The International Council on Infertility Information Dissemination, Inc

Dealing with the Stress of the Holidays

DEALING WITH THE STRESS OF THE HOLIDAYS

By HELEN ADRIENNE, MSW, ACSW, BCD

 

The stress of the holidays is a topic that has appeared with regularity in articles and newsletters since 1979 when I began working as a psychotherapist with infertility patients.  Rightfully so.  Infertility is demanding and stressful.  The Holidays are demanding and stressful.  And in this case, one plus one equals way more than 2.

It is no longer in dispute that both the mental and physical experiences of stress land in the body.  That’s about the last thing that an infertility patient needs.  Your body is the stage upon which the treatment gets played out.  Being poked and prodded physically evolves very naturally into a mental ordeal for everyone.

This article addresses a big opportunity to turn down the level of stress that comes with the holidays.  That opportunity exists in the marital relationship.

In the best of families, tensions abound at holiday time.  The backdrop for get-togethers may have to do with who expects what, who can’t stand whom, whose house is center stage, whose traditions “win”, who’s impossible to buy presents for and who’s jealous of what.  And of course, a separate and very long thorn is who’ll be there who has babies.  The whos, whose and whats go on ad nauseum.

This does not mean that all families are looney toons.  It does mean that in the most serene of families, things can’t ever be perfect – AND – you are not likely to be in the mood for anyone’s imperfections.  It is a known fact that often, well-meaning people do not know what to say and invariably say the wrong thing, presuming that they even know about your struggle.  And if they don’t know, the secret may be the lesser of two evils, but it still creates additional stress.

The opportunity for any couple lies in the fact that it is critically important to be on the same page when it comes to making decisions about how to handle the holidays.  Infertility may be the first crisis of major proportions that has hit you in the time that you’ve been together.  Any crisis will demand that a person locate his or her coping methods.  It might even put you in a spin if you need better coping mechanisms than you have.  But it is only the rare couple whose coping mechanisms are congruent when a crisis hits.  This does not mean that you aren’t supportive of one another.  Most couples are.  But there is a difference between the support that flows out of compassion for someone you love and working to achieve a united front, which works best, at holiday time especially.

The Chinese character for crisis is a combination of the characters for danger and opportunity.  It may feel dangerous to set a limit to one or both families.  But it is very important for any couple to define their “coupleness.”  As married adults, it is your job and your right to let both families know what boundaries you need for your mutual satisfaction.   It is highly recommended that if you cannot get past the pull back to the whos and whats of your respective families, that you seek the guidance of a therapist with skills in both infertility counseling and family counseling.

Whether on your own or with professional help, if you successfully decide and declare your decisions about the holidays, you set yourselves up to minimize the impact of family/holiday stress on your bodies.  And beyond the logistics of who and what, there exists a further opportunity to nurture the marriage.  Now is the time to explore techniques of mind/body relaxation that you can enjoy together.  Besides being on the same page, feeling loved and understood is palliative and has a positive impact as a stress reducer.

As hectic as the holiday time can be, it would make a difference if you could locate a yoga class designed specifically for couples or a massage class for couples.  Or, this could be a really good time to go to a spa together for a weekend.  By focusing on gaining physical relief from tension, you can break the grip of the aspects of the infertility challenge that land in your bodies.

Furthermore, couples can learn methods of breathing, muscle relaxation, mindfulness meditation and self-hypnosis that go a long way toward breaking the grip of the infertility challenge from the inside out.  These techniques are extremely empowering, at a time when couples tend to feel powerless.

In this society most of us live in a state of red alert, tolerating high levels of stress.  The incidence of stress-induced illness and anxiety has risen dramatically.  As a culture, we need to take better tender-loving care of ourselves, but we tend not to.  So, while there are many who need to learn stress reduction techniques as much as you do, few need to learn them more than you.

Infertility is nasty.  But the silver lining in the clouds is that as a couple, you can and should put your needs front and center.  You need to keep your love alive, for each other and for yourselves.  The best way to do this is to acknowledge the enormous stress involved and take the opportunity to learn to communicate so you can land on the same page.  And then, you can pursue the myriad of techniques available these days which reduce stress on the body and the mind.

 

 

HELEN ADRIENNE, MSW, ACSW, BCD

PSYCHOTHERAPIST

PRACTITIONER OF MIND/BODY MEDICINE

 

 

The Infertility Evaluation: Basic Testing with a Reproductive Endocrinologist By INCIID Advisors

Basic Infertility Evaluation - Fertility Tests

This article is a basic overview or review of an infertility evaluation for those individuals and couples struggling with infertility and trying to conceive or carry a pregnancy to term and delivery.

The American Society of Reproductive Medicine (ASRM) revised the definition of infertility to encourage earlier evaluation and treatment in the highest risk group. Infertility has traditionally
been defined as the inability to conceive after twelve months of regular, unprotected intercourse

INCIID suggests seeking evaluation early with a reproductive endocrinologist (RE). Seeking help from a specialist (RE) is
particularly important if you are 30 or over and/or have experienced
more than one spontaneous abortion (miscarriage).

The following experiences suggest seeking specialized help from a reproductive endocrinologist.

·       Regular unprotected intercourse with no pregnancy for a year

·       Trying 6 months when 30 years of age or older

·       Irregular menstrual cycles

·       A history of pelvic pain or other problems such as infection or abdominal or reproductive surgery

·       DES Exposure

·       Two or more miscarriages (under 30) and one if 30 or older

·       Male reproductive problems that may alert you to a problem may include:

  • Reproductive surgery
  • Low sperm count and./or problems with morphology etc.
  • prostatitis
  • Urinary infections

 
Reproductive Endocrinology and Infertility (REI): Why seeing an RE is important.

Education

The reproductive endocrinology specialist is usually an Obstetrician-Gynecologist with advanced education, research and professional skills in the field of Reproductive Endocrinology and Infertility (REI). Reproductive endocrinology is a surgical subspecialty of obstetrics and gynecology that trains physicians in reproductive medicine addressing hormonal functioning as it pertains to reproduction as well as the issue of infertility and multiple pregnancy loss.

Generally, OB/GYN enter into a 3-year fellowship or training program leading to board certification in Reproductive Endocrinology and Infertility by the American Board of Obstetrics and Gynecology. These fellowships provide clinical training in reproductive endocrinology, reproductive surgery, assisted reproductive technology (i.e. IVF and other ART procedures), genetics, embryology, and andrology. The programs are rigorous with comprehensive requirements. The physicians in the program are also required to pass a written examination and an oral exam by a team of REI experts. Once passed the physicians are sub-specialty board certified.

