Why I'm Grateful For My Own Lab: Twins from Stolen Sperm

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.

Things You May Not Want to Hear When You're Trying to Get Pregnant: Stop Drinking Alcohol

"Anything but THAT, Dr. Kristiansen!" I've heard those very words uttered by patients in my office at Houston Fertility Center a few times. There a number of recommendations I might make for optimizing attempts at getting pregnant -- some of those requests are not welcomed by patients!

Here's one: Stop drinking alcohol.

Now, that's a pretty stringent version of what I actually recommend. That blogpost, "TTC with IVF? Skip the Alcohol Tonight" was published on New Year's Eve 2009. Nothing about the information in the links therein has changed: subsequent research bears out the conclusion that alcohol doesn't do you a bit of good if you're using IVF to conceive. In fact -- and there are plenty of theories but no certain, understandable reason yet -- drinking alcohol might be the thing that tips the conception scales against you.

Most recently, clinical researchers published in Obstetrics & Gynecology, the American College of Obstetricians and Gynecologists' journal, that enjoying as few as 4 drinks per week reduces your chances of IVF success. Interestingly, that holds true for couples as well as women who were surveyed prior to going through their first IVF cycle.

As I said, some Houston Fertility Center patients bristle when I suggest they stop drinking alcohol while trying to conceive. I'm sure the same is true in other fertility specialists' offices. But taking charge of your reproductive health means holding yourself accountable -- a little firm but positive self-talk might be in order. If it feels easier to ponder cutting back instead of quitting altogether, try that instead and use the less-than-four-drinks per week as a gauge. Or tell yourself that you're training for parenthood, a time when the idea of drinking more might seem appealing but is really at cross purposes with your goals -- just like during an IVF cycle.

In the end, you'll want to look back on your trying times and be able to say you did everything you could to have that baby.

~ Dr. Sonja Kristiansen M.D.

IVF Myths: You'll Never Be Able to Afford It

My take on another IVF myth, written about by Dr. Kathy D. in a blogpost on Pure Natural Mom:

Myth #3. "IVF is expensive and not covered by insurance"

Money is of tremendous concern to everyone today. One of the first questions I'm asked in a patient's initial consultation is, "Dr. Kristiansen, how much will this cost?"

IVF can certainly be one of the costliest services most people will ever pay for, but when you look at where your household spends its money -- often without much second-guessing -- you can start seeing the expense of fertility treatment as one of the greatest investments of your whole life.

And the truth is that not only will many insurance plans cover some, if not all, parts of the IVF process, many employees have better coverage than they think. There are two different decision-makers in the insurance benefits arena: the insurance company itself and the employer who chooses from among available plans for their workers. Besides contacting the insurance company to inquire about your coverage specifics, talk to the staff responsible for managing your employer's insurance plans. I have specialized staff at Houston Fertility Center who can help you work with whatever insurance plan your employer has chosen.

When you consider how much you'll pay for a car, real estate, travel -- none of which can be compared to getting pregnant and having a baby -- the typical price of a single IVF cycle doesn't seem quite as significant. Some clinics like Houston Fertility Center are able to offer price variations throughout the year. For example, right now, we're offering IVF cycles for $9,250, a considerable discount off our usual rate, through November 30th, 2011. As a way of thanking public servants, I also offer discounted services to teachers, police officers, and fire fighters during different times of the year (like summers, so teachers can benefit during their vacation season.)

The important thing -- which Dr. Kathy D. alludes to in her blogpost -- is to not stop short of getting all the facts. You wouldn't base all of your hopes and dreams for your home and lifestyle on a few personal stories heard on the Internet. Find out for yourself if IVF is out of reach. And if it is, we'll help you find options to make it affordable.

~ Dr. Sonja Kristiansen M.D.

Get Your OB On Board: Regular Menstruation Does NOT Equal Fertility

"Getting your period" is a big event for girls. And many a parent or counselor has tried to console young women's related worries by offering comments that equate menstruation with motherhood. It's understandable that so many of my patients at Houston Fertility Center grew up with the message that if you're menstruating, you can get pregnant.

