The Memorial Day weekend brings to mind time off from work and fun in the sun. It's also a time to remember those who sacrificed so we could enjoy that freedom. If infertility's a part of your life, it might be tough to conjure up this feeling of freedom -- but if you look closer, you'll see it.
Did you know that in some countries, egg and sperm donors are required to reveal their identity throughout the process? Since anonymity is what many prefer, the result of such laws is far fewer donors and fertility patients who must travel internationally just to get pregnant.
Even tighter restrictions exist in other nations where donor eggs are simply not allowed to be used for fertility treatment. Just imagine -- the only options available for these women is adoption, unless they travel to access IVF.
Just as incredible: freezing excess embryos is of questionable legality in some places. Imagine being lucky enough to create many embryos in an IVF cycle, but the law requires you transfer them all, increasing your already upped chances for multiples to dangerous proportions.
The United States continues to demonstrate leadership in the championing of individual rights, and this includes the health care arena. Fertility treatment is a highly personal choice and, so far, it's still very much up to the patient and her physician to decide which treatments to use and when. You can find out about the services we're free to offer at Houston Fertility Center's website, http://CallDrK.com.
Have a great weekend, knowing you're free to choose fertility treatment and make other decisions that are right for your life.
~Sonja Kristiansen, M.D.
Friday, May 27, 2011
Monday, May 16, 2011
15 Is Magic Number?
Last February, I wrote that there's no magic to getting pregnant. That post was specific to "miraculous" fertility supplements. Well, now the news is full of "magic" again. This time, it's a Magic Number.
It's 15.
What kind of magic does the number 15 do for infertile couples?
A study that looked at 17 years worth of data concluded that 15 eggs retrieved in one IVF cycle renders the best chance of a live birth. Retrieving more eggs than that was linked to higher incidence of ovarian hyperstimulation syndrome.
The study authors failed to clarify that they were looking at conventional IVF cycles, not at cycles using very minimal or no ovulation stimulation medication. They did, however, tease out and present their findings related to the different ages within the study subjects. Specifically, the number 15 (eggs) did not make the live birth chances for women over 40 much better than otherwise. But as this article in the Globe and Mail suggests, a chance of live birth boosted by 4 percent might be inspiring to fertility patients older than 40.
I would remind patients that this is statistics, although well done. I worry about patients hearing these sorts of numbers and feeling stressed because theirs haven't "hit". As with so many aspects to treating infertility, your mileage may vary. We do everything possible to make each cycle safe *and* effective, and always, the outcome -- a healthy baby -- is our focus.
It's 15.
What kind of magic does the number 15 do for infertile couples?
A study that looked at 17 years worth of data concluded that 15 eggs retrieved in one IVF cycle renders the best chance of a live birth. Retrieving more eggs than that was linked to higher incidence of ovarian hyperstimulation syndrome.
The study authors failed to clarify that they were looking at conventional IVF cycles, not at cycles using very minimal or no ovulation stimulation medication. They did, however, tease out and present their findings related to the different ages within the study subjects. Specifically, the number 15 (eggs) did not make the live birth chances for women over 40 much better than otherwise. But as this article in the Globe and Mail suggests, a chance of live birth boosted by 4 percent might be inspiring to fertility patients older than 40.
I would remind patients that this is statistics, although well done. I worry about patients hearing these sorts of numbers and feeling stressed because theirs haven't "hit". As with so many aspects to treating infertility, your mileage may vary. We do everything possible to make each cycle safe *and* effective, and always, the outcome -- a healthy baby -- is our focus.
Thursday, April 21, 2011
Tis the Season For Donor Eggs: Fresh or Frozen Work
In our minds, the concepts of fertility and eggs go hand-in-hand -- especially this time of year. Now, there's some very good news for those who want to either preserve their fertility for the future or otherwise have a Plan B in the freezer for subsequent treatment cycles.
Research performed in the nation of Cyprus has concluded that frozen donor eggs are just as likely as fresh to have a pregnant outcome.
Freezing sperm for later use is almost fool-proof, it's been done for so many years. Likewise, freezing embryos has become a far smoother process that ends in success more often than not. Freezing eggs, on the other hand, has been a challenge.
I've spoken often about the use of egg cryopreservation technology -- the tricky nature of the egg cell that makes the freeze-thaw processes so tenuous, and the hope that comes with improvements on the technique. In 2008, I was interviewed by Houston Business Journal about the intersection of related advanced reproductive technology and society. The ASRM has long been pleased to hear of frozen eggs being used for women prior to cancer treatment, but they've been slow to agree on the technique's use for women who aren't preserving fertility in the face of life-threatening illness.
