The AFA thanks Google, a premiere sponsor, for their online advertising grant.
Follow Us:
The American Fertility Association Blog
Minimal Stimulation
July 28, 2009 - Tuesday
Posted by admin
By: Dr. Fred Licciardi
I have been practicing infertility at NYU for 16 years. Basic infertility, reproductive surgery, ovulation induction, IVF, and egg donation are all areas of my expertise. Most of my patients are from New York , but people come to see me from other states and other countries.
Reprinted From Monday, January 21, 2008
Does taking a lower dose of fertility drugs improve your chances of becoming pregnant with IVF? I think not, but I can tell you of some exceptions. Mostly I have had some very good experiences with patients confirming that lower is not better.
How do I know?
Well, as it turns out over the past few years I have been seeing more patients from Europe. There are a few things that have contributed to this. One is the blog. It’s been fun getting e-mails and seeing patients from around the world. The second is the exchange rate: for some, New York is now a “reproductive tourism” destination. The third has to do with laws in Italy, Germany and other countries that restrict IVF and donor egg.
Anyway, the European doctors give their patients a much lower dose of drug that we do in the US. Part of this is due to the fact that they may not be allowed to fertilize more than a few eggs, so they don’t bother trying to get more. Another reason may just be due to a general philosophy that less drug is better.
So the typical European woman that sees me has done IVF many times, usually making just a few eggs on a lower dose of drug. Unless she has had a fantastic response, I increase the dose for her IVF cycle with me. In most cases, the egg yield is much higher (still in a safe range) and the pregnancy rate in these women is very high. So the point is that in these women, a higher dose is better because it increases the number of eggs, and therefore there are more embryos available for selection.
Do some women make more eggs with a lower dose? I have seen a few cases of this. This is typically the woman who was given a lower dose for IUI and develops more follicles than she did with her higher dose IVF cycle. Should we go back to the lower dose for the next IVF cycle? It’s a gamble and it takes a little courage. It is really hard emotionally to go into an “experimental” IVF cycle.
Many patients considering this have had many attempts and may not be ready to give up a couple months for a “let’s see” cycle. If you and your doctor can stomach it, you can give it a try. I can tell you I have one woman, who had been through many cycles, who wanted to give it a go, and she did better with less. Was that her month to make more, regardless of drug dose? Who knows, but let’s give her the credit.
But I do think starting on a minimal dose, just because your doctor thinks it’s more homeopathic and will result in better quality embryos, is not correct. To return to our common theme, if one of the self proclaimed experts in minimal stimulation wants to take 100 women and give them minimal stimulation, and take another 100 and give them regular stimulation, and then show us that minimal is better, great. But until this happens we have to say that it’s not better, and may be worse for most people. I know some of you can tell me that you did minimal and got pregnant. I just feel that my experience has shown that overall, regular may be better.
Categories
Donor Egg •
Egg Donation •
Fertility •
Fertility Drugs •
IUI •
IVF •
Pregnancy
(0) Comments • (0) Trackbacks • Permalink
Oh Bitch Please!
July 16, 2009 - Thursday
Posted by admin
By: Dr. Daniel Shapiro
Today, Maria del Carmen Bousada, the Spaniard who three years ago became the oldest woman on record to conceive through IVF, died of cancer. She left behind twins and no known biological father to care for them. On seeing the news of her passing on CNN, my 16 year old daughter reflexively yelled out ‘Oh Bitch Please!!” at the TV. Being a conscientious father (and an IVF doctor) I castigated my scion to be respectful of the dead. I further cautioned her against use of the ‘B” word in describing women.
My eldest, who suffers fools lightly, explained that she was not in any way criticizing poor Maria, but making a general comment about the absurdity of the situation. She went on to say that ‘Oh Bitch Please!” means the same as ‘Tcha, as if!?’ which she was sure I would understand since I am old and from the 80’s.
In fact, I do understand exactly what she means.
To date, there are fewer than 20 reported pregnancies ever in women over 60. ALL of the recent cases occurred as a result of IVF and donor eggs. These pregnancies occurred solely by choice and with great effort on the part of many players. The press has gleefully shown every sexagenarian pregnancy that they can and in every case the debate about whether we should do this or not rages back and forth both in print and between wonkish talking heads on the tube.
The American Society for Reproductive Medicine says plainly that we should not do this. The ASRM guidelines suggest that egg donation services be limited to women at the natural age of menopause (51+) or less.