INCIID is often asked, “who is the best”. The most important first decision is seeing a specialist. Seeing an RE is the consummate “gold standard”. OB/GYNs will have some basic knowledge about infertility but that information and practice are minimal. The research required during an REI fellowship will support improved clinical outcomes and fewer clinical errors. This sub-specialty also requires updating physician knowledge to continue to provide evidence-based practice.

When looking for a board-certified reproductive endocrinologist check the Society of Reproductive Endocrinology and Infertility (SREI)website. The SREI required board certification in Obstetrics and Gynecology as well as the RE subspecialty. INCIID also offers a biographical overview including the specialty of physician members who support INCIID’s mission. Search the directory by zip code or state.

Patients should not be shy about asking their fertility doctor if they are “Sub-specialty” board certified as a reproductive endocrinologist.

Many patients are reluctant to switch from their OB/GYN. Some sight the expense. But the business of Obstetrics and Gynecology concentrates on routine gynecological care and delivering babies for their bread and butter. While evaluation of a fertility problem can be expensive, to stay with an OB/GYN can waste valuable time and actually become more expensive.

INCIID stresses the importance of seeking early care with qualified practitioners and outlines the criteria for moving to a specialist.

Having a family is an individual or couples’ decision. Whatever your situation, partners are in this together.

Basic Infertility Evaluation

Please note that every reproductive endocrinologist (RE) has his or her own standard protocol, and the following is intended to be a helpful basic guideline. Patients should be in a partnership with their physician and feel comfortable asking questions about any test or procedure. 

FIRST APPOINTMENT: History and Physical Exam

At the first appointment, most REs also do a routine screening of both partners such as HIV, hepatitis, etc. Medical histories for both partners will be taken. Try to keep track of the length of your menstrual cycles for several months beforehand. Charting Basal Body Temps (BBTs) for several months will also give your doctor some insights---as will using home Ovulation Predictor Tests (OPTs) and recording the results. A semen analysis will be scheduled. Some doctors will accept your medical records for review prior to your appointment. If not, bring your medical records with you.

The doctor will generally start with some type of comprehensive questionnaire providing an overview of reproductive history for both partners. He or she may also ask questions about the reproductive history. Some of those questions may include information about:

  • Previous pregnancies (if any)
  • Irregular periods or menstrual cycles
  • Pre-existing conditions or diagnosis such as polycystic ovary syndrome, pelvic inflammatory disease, tubal pregnancy, endometriosis
  • Problems with ovulation,
  • Male infertility issues, sperm count, motility, urinary or prostate issues

The physician may do a vaginal ultrasound. Consider scheduling the first consultation with the RE during the first or second day of the menstrual cycle. Why? Because during the exam, the doctor may be able to do several tests that are cycle-day specific. Instead of re-scheduling for another date, patients may be able to arrange for time-sensitive tests and move forward with evaluations and a plan more quickly.

Assessment of Ovarian Reserves

Human Ovary Antral Follicle Count (Guided Vaginal Ultrasound)

One test and a good predictor of ovarian reserve is the antral follicle count. The count is done of cycle days 2, 3, or 5 using guided vaginal ultrasound. Antral follicles are immature eggs. The number of immature follicles correlates with ovarian reserves.  that looks at the ovaries. Keep in mind that antral follicles vary from month to month.

A vaginal ultrasound can also discover abnormalities within the Pelvis. Infections in the pelvic region often go unnoticed but are a significant cause of infertility (i.e. blocked tubes, uterine scarring, tubal damage, endometriosis, fibroids, adhesions, etc.) 

 If the antral count is too low (generally less than 4 according to Dr. Richard Sherbahn) chances of a successful pregnancy and live birth are low, the higher antral counts can be indicative of PCOS (Poly Cystic Ovarian Syndrome)

Anti-Mullerian Hormone Testing of Ovarian Reserve (AMH) (Blood Test)

The human egg is "housed" inside a structure called the follicle. The follicle is comprised of specialized cells called granulosa cells. The granulosa cells produce a specific hormone directly and predictably linked to egg quality, and that hormone is called AMH. While other means of examining ovarian reserve may offer indirect, and possibly less accurate, less specific, and less predictive tests of egg quality (such as cycle day 3 FSH/estradiol levels and the Clomiphene Citrate Challenge Test), many reproductive endocrinologists believe women are better served by examining their AMH level -- a more direct, more accurate, more specific, and more predictive test of egg quality.

The AMH test has been found particularly useful in the following clinical situations:

·     

Women who either need a Clomiphene Citrate Challenge Test (CCCT) or previously had a CCCT and want to confirm/refute the results;

·      Women of advanced reproductive age (35 years or older);

·      Any women with a diagnosis of "unexplained infertility";

·      Women who have shown a poor response to ovulation induction with either Clomid/Serophene or injectable fertility drugs;

·      Women who have been told they need IVF with donor eggs -- a normal AMH level may permit them to do IVF with their own eggs, while an abnormal AMH level may confirm the need for IVF with donor eggs

For more information on AMH testing, see the article by Scott Roseff, MD

Day 3 Follicle Stimulating Hormone (FSH) and Estradiol (E2) Testing (Blood Testing)

On the third day of the menstrual cycle, the clinic may draw blood and test the FSH levels. This test is not as reliable as other but can give an indication if a woman is closer to menopause (with low ovarian reserves). FSH is a hormone secreted by the anterior lobe of the pituitary and stimulates the maturing of the ovarian follicles in women. In men, the hormone is important in maintaining spermatogenesis.

Unfortunately, a high FSH is always bad but a good level may not mean there are egg reserves either.

Adding to the confusion is the fact that FSH bounces around quite a bit. One month the result may be a 7 and the next month it may be a 13. For a while, it was thought that waiting for a month to cycle may yield a better level and improve the odds that a given cycle would work. Unfortunately, the intermittent high FSH is as bad a prognostic sign in months where the FSH is normal as in months where the level is high.

For more information on FSH testing read the David Sable, MD article.

Other Blood Work May Be Ordered

Depending on the individual or couple’s needs, there may be other blood tests ordered. Blood tests that might be needed include:

Luteinizing hormone (LH): A pituitary hormone that stimulates the gonads. In the male LH is necessary for spermatogenesis (Sertoli cell function) and for the production of testosterone (Leydig cell function). In the woman LH is necessary for the production of estrogen. When estrogen reaches a critical peak, the pituitary releases a surge of LH (the LH spike), which releases the egg from the follicle.

LH controls the length and sequence of the female menstrual cycle, including ovulation, preparation of the uterus for implantation of a fertilized egg, and ovarian production of both estrogen and progesterone. Theca cells in the ovary respond to LH stimulation by secretion of testosterone, which is converted into estrogen by adjacent granulosa cells. In women, ovulation of mature follicles on the ovary is induced by a large burst of LH secretion - the preovulatory LH surge. Residual cells within ovulated follicles proliferate to form corpora lutea, which secrete the steroid hormones - progesterone and estradiol. Progesterone is necessary for the maintenance of pregnancy, and, in most mammals, LH is required for continued development and function of corpora lutea. For more information read this article.

