The IVF Process: One Step at a Time
It's Medical Monday, and as promised, one of our fertility nurses has written her version of step by step instructions on an IVF (in vitro fertilization) cycle. I say her version, because Kirsten's sense of humor and the emphasis that she places on certain words and phrases is all her own. Another nurse or doctor may have explained the process in a slightly different way, with each style having it's own merit. Kirsten's voice comes through on this wonderful piece and makes for lively and yes, almost fun, reading. After seven years here at RMACT, I undestand the IVF process better than I have before. Enjoy~ Lisa Rosenthal
Understanding an IVF Cycle
At Reproductive Medicine Associates of Connecticut (RMACT) we recognize how stressful it is for you, our patient, to undergo an IVF cycle. Unfortunately we can’t take the stress away completely. We can help you tackle this task with a clear head, a sound plan, and the comfort of knowing that you have a supportive team rooting for you every step of the way (that’s us!).
In this post I’m going to do my best to give you an overview of what to expect in a typical IVF cycle … think of it as a “zoomed out” picture. (Rest assured, your doctor, nurse, and navigator will help you “zoom in” on your specifics once you get started.)
Our first step is to gather information about you. We want to know how strong and well-functioning your ovaries and reproductive organs are and confirm that you are healthy and fit for pregnancy. We do this with a series of blood tests and ultrasounds. Depending on where you are in your menstrual cycle, it can take 4-6 weeks to complete this step.
Sometimes even this first step can get confusing - but don’t worry! While you are with us, you will be assigned a patient navigator who will assist you every step of the way. She will be your “go to” person. She will help you schedule appointments, and direct your questions when you don’t know who to direct them to. Navigators help you and navigators help us. We love them and you probably will too.
Once we have all of the necessary info, your doctor will decide if IVF is right for you, and if it is, she/he will customize a protocol. This is a fine tuned, carefully thought out “recipe” (medications and ultrasounds) that is very specific to YOU. You will follow this “recipe” for several weeks and we will carefully monitor you along the way.
Goals of IVF Treatment
Our first goal of treatment is to make sure that your naturally occurring hormones don’t interfere with the IVF medications that we are going to use to stimulate you to produce follicles (sacs containing eggs). We do this by starting everyone on birth control pills (in certain cases you may use medications called Aygestin or Lupron instead). Your nurse will ask you to contact them with your next menstrual cycle and she will instruct you on how to start pills or other medications.
While you are on birth control pills our finance team is hard at work. They have the tricky task of getting insurance companies to approve treatments and medications. They work very closely with you so that you understand what you will have to pay along the way, with no unexpected surprises. Once your finance coordinator is confident that both you and your insurance company are on board, they will give us the “green light” to order your mediations. Medications for IVF are ordered thru specialty pharmacies (you can’t just pick them up at your local CVS or Walgreens). If your insurance company is paying for your meds, they will tell us which pharmacy to use.
In the meantime, your assigned nurse will help you schedule an IVF teach class. This is a 2 hour class where a nurse will explain what medications you are taking, why you are taking them, and how to take them. For many of our patients, this is when the moving parts of the cycle start to “click,” and they feel that they have a clearer understanding of what to expect.
Once you have attended class and gotten your medications, we will instruct you to stop your birth control pills. (Our aim is to have you on pills for 1-2 weeks. Occasionally it can be longer.) A day or two after stopping birth control pills we will ask that you come in for a blood test and ultrasound. We are ensuring that everything is “quiet”. (In fact, you may hear us call this visit a “suppression” or “baseline” check.) We want to make sure that the lining of your uterus is thin, that your hormone levels are appropriately low, and that there aren’t any sneaky follicles or cysts growing on your ovaries. If all looks good we will instruct you to start your injections. If something is going on that we were not hoping for, then you will be instructed to stay on birth control pills or be give a new plan. This potentially could delay you by a week or two.
Most women need injections for 10-12 days. The exact amount of time varies from woman to woman, so don’t be alarmed if you need a little less or a little more time. It’s not a race … and please keep in mind – we don’t compare you to other women, so you shouldn’t either. Your ovaries will tell us how long they need.
During the time that you are giving yourself shots, we will instruct you to come for blood tests and scans regularly … typically every other day. As the follicles on your ovaries grow, we count and measure each one of them.
Count and measure, count and measure, count and measure, until TA DA! Your ovaries have their final say and you are ready for surgery (the retrieval) to collect the eggs.
On retrieval day you should expect to be in our Norwalk office for 2 to 3 hours. You will have anesthesia thru an IV that will make you sleep comfortably. The procedure typically takes 15 minutes and then we will monitor you for about an hour. Before you go home we will be able to tell you how many eggs were collected. At this point we won’t know much about them. We will tell you to go home, take a nap, and to start binge watching Downton Abbey (or the series of your choice). You may still feel crampy, bloated, or tired. Usually Tylenol is sufficient for your discomfort.
