One Woman's Egg Freezing Story & Hope for Brighter Futures

As discussed in October, the American Society for Reproductive Medicine no longer considers egg freezing experimental. The topic was big news, covered by everything from national to local media affiliates.

This interview show on NPR offered an opportunity to hear the patient's perspective of oocyte cryopreservation, as told by well-known New York Times blogger, Suleika Jaoaud. She's the young woman who shares her experience with leukemia in “Life, Interrupted”, including her need to confront the possibility of infertility after life-saving chemotherapy. In this interview, Suleika describes how she learned about the option of oocyte cryopreservation on her own, not from her oncology physicians, and what it was like to go through the egg freezing process just prior to her initial treatments.

Also speaking is Dr. Samantha Pfeifer, one of the physicians on the ASRM committee that made the decision which should result in more expedient coordination of treatment for such patients. I and my Houston Fertility Center staff look forward to continuing teamwork with physicians who are helping save lives, so that our patients can have the brightest futures possible.

~ Dr. Sonja Kristiansen M.D.

Image: FreeDigitalPhotos.net

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

Infertility All In Your Head?

I stumbled across this recently: a survey of 1,000 women in 10 countries found that nearly half of them believe they're infertile because of “God's will” and half also feel infertility is attributable to “bad luck”.

image: freedigitalphotos.net

The study covered the countries of China, India, Japan, South Korea, Thailand, Vietnam, Singapore, Hong Kong, Taiwan and Malaysia.

Hopefully my readers and Houston Fertility Center patients know by now that what is in your mind – whether it's stressful emotions or negative beliefs – is NOT the cause of your infertility. But the study highlights how self-defeating thoughts can certainly prevent you from taking the steps necessary to resolve your problems, including infertility.

Yes, your beliefs can get in the way of your getting pregnant, but only if you let misinformation prevent you from believing that the conditions causing infertility are physiological and treatable – not “only in your mind”.

~ Dr. Sonja Kristiansen M.D.

One Possible Answer for Recurrent Miscarriage

Being unable to get pregnant when you're ready to have a child is difficult enough. Conceiving and then losing a pregnancy adds to the emotional burden. Going through early miscarriage more than once deserves medical attention. This, too, is the realm of a reproductive endocrinologist.

In fact, some of my patients at Houston Fertility Center don't consider getting pregnant their primary problem. For them, the mystery is “Why can't I carry a pregnancy?”

There are several possibilities, but much of what we know about the causes of recurrent miscarriage (RM) remains theoretical. Patients struggling with RM might take some comfort in the fact that it is a research arena of great interest.

A recently published study may shed some light on yet another possible explanation. Researchers in The Netherlands looked at the human endometrial stromal cells (H-EnSCs) of women with RM and fertile women. Their findings support their theory that, for reasons not yet fully understood, “H-EnSCs of fertile women discriminate between high- and low-quality embryos whereas H-EnSCs of women with RM fail to do so.”

In other words, while women with RM seem to conceive more readily than women without RM (a concept called “super-receptivity”), the lining of their uterus is more often facilitating the implantation of non-viable embryos. These pregnancies are destined to end from the start.

While you might feel callously dismissed by some who offer condolences like “It just wasn't meant to be” and “Don't worry, you'll have a baby the next time” – know that there are healthcare providers out there, like the Houston Fertility Center staff, who take your concerns to heart and offer the best that science has to offer.

~ Dr. Sonja Kristiansen M.D.

image: freedigitalphots.net