Dr. Geoffrey Sher, “It is certainly time for us to reflect seriously on what and why e use specific protocols and drugs in IVF.” Dr. Sher thinks the focus might be better by optimizing ovogenesis rather than simply on how to increase the total egg yield.” He goes on to say he favors the use of FSHr-dominant, long pituitary down-regulation protocols that reduce LH. Dr. Sher is experienced in treating older women. Read more about LH regulation here.
Estradiol (E2), 

Prolactin is a hormone produced by the pituitary gland. The pituitary gland sits below the hypothalamus at the base of the brain.

Prolactin causes breasts to grow and develop. It also causes milk production in the breasts of a lactating or pregnant woman. Prolactin can be found in both males and females. A blood test will determine the prolactin levels and your doctor will have a normal or out of range level and recommend the best course of action.

During pregnancy prolactin levels increase. After the birth of a baby, a woman’s estrogen and progesterone levels drop and prolactin levels rise. These high levels of prolactin cause milk to “come in” or milk production to begin so a baby can be breastfed. In women who are not pregnant, prolactin is one of the hormones that regulate menstrual cycles.  In males, high levels of prolactin may be related to sperm production and sexual dysfunction. For more information on prolactin, read this article by Carolyn Coulam, MD.

Testosterone (T): The male hormone responsible for the formation of secondary sex characteristics and for supporting the sex drive. Testosterone is also necessary for spermatogenesis.

Progesterone (P4): The hormone produced by the corpus luteum during the second half of a woman's cycle. It thickens the lining of the uterus to prepare it to accept implantation of a fertilized egg. It is released in pulses, so the amount in the bloodstream is not constant.

17-hydroxyprogesterone (17-OHP) An over-secretion of androgen can cause elevated 17-OHP levels which can, in turn, interfere with ovulation. This is called congenital adrenal hyperplasia. Once this condition is found it can be corrected with medication to help patients ovulate normally.

Thyroid Releasing Hormone (TRH) and low levels of Thyroxine(T4) can also result in an excess of prolactin (normally produced by the pituitary gland to promote lactation) and TSH both of which can have a negative effect on fertility by preventing ovulation or result in irregular or absent periods.

Thyroid Stimulating Hormone (TSH): Women are far more likely and more often (than men) experience thyroid disease during their reproductive years. The most common test done to assess thyroid function is TSH (Thyroid Stimulating Hormone). TSH is produced by our pituitary gland. TSH stimulates the thyroid to produce the hormones T4 (thyroxine) that can interfere with ovulation. 

Different clinics and laboratories standardize testing in different ways. Below is an overview generally of the ranges for the different levels.

Luteinizing Hormone (LH)

·       Follicular Phase (day two or three): <7mIU/ml

·       Day of LH Surge: >15mIU/ml

Follicle Stimulating Hormone (FSH)

·       Follicular Phase: <13mIU/ml

·       Day of LH Surge: >15 mIU/ml

Estradiol

·       Day of LH Surge: >100 pg/ml

·       Mid Luteal Phase (seven days after O): >60 pg/ml

Progesterone

·       Day of LH Surge: <1.5 ng/ml

·       Mid Luteal Phase >15 ng/ml

Prolactin:<25 ng/ml 
Free T3: 1.4 to 4.4 pg/ml 
Free Thyroxine (T4): 0.8 to 2.0 ng/dl 
Total Testosterone: 6.0 to 89 ng/dl 
Free Testosterone: 0.7 to 3.6 pg/ml 
DHEAS: 35 to 430 ug/dl 
Androstenedione: 0.7 to 3.1 ng/ml

KEY: < = less than;
        >= greater than; mIU=milli International Units;

ml=milliliter;

pg=picograms;

ng=nanograms;

uIU=micro International Units;

dl=deciliter; ug=micrograms
 

Additional Testing

After the initial workup, many doctors continue with some of the following tests.

HYSTEROSALPINGOGRAM (HSG):

This test is used to examine a woman's uterus and fallopian tubes. It is essentially an x-ray procedure in which a radio-opaque dye is injected through the cervix into the uterus and fallopian tubes. This "dye" appears white on the x-ray, and allows the radiologist and your doctor to see if there are any abnormalities, such as an unusually shaped uterus, tumors, scar tissue or blockages in the fallopian tubes. If you are trying to get pregnant in the same cycle as an HSG, make sure to schedule the test PRIOR to ovulation so that there is no danger of "flushing out" a released egg or developing embryo. Although most women report only minor cramping and short-term discomfort during this procedure, some women, especially those who DO have blockages, report intense pain. Speak to your doctor about taking a pain medication about 30 minutes prior to the actual procedure.

Transabdominal Saline Contrast Sonohysterography

Although HSG is the standard screening test for the diagnosis of tubal infertility, there are studies that confirm a higher sensitivity, safety and acceptability of Transabdominal Saline Contrast Sonohysterography (compared to HSG) for the evaluation of tubal patency in infertile women.

This technique uses sound waves to produce pictures of the inside of a woman’s uterus and help diagnose unexplained vaginal bleeding. Hysterosonography is performed very much like a gynecologic exam and involves the insertion of the transducer into the vagina after you empty your bladder.

Using a small tube inserted into the vagina, your doctor will inject a small amount of sterile saline into the cavity of the uterus and study the lining of the uterus using the ultrasound transducer. This can also be injected into the fallopian tubes for evaluation of patency. Ultrasound does not use ionizing radiation, has no known harmful effects, and provides a clear picture of soft tissues that don’t show up well on x-ray images.

This technology is readily available, easy to interpret. It is not only safer and cheaper but it’s as accurate as HSG in evaluating the fallopian tubes and the uterine cavity in infertile patients. Some physicians advocate its use as a replacement. (Read more here.)

HYSTEROSCOPY

(Transabdominal Saline Contrast Sonohysterography can be also used in place of Hysteroscopy)

If a uterine abnormality is suspected after the HSG, your doctor may opt for this procedure, performed with a thin telescope mounted with a fiber optic light, called a hysteroscope. The hysteroscope is inserted through the cervix into the uterus and enables the doctor to see any uterine abnormalities or growths. "Photos" are taken for future reference. This procedure usually is performed in the early half of a woman's cycle so that the build-up of the endometrium does not obscure the doctor's view. However, if the doctor is planning to do an endometrial biopsy at the same time, it is done near the end of the cycle.

LAPAROSCOPY

A narrow fiber optic telescope is inserted through a woman's abdomen to look at the uterus, fallopian tubes, and ovaries and to discern endometriosis or pelvic adhesions, and is the best diagnostic tool for evaluating the ovaries. This test is usually done two or three days before menstruation is expected, and only after an HCG beta blood test ensures the woman is not pregnant.