The day after you retrieval a nurse will call to check in with you, and tell you how many of your eggs fertilized. Two days later a doctor will call with an update, and two days after that you will either come in for your transfer (replacing an embryo or two back into your uterus) or get a call to let you know how many of your embryos were frozen for future use. If you have a transfer, we will schedule your pregnancy test 9 days later. If you freeze your embryos instead, we will ask that you call us when your period starts (usually two weeks later) so that we can schedule an FET (frozen embryo transfer).
For some women, the 9 days between the embryo transfer and the pregnancy test can be the most challenging part of the process. Many of you report that it feels strange to not be coming in to the office regularly (don’t worry – we’ll still call to check in on you). Some of you will be tempted to pee on a stick at home. Please don’t. Here’s why: The medications from your cycle may still be in your system. And, therefore you could have a positive test even if you aren’t pregnant. On the day of your pregnancy test we will ask that you come in first thing in the morning for a blood test. Approximately 4-5 hours later we will give you a call with your news. Regardless of the results, we will go over your next steps. We will tell you what meds you should continue, what you should stop, and what to expect over the next few days. If your result is positive, we will instruct you to repeat the levels 2 days later, and from there we will start booking your ultrasounds.
Occasionally the pregnancy test comes back positive, but your levels are lower than we expect. In these situations, we tread very carefully. You will be instructed to come back 2 days later for a repeat test to see if your numbers are rising appropriately. We are optimistic that they will, but very cautious. Unfortunately, most of these pregnancies will not continue normally.
Fertility Treatment Can Be Intense But Also Empowering
Fertility treatment isn’t a perfect science. And, sometimes we have to give you disappointing news along the way; your ovaries may not respond to medications the way that we had hoped, the number of eggs that we get in the operating room may be less than we expected, or your fertilized eggs may not grow to normal blastocysts. If this happens, we realize you may feel sad, disheartened, frustrated, or maybe even angry. Fortunately, this news rarely sneaks up on us and we will be communicating any concerns along the way. We also have a great team of wellness providers who are available to help you if you feel overwhelmed or need help making decisions and moving forward.
So, yes, IVF treatment can be intense, but it can also be empowering. Many women feel excited about being proactive and moving forward. We know that a lot of responsibility falls on our patients. We know that you will be rearranging your schedule like a Personal Admin, mixing medications like a Chemist, and administering injections like a Nurse. We will give you the tools and you will conquer it with confidence. We are your ultimate fans, and we will root you on as you tackle this journey. Good luck!
About IVF (in vitro fertilization)
Here at Reproductive Medicine Associates of Connecticut (RMACT), we have a wealth of experience. One of the reasons that I appreciate that so very much is that we can look at different ways to explain things. Our clinical staff, including our board certified reproductive endocrinologists, physicians assistant, specially trained fertility nurses, patient navigators, medical assistants, financial team and more; they all have a specific way of seeing the fertility treatment process and protocols.
Why is that important? Why does that matter? Because sometimes it is helpful to hear a different perspective. Sometimes hearing the same information from just a slightly different point of view, variation on language, a metaphor that makes more sense to you, can bring you to understanding that you can feel all the way to your toes.
So, something new for this blog, PathtoFertility; an ongoing series by our wonderful, talented team at RMACT. Below, find the information that we have on our website regarding IVF.
Next Monday, on Medical Monday, we will have a more step by step description of IVF (in vitro fertilization) from one of our talented fertility nurses. Don’t worry, I will remind you that it’s coming.
You will love it. It’s well written, with a sense of humor, which can be quite a relief in the middle of the seriousness of fertility treatment.
Something to look forward to~ Lisa Rosenthal
During the in vitro fertilization (IVF) process, eggs are removed from the woman’s body and combined with sperm in the laboratory to create embryos, which are then transferred into the woman’s uterus. Nearly 60% of IVF procedures in the United States are performed on women 35 and older.
Before undergoing IVF in Connecticut, you will be prescribed several medications to stimulate the development of multiple ovarian follicles containing eggs to be fertilized. We closely monitor this process using blood tests and ultrasound. Once the eggs have matured, they are retrieved through a simple procedure under ultrasound guidance. We then expose the retrieved eggs to sperm and transfer a limited number of the resulting embryos back into your uterus.
In Vitro Fertilization at RMA Connecticut Recognized for Scientific Excellence
The fertility doctors at RMACT are all board certified in Obstetrics & Gynecology and Reproductive Endocrinology. They are members of the American Society for Reproductive Medicine (ASRM), a voluntary, non-profit organization devoted to advancing knowledge and expertise in reproductive medicine and biology. They are also members of the Society for Assisted Reproductive Technology (SART), an organization of assisted reproductive technology providers affiliated with ASRM that has collected data and published annual reports of pregnancy success rates for fertility clinics in the U.S. and Canada since 1989.
