few physicians certified by the American Board of Bioanalysis as a high complexity laboratory director. This certification enables him to integrate clinical and laboratory protocols in an IVF program.
A native of Buenos Aires, he graduated from the University of Buenos Aires School of Medicine in 1981. He completed his residency in obstetrics/gynecology at the UConn Health Center. He was a fellow in reproductive biology and endocrinology at the University of Pennsylvania School of Medicine and was a clinical fellow in reproductive endocrinology at the New York Hospital-Cornell Medical Center.
He resides in Farmington with his wife, Lee Ann, a Realtor with Caldwell Banker. They have two college-age children.
Benadiva took time out from his busy schedule to speak with CTLatinoNews.com about the latest advances in treating infertility.
Q: What attracted you to enter this specific field? And what continues to drive your passion for this? A: My interest started in the mid-1980s, when I came from Argentina to the University of Pennsylvania in Philadelphia with a fellowship to do basic research in the, back then, new field of in vitro fertilization. I became fascinated by the new technologies that were allowing us to create human life in a petri dish. Later on, my wife and I also suffered ourselves from infertility. After successful treatments we are now blessed with two young adult children. I knew I wanted to help others, the same way we have been helped. There is nothing like being able to call a woman with the good news she is finally pregnant!
Q: Why has infertility become such a prevalent problem in our society?
A: Many changes in our society have resulted in women delaying childbirth until later in life, when they have completed their careers and finally found the right partner. Unfortunately, fertility declines with age. Despite many stories of miracle pregnancies in the media, the fact is that we still can’t stop the biological clock. Even as science and technology push back the age of reproduction, the efficacy of these advanced reproductive methods is still limited by nature’s timetable. We do all we can to help patients who want to conceive, but women who contemplate postponing childbearing should know they may not be able to conceive with their own eggs. Beyond a certain point, their only option may be to resort to egg donation, that is, using someone else’s genetic material.
Q: Can you tell our readers about the latest advances in the fields of infertility and reproductive endocrinology?
A: Egg freezing has been around for many years, but it’s only recently that the technique has been improved to provide excellent results, very similar to those obtained with fresh eggs. Please note that egg freezing is not the same as embryo freezing. Freezing embryos (fertilized eggs) is something we have been able to do successfully for a long time. The technique that allows us to freeze unfertilized eggs very effectively is called “vitrification.” Basically, it is a flash freezing method where the eggs are frozen very rapidly. By removing the water from the cell, the formation of ice crystals–that can damage the cell–is prevented.
Another great advancement in the field of IVF is what we call elective single embryo transfer. For patients that are good candidates, we are now able to identify the one embryo with the best chance of making a baby — significantly reducing the burden of multiple pregnancies. Although we still see a fair number of twins, the triplets and quadruplets that I used to see frequently when I first started practicing are rarely seen nowadays.
The human genome project has fostered incredible progress in DNA technology. We are now able to test embryos for a large number of genetic disorders prior to implanting them–significantly reducing the risk of miscarriage, or a child born with a genetic disorder.
Q: I’ve also read that women wanting to delay childbirth are freezing their eggs for the future. Is this a trend? Is this even advisable?
A: Absolutely, I’m seeing a growing number of single women who are coming to freeze their eggs. We know that the quality of the eggs decreases with maternal age. I think women are finally getting the message that egg freezing is the best thing they can do if they are not ready to start a family or have not found a partner yet. My advice is for women not to wait too long; unfortunately some patients are coming to see me to freeze their eggs in their late 30s or early 40s, when the number and the quality of their eggs is already diminished. The best time to think about this is in their early 30s — when they should still have good quality eggs to freeze and save.
Some people have questioned whether freezing eggs for “social reasons” may give women a false sense of security. They may wait even longer to start their families. Interestingly, recent studies have apparently found the opposite is true; women who freeze their eggs are more likely to find a partner sooner.
Q: What are some of the options for women suffering from breast cancer or other medical problems who want to have children?