Now, a new subset of patients are given hope by frozen eggs -- women who must use a donor's eggs to conceive a child.
Arriving at "Honey, I think we need to use donor egg to get pregnant" comes only after some serious thought about very tough topics. Women who've gone through menopause prematurely in life -- a huge psychological burden itself -- and older women who've deferred pregnancy find themselves giving thought to what most people don't have to: "I can either have a child who isn't genetically related to me, or not at all."
Using donor egg to get pregnant also adds to the financial burden of these patients, since they are required to meet the donor's compensation needs.
Among other benefits, documentation of frozen donor egg success increases the possibility of egg banks, similar to long-standing sperm banks, which might then make the entire process cost less. More directly for patients, knowing that subsequent cycles using their donor's frozen eggs can be just as likely to help them get pregnant as that first fresh cycle -- that's a huge load of stress taken from the patients' shoulders.
Any bit of hope we can offer to donor egg recipients is a good thing in my book. The news that frozen donor eggs can be just as successful in rendering a pregnancy is very good.
Research performed in the nation of Cyprus has concluded that frozen donor eggs are just as likely as fresh to have a pregnant outcome.
Freezing sperm for later use is almost fool-proof, it's been done for so many years. Likewise, freezing embryos has become a far smoother process that ends in success more often than not. Freezing eggs, on the other hand, has been a challenge.
I've spoken often about the use of egg cryopreservation technology -- the tricky nature of the egg cell that makes the freeze-thaw processes so tenuous, and the hope that comes with improvements on the technique. In 2008, I was interviewed by Houston Business Journal about the intersection of related advanced reproductive technology and society. The ASRM has long been pleased to hear of frozen eggs being used for women prior to cancer treatment, but they've been slow to agree on the technique's use for women who aren't preserving fertility in the face of life-threatening illness.
Now, a new subset of patients are given hope by frozen eggs -- women who must use a donor's eggs to conceive a child.
Arriving at "Honey, I think we need to use donor egg to get pregnant" comes only after some serious thought about very tough topics. Women who've gone through menopause prematurely in life -- a huge psychological burden itself -- and older women who've deferred pregnancy find themselves giving thought to what most people don't have to: "I can either have a child who isn't genetically related to me, or not at all."
Using donor egg to get pregnant also adds to the financial burden of these patients, since they are required to meet the donor's compensation needs.
Among other benefits, documentation of frozen donor egg success increases the possibility of egg banks, similar to long-standing sperm banks, which might then make the entire process cost less. More directly for patients, knowing that subsequent cycles using their donor's frozen eggs can be just as likely to help them get pregnant as that first fresh cycle -- that's a huge load of stress taken from the patients' shoulders.
Any bit of hope we can offer to donor egg recipients is a good thing in my book. The news that frozen donor eggs can be just as successful in rendering a pregnancy is very good.
Friday, March 25, 2011
Personal Desires Still Strong During World Crises. And That's Okay.
As I write this blogpost, I recognize that there are many people in the world trying to survive dire circumstances. And I suspect that many readers who are infertility patients might be experiencing twinges of related discomfort.
For example, the other day I read a Facebook post from someone expressing a sense of guilt over how good her life is compared to people in places like Japan and Libya. She revealed her true feelings: that she was having a hard time enjoying the excitement of an upcoming, hard-earned trip to Disney with her family, because she was so acutely aware of the world's distress.
As you might imagine, her friends responded with comments supportive of her desire to be happy. As one posted, "Nobody in Japan wants you to be unhappy!"
With infertility, the pain you feel is most often hidden from the world. You don't want to be the one who brings sadness into a baby shower. You'd rather friends not see the hurt on your face while they chat about their little one's latest antics. The very fact that you keep grief a secret can compound your sense of isolation, which makes a little pain feel overwhelming.
On the other hand, just as we realize how much worse things can be for others -- as in the case of so much recent news from abroad -- you don't begrudge your friends' pleasure at being new parents.
The bottom line is that we are all human, and we all have drives, the strongest of which is to have a baby. We cannot all feel direct empathy for everyone, but we can strive to understand and be sensitive toward each other. In truth, we really do want everyone else to be safe, happy, and have their hearts' desires.
As many of you are, I am praying for people around the world, for peace and restoration in their lives and communities. I also continue on my personal path toward making life better for myself and for those directly around me, including my patients, because that's where it all begins.
For example, the other day I read a Facebook post from someone expressing a sense of guilt over how good her life is compared to people in places like Japan and Libya. She revealed her true feelings: that she was having a hard time enjoying the excitement of an upcoming, hard-earned trip to Disney with her family, because she was so acutely aware of the world's distress.