In addition, RMACT is fully accredited by both the Accreditation Association for Ambulatory Health Care (AAAHC) and the American Institute of Ultrasound in Medicine (AIUM).
Our Reproductive Endocrinology and Infertility Laboratory meets the highest standards and is certified by the College of American Pathologists (CAP) and the Clinical Laboratory Improvement Act (CLIA) for the State of Connecticut. As a result of its expertise and experience, RMACT is one of just 11 leading In Vitro Fertilization (IVF) centers nationwide chosen by In Vitro Sciences to participate in its Centers of Excellence program.
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IVF News - More Babies, Less Multiples
In the news today! The "Number of test-tube babies born in U.S. hits record percentage," reported The Chicago Tribune, along with other outlets picking up the same IVF news released by SART (Society of Assisted Reproductive Technology) and announced in ASRM (American Society of Reproductive Medicine) Bulletin Volume 16, Number 12.
More IVF babies (when are they going to stop calling them test-tube babies? For goodness sakes, it’s just a little outdated, no?) were born in 2012 than in any other year since the inception of the scientific and technological treatment in the 1980’s.
SART released that data based on the fertility practices that verify and report their treatment results. For those challenged by infertility or more correctly, sub-fertility, this is great news. Technology is working, despite all the recent media buzz about men and women being mislead about succeeding in creating their families with IVF.
IVF Success Rates Released
So let’s be really clear. The numbers are these:
165,172 IVF cycles and 61,740 babies. IVF succeeds and it fails. Many of those cycles represent people who have undergone more than one cycle, having had both an IVF cycle failure and then an IVF cycle success. Many of these 61,740 babies are twins; fewer are triplets or higher order multiples (3 or more embryos/fetuses/babies).
These are the statistics. I’m not going to tell you whether they are good or bad statistics. You, anyone, can read them any way you want. An average of 1/3 success. An average of 2/3 failure. Too many twins. More singletons. Technology that is used to help create families. Technologies that cost a lot of money and result in people still not having their babies. Any point of view has its own validity. There is no one right point of view. IVF fails. IVF succeeds. IVF fails at a larger rate, on average, than it succeeds.
I have a few points that I’d like to focus on.
1. It does matter where you are in treatment. It does matter what the pregnancy rates are; that the fertility program you are considering reports to SART. To me, that’s one of the few slam dunks. For the pregnancy results to be verifiable and not just what someone would like you to believe. If it turns out that the fertility practice that has the highest pregnancy rates in your area is one that you are considering, dig a little deeper. Pregnancy rates aren’t the only means in which to measure success. Odd sounding? Consider. If a fertility practice will not take a patient over the age of 40 or 42, or 44, given that over the age of 35 IVF is far less successful, then that’s a practice that is treating patients who will skew their statistics down, not up. If a fertility practice will not accept patients for IVF with a FSH of over 12 or 16, or 18, there again, you have a program that is only accepting patients that will, statistically, do very well with IVF.
2. Be aware of the issues. I would not suggest that you discriminate against a fertility practice that accepts patients who may not do as well as other patients, who, by definition, will skew their pregnancy statistics downward. But be aware of these issues. Ask the questions, even if they do not apply to you. Because conversely, the fertility programs that are eliminating patients who might cause a drop in their pregnancy rates are also, in essence, artificially raising their pregnancy rates. Please note, I did not say they were being misleading or lying. It just makes perfect common sense, statistics aside, that if a fertility program will not take patients that are “difficult” (high FSH, low AMH, advanced maternal aging, premature ovarian failure, etc.) that there pregnancy rates will be higher.
I am not saying don’t use these practices. I am saying KNOW what the fertility programs that you are considering use as a barometer to accept patients. If you have any of the criteria that make you a “difficult” patient, you will want a fertility practice well versed in handling those issues, both in the medical treatment they provide and the support services they offer.
3. Be an educated patient. It will serve you well. It will help you avoid the feelings that have been expressed by so many recently in the public eye about having been deceived and betrayed. Know the questions to ask and if you are not sure, educate yourself. SART, ASRM, ACOG (American College of Gynecology) are all reliable and responsible websites and organizations that you can trust. They are a great place to start. The patient not-for-profit organizations are also full of helpful and reliable information. Try the following websites: Resolve, The American Fertility Association, INCIID (InterNational Council on Infertility Information Dissemination), Fertility Within Reach, PVED (Parents Via Egg Donation), A.T.I.M.E. (A Torah Infertility Medium of Exchange), and Centerlink (The Community of LGBT Centers).