ENDOMETRIAL BIOPSY

In the past, the endometrial biopsy was a routine part of the fertility evaluation, but currently, it is performed mainly on patients at risk for endometrial cancer or with repeated IVF failures. An endometrial biopsy is a simple office-based procedure that is performed just before the onset of a woman's menses.

Baseline tests for follicle stimulating hormone (FSH) and luteinizing hormone (LH) must be done on day three of your cycle. If your consultation should take place before that, you'll be instructed to come in for these tests on day three of your cycle. Additional tests will be conducted on the day of Luteinizing Hormone (LH) surge (mid-cycle), and again about seven days after ovulation.

Luteinizing Hormone (LH)

·       Follicular Phase (day two or three): <7mIU/ml

·       Day of LH Surge: >15mIU/ml

Follicle Stimulating Hormone (FSH)

·       Follicular Phase: <13mIU/ml

·       Day of LH Surge: >15 mIU/ml

Estradiol

·       Day of LH Surge: >100 pg/ml

·       Mid Luteal Phase (seven days after O): >60 pg/ml

Progesterone

·       Day of LH Surge: <1.5 ng/ml

·       Mid Luteal Phase >15 ng/ml

Prolactin:<25 ng/ml 
Free T3: 1.4 to 4.4 pg/ml 
Free Thyroxine (T4): 0.8 to 2.0 ng/dl 
Total Testosterone: 6.0 to 89 ng/dl 
Free Testosterone: 0.7 to 3.6 pg/ml 
DHEAS: 35 to 430 ug/dl 
Androstenedione: 0.7 to 3.1 ng/ml

KEY: <= less than; >= greater than; mIU=milli International Units; ml=milliliter; pg=picograms; ng=nanograms; uIU=micro International Units; dl=deciliter; ug=micrograms

Semen Analysis

A semen analysis is a  very important test and it should be done early in the evaluation. If there is a significant sperm problem, the female analysis may be modified to more basic tests and certainly, the analysis should be conducted before more invasive female surgical interventions are attempted.

About a quarter of infertility cases are due to a sperm defect. Almost half of the infertility patient cases will include a sperm deficit as a contributing factor in the causation of infertility. Take a closer look at the male reproductive system and the way sperm is analyzed here.

Multiple Miscarriages, Stillbirth and Pregnancy Loss

Until the last decade, there was little a couple could do if they suffered from recurrent pregnancy losses. Miscarriages that couldn't be attributed to chromosomal defects, hormonal problems or abnormalities of the uterus were labeled "unexplained," and couples would continue to get pregnant, only to suffer time and again as they lost their babies. New research, however, has provided information on the causes of the heretofore unexplained pregnancy losses allowing more effective treatment enabling women to carry their babies to term.
 
About 15-20% of all pregnancies result in miscarriage, and the risk of pregnancy loss increases with each successive pregnancy loss. For example, in a first pregnancy, the risk of miscarriage is 11-13 %. In a pregnancy immediately following that loss, the risk of miscarriage is 13-17 %. But the risk to a third pregnancy after two successive losses nearly triples to 38 %.

There are a number of tests for multiple pregnancy loss. Those patients with unexplained infertility may also want to read this article by Carolyn Coulam, MD and investigate immunological issues that may curtail or prevent pregnancy. (A list of tests can be found in the article.)

If you have questions about a basic fertility evaluation, please contact INCIID.

 

Tips on Progesterone Use for IVF

IVF cycle

IVF cycleMaking Progesterone in Oil shots less painful.

Welcome. The goal of this educational module is to provide information and tips for making progesterone in oil injections easier and less painful. This tutorial is for informational purposes only. It is not intended to replace treatment plans provided by your physician.  You should always consult your doctor with questions about your treatment.

After viewing the presentation participants will become familiar with the kinds of progesterone medications offered as well as the most preferred forms of progesterone for patients during the last phase of an in vitro fertilization or IVF cycle.

After viewing the module, you should be able to describe the purpose and function of Progesterone in Oil injections. You will also be able to name  the three most common types of progesterone in oil used by most IVF practitioners and why particular kinds of progesterone are preferred over others – including which type is NOT recommended for pregnant women. Lastly, the tutorial will provide you with tips to make administration of the progesterone in oil injection less painful.

Miracles and Memories Pins

Miracles and Memories Pin

Miracles and Memories PinConsider the first and ONLY family-building INCIID Miracles and Memories pin for yourself, your family and friends - or if you are a reproductive endocrinology and infertility clinic or a patients who might want to provide them to your extended family members or to friends. INCIID was the first to come out with a pin covering all aspects of family-building.

Providing these particularly during "parenting" holidays (Christmas, Mother's Day, Father's Day etc.) can be supportive and helpful to those struggling to build their family. For thousands of reproductively challenged couples, the holidays can be a difficult time, as their only wish is to have a family of their own. If you are a doctor caring for patients,  INCIID is asking you to give out “Miracles and Memories” family-building pin to show patients and staff in a small but caring way that you support efforts to build a family. The idea is to build awareness and support for INCIID, a non-profit organization, providing scholarships for couples with infertility diagnoses as well as support and information on family building options. If you are a patient, or the family of a patient struggling with fertility, pregnancy loss or making the decision to adopt - Miracles and Memories Pins can provide added support.

Because INCIID is a non-profit organization, it relies solely on donations and contributions to maintain the success of the “From INCIID the Heart” scholarship program.  The INCIID team has created “Memories and Miracles” pins. INCIID is asking  couples, doctors, family members to donate just $25 to increase infertility awareness while at the same time providing a tax deductible donation to increase awareness and in support of creating a family.

The pins are packaged in a small clear plastic baggy attached to a white card that explains representation of each color on the pin and that pins support INCIID’s work and the IVF Scholarship.

The MAM (Miracles & Memories) Family-Building Pin :

Download the Bulk order form (for bulk orders of 100 or more pins) including a photo of the Miracles and Memories (MAM) pins

 

 

THE PAIN OF THE "PARENTING HOLIDAYS" FOR THE PRE-PARENT by Helen Adrienne, LCSW, BCD

 

[Register for the Webinar to talk directly to Helen Helen has valuable and common sense approaches to the holidays. We know you will feel better after the discussion] When I was a little girl, I remember putting rolled up socks in my undershirt to create the "breasts" that a mommy has. This made playing house that much more authentic. Although it was hard to recruit the little boys in the neighborhood to join in, it was not impossible. Yet their resistance was not a statement about not wanting to be a father someday, but rather that the game itself didn't resonate with a young boy's typical need for more rigorous physical activity in play than females.

