Why one baby at a time?
Some very simple basic reasons.
Why am I talking about this?
Because once again, I spoke to a patient who was hoping for twins. One boy, one girl. Done.
I get it.
Never have to go through fertility treatment again?
I get it.
We all get it, actually.
Your doctors, your nurses, your medical staff, they get it too.
But we also get how much more challenging a pregnancy is with more than one baby.
We want you to have the healthiest possible outcome.
We all see multiple pregnancies that are healthy and uncomplicated.
We also see babies that have serious health problems and mothers that are on bedrest for months at a time, often with their own health problems.
We try to avoid this. We are encouraged to avoid this. Both SART (Society for Assisted Reproductive Technologies) and ASRM (American Society for Reproductive Medicine), the two professional organizations dedicated to reproductive medicine, ask us too. Tell us to, actually.
There are guidelines that infertility programs in the United States are supposed to follow. the guidelines dictate how many embryos are transferred in an IVF cycle. The amount of embryos depend mainly on diagnosis and age of mother.
Most infertility programs follow these guideline. Check. Ask. If your program does not follow these guidelines, you may want to consider a different program.
Yes, we do get it. Creating a family via fertility treatment is very challenging and stressful. Not to mention time consuming and financially difficult.
Having the chance to do it all at once is tempting. Very, very tempting.
We want to support you having as healthy a family as possible.
That's our job.
We don't all get pregnant the first month we are trying to conceive. Often we don't get pregnant the second month either, despite many reports of honeymoon babies.
If, however, you have not gotten pregnant after twelve months, usually there's a problem.
If you are over 35, we advise you to see a fertility specialist (Board Certified Reproductive Endocrinologist) after six months.
Here's the assumption that you do NOT have to make.
Do not assume that you will have to spend tens of thousands of dollars or have invasive surgeries.
Many problems in our reproductive system need a simple adjustment with either timing or medication. There are protocols and procedures that can easily tilt fertility in your favor.
In fact, some of the diagnostic tests are also theraupetic. The HSG (Hysterosalpinogram) is one of those tests:
Hysterosalpingography, or HSG for short, is an X-ray procedure used to evaluate the status of a woman’s fallopian tubes, the two structures that carry eggs from the ovaries to the uterus. It is also used to make sure that the uterine cavity has a normal shape and size and to identify uterine malformations, adhesions, polyps or fibroids. These types of problems may cause painful menstrual periods or repeated miscarriages.
Because the HSG uses a dye that moves through the fallopian tubes, often small blockages are cleared out and a pregnancy will occur.
We know that it can be difficult to decide to see a fertility specialist. We know that you don't really want to be in our office. We know that you would have preferred to have gotten pregnant by being intimate with your partner.
Just also know that your path to fertility might be much shorter and simpler than stories you may have heard or read about.
One way to find out.
If you haven't gotten pregnant or been able to carry a pregnancy to term, find a fertility specialist in your area.
The Society for Assisted Reproductive Medicine (SART) is a great source to find one. All of the physicians in the field of reproductive medicine who report their findings are listed here, as well as other pertinent information about the infertility clinics.
Please feel free to ask questions here. They come to me personally and I will answer you, either on the blog, or privately.
You do not have to do this alone. I'm here to help.
Let's talk about pregnancy rates.
You probably have all heard those stories that start out with, "when I was your age, I had to walk three miles to school in the snow, chop wood for the fire and walk the same three miles back home".
Well, when I was trying to conceive, pregnancy rates were hovering about nineteen per cent. Yes, nineteen per cent. Actually, they were a bit higher for me as I was 26 years old, with unexplained infertility. So maybe my chances of getting pregnant were about twenty three per cent.
How things have changed. While some things have remained very much the same, pregnancy rates have most decidedly not. They have gone up, up and up.
More good news.
Fertility treatment cycles do work the first time. Perhaps not often enough, but more often than any of us realize. At RMACT, our pregnancy rates are something that we are very proud of and that you can check on our website.
Even more good news. You can check this type of information on the SART website.
So, for my friends out there who have been in fertility treatment for longer than they'd like to be and are starting to lose hope, please hang in there. I know it's discouraging to hear bad news, to have cycles that don't work, to see everyone around you become parents.
The best news is that fertility treatment does work. A lot of the time, even the first time.
It's not an easy journey, I know that too, but, as often said here, you are not alone. I'll be glad to keep you company.