IVF Statistics and Considerations
Finally, on a very human note, there are babies being born, enlarging families, every single day, from IVF (in vitro fertilization) treatment. They are not IVF statistics. They are not 30% of a baby. They are the 100% baby that are the dreams that their parents are dreaming when they come into fertility treatment. They are real, tangible, flesh and blood children who cry and poop and sleep and eat and drool.
There’s a lot to consider when reading an article about statistics. Ultimately, you will take away from such an article what you most want to believe. Maybe you will take away from this article what you most need to believe.
Educate yourself; learn more about the fertility treatment and program that you consider using. Honor your feelings and, if you need to, find a way to silence so that you can discover what you are feeling. Statistics and facts can only lead you so far. Only you will know what is right for you.
We’re here to help.
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Pregnant with Twins: One Couple's Reaction
Bear with me, there’s a blog out there that I want to comment on concerning IVF and twins. Namely, the blog about a couple who is pregnant with twins and are “pissed off” about it. Being me, I have a few things I want to say first.
Becoming pregnant and having a safe and healthy delivery and beautiful baby afterwards.
Those are the goals when you are up against infertility issues.
A lot of us go through a period of wishing, hoping, and even praying for twins.
You have your baby. And your baby has its sibling.
And so you’re done.
Some of us stay in that phase and are thrilled when that is what comes to pass. Two babies at the same time. Twins.
Many of us move on to feeling that one at a time, or simply one is a safer, healthier, even saner choice.
IVF and Twins: Elective Single Embryo Transfer (ESET)
Certainly the infertility field and most board-certified reproductive endocrinologists and fertility programs are moving away from multiples with elective single embryo transfer (ESET). There are many reasons why conceiving, carrying and delivering a single baby is preferable to multiples.
Main reason: it’s safer for baby and mom. The outcome is more predictable with just one at a time.
Really. We all know this.
Thank goodness so many twins and multiples are born healthy and strong and vital. And that so many moms make it through just fine as well. That’s a huge comfort for any of us carrying more than one. Good prenatal care, eating properly, exercising moderately, sleeping and listening to your doctor’s advice carefully will help ensure a good outcome.
This is the longest preamble in history to talk about the blog on CNNHealth yesterday.
Title: “We’re Pissed” to be pregnant with twins.
Here’s a quote from the dad to be: "To say we're excited would be an exaggeration," the dad wrote on Babble.com in an anonymous post that recently started trending on social media. "More truthfully, we're pissed. And terrified, and angry, and guilty, and regretful."
I know this is not politically correct. I know that we’re all supposed to be happy and thrilled because there’s a healthy, on-going pregnancy and that infertility has been conquered. I know that those of us who are still not pregnant could feel really resentful and angry towards this couple for speaking out about their upset.
I want to send them a thank you note.
What I have learned about human nature is that we are not unique. Well, we are, of course. We are all individuals and have our own DNA and personalities. Of course we do.
We also have a lot more in common with every other human being on earth than we do with any other species.
That’s a lot to have in common.
And in my humble opinion, there are folks out there that are relieved that this couple opened their mouths and said what they were not comfortable saying. Because it’s not politically correct or okay. And they said it anyway. They have voiced what some of us may have felt when we found out that there was more than one gestation.
That they’re scared. And upset. And maybe they would have preferred childfree to two at one time.
I thank them because if it relieves guilt and shame for other people pregnant with more than one, then that’s a good deed.
Pregnancy Emotions and Honest Admissions
Admitting to mixed or even negative feelings is not easy to do. But it’s honest. And it’s not a predictor, by the way, about how they will do as parents. Feelings aren’t reality. Feelings can pass. They can change and shift, especially with the help of a mental health professional.
Many of us are thrilled to become pregnant with multiples.
But not all of us.
And for those of us who are not, I applaud this couple for speaking so frankly about what others may not want to say. It can relieve the shame and guilt of these feelings.
So please, let’s not judge them. They’re not asking you to feel differently. And they are entitled to how they feel and to say it out loud. I know it’s hard to hear. Still, they have the right to say it.
More tomorrow on how to make choices and avoid situations that truly are not right for you.
Lisa Rosenthal's Google+
A Tribute to Dr. Robert Edwards
It is with great sadness and a profound feeling of loss that I share the information that Professor Sir Robert Edwards, who was a pioneer in the field of treating infertility and creating families, has died this week. He was responsible, with Dr. Robert Steptoe and others, for creating in vitro fertilization. Read below the blog that I wrote when Dr. Edwards won the Nobel Prize.
It will give you an idea of the magnitude of the impact Dr. Edwards had on the fertility treatment that is available today. For all intents and purposes, he and Dr. Steptoe were primarily responsible for in vitro fertilization (IVF). If you are the parent of a baby or babies that have been conceived with IVF, consider the vast company that you are keeping, that Dr. Edwards was so intricately involved in creating. According to IVF.net, there are over three million IVF babies worldwide. Please give your children an extra hug today in tribute to this wonderful pioneer.