Reproduction is germane to being alive, human or otherwise. It sometimes seems that you are surrounded by babies: birds, bees, dogs, sloths, and more galling than anything, your friends or neighbors who aren't sure that they want a baby but find themselves pregnant by accident. And as the cynical expression goes, you're born, you grow up, you pay taxes, you reproduce, and you die. That is, everyone and everything reproduces but you. There is only one word to describe the infertility experience: agony.

So many articles on infertility lay out all of the feelings that cascade from the situation, and conclude with a statement about feeling out of control. To me, the centerpiece of this emotional agony is feeling out of control. The one thing that you long for the most, you cannot have. Whether this creates (a normative, but arduous) anxiety for you, or depression, marital imbalance, or friction in the family, the workplace or in friendships, these symptoms take a back seat to the sometimes protracted amount of time that resolution of the infertility struggle can take. And the bottom line of that results in the feeling of being painfully out of control with no end in sight.

Now add to this Christmas, Mother's Day and Father's Day. This is an emotional ordeal because parenthood is what you want so much for yourself. It can be even more painful if you either want to or are expected to honor your parent in a setting which is a gathering of siblings, in-laws and maybe "out-laws" who show up with their babies, toddlers and/or bellies.
I take the position that in your circumstances, you need to be protected from the salt that would unwittingly be rubbed in your wound by people who might very well want the best for you, but do not have the emotional sophistication to access from within them what sensitivity you need from them. Or they may have no awareness of the need for sensitivity because you haven't shared the struggle with them, probably for some very good reason. 
Given all of this, what form does protection take? Sometimes, protection means simply not showing up. As a young couple, you might not have the clarity or the experience of setting boundaries around yourselves as "a couple", free to and entitled to write your own script according to your needs. This takes a willingness to be straightforward and expect those who love you to respect your decision. It doesn't mean that you do not honor or love your parent; it does mean that Christmas, or Mother's day and Father's day is an arbitrary social declaration. You can arrange for a private time with each mother and father and bypass the hoopla that is more a boon to Hallmark than anything else. In a more realistic world, any day or every day can be mother's/father's day.

But protection can mean something else, exemplified in this story. I recently had a conversation with a woman who was in one of the mind/body support groups that I run for New York City RESOLVE, a national organization that provides advocacy, educational seminars and support of all kinds for infertility patients. She called to tell me that she was pregnant. Among other things, I asked her if the experience of having been in the group last year had made a difference. She said, "Absolutely!" I asked how. She said that what she learned from me and the whole gestalt of the group experience "gave her the stamina to just keep going."

The strength implied in the word stamina is very important when it comes to coping with stress. And no one would debate that infertility ranks way up there in the stress department. Everyone wants life to be easy. It isn't. Everyone wants safety and stability. This is a sensible goal, but a more sensible goal is to expect the unexpected which can ruin the best laid plans. But if you have stamina, you've got most of what you need in this unpredictable world. No doubt you never predicted that you would be dealing with infertility.
There are all kinds of strength, all valuable. The stamina to "pull up your socks and get on with it" figures in heavily in the "job" of bringing the fertility struggle to resolution by whatever means. This kind of strength protects you from giving up too soon. If my patient hadn't forged ahead, her doctor never would have discovered the heretofore undiagnosed disorder that, when corrected, yielded a pregnancy the next month.
Another kind of strength surpasses all others as far as I am concerned. It is the inner strength of self-esteem. This is easier said than done. We all have wounds from our early years to a greater or lesser degree. These wounds handicap us a little or a lot in the formation of a healthy sense of assertiveness, entitlement, ability to communicate, ability to relax, to know what we feel, to see things clearly, and to take on challenges without feeling victimized. 
Infertility is so demanding that however emotionally healthy we may havebeen before, now we need every ounce of inner strength we can muster to navigate the process successfully. The good news is that however you may have been handicapped, and however infertility throws your need for emotional growth into high relief, you may be one of those people/couples who come out of the experience stronger. Any aspect of self-esteem or inner strength that is needed is a skill which can be learned, practiced and integrated.
The challenge of infertility is raised exponentially at certain times, Christmas, Mother's Day and Father's Day among them. It is highly recommended that rather than getting lost in your grief and upset, take it as an opportunity to get a panoramic view (best accomplished with a seasoned therapist) of what skills you and your partner need to develop or enhance so that you can be among those who come out of the experience with both a family and a clearer sense of your strength and capacities.

 

Helen, a long-time advisor to INCIID, is the author of On Fertile Ground: Healing Infertility. She teaches stress reduction classes at NYU Fertility Center in NY City. Read her blog, The Baby Manifest-O™ 

Helen's web site has many resources for infertility.

Helen Adrienne, LCSW, BCD
Psychotherapist, Clinical Hypnotherapist,
Practitioner of Mind/Body Therapy
420 East 64th Street - 1D(East)
New York, New York 10065
212-758-0125
helen@mind-body-unity.com
www.mind-body-unity.com

Prolactin Levels

Pituitary Gland Image

High Prolactin Levels
By Carolyn Coulam, M.D. and Nancy Hemenway

A basic work-up by a reproductive endocrinologist will likely include a variety of blood tests including prolactin levels. Prolactin is a hormone that is produced by the pituitary gland. The pituitary gland sits below the hypothalamus at the base of the brain.

What does Prolactin do?

Prolactin causes breasts to grow and develop. It also causes milk production in the breasts of a lactating or pregnant woman. Prolactin can be found in both males and females. A blood test will determine the prolactin levels and your doctor will have a normal or out of range level and recommend best course of action.

During pregnancy prolactin levels increase. After the birth of a baby, a woman’s estrogen and progesterone levels drop and prolactin levels rise. These high levels of prolactin cause milk to “come in” or milk production to begin so a baby can be breast fed. In women who are not pregnant, prolactin is one of the hormones that regulate menstrual cycles.  In males high levels of prolactin may be related to sperm production and sexual dysfunction.

What is Hyperprolactinemia?

“Hyper” ( meaning over, super, or excess) or in this case Hyperprolactinemia – meaning one has an excess of prolactin or high prolactin levels. Hyperprolactinemia is a condition where non-pregnant women (or men) have too much or an excess of prolactin in their bodies. This condition is fairly common in women of reproductive age who are experiencing irregular periods but who have normal ovaries (about 30%). High prolactin levels may also interfere with estrogen and progesterone production. Prolactinemia can stop ovulation altogether.

Sometimes there are no symptoms and women will often discover they have high prolactin when they have trouble getting pregnant and go for fertility testing or because they need to regulate their irregular periods.  Some women will start producing milk or a milky substance outside of a pregnancy (a condition called galactorrhea). In men with elevated levels prolactinemia can cause impotence or reduced libido (desire for sex). However, prolactinemia is more frequent in women than in men.

