Surviving Infertility & Mental Illness

As more men reveal their experiences with infertility, a picture is unveiling that the male struggle is just as impacting and, sometimes, debilitating as for women. While not all guys are comfortable enough yet to be as open as women tend to be about their fertility problems (as evidenced by the huge number of online infertility support groups, and the relatively sparse number of men participants), the ones who are “coming out” have powerful stories to tell.

I recently came across this interview with Matt Barwick, a young man whose life has already included a great deal of loss, including family tragedy, infertility, and mental illness. But when you listen in on this radio show where he talks about his new memoir, “My Life in Limbo: Surviving depression, infertility and mental illness” (Big Sky Publishing), what you hear isn't depressing at all.

Like some of my patients at Houston Fertility Center have expressed, venturing through the infertility journey is daunting, but also instills of sense of being a “survivor” along the way. Couples usually find that this shared experience both challenges and strengthens their relationship. For anyone, regardless of relationship status, taking such conscious steps to have a child becomes a hallmark period of time in their life, and most often, a time that they look back on with great pride. The same feelings can be felt by individuals who are further challenged in life by mental illness.

Take a few minutes to listen to this young man's story. While the title sounds like it would be a let-down, in fact, it is inspiring and should be shared, especially with the men in your life.

~ Dr. Sonja Kristiansen M.D.

Image: FreeDigitalPhotos.net

Egg Freezing Is No Longer Experimental

I spent part of the past week at the annual meeting of the American Society for Reproductive Medicine. Each year, thousands of individuals from all realms related to fertility come together to share research news and camaraderie. This year, as always, the days were filled with hopeful ideas and grounded conclusions about how best to help men and women with their reproductive medical needs. One of the big announcements this year was not about a brand new technique; rather, an announcement was made about a change in perspective toward techniques that have been in limited use for several years now.

Oocyte cryopreservation, or egg freezing, has been offered by several clinics in the world since the early 2000's. Specialists in Italy, especially, charged ahead with making egg freezing a viable option, because of that country's stringent laws regarding freezing embryos. It took reproductive lab experts a long time to finally “get it right” – specifically, egg cells (the human body's largest cells) were easy to freeze but often did not survive the thaw. When the science began closing in on successful freeze-thaw methods, many fertility specialists started offering the service to women for the deferment of conception.

In 2008, the ASRM published “Ovarian Tissue and Oocyte Cryopreservation” (Fertil Steril 2008;90:S241-6) which stated egg freezing, while not harmful, should still be considered experimental because of the unknown efficacy of the process. In that same year, I published a website called BabyLater introducing Houston Fertility Center's egg freezing services for women who wanted to preserve their fertile potential for later use with IVF. I joined many fertility providers around the country who saw the enormous need for cancer patients (and others who undergo sterility-causing chemotherapy or radiation treatments) to be able to “put their eggs on ice” before undergoing life-saving therapy, in hopes of parenthood later.

At this year's ASRM meeting, the announcement was made that egg freezing is no longer considered experimental. Enough data now exists to demonstrate that the science and clinical techniques behind the process is solid enough to present acceptable success rates. The committee continues to strongly advise that patients interested in egg freezing must be fully informed about the limitations of the technique, which primarily include the age factor: As always, eggs from younger women survive the process and result in pregnancy more often than eggs from older women.

I expect far more fertility providers to start offering egg freezing, and as with any “new” technique, tenure of experience can have an impact in treatment success. I'm happy to respond to related inquiries about how oocyte cryopreservation can be part of a reasonable family-building plan.

You can read the new guidelines from the Practice Committee of the ASRM here.

Image: FreeDigitalPhotos.net

Waiting on Infertility Insurance Reform? That's Risky

The issue of insurance coverage for the diagnosis and treatment of infertility has been a hot topic for many years. Just ask the good folks at RESOLVE and the American Fertility Association, the country's primary organizations that carry the advocacy banner for fertility patients into the halls of legislators. And while there is much discussion about hopeful possibilities for the majority of patients without infertility insurance coverage, there is still far more up in the air than nailed down in reality.

This article in the WashingtonTimes illustrates how hard it has been for states to decide what is an “essential health benefit” in accordance with the 2010 Federal health care law. These decisions must be hard-wired into place – ready for sale through insurance policies – by January 2014.

As of October 10, 2012, the state of Texas has not chosen a benchmark plan If you want to follow along, the Texas Department of Insurance maintains an updated page about thedetermination of Essential HealthBenefits. From that page, you can access a chart that shows the plans being considered, on the “Updated TDI Analysis of Essential HealthBenefits Benchmark PlanOptions”. If you're either a legislative or insurance expert, you might be able to discern from the TDI website whether or not infertility treatment will be covered. If, on the other hand, you're not an expert in those areas, you could be left simply confused and frustrated.

My opinion, after nearly 20 years of helping worried patients resolve their infertility: You can put off getting pregnant for years waiting for insurance coverage to be available. Eventually, some patients find that putting off fertility treatment for years equates to forever. I've never had a patient tell me that postponing treatment, sometimes to the point of making treatment no longer an option in terms of a woman's age, was worth it. I've also never heard a new parent say that they wouldn't do whatever they did to afford treatment all over again.

If you haven't sought help but need to, don't put it off by waiting for the states to figure it out. HoustonFertility Center has financial staff who can guide you, and time is of the essence.

~ Dr. Sonja Kristiansen MD

Image: Freedigitalphotos.net

Can ART Kickstart Your Body's Natural Fertility?

Are the rumors true, that if you get pregnant using assisted reproductive technology, you might also later conceive via the old-fashioned way? An article on the Huffington Postwebsite by reporter Catherine Pearson offers up several women's stories with a conclusion of “Maybe.”


The stories, while excellent accounts of what many infertility patients struggle through to have a baby, amount to what we call “anecdotal evidence,” individual's experiences that don't necessarily hold up statistically for large groups of people. Some of my patients have said to me with hope in their voices, “Dr. Kristiansen, I have a friend who finally adopted a baby – and then got pregnant on her own!”

The reporter cites a couple of studies that build on the rumor:

• a French study published in 2012 in Fertility & Sterility, the American Society for Reproductive Medicine's journal, and

• a German study from 2008 published in Reproductive Biomedicine Online
  

In the French study, 24 percent of women who attempted IVF unsuccessfully went on to conceive spontaneously (that is, without fertility treatment.) The German study looked at patients who had successfully used ICSI with IVF (and so had a child), finding that 20 percent of them later conceived intentionally without fertility treatment, most within two years of their “ART baby's” delivery.


The still-untested theory is that the state of pregnancy, itself, may be healing for some forms of female infertility. Some also say that components of the fertility treatment process may also have a hand in kickstarting a woman's natural fertility levels, beyond the treatment cycle.


Both ideas make a sort of intuitive sense. I and my staff at Houston Fertility Center would love to be able to tell patients that spontaneous conception is something they can look forward down the road, should they want to have another baby. But even the French study's authors, after surveying more than 2,000 couples, call for conservative reason with their conclusion that “it should be remembered that the BSP [spontaneous pregnancy] rates are cumulative rates observed over a long period of time and that these couples have a very low monthly probability of conceiving.”

~ Dr. Sonja Kristiansen MD

Image: FreeDigitalPhotos.net