Pioneer of In Vitro Fertilization (IVF)
The blog below, written to celebrate the Nobel Prize:
A very exciting news announcement earlier this week shook the reproductive health community in the best possible way. The Nobel Prize, arguably the most famous and prestigious scientific prize awarded each year, has been bestowed on Dr. Robert Edwards. Dr. Edwards was one of two men responsible for the first In Vitro Fertilization (IVF) baby in the world (Louise Brown). Dr. Edwards worked with Dr. Patrick Steptoe as far back as 1968, creating the first fertilized human embryo in a laboratory setting.
Read what Scientific American had to say:
"Edwards, a professor emeritus at the University of Cambridge, began research on the problem of infertility in the 1950s. The first "test-tube baby," Louise Brown, was born in 1978, an event that the Nobel expert panel called "a paradigm shift." Since then, approximately four million babies have been born worldwide via IVF, many of whom now have children of their own."
Something else to be noted:
"Since it was first awarded in 1901 the Nobel Prize in Physiology or Medicine has rarely been bestowed on an advance that has led to such a singular clinical application (last year's Nobel in physiology or medicine was awarded to Elizabeth Blackburn, Carol Greider and Jack Szostak for their work with telomeres and telomerase), and it has rarely been given for work in reproductive research."
Read Medical Director of Reproductive Medicine Associates of CT (RMACT), Dr. Mark Leondires' comments about Dr. Edwards, along with many others from our team:
The achievement of Dr. Edwards has had a profound effect on the world. Not only has he helped millions of couples achieve the dream of having a family, but his work has led to over 4 million new lives. These live represent children who were truly a gift to their parents. This work has opened up new doors and continues to open eyes across the globe. I am still in awe at the time of embryo transfer to see dividing embryos under the microscope. I thank him for his work and courage in the face of adversity. I hope to proudly continue his legacy and dream to help infertile patients conceive and have families.
~Dr. Mark Leondires
We all recognize and pay tribute to Dr. Robert Edwards pioneering contribution to our field. Through his work so many families and children have been touched. He made such an important contribution to science and society.
~Dr. Spencer Richlin
Dr. Robert Edwards’ pioneering effort blazed a path that we, reproductive endocrinologists and fertility patients together, are still following today. Not only was his work, along with Dr. Patrick Steptoe, a monumental achievement in science and medicine, it has helped millions of people achieve their dreams of family-building. IVF has helped usher over three million babies into the loving arms of families. It all started with their work and dreams, 35 years ago. Every one of us here at RMACT is proud, and humbled, to stand on Dr. Edwards’ shoulders and continue the work of helping patients create their families.
~Dr. Joshua Hurwitz
The awarding of the Nobel Prize to Dr. Robert Edwards is a long overdue recognition of his and Dr. Patrick Steptoe’s pioneering work in developing IVF. It is so important because of the statement it makes about the importance of In Vitro Fertilization (IVF). There are over 4 million babies, children, and adults out in the world today who would not be here today if it was not for their discovery. This award also represents the fact that IVF is in the mainstream and is no longer considered to be an experiment, but a legitimate medical treatment that has the potential to benefit many more people.
~Dr. Cynthia Murdock
Even though we recognize the pivotal role he played 35 years ago with the first IVF birth in England, he has influenced the field of reproductive endocrinology for his entire career. Even in the early 60’s, he was working closely with Dr. Georgeanna Jones and her husband Dr. Howard Jones to understand the interactions between sperm and egg that have allowed fertilization to occur outside of the human body. Eventually, the Drs. Jones reported the first successful pregnancy after in vitro fertilization in the United States. And even in the new century, Dr. Edwards was a fixture at professional meetings, challenging even the most modern research into the molecular mechanisms of reproduction, and influencing a new generation of scientists as he influenced the other pioneers of our field. He was truly an extraordinary scientist, dedicated to the advancement of knowledge and learning.
~Dr. Shaun Williams
It goes without saying that Noble Prize winning, Dr Bob Edwards was a brilliant scientist. He was also much more than that. Long after his 1978 success with the birth of Louise Brown (the first IVF baby), he continued to be passionate about improving embryo culture. At scientific conferences in years past, he would engage and mentor more junior embryologists, such as myself, in thought provoking discussions. He challenged and inspired those of us in the field to be our best, all toward his ultimate belief that all families deserve to parent a healthy baby. Dr Edwards will be sadly missed but there is no question that his IVF legacy has changed & will continue to change our world for the better.