A: Women suffering from breast cancer or other medical problems requiring treatments with chemotherapy or radiation have a high risk of becoming infertile after treatment. Fortunately, they now have many options to preserve their fertility before they undergo treatment, including freezing embryos if they have a partner, or freezing their eggs if they don’t. Those eggs can be used in the future to achieve a pregnancy after they have completed their treatment and hopefully are cancer-free.
Claudio Benadiva MD, HCLD, may be reached at The Center for Advanced Reproductive Services, 263 Farmington Avenue, Farmington. Call 860-79-4580 or email him at firstname.lastname@example.org.
Real Life - October 8, 2013 - Jen Vuk
“For the past six years our single surviving embryo has been in stasis.”
In a few days a big part of our lives will be no more. For the past six years our single surviving embryo has been in stasis; frozen in time. Here, but not here. The promise and whisper of another precious life, yes, but also its spectre.
The paperwork we can no longer ignore tells us that on Thursday, 10 October, its time will be up. And my husband and I must face the final hurdle of our infertility. Letting go.
My head says, yes. My heart’s lost its voice (plaintive bleating aside). Here’s why: this embryo comes from the same ‘batch’ that yielded us two healthy sons. If its brothers are anything to go by, then this frozen pea is one tough nut.
Oh, the power—and predicament—of one. One embryo propels you out of your inertia. It forces action. One says, “Go on. You know you want to.”
Of course, I could have gone through with the transfer and, perhaps, given my boys a welcome sibling, but at 44 it just doesn’t feel right. Because while it most likely wouldn’t have worked, it might have; and there’s nothing salubrious about going through a procedure, while all along hoping that it fails.
It was with no small irony that we were once told that the best-case scenario for couples going through IVF is completing your family and not having a single embryo left in storage.
As I wrote in the Sydney Morning Herald last year, this statement came back to haunt us every three months when another ‘storage bill’ would arrive in the mail. Ruminating on the dilemma of what to do with our embryo, one option we considered was ‘adopting’ it out.
But again the insurmountable challenges (i.e. the blood tests, compulsory counselling, red tape, ongoing ethical and emotional ties etc.) and not to mention the reality of having our sons’ genetic sibling out ‘there’ somewhere proved too much for us.
And we’re not alone. It’s estimated that about 90 per cent of IVF clients ‘choose’ not to donate their surplus embryos to other couples, while even less donate for research.
Such dire statistics have helped shift the mindset of Sydney journalist Prue Corlette and her partner Aaron Sharp. Corlette and Sharp, who have two-year-old twin boys via IVF and six embryos in storage, told Fairfax earlier this year that when the time feels right they’re hoping to donate their embryos to research.
“If people didn’t donate to research, then they would never discover anything and we would never have had our boys,” Corlette says.
Corlette and Sharp certainly have my admiration. It’s a worthy final act; full of wonderful karmic intention. And yet I simply can’t leave our embryo to science. Of course, I know it’s selfish and churlish, but in my defence once again I present my bloody, obsequious, trembling heart.
This embryo carries every microcosm of our longing.
So when my husband suggests we take the embryo home I feel something close to peace of mind for the first time in a long time. While we aren’t sure if it’s possible, for days afterwards we’re buoyed by the idea of holding in our hands this final link in our family chain.
To their eternal credit, the nurses at the IVF clinic don’t seem to think I’ve lost my mind. Within minutes of shooting off an email, I receive a call from Lee*, who assures me that it won’t be a problem. It seems that while the clinic doesn’t strictly advertise taking home the embryos, several former clients have done just that.
So as we edge ever nearer to that implacable date, I go over and over the scenario of driving to the IVF clinic for the last time (but this time with my three year old in the backseat), and departing with the final paperwork, good wishes and…what? Perhaps a small, indiscreet box?
And on the weekend, we’ll try our best to explain to our boys the significance of that precious cargo. We’ll grapple with questions big and small (and not only from our boys); such as how something so miniscule could have left such a mark on our lives and how they might remember this noteworthy, yet still-to-be-fully-grasped moment of putting to rest a living memory.