Common Causes

Prolactinemia causes vary. Some common causes include:

  • Pituitary Tumors
  • Under Active Thyroid (Hypothyroidism)
  • Medications
    • Antidepressants Medications
    • Anti-psychotic Medication
    • Anti-Hypertension (High Blood Pressure) Medications
    • Stress
    • Excessive exercise
    • Nipple Stimulation
    • Some Foods (A recent research study appears to demonstrate one of the brain altering effects of gluten.  In this case, a compound in gluten acts as an opioid chemical that leads to the excessive excretion of the neuro hormone, prolactin. More)
    • Some Herbs may elevate prolactin levels (Fenugreek, Goat’s Rue, Red Raspberry Leaf and others)

Magnetic resonance imaging (MRI) – a scan of the brain checks for the presence of a tumor of the pituitary gland.

Treatment

Treatment is determined based on diagnosis. If there is evidence (MRI) of a pituitary tumor, for example, the usual treatment is medication. Hypothyroidism is treated by replacing the lack of hormone normally present with normal thyroid production.  Follow ups with your doctor will determine if prolactin levels return to normal.  If medication is found to be causing high prolactin levels, work with your doctor to find an alternative medication.

Medications used to treat elevated prolactin levels are cabergoline and bromocriptine. Treatment with these medications will usually continue until your symptoms lessen or pregnancy occurs.

These are category B classified medications.

Animal studies have revealed no evidence of harm to the fetus; however, there are no adequate and well-controlled studies in pregnant women.
or
Animal studies have shown an adverse effect, but adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus.

Check with your doctor about how any medications should or should not be taken during pregnancy.

Cabergoline is taken once or twice a week and has been reported to have fewer side effects than bromocriptine. Cabergoline may drop prolactin levels back to normal range more quickly than bromocriptine.

Side Effects of Cabergoline (Trade Name - Dostinex) include:

Most Common Side Effects

  • Dizziness
  • Nausea
  • Constipation
  • headache

Less serious side effects may include:

  • Nausea, vomiting, stomach pain, gas, indigestion, constipation;
  • Headache, depressed mood;
  • Dizziness, spinning sensation;
  • Drowsiness, nervousness;
  • Hot flashes;
  • Numbness or tingly feeling; or.
  • Dry mouth.

Bromocriptine can be prescribed in a suppository form to be inserted directly in the vagina. This is an off-label use of the medication.

Note: Not all women with elevated prolactin need treatment. Women with elevated levels of prolactin who don’t make estrogen will need treatment to increase estrogen production. If the cause is found to be a pituitary tumor, the woman may need no treatment if she is making estrogen. Birth control pills will help with regulation of periods.  

An MRI baseline should be taken and the patients should be followed yearly with MRI for 3 years to record any changes in the small pituitary tumor.

Please check with your reproductive endocrinologist or physician for individual guidance on elevated prolactin.

2015 Online Angel Award

2015 Heather Bruce Thiermann Online Angel Award

We live in a truly digital age. It's nearly impossible to do anything or go anywhere without a smartphone or computerized or generated something.  The early nineties was a time when for all practical purposes – the Internet as we know it today was in its infancy.  Today there are all kinds of digital scams, hackers lurking around every cyber corner and a lot of cyber bullying. But there are also many acts of kindness, paying it forward and lots of interactive success stories. We think the time has come to make once again that the community of people who use the Internet for the benefit of others. These are the people (including corporations within the reproductive and adoption industry) that go above and beyond to help others. They pay it forward with selfless determination to help others.

In 2015, INCIID will present INCIID's Online Angel Award in several categories to an individual, a professional and/or a corporation. These are the people that use the Internet to give back to the community.  Do you know someone that deserves an award for being an ONLINE Angel?

  • Details about how to nominate – coming soon!

 

The History of the Online Angel Award

Heather's story is a triumphant example of how going on-line can not only change lives, but enhance them. Her story shows that friendships made via computers can be as rewarding as any, even if participants never meet face-to-face. But most of all, it demonstrates how experiences in Cyberspace can be exhilarating and sorrowful, and just as in "real life," love, support, encouragement and shoulders to lean on can be found.

Heather was a popular participant on the Infertility Bulletin Boards started through AOL at the beginning of the 1990’s. She and her husband, Steven, were in the IVF program at The New York Hospital-Cornell Medical Center in New York City. Heather struggled with massive uterine fibroids that prevented her from conceiving, but she was positive and hopeful despite eight years of infertility. After five surgeries, she finally became pregnant following her second in vitro fertilization attempt.

At this time, Heather moved on to the "Pregnant After Infertility" bulletin board on AOL, a subject created by INCIID cofounder, Nancy Hemenway. She shared all the fear and excitement of finally being pregnant with others on the board. As time neared for her planned C-section (previous surgeries made this necessary), her posts on the bulletin board became increasingly excited, and nervous. Then, just hours before the long-awaited time on January 8, Heather's C-section was canceled because of intense snow storms on the East Coast. Her doctor couldn't get to the hospital.

Two days later, on Wednesday, January 10, Heather and Steven became the proud parents of a beautiful and healthy baby girl they named Tara. Steven said he had never seen such a beautiful look of complete happiness in those brief moments when Heather laid eyes on daughter. Heather saw Steven holding Tara than fell into a coma. She never regained consciousness, and thirteen days later, Heather died.

This terrible loss has been retold throughout Cyberspace and people on all the on-line services and the Internet reacted with shock and sorrow. You didn't have to know Heather to love her for all that she did to support others on-line.

INCIID established an award to recognize the contributions of an individual or group whose participation on-line has served to support, encourage and educate others about infertility. It is named the "Heather Bruce Thiermann Online Angel Award," and Heather was the first recipient, posthumously honored. Steven accepted the award in March, 1996 at INCIID’s conference.

At INCIID, we continue the mission to educate and support infertility consumers through online education and the “From INCIID the Heart IVF Scholarship Program”. INCIID works very hard to educate others, especially about their options regarding IVF. helps individuals and couples explore their family-building options. INCIID provides current information and immediate support regarding the diagnosis, treatment, and prevention of infertility and pregnancy loss, and offers guidance to those considering adoption.

Please contact INCIID if you are interested in serving on or helping on a committee to select the INCIID Online Angel Award

 

 

Testing Anti-Mullerian Hormone to Determine Egg Reserves by Scott Roseff, MD

Golden egg sitting amoung ordinary white eggs

Golden egg sitting amoung ordinary white eggsEGG QUALITY starts declining when a woman is in her mid-20's!

There is a slow decline in quality from about age 24 to age 30, followed by a fairly quick decline between age 30 and age 35, with a rapid decrease between ages 35 and 40. And, over age 40, egg quality is generally quite poor. All of this may make it difficult to get pregnant...