~Dawn Kelk, PhD, HCLD
I have had the pleasure of meeting Dr. Robert Edwards many times over the past two decades. He is always charming and acts as though he has all the time in the world for whatever conversation he is immersed in. Dr. Edwards always supports patient organizations by giving interviews, participating in events and discussing the importance of the work that they do. Although first and foremost a scientist, his obvious concern for the patient, for those needing the techniques that he was at the forefront of creating, is always apparent. He very much understands the human side of what his work has allowed.
To have IVF called a paradigm shift by the Nobel expert panel is an acknowledgement of reproductive health that has not occurred in any way before. It is huge. Really no other way to say it, it’s simply huge. And it validates all of you using this technology. This is not a lifestyle choice, this is not frivolous, this is important, life changing medicine. A paradigm.
Without a doubt, Professor Edwards will be sorely missed. For his academic and scientific brilliance, as well as his compassion and sense of humor. Our sincere condolances to his family, friends and colleagues.
Lisa Rosenthal's Google+
Hugh Jackman on Infertility and Les Miserables
I took my own advice yesterday.
It was Christmas so I went to a movie. It was packed, which was not surprising as Les Mis was opening.
The full title, of course, is Les Miserables, but most of us know it as Les Mis.
By the way, it is a no brainer to go see a production of Les Mis with Hugh Jackman, Russell Crowe, Anne Hathaway, Eddie Redmayne and more. At least for me. And by the fact that the theatre was full, by many others as well.
I am not much of a groupie. Celebrities don't really light me up all that much. I've been known to call my best friends from parties or galas where there were "stars" floating around because, simply? I don't care all that much.
There are a few, though, that are exceptions.
Hugh Jackman is one.
For all the obvious reasons. He's gorgeous, with a fabulous accent. And he's a good, even frequently, a great actor. He can do funny really well too. And he's even got a lovely singing voice. There have been very few times that I've been disappointed by him in the theatres. Including live on Broadway.
He also spends a lot of time in my neck of the woods. He is seen fairly regularly in the town that I spend most of my time in and is known as a gracious, friendly man. And a great father. He picks his children up and does a lot of very regular things with them, casually with no big fanfare. Just a regular, albeit, fabulous looking dad.
Talking about IVF, Miscarriage and Movies
I was surprised by the interview with Katie Couric on December 18, 2012, where he shared the multiple IVF (in vitro fertilization) procedures and subsequent miscarriages that he and his wife experienced.
Why surprised? Not because of the infertility factor. We know how often people experience infertility problems. One in six or eight couples, depending on the statitistics you use. Infertility occurs incredibly frequently. Surprising, isn't it? Given how alone some of us feel going through fertility treatment.
Why do we feel alone? Because very often, we don't talk about it. Not with our friends, not with our families. Not in a nationally broadcast interview.
So why was I surprised about Hugh Jackman's challenges with infertility?
Because he chose to share it. The interview was really about the opening of this movie, no? I'm thinking that it was, given that the movie was coming out a week later and he played a big part in making this movie happen beyond starring in it.
He shone the light on infertility in an interview where he could easily have focused on the movie or other aspects of his family and life.
He chose to speak about infertility, IVF cycles and miscarriages. He chose to speak about grieving losses and the healing that occured after his son was born.
I always liked and admired Hugh Jackman.
Now, though, I think I'm a fan.
Affordable IVF: Are Raffles for Infertility Treatment an Appropriate Option?
In the discussion of affordable IVF treatment, maybe today's blog should just be one quote from The New York Times article, "Clinic Raffles Could Make You a Winner, and Maybe a Mother," published on October 2, 2012.
That quote would come from one of my fertility heroes, who also happens to be my best friend, Pamela Madsen. Pamela's been a national and international spokesperson in the field of infertility for over two decades. As evidenced by The New York Times interviewing her for this article. Here's her quote. Oh, in for a pound here, I'll share the entire paragraph.
“It is against the law to raffle off a puppy, but we’re allowed to raffle off the opportunity to have a baby?” said Pamela Madsen, a founder and former executive director of the American Fertility Association, a nonprofit organization based in New York City. “What if they were raffling off chemotherapy? Would we be O.K. with that?”
I have to admit here, that this is not a topic that I am passionate about. Not. If you have read this blog before, even once, you will know that I am passionate about many issues around infertility, fertility and fertility treatment. For some reason, raffling off IVF cycles just hasn't rocked my boat.
Considering Free In Vitro Fertilization (IVF) Cycles
There is the side that a lucky person or couple gets a free IVF (in vitro fertilization) cycle. I get how that is appealing and even advantageous.
Then I look at the advertising around it. The marketing around it. It's not even that awful. Tasteful even. Maybe. Maybe not. (Sending in a video, explaining the depths of your desire and the desperation that you are experiencing around not having a child or the financing needed?) And then my skin does start to crawl a bit.
For a few reasons.