Proponents of individual rights correctly point out that men are under no such limitation and that it is inherently sexist to apply age limits to women who wish to be parents.
So what’s a society or an IVF clinic to do?
The debate really boils down to competition between the rights of the individual and the best interests of society as a whole. Though I do not pretend to know the right answer to this one, I think I can make a logical argument as to why the rights of the individual here should be secondary to societal norms.
The desire to parent is essentially an accepted form of narcissism. Though childbearing serves a social need by bringing joy to family units and creating a new generation of workers, consumers and thinkers we are all deluding ourselves into thinking that we are individually capable of parenting well. Of course no one person has the right to criticize the parenting style of any other person as long as we stay within legal boundaries and keep our children housed, fed, clothed, schooled and reasonably safe. At the same time we do have the right as members of a larger social group to limit parenting arrangements that put a child or a parent at risk.
In cases such as these the benefit to the individual is narrow and particular and does not serve the greater good. We now see in painful strokes of pointillist realism why this is so. Who now will care for Maria’s twins? Aside from the inherent benefit to the children by being born, who else benefited from this arrangement beside the doctor and those who write about this for the tabloids?
Though Maria’s death is tragic at many levels, the real tragedy is that this happened at all. Saying this usually elicits an uncomfortable ‘utz’ in the stomachs of reasonable people: criticizing the birth of any child after that child is born goes against our natural wiring. Yet this story represents failure at many levels.
Let’s start with Maria herself. Ms. Del Carmen Bousada just wanted to have a baby. Fair enough. But at age 66, she should have asked herself how being 83 teaching her twins to drive would work. Or maybe she should have asked who would manage the house if she broke her hip at 77. Maria sadly was only thinking of herself and succumbed to narcissistic rationalization.
Now let’s consider her doctor. The clinic’s cut-off was age 55. This is outside ASRM guidelines and opens the clinic up to criticism and scrutiny. The doctor here was a ‘co-dependant enabler’ of our tragically narcissistic lead player. A simple 2-letter word, ‘NO’ would have prevented this.
Our clinic cut-off used to be 55. I personally have helped a 54 year-old conceive. We now adhere to ASRM guidelines precisely because of what we are seeing happen here.
Maria lied to her doctor about her age. The doctor is on record as saying that she falsified records from Spain. He went on to say that he should not be in the business of checking passports. Passports are not as easy to fake and frankly he SHOULD have asked to see it. She was a beautiful woman and did look younger than her real age. But 50 something is still iffy and it should be clinic policy to verify by best possible means a patient’s true age where the reality will make a difference in management. A reproductive tourist like Maria would have had her passport handy. A minimally curious doctor should also have wondered why a Spaniard would need to travel to Los Angeles when Europe’s busiest egg donor program is in Valencia, Spain!
Society as a whole is to blame for this too. Our belief that we are entitled to anything we can conjure and the unquenchable thirst we have for sensational stories create the tableau on which such a picture is painted.
Let me be clear that I do think age limits are sexist, but I also believe that the power of true feminism is not in mimicking male patterns of behavior but in giving women the power to choose wisely for themselves. Maria and her doctor chose unwisely.
Oh Bitch Please!
Categories
Donor Egg •
Egg Donation •
Family Building •
Fertility •
Infertility •
IVF
(0) Comments • (0) Trackbacks • Permalink
Stories of Persistence
July 15, 2009 - Wednesday
Posted by admin
By: Dr. Fred Licciardi
Dr. Fred Licciardi of NYU Fertility Center in NYC was one of the first voices in reproductive endocrinology to blog. Being ahead of the curve has always characterized Dr. Licciardi for us here at The AFA, where we are some of his biggest fans. We wished to share his compassion, insight and wisdom with all of you. Please welcome Dr. Licciardi as the newest voice on our growing blogger team. We will be syndicating Dr. Licciardi’s blog, as well as resurrecting many of his past posts, for you to read and learn from.
Thanks,
The AFA Staff
Reprinted from: Wednesday, November 26, 2008
Anything we need or want, we hope for.
As stories from the internet have shown, some women with low chances can become pregnant.
Here are a few of my own. And these are only a few out of many others, these just came to mind.
Ms. A was 38 when we met. Her FSH was 22. She was “dismissed” from another program. 2 years earlier she delivered, but this was after trying for 18 months. The sperm motility was a little low, but the sample was close enough to normal, ICSI was not needed.