OVARIAN RESERVE describes a woman's capacity to produce a reasonable quantity of good quality eggs. Of course, measuring a woman's ovarian reserve is very important in determining why someone may not be getting pregnant, as well as in finding out the ease (if she has good eggs) or difficulty (if she has poor eggs) with which a pregnancy may be realized.

Women with normal ovarian reserve (good eggs) may conceive via simple therapies (such as timed intrauterine insemination), while women with abnormal ovarian reserve (poor eggs) may require in-vitro fertilization (IVF) or even IVF with donor eggs. Until now, we have only been able to INDIRECTLY measure a woman's ovarian reserve via a cycle day 3 FSH/estradiol blood test, or through a "Clomiphene Citrate (Clomid) Challenge Test", or CCCT. These tests measured the brain's hormones which were INDIRECTLY affected by the ovary's egg quality. While these tests were the best we had, we now have a more modern and sensitive blood test which DIRECTLY measures a woman's ovarian reserve!

The human egg is "housed" inside a structure called the follicle. The follicle is comprised of specialized cells called granulosa cells. The granulosa cells produce a specific hormone directly and predictably linked to egg quality, and that hormone is called AMH. While other means of examining ovarian reserve may offer indirect, and possibly less accurate, less specific, and less predictive tests of egg quality (such as cycle day 3 FSH/estradiol levels and the CCCT), many reproductive endocrinologists believe women are better served by examining their AMH level -- a more direct, more accurate, more specific, and more predictive test of egg quality.

The AMH test has been found particularly useful in the following clinical situations: Women who either need a Clomiphene Citrate Challenge Test (CCCT) or previously had a CCCT and want to confirm/refute the results; Women of advanced reproductive age (35 years or older); Any women with a diagnosis of "unexplained infertility"; Women who have shown a poor response to ovulation induction with either Clomid/Serophene or injectable fertility drugs; Women who have been told they need IVF with donor eggs -- a normal AMH level may permit them to do IVF with their own eggs, while an abnormal AMH level may confirm the need for IVF with donor eggs. If you have individual questions about this article, please feel free to ask them on the General Infertility Medical forum: moderated by Dr. Scott Roseff.

Children First: Making the Paradigm Shift from Infertility to Adoption By Patricia Irwin Johnston, MS

Moving from infertility to adoptive parenting is a complicated emotional process. In transferring from the process and the culture of infertility and its treatment to the process and culture of adoption, consumers are expected to make a huge shift. The Barrier? Medical treatment is centered on the needs and wishes of the paying-client—the adult who wanted a baby (that’s you!). Adoption’s culture is centered on the needs and best interests of the one client who has no say in the process and who bears no financial responsibility—the child (not you!) Adoption is child-centered rather than adult-centered. But you, one of three clients in the picture, will carry all of the financial risk and burden.

Not fair, you say? I understand. Been there. Felt that. But as my children by adoption have grown up, as our relationships with them and some of their birthparents have developed, I’ve changed my thinking a lot.

Here’s something you probably don’t understand if you are not yet a parent. Parenting itself changes everything. From the moment you become a parent forward, your child’s needs will always come before yours and before anyone else’s in your life. For those who conceive their children, that shift comes automatically as part of the pregnancy experience. Indeed, it’s that shift in thinking that makes it possible for birthparents to plan an adoption.

For those who adopt, however, making that shift is not automatic. Unless one makes a deliberate choice to shift thinking, to participate in an adoption expectancy period, the shift won’t likely happen until after the child arrives. And by then, many infertile couples can have made some pretty bad choices already—choices rooted in their frustration, in their reactions to many losses that infertility has brought to them, in the desperation they have begun to feel about ever being able to parent.

Over the past twenty years or so, changes in adoption have done little more than move the locus of power in adoptions. First power was moved from adoption professionals to adoptive parents, and now it has been transferred to birthparents. But changes in who holds the power have not often included the education necessary for all of these parties to understand and accept what children themselves need from adoption. And what is it that children need? They need well-prepared, unafraid, stable and loving families over their entire lifetimes!

Too many of those involved in adoption right now seem to experience it as a competition. Agencies compete with other agencies and with independent service providers to draw in limited numbers of birthparents whose healthy babies can be offered to an apparently unlimited supply of prospective adopters. Special needs agencies compete with one another for public and private grant money, and often trash one another and their differing approaches to counseling and preparation. Prospective adopters compete with other prospective adopters for the opportunity to adopt available babies. They look for too many shortcuts to “faster” placements by looking for providers who will not require education, extensive preparation, and screening, because it is too “invasive and unfair.” Adopters attempt to demonstrate to expectant parents that their adoptive family would offer a "better" life for the child about to be born than would the child’s family of origin or any other prospective adopters. When an expectant parent has a change of heart about adoption during the window of time a state or province grants for the change-of-mind process, many adopters and their professional advisors take the stance that possession-is-nine-points-of-the-law and go to court so that they might "keep" the baby, even though they are not yet the legal parents. Adopters, birthmothers and professionals often conspire to keep birthfathers and their families out of the picture entirely.

Ideally, changing adoption so that it really meets the needs of children would begin with fundamental changes in thinking and in the law. Different thinking would end the adversarial aura that surrounds adoption. If adoptions really kept the child's interests center-stage, everybody involved in any untimely pregnancy would be seeking the best possible solution for the child to be born. This solution would find him with his permanent family (birth or adoptive) as soon as possible after his birth.

Getting off to this kind of a "clean" start in an adoption, however, demands a tremendous amount of understanding and emotional work on the part of both sets of parents, as well as careful judgment on the part of well trained and well informed professionals. Those working to launch a child-centered adoption must be helped to understand how each of the decisions made and each of the procedures followed will help the child at the adoption's core.

For a baby's launch to be optimal, everyone involved must be committed to being honest with everyone else in the adoption. Birthparents must be honest with one another, with helping professionals, and with prospective adopters. Adopters must be scrupulously honest with professionals and expectant parents. Intermediaries must be scrupulously honest with expectant parents and prospective adoptive parents. There must be no assumptions that “leaving that little something out” “letting that little something go,” causes no harm. Scrupulous adherence to ethical standards that keep the child at the center while respecting the needs and interests of both adoptive parents and birthparents is absolutely crucial in making all decisions concerning an adoption.

As an adoptive parent, wife, sister-in-law, daughter-in-law, cousin-in-law, sister-in-open-adoption to my child’s birthmother, and adoption educator, I hold those who elect to join to adopt to very high standards. That’s because this is what children deserve from their parents.

Patricia Irwin Johnston. is an INCIID Advisory Board Member. She is a long-time advocate, infertility and adoption educator and author of several books, including Adopting after Infertility, Launching a Baby’s Adoption, and INCIID’s own Adoption Is a Family Affair, written with the participation of the INCIID community members on two of the forums which Pat moderates: Exploring and Expecting through Adoption.