One of which is that if a fertility program truly wants to help someone with a free cycle, it's easy enough to create a scholarship program and QUIETLY give a reduced or free IVF cycle. The idea that one would need to be sympathetic (pathetic?) enough to win a cycle would argue that all those who did not win were somehow not worthy enough. And we all get enough of that feeling throughout treatment, no?
Then there's the fact that infertility is a medical condition. It's even considered a disease, by the AMA (American Medical Association). How do we raffle off treatment for a medical disease and then expect and get the respect needed to lobby for insurance coverage or insurance mandates? Perhaps a fertility programs' money and altruism is better spent supporting those efforts, quietly or not. Unfortunately, those efforts will not get an article in The New York Times.
Or perhaps it's just as simple as Pamela said it, which she discusses in more detail at her blog, The Fertility Advocate. We're not allowed to raffle off a puppy. It's illegal. Why? Because it's demeaning? Because it's not an ethical way to treat a living being? Because it's been proven in the past to have deleterious effects that weren't expected or anticipated?
I'm grateful to have a community, full and robust, to have helped me out here about why IVF cycles being raffled is not in the best interest of patients. Sometimes, you just need a little help from your friends. Or a lot.
Thank you to Pamela Madsen, Terri Davidson, Amy Demma, Rachel Gurevich, Mary Moritz Fusillo, Elizabeth Swire Falker, Keiko Zoll, Alissa Vitti, Kristen Magnacca, Mike Berkley, Sharon LaMothe, Fertility Authority and more. You have all helped me with seeing things around this issue, whether you know it or not!
Big, extra special thanks to the entire team at Reproductive Medicine Associates of Connecticut (RMACT), who instintively knew, way before me, that this was not the right thing for them to participate in. Who quietly support patients with financial needs, who give money to Resolve (The National Infertility Association) and The AFA (American Fertility Association) to support legislative efforts, who personally give of themselves every single day.
Good things for friends and community.
IVF Coverage Proposed for Veterans
There's a bill being considered in the U.S. Senate to expand fertility coverage, specifically IVF (in vitro fertilization), to veterans who need it. Eric Tucker reported the story for the Associated Press and the IVF story appeared in The Seattle Times on August 18, 2012.
I'm in favor of it.
My reasoning is if someone has served in the armed forces, has been wounded in a way that affects his/her fertility and reproductive ability, I believe that it's only fair that their health insurance should cover their IVF attempts.
To be perfectly honest though, I believe that there should be fertility treatment coverage for all men and women who have impaired fertility.
It also makes sense to have medical health insurance coverage for problems that you have with your spleen, or gall bladder or heart. Or any other organ or system in your body.
That's what medical health insurance is for, isn't it? To cover the financial aspects of medical coverage when something isn't functioning properly in your body.
Access to Fertility Treatment Insurance
Why isn't there more access to insurance for fertility treatment? Why isn't fertility treatment covered?
Why isn't it covered?
It's been described as being elective, for one.
I don't get it.
It's elective that someone's fallopian tubes are blocked and an egg can't move through them to her uterus?
It's elective that a woman's thyroid and hormones don't respond the way that they should and don't produce enough estrogen?
I don't get it.
These are not choices that any of us make, anymore than we choose any dysfunction of our body.
Just for the record, I agree that medical insurance should cover treatment of erectile dysfunction. And reconstruction after mastectomies. These are treatments related to our bodies dysfunction and disease.
Reproductive Health and Equal Treatment
Why is reproductive health any different? How does it become elective because there's a baby involved?
How does it become more of a responsibiility of a health insurance agency to cover fertility treatment because the cause is from active, military duty?
Read what one veteran had to say about his experience with fertility treatment, medical insurance coverage and IVF. Especially notice the last paragraph.
"Robinson, the now-29-year-old Marine who suffered the broken neck, said he started exploring ways to have children — something he and his wife had always discussed — during an extensive rehabilitation process.
They tried artificial insemination, which didn't work because of poor sperm quality resulting from his injury. They spent $6,000 of their own money on IVF and got pregnant on the first try — and now have 8-month-old twins Collin and Leah.
"Everyone deserves to have a chance at a family. We were able to save the money and stuff like that. But maybe for someone who isn't able to do that, I would hate to see that they don't have that option," he said."
Note that he did NOT say, "everyone deserves a chance at a family" . . . unless they have blocked fallopian tubes, insufficient hormones, unexplained infertilty.
Just that everyone deserves a chance at a family.
I couldn't agree more.
PATIENT FACT SHEET from ASRM (American Society for Reproductive Medicine)
Sperm Shape (Morphology): Does It Affect Fertility?
How do doctors decide if a man might have a fertility
For many years, experts have focused on semen analysis, but research studies show that the number of sperm (count) and the movement of sperm (motility) do not always predict fertility very well by themselves.