As you might imagine, her friends responded with comments supportive of her desire to be happy. As one posted, "Nobody in Japan wants you to be unhappy!"
With infertility, the pain you feel is most often hidden from the world. You don't want to be the one who brings sadness into a baby shower. You'd rather friends not see the hurt on your face while they chat about their little one's latest antics. The very fact that you keep grief a secret can compound your sense of isolation, which makes a little pain feel overwhelming.
On the other hand, just as we realize how much worse things can be for others -- as in the case of so much recent news from abroad -- you don't begrudge your friends' pleasure at being new parents.
The bottom line is that we are all human, and we all have drives, the strongest of which is to have a baby. We cannot all feel direct empathy for everyone, but we can strive to understand and be sensitive toward each other. In truth, we really do want everyone else to be safe, happy, and have their hearts' desires.
As many of you are, I am praying for people around the world, for peace and restoration in their lives and communities. I also continue on my personal path toward making life better for myself and for those directly around me, including my patients, because that's where it all begins.
Friday, March 11, 2011
How Many IVF's Is Enough?
Yesterday I wrote about the importance of perseverance in fertility treatment. And in light of research that says "more IVF attempts equals greater chances of success" plus my concurring with Dr. Rosen's comment that likelihood of success per cycle decreases... here's my explanation of what sounds like conflicting stances:
There are so many facets that add up to IVF success or failure, we potentially learn something each time we use this technique for a patient. I use every tool I have -- the latest research findings, my years of experience in treating infertility, state-of-the-art equipment, highly skilled staff -- and still must approach each patient as a unique situation. Every body is different.
So any treatment cycle is an opportunity for us to find out more about how this body responds to various components of the IVF journey. When subsequent treatments are required, I take what we've learned, adjust the plan accordingly, and continue to observe the results carefully. Try again.
Decreasing success per cycle may not be related to the failure of the IVF technique itself, but to an organic sort of patient-screening dynamic.
For example, a patient chooses to undergo IVF. Her diagnostic workup reveals a potential reason for her infertility thus far, and we believe IVF can help resolve this issue. Her first IVF attempt does not result in a pregnancy, yet through that experience we learn something else about this patient's fertility factors. We decide on parts of the IVF process to change -- we may tweak the medication protocol, or use some additional technique or tool -- and we all try again. If we continue in this manner, the IVF process may wind up revealing even more causes of this patient's infertility with each treatment cycle. In most cases, after paying careful attention to a patient's IVF responses and adjusting the next cycle accordingly, success -- a healthy pregnancy -- is the outcome. For some, the result is coming to terms with the need to move forward, either with a different treatment technique or to adoption or to living child-free.
So in some situations, each procedure adjustment we make whittles away at the possible infertility causes until finally, we determine that IVF either is or is indeed not the answer for this patient. But there may have been no way to determine that fact if IVF had not been tried.
Of course, passing time is one of the biggest factors for decreasing success rates per cycle. Especially for women who are already in their 30's when they start fertility treatment, the natural biology of the female results in fewer chances for pregnancy as her body ages.
To some extent, medical treatment -- not just for infertility, but other conditions as well -- involves taking risks. My fellow practitioners and I always first balance the risk of harm to a patient versus the potential success of treatment. Each patient is different, not only in their body's responses to treatment, but in attitude and ability to move forward. Some are naturally more at ease taking risks, while others are more comfortable risking little. Helping patients make those choices is part of my job.
~ Sonja Kristiansen M.D.
There are so many facets that add up to IVF success or failure, we potentially learn something each time we use this technique for a patient. I use every tool I have -- the latest research findings, my years of experience in treating infertility, state-of-the-art equipment, highly skilled staff -- and still must approach each patient as a unique situation. Every body is different.
So any treatment cycle is an opportunity for us to find out more about how this body responds to various components of the IVF journey. When subsequent treatments are required, I take what we've learned, adjust the plan accordingly, and continue to observe the results carefully. Try again.
Decreasing success per cycle may not be related to the failure of the IVF technique itself, but to an organic sort of patient-screening dynamic.
For example, a patient chooses to undergo IVF. Her diagnostic workup reveals a potential reason for her infertility thus far, and we believe IVF can help resolve this issue. Her first IVF attempt does not result in a pregnancy, yet through that experience we learn something else about this patient's fertility factors. We decide on parts of the IVF process to change -- we may tweak the medication protocol, or use some additional technique or tool -- and we all try again. If we continue in this manner, the IVF process may wind up revealing even more causes of this patient's infertility with each treatment cycle. In most cases, after paying careful attention to a patient's IVF responses and adjusting the next cycle accordingly, success -- a healthy pregnancy -- is the outcome. For some, the result is coming to terms with the need to move forward, either with a different treatment technique or to adoption or to living child-free.