The American Society for Reproductive Medicine (ASRM) is having their annual meeting in Denver Colorado this week. The meeting brings together the finest reproductive endocrinologists, scientists, clinicians, administrators, attorneys, nurses and more, in the reproductive health field. ASRM’s annual meeting is an opportunity for the professionals in the reproductive health field to take post-doctorate courses, continuing medical education courses, (CME’s), present oral presentations, papers, posters, and videos for just some of the following topics:
A sample of the topics to be covered includes: steroid hormone action, stem cell research, technological advances in reproductive surgery including robotics and adhesion prevention, effects of appetite and diet on reproduction, gender-specific aspects of cardiovascular disease and impact of infertility diagnoses and therapies, the ethics of cross-border reproductive healthcare, molecular genetics of male and female gametes and the early embryo, medical and public health ramifications of menopause, new innovations in contraception, ovarian stimulation, oocyte and sperm cryopreservation, and integration of medical and psychological care of the couple undergoing reproductive medical care.
Reading the press releases is a way that I have always found useful to sift through the tremendous amount of information that is both presented at the meeting and released to us, the public. The first press release that I will share with you this week is on a subject that we have been addressing closer to home at Reproductive Medicine Associates of CT with our nutritionist and our Fertility Seminar Series. That subject is obesity and infertility. Read below for ASRM’s press release:
Denver, CO - Two studies released today at the 66th Annual Meeting of the American Society for Reproductive Medicine, shed light on the link between obesity and infertility.
In the first, investigators used the national database collected by the Society for Assisted Reproductive Technology (SART). Examining the 158, 385 cycles where the height and weight of the woman were reported, they found that cycle cancellation rates increased with increasing body mass index (BMI). The odds of the patient failing to become pregnant, or that pregnancy not being successfully carried to term, also rose significantly with increasing obesity.
A team from Harvard and Brigham and Women’s Hospital in Boston sought to explore the reason behind the link between infertility and obesity. In their study they examined the quality of the eggs and embryos from women of different BMI categories. They found that the eggs from women with high and low BMI’s were more likely than other women to produce immature oocytes during an ART cycle. This led to lower odds of successful embryo transfer per retrieval and a lower live birth rate.
“Clearly a healthy body weight is an important advantage in all aspects of health, including reproductive health. We are hoping that with better information we can provide better help to our patients whose struggle with infertility includes a struggle with weight,” said James Goldfarb, MD, President of the Society for Assisted Reproductive Technology (SART).
More to come this week from the ASRM annual meeting. The information that comes out of this annual meeting, whether it is medical breakthroughs, research, scientific data, legal updates, a clearer understanding of the emotional components is always outstanding and sometimes startling. There will be updates on this blog throughout the week.
How to Choose a Top Fertility Doctor
How to pick a top fertility doctor
; course 101. You can get recommendations from everywhere, some places much more reputable, reliable and dependable than others. Doctors are pretty savvy these days. You will see advertisements on billboards, in the yellow pages, magazines, newspapers, all over the internet, on television. You will hear advertisements on the radio as well. In some ways, you can barely escape the marketing that swirls around. Here, there are three ways that are reliable, can work together and that are safer than picking a doctor from the yellow pages.
3 Tips for Choosing Top Fertility Doctors
1) Ask your primary physician for a direct referral.
Hopefully, you are talking to either your primary physician or Obstetrician/Gynecologist (OB/Gyn) if you are trying to conceive. Your OB/Gyn will generally know the specialists (reproductive endocrinologists) in the area, either through the hospitals where they attend meetings together, or from residency programs or even just from practicing medicine in the same area for a period of time. They will also hear things that perhaps a lay person would not; how well regarded the specialist is in the medical field. While your OB/Gyn may not share all the information that they have with you, rest assured it is part of why he/she is referring you to a specific physician. Sometimes your doctor will send you to the closest doctor in the area, sometimes they will send you to a doctor who they feel might be a better temperament for your personality. If you want to know why they are referring you to a specific doctor, ask them. Some OB/Gyn's are aware of pregnancy rates from a particular reproductive endocrinologists program or specific procedures that they feel you may need.
2) Learn more about a reproductive endocrinologist that you are considering seeing by visiting SART and CDC websites.
Both of these organizations give you specific data that is controlled and proven to be true. Neither website accepts advertising and the information that they release is not based simply on what a clinic says but on particular data that they check. The SART and CDC reports have become easier to read over the years and it is simple to compare two clinics in a close geographical area.
Careful about deciding on a reproductive endocrinologist simply on the pregnancy rate though, for a few reasons. One, the SART report is typically two years behind. Right now, they are reporting on 2008, so information is not up to date. Second, this is the disclaimer that SART puts at the bottom of each clinic summary, "Caution: Patient characteristics vary among programs; therefore, these data should not be used for comparing clinics." Of course, that's in the small type, running alone the bottom, barely noticeable. The treatment type on the summary clinic is IVF (in vitro fertilization) only; nothing is mentioned about other types of infertility treatment, such as IUI (intrauterine insemination). It's good to understand what "patient characteristics" mean though. Some clinics will routinely not treat patients with an FSH (follicle stimulating hormone) level above a certain number. Some clinics will not accept patients into their programs who have been unsuccessful for a certain amount of IVF cycles at another clinic. Maternal age (how old the woman is) also factors into a clinics decision about treatment. Third reason to avoid choosing a clinic solely on pregnancy rates is the still somewhat confusing information listed by SART. As they don't subdivide by diagnosis, simply choosing your age group does not give you an accurate idea of your individual chances of pregnancy.