It may also be useful to look at the shape of the sperm (morphology),
which is also one of the important parts of the semen evaluation.
An updated way of determining sperm shape is called the
Kruger's strict morphology method. Kruger morphology is
a useful system that helps doctors determine if a sperm is
normally shaped or not. It was originally used to predict
the success of in vitro fertilization (IVF), a fertility treatment
in which the sperm are mixed with the woman's egg
in a laboratory.
More recently, it has been used to tell if
intracytoplasmic sperm injection (ICSI) is a necessary
treatment. ICSI is a procedure that helps a sperm fertilize
an egg by injecting a single sperm directly into the center
of the egg.
Even though it is used for these purposes, not all physicians
and scientists are sure that strict morphology method alone
predicts success with IVF or whether it indicates the need
Characteristics of normal sperm
A normal sperm has:
• a smooth, oval shaped head that is 5-6 micrometers long
and 2.5-3.5 micrometers around (less than the size of a
• a well defined cap (acrosome) that covers 40% to 70% of
the sperm head
• no visible defect of neck, midpiece, or tail
• no fluid droplets in the sperm head that are bigger than
one-half of the sperm head size
Intercourse versus artificial insemination
For patients with fertility problems, sperm morphology may have an effect on your ability to achieve a pregnancy. If the strict sperm morphology is more than 4%, there may be little difference in success whether timed intercourse or artificial insemination is utilized.
A successful pregnancy using IVF depends on many of
factors: how many eggs are fertilized, whether the fertilized
eggs grow into embryos, and whether the embryo implants
in the woman's uterus. When strict morphology is 4% or
less, eggs may have a better chance of fertilization with the
use of ICSI.
Frequently asked questions
If an abnormally shaped sperm fertilizes the egg, does
that mean that my child will have genetic abnormalities?
There's no scientific link between the shape of a sperm and
its chromosomal content. Once the sperm penetrates the
egg, fertilization has a good chance of taking place.
However, there may be some male offspring who will
inherit the same type of morphology abnormalities.
Whether routine investigation of Y-chromosome abnormalities
should be initiated when low morphology is noted is
Are there any substances that I can reduce or eliminate
exposure to (e.g., alcohol, tobacco, caffeine) in order to
improve the shape of my sperm?
Studies haven't shown a clear link between abnormal sperm
shape and these factors, but it's a good idea to try to eliminate
use of tobacco and recreational drugs and limit your
consumption of alcohol. These substances reduce sperm
production and function in several ways. They may hurt
sperm DNA (material that carries your genes) quality.
Studies have not shown a clear link between caffeine consumption
and changes in sperm shape.
Are there any dietary supplements or vitamins that I
can take to improve morphology?
Dietary supplements or vitamins have not been clearly
shown to improve sperm morphology. Some specialists do
recommend that you take a daily multivitamin to improve a
number of body functions, including reproductive health.
The American Society for Reproductive Medicine grants permission to photocopy this fact sheet and distribute it to patients.
Dr. Spencer Richlin
Dr. Spencer Richlin is Surgical Director and a fertility specialist in reproductive endocrinology at Reproductive Medicine Associates of Connecticut (RMACT). In addition, he is Division Chief of Reproductive Endocrinology at Norwalk Hospital. Dr. Richlin is Board Certified in both Reproductive Endocrinology, Obstetrics and Gynecology.
Board-Certified Reproductive Endocrinologist: Infertility Specialist – Connecticut & New York
Prior to joining RMA, Dr. Richlin served on the faculty of Loma Linda University School of Medicine, in California, as a Clinical Assistant Professor of Gynecology and Obstetrics. He is a member of both the American College of Obstetrics and Gynecology and of the American Society for Reproductive Medicine.
Dr. Richlin has published numerous abstracts, articles and book chapters, and is the lead author of the IVF section in Danforth’s Obstetrics and Gynecology, 9th Edition. He coauthored with Dr Leondires the “Infertility” chapter in the text “Avoiding Common Errors in Obstetrics and Gynecology. This is due out in 2011.
Dr Richlin received his undergraduate degree in psychology from The University of California at Berkeley, and his medical degree from the University of Southern California’s School of Medicine. He completed two internships, in Emergency Medicine and Obstetrics. Dr. Richlin served his residency at The Stamford Hospital in Stamford Connecticut from 1995-1999, where he was named Berlex Best Teaching Resident.
He then completed his subspecialty fellowship in reproductive endocrinology and fertility at Emory University’s School of Medicine in Georgia. Then he carried out research projects in in vitro fertilization and intrauterine lesions such as fibroids and polyps. There he wrote book chapters on abnormal uterine bleeding and endometrial ablation.
Editor's side note- Look for a personal interview with Dr. Richlin next week where you can learn more about why he chose to go into the field of fertility treatment as well as what he likes to do when he is not practicing medicine.