TTC with IVF? Skip the Alcohol Tonight

As 2009 comes to a close, we at Houston Fertility Center would like to wish everyone a healthy and fertile 2010!

And as a physician, please allow me a little nagging space before the celebrating begins: alcoholic beverages can negatively impact both your overall health and fertility.

It's true.

Now, complete teetotaling may not be necessary for everyone, but if you're about to invest in IVF treatment, you might consider a sober New Year's Eve.

This article on ConceivingConcepts.com refers to a study that even pointed to specific types of alcohol that seem to stand in the way of success for patients going the IVF route to pregnancy.

Taking advantage of Internet searches this week for "all things Party", The Harvard Gazette points to a full related article on London's Guardian that was written earlier this year when the research results were first publicized.

The study was large (over 2,500 couples interviewed before IVF treatment) and the results were striking.

Besides, if you're just about to undergo fertility treatment, now may be a good time to get used to the little sacrifices that parents make. Keep looking to the future!

ASRM Embryo Guidelines Should Improve Overall Picture for Fertility Patients

This year, the American Society for Reproductive Medicine took an expected step forward to increase the safety and health of prospective IVF moms and their future babies. They issued guidelines stating specifically that women under age 35 should have no more than two embryos transferred per IVF treatment cycle.

The goal is to prevent multiple pregnancy, which is full of risks to both mother and babies.

The patient's prognosis, not just her age, should also be taken into account. In cases of a woman younger than 35 having optimal chances at pregnancy, the ASRM further recommends that single embryo transfer be considered.

Other ASRM embryo transfer recommendations, by which Houston Fertility Center adheres, are:

Patients 35 to 37 years old with good prognosis -- 2 embryos
Same age group with less optimal prognosis -- up to 3 embryos (or up to 2 resulting from extended culture)

Patients 38 to 40 years old with good prognosis -- up to 3 cleavage-stage or 2 blastocysts
Same age group with less optimal prognosis -- up to 4 cleavage-staged or 3 blastocysts

Even in cases of patients who typically have the least optimal chances of pregnancy -- women 41 to 42 years old -- no more than 5 cleavage-stage or 3 blastocysts should be transferred.

Balanced Media Reporting Highlights Balanced Infertility Treatment Approach

It's hard enough for infertility patients to find well-founded facts on the Internet, but confusion can really swirl when the marketing of books or products by physicians becomes involved.

This piece by Tennessee Valley's NBC affiliate, WRCBtv, does the right thing with a strong attempt at clearing the air over one fertility expert's book.

I wouldn't go so far as to refer to Dr. Sami David's book as "controversial" (as the title of the WRCB piece implies) but his stance -- that possibly "as high as 50 percent" of IVF procedures are unnecessary -- can be quite misleading taken out of context.

The WRCB team accordingly interviewed another local IVF specialist who introduces the idea of "a balanced approach" to fertility treatment.

Infertility A Blessing in Disguise?

Here's a way to re-frame things: Michele Olson of thinkmarriage.org suggests that infertility could actually be helpful to couples.

In this article from the Wausau Daily Herald, she offers tips on how to think about fertility challenges so that your relationship not only doesn't crumble, but improves.

Economy Makes Saving Embryos Tougher Decision

A recent study found that there is indeed an expected correlation between the United States economic downturn and people's choices regarding their frozen embryos.

In other words, presumably the cost of maintaining frozen embryos has pushed patients to think harder about whether or not to keep them on ice in perpetuity.

Last December, I referred to The Embryo Dilemma which was front-and-center in the media at the time. Single embryo transfer is absolutely the answer for some patients, whereas for others, it simply won't provide their desired outcome.

ART research has focused on the fine-tuning of techniques that will allow fewer IVF-created embryos to be transferred and still create a healthy pregnancy. Still, many patients will end up with extras.

The options -- aside from cryopreservation storage or discarding -- for unused embryos at Houston Fertility Center:

*If couples let us know before their eggs and sperm are combined for fertilization via IVF, we can perform the FDA-required testing for embryo 'adoption' to be an option.

*We will assist couples in making their embryos available for research at approved institutions.

It's imperative that patients using IVF to create embryos discuss -- in advance -- all of the options with their partners and any others they typically consult for life's big decisions.

Safer Fertility Treatment Must Be Made Available

The New York Times' recent series on "21st Century Babies" provides a distressing glimpse into an unpleasant side of reproductive medicine.

Besides being the Medical Director of Houston Fertility Center, I am a mother -- and one who is especially sensitive to NICU issues. My first-born spent the first week of his life in the NICU.

