In the United States, we're relieved to be free of a strong government hand in private affairs like choosing to use reproductive medicine. Occasionally, though, my inbox is filled with rather frantic "Did you see this, Dr. Kristiansen?!" emails bearing news stories that remind us of why some regulations are necessary.
One such story -- about accusations of stolen sperm and unwanted fatherhood -- is coming out of Houston right now.
A young man is taking a Houston area fertility center to court, saying they never actually had his consent to use his semen for IVF that eventually impregnated a former girlfriend. This news video on Click2Houston.com has interviews of both the man -- now the father of twins -- and a representative of the fertility center.
Stories like this are fortunately rare, but they still play on the fears of fertility patients. It's understandable -- not all fertility specialists use their own labs. In fact, Houston Fertility Center's own in-house, state-of-the-art laboratory has provided embryology and related services for physicians from other clinics for years. Being able to rely on my own lab provides me and my staff with an extra layer of confidence in the fertility services we provide to patients.
While things in general are far more easy-going in the U.S. than in other countries, reputable fertility centers honor both the requirements and recommendations of existing regulatory bodies. This young man's experience clearly demonstrates one reason -- no one should be cornered into parenthood.
Rules about patient consent and the use of tissue (which includes sperm and eggs) can add a layer of cumbersome bureacracy to the IVF process. Now and then, a patient will complain, "But Dr. Kristiansen, some of these requirements seem over the top and unnecessary!" My response? I am grateful to have my own laboratory serving Houston Fertility Center, and for staff who are vigilant in maintaining compliance with regulations for the benefit and well-being of everyone involved.
Showing posts with label reproductive medicine. Show all posts
Showing posts with label reproductive medicine. Show all posts
Wednesday, November 30, 2011
Monday, September 19, 2011
Building a Family In Tough Times
The country's economy is struggling so much that women are quite possibly having fewer children as a result. A report published last month by the Centers for Disease Control likens the trend to the Great Depression's fertility rates.
My patients feel the pain. If getting pregnant the old fashioned way is harder now, imagine what it's like to need special fertility treatment in order to have a baby.
In that light, I'm currently offering a big discount on IVF: $7995 through November 30th.
Because Houston Fertility Center has its own state-of-the-art laboratory, I'm able to provide the highest quality reproductive medicine services at more affordable prices. And since this is the time of year when people living in the Houston area are caught between high electric bills (for air conditioning!) and impending holiday season expenses -- it seems like the best time of year to make family-building a reality for so many.
Hang in there!
~Dr. Sonja Kristiansen MD
My patients feel the pain. If getting pregnant the old fashioned way is harder now, imagine what it's like to need special fertility treatment in order to have a baby.
In that light, I'm currently offering a big discount on IVF: $7995 through November 30th.
Because Houston Fertility Center has its own state-of-the-art laboratory, I'm able to provide the highest quality reproductive medicine services at more affordable prices. And since this is the time of year when people living in the Houston area are caught between high electric bills (for air conditioning!) and impending holiday season expenses -- it seems like the best time of year to make family-building a reality for so many.
Hang in there!
~Dr. Sonja Kristiansen MD
Monday, July 11, 2011
How Do Fertility Patients Feel About Donor Anonymity?
I work in a medical field that is ripe with controversy at times. There's nothing casual about helping people try to create life. But I try to avoid bringing a sense of alarm to my patients, even when the news headlines are worrisome. I do think there's a place for staying updated, though, when the news is about laws that may find their way into how I practice reproductive endocrinology and how my patients' treatments will be impacted.
The most recent such item is a state law that's about to bump up against the way things are often done for patients who need third-party reproductive treatment. Later this month, the state of Washington will enact a law that chips away at the anonymity of egg and sperm donors.
Now, most fertility specialists and their patients have been sharing medical history from their egg and sperm donors. It makes good common sense in light of what we know about genetic transmission of many things. If you have a baby using an anonymous donor's sperm or eggs, you likely at least want to know if there are potential medical conditions that may show up in your child. But the sharing of identifying information about donors has long been handled case-by-case, depending on the needs and comfort level of the donors and the fertility patients.