Absolutely the SART report (I was not able to find a report more recent than 2006 on the CDC website so I am not going to discuss it here) has valuable information and is a good way to compare clinics for certain things. An invaluable and reliable resource, definitely.
3) Look at a prospective fertility doctor's website.
You'll find information about whether that doctor would be a good fit for you. What do they choose to say about themselves? Using what language? What treatment options do they offer?
What types of support programs are available? Do they have mental health professionals on staff? How much information do they actually disclose in terms of their credentials, certifications, degrees? Do they have educational materials on their website? One simple way to ascertain the level of training and proficiency is to check whether a doctor is a board certified reproductive endocrinologist.
A physician referral, the SART report, and what the doctors say about themselves are three methods to choosing a doctor. They are not exclusive of each other. When I choose a doctor, I use all three. I ask for a referral from a doctor that I already trust and respect, then I go see what else I can find out about them through medical organizations and their websites.
Coming into a consultation with a doctor that you all ready trust because of the research that you have done can bring a level of comfort that would not be there otherwise. That comfort can go a long way when you are worried about trying to conceive.
Take some of the worry out of the picture by choosing a doctor in a way that feels safe and comfortable for you. Please share other ways that have worked well for you, perhaps it will help someone else.
How do you know when you are looking at a website to get accurate, reliable, well documented infertility
and egg donation information, that this is what is being delivered? It takes a while of going through the website, starting with "about us
". "About us" is the first place I look when I visit any new website. I want to know if there is an agenda on the part of the author and I want to know what it is. I have learned the hard way that disclosure is not always all that apparent and a website may not always be what it seems. Here are a few websites that I trust and often start with when researching infertility issues. I went looking to see what information there was out there, specifically regarding financial compensation for egg donation (oocyte donation). I am in no way suggesting that these are the only websites that can be trusted, however they are the two largest organizations of reproductive endocrinologists in the United States.
One of the first places to take a look is at the American Society of Reproductive Medicine, (ASRM) website. This is what ASRM says about itself under the tab, "about us": http://www.asrm.org/mission.html
The Vision of the American Society for Reproductive Medicine (ASRM) is to be the nationally and internationally recognized leader for multidisciplinary information, education, advocacy and standards in the field of reproductive medicine. The ASRM is a non-profit organization whose members must demonstrate the high ethical principles of the medical profession, evince an interest in infertility, reproductive medicine and biology, and adhere to the objectives of the Society.
If you have never looked at ASRM's website, now might be a good time. ASRM Ethics Committee Report on the Financial Compensation of Oocyte Donors is well written, thoughtful and has the brain power of many well respected leaders in the field of reproductive endocrinology. ASRM also has a series of well written, well researched patient fact sheets that are worth taking a look at.
Another area of the ASRM website that I have found helpful is the index of professional groups of ASRM. There is a wealth of knowledge there and I find that the more I look, the more I find . A new find for me has been the mental health professional group's book reviews for patients. Love the reviews, they are thoughtful and professional, great combination.
A second website that you can take a look at, that is the Society of Assisted Reproductive Technology (SART) has this to say about itself:
SART is the primary organization of professionals dedicated to the practice of assisted reproductive technologies (ART) in the United States. ART includes the practice of In Vitro Fertilization (IVF). The mission of our organization is to set and help maintain the standards for ART in an effort to better serve our members and our patients.
One of the most important functions of our site is to help patients locate and contact infertility clinics and view national and individual clinic IVF success rates.
While SART doesn't speak specifically to financial compensation for egg donors, it has a good general section with an overview regarding donor oocyte. SART also is the most reliable, up to date place to get information about an infertility program or clinic. SART collects data, having worked closely with the Centers of Disease Control (CDC) in the past and then reports on the data which is available for patients to see. A good overview of what SART's purpose is available and easily read. And having said that the SART reports on infertility programs are easy to read, I will now backtrack. They are easy to read, slightly harder to understand. When you compare fertility clinics, make sure you are comparing apples to apples, so to speak. The SART reports are a good place to get a very general idea of a infertility program, not the way to make a decision about a program. The reason being that there are lots of variables that the SART reports do not take into consideration when doing the reporting. More in the next few weeks concerning how to read the SART report in a way that will be most helpful to you.
Take a look at the websites, if you have any questions, any of the RMACT doctors will be glad to answer. So, ask away!