Contact Information:

Phone: (317) 872-3055

Email: patjohnston@perspectivespress.com

Website: http://www.perspectivespress.com

New Developments in Assisted Reproductive Medicine by Gad Lavy, MD

New Developments In Assisted Reproductive Medicine

By Gad Lavy, MD, FACOG

 

The success of IVF (in vitro fertilization) has risen dramatically over the past two decades.  The increase in success can be attributed to better understanding of various conditions leading to infertility and to development in cell biology in our understanding of egg and sperm interaction, embryo development, and implantation. At the same time, the IVF procedure has been simplified. Egg retrieval, once requiring laparoscopic surgery and general anesthesia, is now done in an office setting using ultrasound.  The increase in success combined with the ease of use has made IVF accessible and applicable to more couples.

However, despite these significant improvements, IVF success is still limited by factors such as age and the accompanying reduction in egg quality. Additionally, standard IVF requires the use of ovulation drugs with the potential of side effects and serious complications.

In this review we will address three emerging technologies aimed at addressing the above issues and making IVF easier and more effective.   These include:

 

  1. PGD: Pre-Implantation Genetic Diagnosis

2)   Egg Freezing

3)   IVM: In Vitro Maturation

 

PGD: Pre-Implantation Genetic Diagnosis

PGD has joined amniocentesis and CVS (chorionic villi sampling) and is becoming an important addition to our prenatal testing (tests done prior to birth). In contrast to the other two, PGD provides information on the developing embryo, allowing the diagnosis to be made prior to implantation. This allows us to prevent a variety of abnormal pregnancies, miscarriages, and birth defects.

PGD was pioneered in the early 1980’s as a genetic testing tool to help identify healthy embryos in couples that were carriers of debilitating and even fatal genetic disorders such as cystic fibrosis and muscular dystrophy. These conditions involve a specific defect in a single gene. More recently it has become possible to use PGD to diagnose a different class of problems, those involving an abnormal number of chromosomes (aneuploidy). Those problems can lead to conditions such as Down’s syndrome and are much more prevalent in the infertile population than the gene disorders. These abnormalities are generally linked to poor egg (or sperm) quality and are often a result of aging.

 

Indications for PGD:

  1. Known carriers of genetic defects
  2. Older couples undergoing IVF
  3. Couples with repeated IVF failures
  4. Couples with a history of miscarriages
  5. Couples with severe male factor infertility

 

In those cases, PGD can:

  1. Improve the odds of a successful outcome
  2. Lower the risk of miscarriage
  3. Lower the risk of various birth defects
  4. Allow the couple to understand the cause of their infertility and “move on”

 

The PGD procedure is highly complex and requires the coordinated efforts of the entire IVF team, the physician, nurse, embryologist, geneticist, and psychological counselor.

Two technologies have made PGD possible:  micromanipulation and genetic diagnosis.  Following fertilization and embryo growth, a single cell is removed from an eight-cell embryo.  Micromanipulation allows the “biopsy” to be done without damage to the embryo. The cell is then analyzed using modern genetic testing to allow the information to be available in time for the embryo transfer 24-48 hours later.  The information is then used to determine which and how many embryos will be transferred.  At the present time our ability to use PGD for diagnosis is limited by the fact that not all disease-causing genes have been identified and by the fact that we are still unable to count all the chromosomes in a single cell using the available techniques. However, these issues are currently being studied and will likely be remedied in the near future.

To date over 20,000 births have been reported following IVF/PGD. There appears to be no impact of PGD on the embryo’s ability to implant and grow into a healthy baby.

The future of PGD appears promising. It is very possible that it will become an integral part of the IVF procedure. At our center we explain PGD to all patients who are undergoing IVF. Any patient who thinks she may be a PGD candidate should ask her reproductive endocrinologist to do the same.  We use the indications listed above to recommend the procedure to an individual couple.

 

Egg Freezing

Freezing of sperm and eggs has been available for quite some time and is used routinely with good results. The success of egg freezing however has been limited.

The potential applications of egg freezing can be far-reaching and include:

  1. Single women who are diagnosed with cancer and are about to have surgery or chemotherapy, which is likely to damage their ovaries.
  2. Single women who are concerned about the effect of aging on the quality of their eggs and their chances of achieving a successful pregnancy.
  3. Creating egg donor banks similar to sperm banks, providing couples in need of egg donors a wider choice and simplifying the procedure.
  4. A way to limit the number of embryos created during standard IVF.

 

Recent developments in the field of cryobiology have made egg freezing a reality. Cryobiology involves the study of the freezing of cells and biological material. During freezing, ice crystals form within the cell and can damage essential structures leading to cellular abnormalities or cell death. In order to minimize cell injury during the freezing process, special “anti-freeze” solutions are used. Each cell has its own special characteristics, which need to be addressed in order to achieve success. The egg cell, the largest cell in the body, is especially sensitive to the damage caused by freezing.

Recently, better understanding of the egg cell has led to successful freezing. Experience is still limited. Only 300 births have been reported thus far worldwide with no evidence of birth defects resulting from the procedure.  The process involves the use of ovulation drugs similar to those used for standard IVF. Eggs are retrieved and frozen prior to being fertilized. The eggs can then be kept for prolonged periods without any deterioration.  When needed, the eggs are thawed, fertilized, and transferred, again the same as with standard IVF.

 

In Vitro Maturation of Eggs (IVM)

The IVF procedure includes the use of ovulation drugs in order to help develop and mature a large number of eggs. Those eggs are then retrieved and fertilized. There are certain drawbacks to the fertility drugs, particularly the gonadotropins that are used for IVF.  The drugs have to be administered by injection; side effects are not uncommon and on occasion can be serious (hysperstimulation). In addition, there is some theoretical concern of long-term side effects with prolonged exposure to these drugs.

The idea of performing IVF without drugs is therefore very attractive.  In IVM, egg retrieval is performed using a minimal dose of medications or no drugs at all. In most cases up to 10 eggs can be retrieved. Those eggs are immature and need to be treated with the same fertility drugs in order to achieve maturation. Only then can they be fertilized and grown into healthy embryos. Despite repeated attempts over the years, the success of this procedure is still limited, probably due to gaps in our understanding of the normal process of egg maturation. It remains, however, a very promising technique.

 

Summary

IVF is rapidly evolving. Major improvements have been made but apparently much remains to be learned.  For the infertile couple, these advancements can mean easier access to therapy and better outcomes.  The key to success is proper diagnosis of the cause of infertility and the application of new technology when appropriate.

 

Dr. Gad Lavy, MD, FACOG, is the founder and

Medical Director for New England Fertility Institute and

Lifeline Cryogenics.  Dr. Lavy can be reached

at GLavy @nefertility.com or 203-325-3200.

 

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