The Washington state law requires that anyone who donates eggs or sperm must provide both medical history and identifying information. Also, children born from third-party reproductive techniques will now be allowed to obtain the donor's information from the fertility clinic once the child becomes 18 years old. However, donors can file a disclosure veto with the clinic that prevents the identifying info from being revealed to the offspring; only the medical history is mandated to be disclosed on request.
This is a first in the United States, but it's not a surprise. Adult donor offspring over the past few years have been gathering to make their needs known. In some countries, donor anonymity is already a thing of the past. America has been slow to legislate these unique and intimate relationships. Those of us impacted by such laws -- fertility specialists, patients, and their families -- will be watching with interest to see if Washington state encounters some of the challenges that have resulted in other nations, most notably a serious decline in the number of available sperm and egg donors. In the meantime, I will continue serving my patients' best interests by providing access to the highest quality fertility care available, including third-party reproductive technology.
~ Dr. Sonja Kristiansen MD
Here's what Huffington Post blogger Naomi Cahn had to say about the new law and its potential repercussions: The Biological Clock -- for Donor-Conceived Offspring?
The most recent such item is a state law that's about to bump up against the way things are often done for patients who need third-party reproductive treatment. Later this month, the state of Washington will enact a law that chips away at the anonymity of egg and sperm donors.
Now, most fertility specialists and their patients have been sharing medical history from their egg and sperm donors. It makes good common sense in light of what we know about genetic transmission of many things. If you have a baby using an anonymous donor's sperm or eggs, you likely at least want to know if there are potential medical conditions that may show up in your child. But the sharing of identifying information about donors has long been handled case-by-case, depending on the needs and comfort level of the donors and the fertility patients.
The Washington state law requires that anyone who donates eggs or sperm must provide both medical history and identifying information. Also, children born from third-party reproductive techniques will now be allowed to obtain the donor's information from the fertility clinic once the child becomes 18 years old. However, donors can file a disclosure veto with the clinic that prevents the identifying info from being revealed to the offspring; only the medical history is mandated to be disclosed on request.
This is a first in the United States, but it's not a surprise. Adult donor offspring over the past few years have been gathering to make their needs known. In some countries, donor anonymity is already a thing of the past. America has been slow to legislate these unique and intimate relationships. Those of us impacted by such laws -- fertility specialists, patients, and their families -- will be watching with interest to see if Washington state encounters some of the challenges that have resulted in other nations, most notably a serious decline in the number of available sperm and egg donors. In the meantime, I will continue serving my patients' best interests by providing access to the highest quality fertility care available, including third-party reproductive technology.
~ Dr. Sonja Kristiansen MD
Here's what Huffington Post blogger Naomi Cahn had to say about the new law and its potential repercussions: The Biological Clock -- for Donor-Conceived Offspring?
Thursday, March 10, 2011
Try, Try Again
"If at first you don't succeed, try, try again."
I can nearly hear your sighs. One of the hardest parts about infertility and its treatment is the need for perseverance. Many of my patients who are now parents will tell you that even more than peaceful patience, going through infertility treatment and keeping your sanity requires maintaining a heavy dose of "hang in there".
Recently, Australian researchers concluded that the likelihood of IVF success increases with each cycle. This is especially true for mothers-to-be who are older than 35, but even for younger women, going through an average of three IVF cycles boosts success rates up to 58 percent.
Granted, this makes common sense in a way -- the more you try something, the greater the odds you'll succeed eventually. But this isn't the first bit of research that hints at something more: the treatment learning curve and the artful practice of medicine.
of course, as Dr. Rosen points out at the end of the article in BioNews, the likelihood of success per cycle decreases, and eventually an end to treatment attempts may need to be considered for some patients. I'll discuss that seemingly paradoxical point in a future blogpost.
For now, I'll leave you to consider the reality that, yes, for many fertility patients who choose IVF, it takes more than one treatment cycle to get pregnant. As I mentioned in my last blogpost, coming to grips with treatment realities is a kind of loss. Perseverance is a good trait to muster. And when you run out of your own, borrow some from a loved one or friend. Keep trying.
More to come...