And then we’ll search for a nook in the garden that’s bathed in light.
*Not real name.
By Jessica Henderson
You can’t bear to let anyone else hold your 6-month-old niece at family gatherings, the hat you’re absentmindedly knitting seems suspiciously small, and your Netflix queue is overrun with titles like “Baby Boom” and “What to Expect When You’re Expecting.”
If you’re ready for a baby, but not sure that your body is cooperating, it may be time to consult a fertility specialist.
Infertility—a disease of the reproductive system that impairs the body’s ability to conceive children—affects about 7.3 million women and their partners in the U.S. according to the CDC’s 2002 National Survey of Family Growth. And with the average cost of an IVF cycle coming in at a gulp-inducing $12,400, you’ll want to maximize your chances from the start.
To help you take those first, er, baby steps down the path to fertility, LearnVest spoke to Dr. Alan Copperman, director of infertility at Mount Sinai Medical Center in New York City, about the anxiety, misconceptions, key questions, and finally the triumph of today’s fertility treatment options to help get you started on diaper duty.
LearnVest: What does a fertility specialist do?
Dr. Alan Copperman: A reproductive endocrinologist practices all aspects of reproductive medicine, but in this day and age, we find ourselves really focusing on fertility preservation or curing infertility. There are animals that can simply look at each other from across a pond and get pregnant with quintuplets, but humans can be incredibly inefficient when it comes to reproduction. In humans, not all eggs are normal, they don’t always fertilize, they don’t always implant and they don’t always stick. And the major reason why there’s so much infertility is not because people aren’t eating right or are too stressed out—it’s because of reproductive aging.
For a woman in her twenties, about 90% of her eggs are normal, but by the time she’s in her forties, nearly 90% are abnormal. What we do is try to maximize fertility—and that starts with encouraging a woman to take her reproductive options seriously. If she’s in her thirties, and isn’t ready to conceive, egg freezing is an option that’s really come of age—it’s no longer considered experimental, and there have been thousands upon thousands of healthy babies born. If a woman is married, then we encourage her to conceive sooner than later because it doesn’t get easier over time.
What exactly is fertility preservation?
In general, fertility preservation is egg freezing, although it could also be embryo freezing. We’ve had many couples that aren’t at the right point in their lives or careers just yet, but they want to have children in the future, so we give them fertility medications, retrieve the eggs, fertilize them with the sperm and then freeze and hold them in liquid nitrogen. In a couple of years, the couple can thaw the embryos—and their fertility will essentially be preserved at the age that they are now, instead of the age that they will be.
How do you go about trying to locate the source of infertility?
When a couple comes in, it’s important to look at the basics: Are the eggs OK? Is the sperm OK? Is the uterus OK? Are the fallopian tubes normal? So we test the eggs through bloodwork and an ultrasound. We can see if a uterus is normal with an ultrasound. We can determine if the sperm is OK with a semen analysis. And we can tell if the fallopian tubes are open by doing an X-ray called an HSG, in which we inject dye through the cervix to tell whether or not it flows through the tubes.
Just by doing these basic tests, you’re usually going to pick up on a reason for infertility in almost all patients. So if you find a problem with the sperm, we can start with inseminations or in vitro fertilization, which involves implanting one normal embryo. If the fallopian tubes are blocked, we can unblock them surgically or do IVF and bypass them.
What should people take into consideration when they first start seeing a fertility specialist?
They should be prepared for physical, emotional and financial challenges. Walking into your specialist’s office empowered with questions to ask is my first piece of advice—and not necessary questions culled from random blogs or chatrooms that can sometimes heighten the hysteria surrounding infertility. Some questions to bring: What is your philosophy on twins? What is this going to cost? How has your practice performed compared to others? Are the technologies offered here the ones that I have the biggest need for? It’s OK to ask these questions. Cancer patients are certainly asking about their expected survival—and it’s only reasonable that a fertility patient know what are their chances for success.