Your OB/Gyn may even tell you something similar. After all, it's basically true for the average woman with average fertility. But if you're one of the many women who has regular menstrual periods but can't seem to get pregnant, you might be feeling dismissed by your primary care doctor's casually hopeful remarks.

Once you have reason to understand more than the average woman about menstruation, you'll find that the connection between periods and fertility is a bit more complicated. Your OB/Gyn might do a great job of providing you with that in-depth education about the reproductive details of menstruation -- but you'll probably first have to request more explanation. And never hesitate to ask! You definitely won't be the first patient in my office to say with great frustration, "But, Dr. Kristiansen, I have a period every month!"

Your body's menstrual and ovulatory cycles are absolutely linked, but they are also separate. Both cycles are the result of communication between several organs and glands which emit different levels of various hormones, producing a cascade effect that's supposed to be ongoing. There are so many different points along the path where something can go wrong. A small, seemingly insignificant glitch in one spot -- whether it's a gland that produces too much or too little of a hormone, or an organ that isn't responding to its cues -- winds up disrupting the whole fertility process.

Simply put, and as many Houston Fertility Center patients will attest, women can have regular periods and still be infertile, for many reasons -- some structural (as in blocked fallopian tubes), some hormonal (sometimes resulting in anovulatory bleeding, in which no eggs are being released).

It's pretty complicated. And if your OB/Gyn is more OB than Gyn (they're really not all the same!), then their focus in both training and, more importantly, experience may be on helping women manage their pregnancies and deliver their babies -- not on the many things that can go wrong when you're trying to get pregnant.

So if you've heard "If you're having a period, you have nothing to worry about" from your doctor, he or she may not be putting you off or ignoring your worries. It might just not be their area of expertise.

This is the 3rd post in a series called Is Your OB On Board With Baby-Making?
Also see: Get Your OB On Board: Time Is (Almost) Everything

~ Dr. Sonja Kristiansen M.D.

Fertility Treatment & Wellness Go Hand in Hand

A recent article on Fertility Authority reminds fertility patients to get their flu shots (and be sure you get the shot, not the nasal spray!) The article reminded me about all the preventive health measures that might get back-burnered by patients.

Many new patients at Houston Fertility Center enter fertility treatment territory in great physical shape and feeling emotionally hopeful. Some arrive at their first consultation already dragged out, physically and mentally, by their months or even years of trying to conceive. Naturally, their first question is, "Dr. Kristiansen, what can we do to finally get pregnant?" My first recommendation for all of them is to optimize their fertility at baseline by getting or staying healthy, whatever that means for them.

Once you enter fertility treatment, you could find your calendar newly crowded by the required exams and office consults, by scheduled at-home injections and tests, even by scheduled intimate time with your partner. It's easy to lose track of all the good things you've learned to make a regular part of your day-to-day experience to keep yourself feeling fit and well.

Fertility treatment and preventive health measures are different yet interactive. Many facets of your fertility in general can change, for better or worse, as your overall health changes. So you could say your efforts at maintaining wellness -- balanced, healthy diet, moderate and regular exercise, relaxation activities, managing exposure to toxins -- are even more important during this point in your life.

So do remember your flu shot and all the other good things you do to stay healthy. And if you haven't yet instituted preventive health activities into your life, now's the time. It's an investment not only in your wellness, but your fertility, too.

~ Dr. Sonja Kristiansen M.D.

IVF Myths: You'll Wind Up With a Football Team

More debunking of myths about IVF, referring to a recent blogpost I found by Dr. Kathy D.


Myth #2. “IVF produces twins, triplets and more”


Bearing in mind that this is a quick blogpost and not a full-on journal article on the subject, Dr. Kathy D. is right about the age of a woman's eggs. But I want to interject that there are many more facets to consider when trying to institute how many embryos should be transferred in an IVF cycle. So in fact, the decision to use single embryo transfer (or SET) is not as clear cut as it sounds.