~ Sonja Kristiansen
I can nearly hear your sighs. One of the hardest parts about infertility and its treatment is the need for perseverance. Many of my patients who are now parents will tell you that even more than peaceful patience, going through infertility treatment and keeping your sanity requires maintaining a heavy dose of "hang in there".
Recently, Australian researchers concluded that the likelihood of IVF success increases with each cycle. This is especially true for mothers-to-be who are older than 35, but even for younger women, going through an average of three IVF cycles boosts success rates up to 58 percent.
Granted, this makes common sense in a way -- the more you try something, the greater the odds you'll succeed eventually. But this isn't the first bit of research that hints at something more: the treatment learning curve and the artful practice of medicine.
of course, as Dr. Rosen points out at the end of the article in BioNews, the likelihood of success per cycle decreases, and eventually an end to treatment attempts may need to be considered for some patients. I'll discuss that seemingly paradoxical point in a future blogpost.
For now, I'll leave you to consider the reality that, yes, for many fertility patients who choose IVF, it takes more than one treatment cycle to get pregnant. As I mentioned in my last blogpost, coming to grips with treatment realities is a kind of loss. Perseverance is a good trait to muster. And when you run out of your own, borrow some from a loved one or friend. Keep trying.
More to come...
~ Sonja Kristiansen
Tuesday, April 13, 2010
Summer in Texas Means Heat -- & Babies
I've noticed in my years of practicing reproductive medicine that given every other factor, there does seem to be a calendar-based trend to conception. So I'm happy to find out about studies that point to what we've seen in our practice here in sub-tropical Houston. It appears that summer is a great time to try and conceive with IVF.
In this study, published in Human Fertility (Vol 9, No 4, 2006), the researchers looking at more than 2,700 IVF/ICSI cycles saw "significant improvement in assisted conception outcomes performed" in summer months.
They're not exactly sure of what causes the boost but they propose it may be related to production of melatonin, a light-inhibited hormone that regulates sleeping and waking cycles.
This bit of information turns out to be in many patients' favor, since summer is the traditional season to take time off from work for vacation.
We've always encouraged our patients with seasonal jobs, like teaching, to take advantage of those stretches on the calendar when they're likely to be less stressed and busy on a daily basis. IVF treatment is carefully timed, so fitting it into a more relaxed schedule is beneficial -- lessened stress has also been linked to better fertility treatment outcomes.
Not only do I consult with patients to determine best times to schedule fertility treatment, I've started offering discounts timed specifically so they can take advantage of summer months.
In this study, published in Human Fertility (Vol 9, No 4, 2006), the researchers looking at more than 2,700 IVF/ICSI cycles saw "significant improvement in assisted conception outcomes performed" in summer months.
They're not exactly sure of what causes the boost but they propose it may be related to production of melatonin, a light-inhibited hormone that regulates sleeping and waking cycles.
This bit of information turns out to be in many patients' favor, since summer is the traditional season to take time off from work for vacation.
We've always encouraged our patients with seasonal jobs, like teaching, to take advantage of those stretches on the calendar when they're likely to be less stressed and busy on a daily basis. IVF treatment is carefully timed, so fitting it into a more relaxed schedule is beneficial -- lessened stress has also been linked to better fertility treatment outcomes.
Not only do I consult with patients to determine best times to schedule fertility treatment, I've started offering discounts timed specifically so they can take advantage of summer months.
Friday, January 29, 2010
Trying to Get Pregnant After 30 - Time to Panic?
Good Morning America featured a Scottish study that concluded by the time a woman is 30 years old, she's already lost 90 percent of her eggs.
That's enough to make the typical young woman panic.
We've always known that female fertility is more dependent on age than any other variable. This study points to a sharper decline in fertility than we like to believe.
Before everyone rushes to assisted reproductive treatment, though, let's remember that stress can negatively impact fertility.
Next, it's easy enough to have a consultation and do a quick work-up to determine your baseline level of fertility. That won't provide the definitive answer as to whether or not you will have a baby later, but it can certainly help a woman determine if she has an unexpected, silent infertility condition. Then, a plan of action can be put together to promote her future fertility.
Panic won't help you get pregnant. A little foresight and action can.