It was several days before we knew if he would live. Although he was not a twin, I cannot imagine how awful it would be to wonder if two or three of your children would die before coming home, or have long-term sequela.

Because of this heightened sensitivity, and because assisted reproductive techniques have become so finely tuned, I encourage single embryo transfer in indicated situations.

The NYT series, by Stephanie Saul:

The Gift of Life, and Its Price

Grievous Choice on Risky Path to Parenthood

Experts weigh in on the subject on the blog
The Trouble with Twin Births

Surrogacy The Final Stop In the Journey For Some

The Wall Street Journal has published a detailed article on the growing prevalence of international surrogacy as a way to build American families. The piece describes the incredible lengths that some couples will go through to have a child, heart-rending stories in some cases. It also brings up some of the concerns about connecting cross-culturally to resolve infertility.

To be sure, using a "third party" -- whether through donated sperm or egg, or gestational surrogacy -- requires more contemplation than other forms of fertility treatment. In situations where the donors are from relatively impoverished circumstances, hopeful parents-to-be must wrestle with the realities and potential consequences of their choices. With international medical care of any kind, some of the gravest issues can become mired in the differences between laws and health care technology and provision.

International medical care may be less expensive, but there are other costs. All parents must choose between rocks and hard places in "the parenthood."

How Do My Patients Want Their Loved Ones To Think About Infertility?

Every now and then I run across unusually good advice to friends and loved ones of infertility patients. This Q&A by Dr. Miriam Stoppard on UK's Daily Mirror is one such piece.

Titled How can I help my daughter cope with not having children?, Dr. Stoppard's response explains both succinctly and thoughtfully some of the emotions that infertile people experience. She also describes in understandable terms a healthy frame of mind that family and friends can adopt toward loved ones to lend respect to the individual's experience and journey.

This is a nice one to clip and pass around.

When Fertility Really Is About Your Diet

No woman wants to be told she needs to lose weight, least of all my patients who have struggled (sometimes for years) with trying to get pregnant. Whether we decide their fertility treatment will include fertility medications, IVF, IUI, or some other assisted reproductive technology, the best starting point is a healthy body -- and for many, that means coming to a more optimal weight.

This article in the Belfast Telegraph describes a rather novel approach to meeting the challenge of weight versus fertility, specifically as it relates to polycystic ovarian syndrome (PCOS), one of the most common causes of female infertility.

Are there similar programs in the United States?

Another Step Forward Toward Fertility Preservation

A drug used to treat ovarian cancer (cisplatin) promotes egg cell death by way of a particular enzyme. The good news: a drug used to treat a different (but related) disease, chronic myeloid leukemia (CML), protects egg cells from cisplatin's killing effects.

Researchers in Italy have published their interesting conclusions in the online edition of Nature Medicine (see a HealthDay News report on the Medline website.)

So far, these are initial studies performed with mice, but the call by cancer patient advocates for such research is loud enough that follow-ups shouldn't be far behind.

Fertility Preservation and Oncology

In this New York Times piece, Jane Brody quotes the University of North Carolina's Fertility Preservation Program as estimating that a mere quarter of U.S. oncologists address fertility issues with their patients prior to infertility-causing chemo or radiation treatments.

It's encouraging to see someone as widely read as Ms. Brody helping put the word out about fertility preservation. However, she was a tad off the mark in her reference to the obstacles of cost and timing.

In fact, rather than the "tens of thousands of dollars" that Brody says fertility preservation will cost cancer patients, fertility specialists can assist women with egg freezing for roughly half that amount. Simply freezing sperm costs even less. Creating embryos and then freezing them is the most costly option, but patients should consider that the transfer and resulting monitoring (and related fees) will be delayed by a few years. Additionally, many reproductive experts are aligning with Fertile Hope's Sharing Hope program to further alleviate the financial burden for eligible patients.

Timing is particularly important to oncologists and their patients. Contrary to Ms. Brody's comment about appointment scheduling taking "months," some fertility specialists are especially vigilant about getting cancer patients in within days of their diagnosis.

Kudos to Jane Brody and the New York Times for continuing to spread the word. It is this sort of attention from highly respected media outlets that will eventually encourage more oncologists to make fertility preservation part of standard patient care.

Women Want Working Options for Motherhood

At last November's ASRM meeting, some of us had the pleasure of listening to Lindsay Nohr Beck, the founder of Fertile Hope, present the patient's perspective on egg freezing. A podcast of that presentation is now online and available.

I think you'll find Lindsay's remarks (and the photos of her beautiful children) to be meaningful. The point she consistently boils down to is that women want the option to freeze their eggs, and they want it to work.