Age of the hopeful mother is a huge factor, as is her overall health. Possibly the even greater factor we take into account is the grade of the embryo.

Embryos are graded by observing several parameters. For a detailed but patient-friendly description of the embryo grading process, check out this Healthline article.

At this week's annual gathering of the American Society for Reproductive Medicine, the question of how many embryos to transfer was addressed again. It is, indeed, still an unanswered question -- but we're getting closer!

One poster presentation, titled simply "Optimum Number of Embryos to Transfer on Day 3 to Achieve High Pregnancy Rates and Low Multiples Rates Based on Patient Age and Embryo Quality," looked at 717 ART cycles at one IVF center with Day 3 (post-fertilization) transfers and their outcomes. Their conclusions:

Patients < 35 yrs; transfer of 1 Top quality embryo is recommended. Addition of a second embryo for transfer increases twin rate without significantly increasing pregnancy rate. Patients 35-37 yrs; transfer of 2 embryos is recommended to achieve desired pregnancy rate, however, risk of multiples needs to be addressed particularly if Top quality embryos are transferred. (L. Hill, S. LaBrie, P. St. Marie, K. Lynch, E. Tougias, M. Arny Baystate Reproductive Medicine, Baystate Health, Springfield, MA)

Researchers are continually trying to determine the best culture medium, the best time period, the best tools for helping fertilized eggs grow into the healthiest possible embryos, but there are many things out of even the best embryologist's control. Still, conscientious fertility specialists, like the staff of Houston Fertility Center, stay on top of the latest findings and apply them in their labs and clinics.

Whether your specialist is in Houston or New York or any other location, we're all interested in how to make pregnancy a reality for our patients. So success -- a healthy singleton baby -- becomes more quickly achievable all the time.

IVF Myths: It's "Last-Ditch" Fertility Treatment

When it comes to fertility treatment, IVF (in vitro fertilization) is indeed the most costly and invasive technique available. But it's also very successful -- in many cases, the only thing that works -- for helping men and women who might otherwise not have a chance at having biologically related children.

I recently ran across this blogpost that nicely sums up a few of the myths about IVF. The author, a physiologist and reproductive endocrinology researcher, also has personal experience with using IVF to build her family.

I'm going to write my own responses to Dr. Kathy D's debunking of the myths she calls "most common" through the next few posts.

Myth #1. IVF is a last-ditch effort to become pregnant

She's correct in her responses to this myth! But I'll add that for many patients, IVF is definitely "a last-ditch effort."

For some infertile patients, like those described by Dr. Kathy D., IVF is the only way conception is going to happen. In those cases, heading straight for IVF first is sensible. But for most fertility patients, making the choice to use IVF instead of, say, intrauterine insemination (IUI) is definitely a step that feels like the "final straw" in a series of attempts. In fact, this patient page on "Preparing for IVF: Emotional Considerations" puts it succinctly, saying that for most people, IVF is "the last, best option for having a child."

No experienced, qualified fertility specialist will tell you that IVF (or any other treatment) will definitely result in pregnancy. But it is true that IVF, in particular, helps us get around the greatest number of obstacles and barriers of the most severe nature. So it's no wonder everyone thinks of it as "last-ditch"!

When to recommend IVF for a fertility patient is part of the art (and I don't mean Assisted Reproductive Technology here) of medicine. Some of my colleagues will recommend IVF a little too soon in a patient's fertility treatment journey, while others might wait until it's only going to work with a third-party involved (most often, an egg donor). It takes years of experience on top of specialized training, plus an excellent laboratory team (like the staff I'm grateful to have with me at Houston Fertility Center) to know when a patient's family-building needs will be best served by IVF versus other techniques.

So this myth is actually reality for some patients. And while your attitude and feelings toward whatever medical treatment you choose is important, and timing is a crucial factor in fertility treatment success, in the end, whether it's "last-ditch" or not -- IVF works.