That's enough to make the typical young woman panic.
We've always known that female fertility is more dependent on age than any other variable. This study points to a sharper decline in fertility than we like to believe.
Before everyone rushes to assisted reproductive treatment, though, let's remember that stress can negatively impact fertility.
Next, it's easy enough to have a consultation and do a quick work-up to determine your baseline level of fertility. That won't provide the definitive answer as to whether or not you will have a baby later, but it can certainly help a woman determine if she has an unexpected, silent infertility condition. Then, a plan of action can be put together to promote her future fertility.
Panic won't help you get pregnant. A little foresight and action can.
Monday, February 2, 2009
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.
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.
Wednesday, November 26, 2008
Our Presentation at ASRM: More Pieces of the Pregnancy Puzzle
We were pleased to have our poster presentation accepted into this year's meeting of the American Society for Reproductive Medicine. The title -- Differential Relationship Between the Total Number of Oocytes Retrieved and the Implantation Rate in IVF and ICSI Patients -- may sound dry, but our results were positive news for patients who need IVF to have a baby.
The Houston Infertility Clinic staff, in conjunction with the Department of OB/Gyn at the University of Sydney in Australia, examined 351 IVF cycles. In each case, patients were using their own eggs and non-frozen embryos. We looked at:
the number of eggs retrieved
number of embryos transferred
results of clinical pregnancy tests
Next we compared those cycles that included ICSI and those that used "conventional" IVF for insemination. These two groups were then split up into three sub-groups, based on the number of eggs that were retrieved (either 1-10 eggs, 11-20 eggs, or 21-40 eggs.)
It might seem a simple question of statistical odds that the more eggs you produce, the better your chances, but...
Here's the good news: We concluded that, at least in our hands, patients using ICSI who were in the 11-20 egg group had the highest implantation rate. Patients using "conventional" IVF w/o ICSI had higher implantation rates when they were in the subgroup producing the most eggs (21-40 eggs).
It's important to note that quality of eggs -- rather than quantity -- is the more important measure. Patients shouldn't be discouraged if their bodies aren't producing a high number of eggs. As our study indicates, the use of ICSI seems to make a noticeable difference in outcome.
On a related note -- in some cases, women's ovaries will produce far fewer eggs than everyone hoped for in an IVF cycle. Different clinics have different policies; many are, frankly, guided by heavy concern about success rate statistics.
Our policy is that if a patient wants to move forward and retrieve the one follicle that her ovary brought forth, we will respect her wishes and do our best to render highest quality care toward the best possible outcome.
We want every patient to have a fighting chance at getting pregnant.
The Houston Infertility Clinic staff, in conjunction with the Department of OB/Gyn at the University of Sydney in Australia, examined 351 IVF cycles. In each case, patients were using their own eggs and non-frozen embryos. We looked at:
the number of eggs retrieved
number of embryos transferred
results of clinical pregnancy tests
Next we compared those cycles that included ICSI and those that used "conventional" IVF for insemination. These two groups were then split up into three sub-groups, based on the number of eggs that were retrieved (either 1-10 eggs, 11-20 eggs, or 21-40 eggs.)
It might seem a simple question of statistical odds that the more eggs you produce, the better your chances, but...
Here's the good news: We concluded that, at least in our hands, patients using ICSI who were in the 11-20 egg group had the highest implantation rate. Patients using "conventional" IVF w/o ICSI had higher implantation rates when they were in the subgroup producing the most eggs (21-40 eggs).
It's important to note that quality of eggs -- rather than quantity -- is the more important measure. Patients shouldn't be discouraged if their bodies aren't producing a high number of eggs. As our study indicates, the use of ICSI seems to make a noticeable difference in outcome.
On a related note -- in some cases, women's ovaries will produce far fewer eggs than everyone hoped for in an IVF cycle. Different clinics have different policies; many are, frankly, guided by heavy concern about success rate statistics.
Our policy is that if a patient wants to move forward and retrieve the one follicle that her ovary brought forth, we will respect her wishes and do our best to render highest quality care toward the best possible outcome.
We want every patient to have a fighting chance at getting pregnant.
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