So in some situations, each procedure adjustment we make whittles away at the possible infertility causes until finally, we determine that IVF either is or is indeed not the answer for this patient. But there may have been no way to determine that fact if IVF had not been tried.
Of course, passing time is one of the biggest factors for decreasing success rates per cycle. Especially for women who are already in their 30's when they start fertility treatment, the natural biology of the female results in fewer chances for pregnancy as her body ages.
To some extent, medical treatment -- not just for infertility, but other conditions as well -- involves taking risks. My fellow practitioners and I always first balance the risk of harm to a patient versus the potential success of treatment. Each patient is different, not only in their body's responses to treatment, but in attitude and ability to move forward. Some are naturally more at ease taking risks, while others are more comfortable risking little. Helping patients make those choices is part of my job.
~ Sonja Kristiansen M.D.
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
Monday, March 7, 2011
Infertility's Grief: Unwelcome, Yet Present
We typically think of grief as related to traumatic events in our lives, and mostly, in terms of death. It's not a word that anyone wants to apply to their present or future, and even thinking about grieving in the past is tough.
But grief is often a big part of infertility for most patients.
Even for patients who are quite pro-active and forward-thinking about treatment, where infertility is, so is loss. And with loss, necessarily comes grieving.
The first loss that comes hand-in-hand with infertility is the dream of how you thought getting pregnant and having a baby would be. That's a loss that virtually every infertility patient must grieve. From there, variations in grieving depend on many things, including how individuals cope with whatever life throws their way.
I've had patients come to me and say, "Dr. Kristiansen, I'm finding it hard to stay positive about our fertility treatment."
To make it through the losses and grief of infertility, the first important step to take is simply acknowledging they are there. Doing so -- looking loss and sadness matter-of-factly -- does not mean you're being pessimistic. Optimistic thinking based on unreality is not helpful for anyone. Optimism that starts from a solid foothold of understanding where you are is the kind of thinking that allows you to put one foot in front of the other toward resolution.
No need to wallow in it, but if you find yourself doing so, be forgiving. Seek help. It's here.
The staff of Houston Fertility Center can refer you to resources that can support you through your grief.
Here are a couple of related items online:
Writer Ryan Jacobson succinctly described the grief of infertility from a personal perspective in this article, "Infertility: I Wish Someone Would Have Told Me"
He also gives very direct advice to friends and loved ones of those struggling through infertility.
While "how-to's" can sometimes oversimplify complex emotional processes, they can also be helpful for breaking down tough stuff into do-able chunks. This is one filled with meaningful steps:
How to Grieve Infertility Losses
By FaithAllen on eHow
Wherever you are in your journey, I and my staff are prepared to meet you.
~Sonja Kristiansen
But grief is often a big part of infertility for most patients.
Even for patients who are quite pro-active and forward-thinking about treatment, where infertility is, so is loss. And with loss, necessarily comes grieving.
The first loss that comes hand-in-hand with infertility is the dream of how you thought getting pregnant and having a baby would be. That's a loss that virtually every infertility patient must grieve. From there, variations in grieving depend on many things, including how individuals cope with whatever life throws their way.
I've had patients come to me and say, "Dr. Kristiansen, I'm finding it hard to stay positive about our fertility treatment."
To make it through the losses and grief of infertility, the first important step to take is simply acknowledging they are there. Doing so -- looking loss and sadness matter-of-factly -- does not mean you're being pessimistic. Optimistic thinking based on unreality is not helpful for anyone. Optimism that starts from a solid foothold of understanding where you are is the kind of thinking that allows you to put one foot in front of the other toward resolution.
No need to wallow in it, but if you find yourself doing so, be forgiving. Seek help. It's here.
The staff of Houston Fertility Center can refer you to resources that can support you through your grief.
Here are a couple of related items online:
Writer Ryan Jacobson succinctly described the grief of infertility from a personal perspective in this article, "Infertility: I Wish Someone Would Have Told Me"
He also gives very direct advice to friends and loved ones of those struggling through infertility.
While "how-to's" can sometimes oversimplify complex emotional processes, they can also be helpful for breaking down tough stuff into do-able chunks. This is one filled with meaningful steps:
How to Grieve Infertility Losses
By FaithAllen on eHow
Wherever you are in your journey, I and my staff are prepared to meet you.
~Sonja Kristiansen
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