What concern do you most often hear from patients who are just beginning treatments?
That they are going to wind up with twins or multiples. It can be unhealthy to carry twins—and certainly Octomom scared off a lot of patients—so I reassure couples that we’re striving for healthy, singleton births. We’ve tried to change treatments in recent years to minimize that risk by putting in one embryo, rather than two or three, because there’s more understanding that twin pregnancies can be complicated.
Fertility treatments are usually perceived as scary expensive. What financial considerations should you take into account?
This is such a complicated question. Different states have different mandates, and that might all be disappearing with the Affordable Healthcare Act. I would say that it’s important—upfront—for a patient to understand what the financial cost could be, and what their potential out-of-pocket expenses will be.
The practice should have a designated financial coordinator who understands their plan, and who will help them understand what it is to precertify treatments, what their pharmacy benefits are, and what the short- and long-term costs are going to be. It really is extremely variable—some people have very little covered, some people have almost everything covered, and most people have at least something covered.
I don’t usually like to speak to the financial side, but very generally speaking, the consultation and work-up can be in the hundreds, a cycle of fertility medications and inseminations can be in the thousands, in vitro can be $10,000 to $12,000, and getting pregnant using donated eggs can be over $20,000.
Often, we’re finding that it’s more cost-effective to do a single, higher-tech treatment than multiple months of low-tech treatments—i.e., trying in vitro fertilization, which has a very high success rate, rather than doing multiple low-tech treatments, such as taking fertility pills and trying to time intercourse or intrauterine insemination, which involves injecting sperm directly into the uterus. This way, you can also take advantage of any financial caps that your insurance may have on treatments.
It’s clear that having as much information as possible upfront is key. But how else should a patient prepare?
If a woman wants to be a single mom by choice, she should definitely look at what her support systems are—and what the future looks like. If a couple comes in, they should have a good idea of each other’s thresholds and concerns.
We see men who don’t want to get a semen analysis because they’re afraid there’s something abnormal, and we have women who are afraid of gaining weight or that their emotions might change while on medication, so talking to each other about tolerance before walking into the visit is important. The answer to much of the stress that fertility treatments present is communication. Hopefully, articles like this will help empower patients to ask questions, control expectations and have some faith in the process—because most couples are successful.
Say a patient has decided to move forward with treatment. How do you go about finding a specialist who best fits your needs?
Most ob-gyns have relationships with specialists in the community, and they have a sense for who takes the best care of their patients, who might have a concierge environment, and who helps their patients come back to them pregnant quickly and with a healthy, singleton pregnancy.
The American Society of Reproductive Medicine can help you find a doctor who’s been board-certified. There’s also information available through sart.org, which profiles clinic-specific information to at least let you know what your realistic chances are at various clinics. Also, different clinics participate in different insurance plans, so a patient can call up their plan representative and ask if there’s a Center of Excellency close to them, based on their criteria. All of these are reasonable ways to do some homework.
How much of a role do family genes and history play in fertility?
I think it’s less reassuring than most couples would believe. In other words, it’s very common for a woman to come in and say, “My mom had kids into her forties, my grandma had them in her forties, and my sister is ultra-fertile. It’s unbelievable that I’m not getting pregnant!”
But it actually is believable—there isn’t really a fertility gene that goes around in families. Of course, there can be something causing miscarriages in families at a higher incidence or a history of premature menopause. But while there are negative predictors of fertility that can be familial, I would not be overly reassured by the super fertility of Grandma.
Speaking of, what’s the most common misconception about infertility?
That stress causes infertility—and that simply relaxing can cure it. By telling a woman to just relax, you’re really blaming her or saying she’s got control over something that she doesn’t. There really is no evidence that taking time off or meditating is going to make someone more fertile—as long as she’s having intercourse during ovulation, she has just as good a chance of getting pregnant than someone who’s feeling calm.