TV Reflecting Hopeful New Reality

Especially after hearing from my staff (who atttended the annual Young Survivors Conference in Dallas last month ) about the mix of hope and anguish that young women with cancer express about their future motherhood, it was reassuring to see the very popular TV show, Grey's Anatomy, work the forethought of fertility preservation into a current, compelling storyline.

A young woman must undergo intense and immediate treatments for invasive cancer. Her colleagues and friends think ahead for her and automatically include the OB team in her treatment plan.

In this related scene, the cancer patient's boyfriend reveals the understandable and expected emotions involved as people struggle to muster hope amid fears:

Men, Infertility, & Cancer

A large study published in February's Archives of Internal Medicine links testicular cancer to men who are seeking fertility treatment.

The researchers analyzed data from over 22,500 men in couples who sought fertility treatment between 1967 and 1998. After comparing against cancer registry data, the study authors concluded that the men were 1.3 times more likely to develop testicular cancer, and that those with male factor infertility were 2.8 times more likely.

Rather than believe that infertility treatment is the culprit, the researchers feel it's more plausible that the men have something else in common, for example, exposure to certain environmental toxins or faulty DNA repair, that increases their risks of both infertility and cancer.

There are times when seeking a diagnosis for fertility problems can result in other seemingly unrelated health conditions turning up. This study is another example of how a body's reproductive function can sometimes serve as a red flag indicator for overall health.

Concerns About the Octuplets' Conception

The birth last week of octuplets -- eight babies from one pregnancy -- is widespread news. For those of us whose work is all about helping creating new life, the news is bittersweet.

As strong as the yearning for a child can be, virtually no one believes that multiple pregnancies and births are the optimal situation for either the parents or the children. I do occasionally encounter hopeful parents-to-be who get excited at the prospect of completing their family with two or three children in one pregnancy. More babies than that, however, present far more soul searching opportunity than most people encounter in a lifetime.

Details of the California octuplets' conception are now being shared publicly, with the babies' grandmother reporting that her daughter (the mother) indeed used IVF. Reproductive experts would find the transferring of eight or more embryos into a woman's uterus after conception by in vitro to be medically unethical. High-order multiples (more than twins) are most often the result of unchecked use of superovulation medication and possibly intrauterine insemination.

The responsible use of ovulation medication includes monitoring to check on the drugs' effects and, sometimes, canceling a cycle if too many eggs became available for fertilization whether by IUI or intercourse. The reason for such cancellation is to ensure the health of the patient and to avoid a pregnancy with high-order multiple babies.

With IVF, there was a time when fertility experts routinely transferred up to five embryos, depending on the cause of infertility and, notably, the woman's age and health condition. But because of how different facets of the IVF process have improved, that practice is no longer necessary. Now, we routinely transfer only two or three embryos per IVF cycle and even a single embryo when the patient would have a good chance at pregnancy with only one.

Everyone is breathing a sigh of relief at the relatively good condition of the eight babies and their mother. Still, reports about the mother's family-building goals and that she was assisted by a still-unnamed fertility expert leave us all dismayed and concerned.

Coping With a Ticking Clock When You're Single

As I was exploring the Internet for fertility-related news the other day, I came up with this link to a psychologist's thoughts on single women and their biological clocks.

In "Tick-tock goes your biological clock" on Examiner.com, Dr. Paulette Kouffman Sherman makes some insightful comments on how single women might approach their natural drive to have a baby. I was frankly surprised to see that she included egg freezing as one of the alternatives to quickly tracking down a mate. Apparently, word is really getting out beyond the infertility world that we have turned a bend in family planning.

If you're single and wondering about whether fertility treatments might be your answer to quiet a clanging clock, please feel free to inquire. Don't lose precious time simply by failing to educate yourself.

Upcoming Seminar on Fertility Preservation

On Monday, January 19th, I will be speaking to a public audience on the topic of egg freezing for fertility preservation.

Hosted by the Young Survivors Coalition, a non-profit breast cancer support and advocacy group, my primary focus will be on the potential for women who are newly diagnosed with cancer to protect their eggs from sterilizing effects of chemo or radiation therapy.

Our primary goal is to continue getting the word out there, so that pre-cancer treatment fertility preservation considerations are standard of care in the oncology field. I welcome attendance at these presentations by patients and professionals alike.

I like to present in a casual Q&A style, so please feel free to come with your questions.

The location will be one of the facilities of The Rose, an organization committed to helping all women be adequately screened for breast cancer.

When: Monday, Jan 19th, 6:30 PM
Where: The Rose, 12700 North Featherwood, Suite 260 Houston, Texas 77034


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This presentation is made possible in part by Fertile Hope and Organon, a part of Schering-Plough Corporation.