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.
Monday, February 2, 2009
Wednesday, January 28, 2009
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.
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.
Friday, January 9, 2009
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
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This presentation is made possible in part by Fertile Hope and Organon, a part of Schering-Plough Corporation.
Monday, December 15, 2008
The Embryo Dilemma
Recent news reports brought up again the ongoing questions surrounding embryo creation via IVF. Actually, the questions aren't so much about the creation side of things as they are about disposition of extra embryos.
As reproductive medicine specialists, we have focused mostly on the best ways to help individuals and couples conceive biological children. Success is very often a matter of numbers: the more eggs a woman ovulates, the more sperm a man has available, the more embryos created... the greater their chances at getting pregnant.
For years now, we specialists have been boiling down the science and finely tuning the techniques toward the ultimate goal: how best to unite only as many eggs and sperm necessary to create only as many embryos needed to make one healthy baby.
Single embryo transfer is a true possibility for some patients, but almost a pointless, expensive protocol for others.
At this point, it remains common for IVF patients to wind up with at least some "extra" embryos -- that is, too many embryos to transfer within the same treatment cycle -- so the question of what to do with the surplus continues to be answered.
In the study recently published in Fertility & Sterility, more than 1,000 infertility patients were surveyed about the choices they've pondered and made to address their own embryo surpluses.
Among other things, the survey results reveal a broad consensus of disappointment -- with the options offered at various clinics and with the level of pre-IVF information made available to them.
Fertility treatment centers are like any medical practice: filled with professionals who are people first. Different practices have varying policies based on many factors, including the personal beliefs of the professionals. Another component that steers clinic policies is the availability of resources.
Patients and professionals need not have all their beliefs in common, but there are sometimes "bottom lines" that patients use to make their choices about which fertility practice to turn to for assistance with getting pregnant and about which treatments to use. In the past, some practices were so results-driven, so focused on success rates, that even crucial issues like the disposition of surplus embryos were side-stepped or, at least, addressed with as much brevity as possible. The dilemma of extra embryos is very real and can no longer be seen as ancillary.
I'll discuss specific related options for patients of Houston Infertility Clinic in a follow-up blogpost.
As reproductive medicine specialists, we have focused mostly on the best ways to help individuals and couples conceive biological children. Success is very often a matter of numbers: the more eggs a woman ovulates, the more sperm a man has available, the more embryos created... the greater their chances at getting pregnant.
For years now, we specialists have been boiling down the science and finely tuning the techniques toward the ultimate goal: how best to unite only as many eggs and sperm necessary to create only as many embryos needed to make one healthy baby.
Single embryo transfer is a true possibility for some patients, but almost a pointless, expensive protocol for others.
At this point, it remains common for IVF patients to wind up with at least some "extra" embryos -- that is, too many embryos to transfer within the same treatment cycle -- so the question of what to do with the surplus continues to be answered.
In the study recently published in Fertility & Sterility, more than 1,000 infertility patients were surveyed about the choices they've pondered and made to address their own embryo surpluses.
Among other things, the survey results reveal a broad consensus of disappointment -- with the options offered at various clinics and with the level of pre-IVF information made available to them.
Fertility treatment centers are like any medical practice: filled with professionals who are people first. Different practices have varying policies based on many factors, including the personal beliefs of the professionals. Another component that steers clinic policies is the availability of resources.
Patients and professionals need not have all their beliefs in common, but there are sometimes "bottom lines" that patients use to make their choices about which fertility practice to turn to for assistance with getting pregnant and about which treatments to use. In the past, some practices were so results-driven, so focused on success rates, that even crucial issues like the disposition of surplus embryos were side-stepped or, at least, addressed with as much brevity as possible. The dilemma of extra embryos is very real and can no longer be seen as ancillary.
I'll discuss specific related options for patients of Houston Infertility Clinic in a follow-up blogpost.
Thursday, November 27, 2008
Finding Gratitude
With understanding of your struggles to achieve one of life's simplest joys, my Thanksgiving wish for all of you is to find treasure in the smallest things. Some of my staff and I will be hopefully helping a few patients do just that as we transfer some embryos to hopeful mothers on Thanksgiving morning.
I am grateful for the opportunities to play a role in the creation of families.
I am grateful for the opportunities to play a role in the creation of families.
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.
Wednesday, November 5, 2008
Write About Your Experience: Infertility Haiku Contest
The new business called My Fertility Plan has started something unique - a poetry contest about infertility.
They're inviting everyone to submit haiku poetry until November 24, 2008. Entries will be judged by a panel of people in the infertility treatment business and some who blog about it. Your haiku can fall into either a serious or humorous category, but must be in the proper format, syllable-length-wise. For details, see their related webpage.
My Fertility Plan Blog: Your Conception Action Plan
They're inviting everyone to submit haiku poetry until November 24, 2008. Entries will be judged by a panel of people in the infertility treatment business and some who blog about it. Your haiku can fall into either a serious or humorous category, but must be in the proper format, syllable-length-wise. For details, see their related webpage.
My Fertility Plan Blog: Your Conception Action Plan
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