She first tried a day 2 start, her FSH was 13,4, and was cancelled and converted to IUI because there were only 3 follicles. The plan: keep trying. Her second cycle never got off the ground because of a day 2 FSH of 17.7.
Her FSH was 11.9 on her 3rd attempt and she went on to make 4 eggs, 4 fertilized . On day 3 one looked good, the other fair. This ended in an early biochemical loss.
Her next cycle we changed up the protocol a bit. She had 4 eggs, and 2 embryos transferred, both looked good. This worked, and she just delivered.
So here we have a woman who most doctors would tell there is no chance, but she persisted.
Ms. B was 35 when we met. Her FSH was 14. Her resting follicle count was less than 5. She started a cycle with an FSH of 12, got 6 eggs, poor fert and a cancelled transfer for arrested embryo growth.
Her second cycle was cancelled for no response (not one follicle).
She got pregnant on her own. This theme is an internet favorite. Buy the way, she did not use DHEA.
Mrs C. was 36 and suffered from severe edometriosis. She did 2 IVF cycles before we met.
She did 3 more retrievals with me, always making a good egg number and having good embryo quality. She travelled long distance to get to NYU. On her 3rd cycle (5th total) she became pregnant.
The next one goes under the dumb doctor category (that would be me). Mrs D, a 38 year old from overseas, e-mailed me and told me about her FSH of 25. Realizing she was from far away, I tried to save her some travel time and money and told her IVF was out, but donor egg was in. The couple came to see me, heard the donor egg schpeal and as I finished the husband looked up and said that his wife was going to be day 2 in a few days, could they try IVF while they were still in the States? Without boring him with the low odds speech, I just said, “sure why not.”
Sure enough the FSH was 12, she made 9 eggs and delivered twins. I think they are happy with me, but I am sure they have their reservations.
How can we put these all together?
1) They about women under 40. I don’t mean to exclude the 40 and over crowd from the hope discussion, as there are plenty similar stories about women in their 40’s, but the facts support that it’s easier to beat the odds when you are younger.
2) FSH may not be as important as we once thought. Again, a bad FSH is better under 40. Every so often there is a paper or abstract reminding us that pregnancy rates shoot down with increasing age and FSH levels. Which leads us to the next point:
3) Some infertile women can at times become pregnant on their own. We do use this fact when recommending that some women cancel their cycle or give up on IVF. We say yes you can get pregnant with IVF, but your odds are low, about the same as getting pregnant on your own. Of course this is much more difficult concept to accept when there is a severe male factor.
So for Mrs. A, C, and D, their persistence is what lead to their success. They did not accept the advice of a doctor; they did what they felt they needed to do. Of course we have to keep in mind that it is also true that there are women who try and try unsuccessfully.
Sometimes the fertility establishment is criticized for giving a bit too much hope, while profiting nicely from tons of women who are needlessly spending tons of dough. And sometimes we are criticized for not giving an infertile woman the chance she deserves.
But it will always be true that for most women with low odds, there is a small chance, and sometimes their only chance, using IVF. So it all goes back to getting to the right clinic and getting informed about your odds. After that it’s between you and your doctor, sometimes with a little tug of war.
Dr. Licciardi
Categories
Donor Egg •
Endometriosis •
Fertility •
FSH •
ICSI •
Infertility •
IVF
(0) Comments • (0) Trackbacks • Permalink
News Alert: There Are 50 States & Michael Jackson’s Children Were Born in Only One – California
July 2, 2009 - Thursday
Posted by admin
California is one of the only states that permits the intent of the parent(s) to govern their parental rights, so that the intended parent (or intended parents) are listed as the legal parents on the birth certificate, regardless of biological connection, so long as this intent is formalized in an agreement/consent.
I, like all of us, have been intently watching the news involving Michael Jackson and his children, yet what amazes me is that lawyers on TMZ and other national news outlets are declaring that Michael “never formally adopted the children.” Therefore, he must not be the father of these children…..And, they then ask, who are the parents of these children?
Well, guess what? He is the father – no adoption required in this case no matter if he is the biological father or not, which appears to be the case for all three children. In California, surrogacy law is very clear as to who is the parent, regardless of biological connection, based upon intent. We can only guess at the facts in this case, but a birth in California with a surrogate, egg donor and sperm donor, will not affect his rights to these children, or the rights of his children to his estate. The only uncertainty is the fact that he was married to Ms. Rowe at the time of the birth of the first two children. She may certainly have a claim if she remains on the birth certificate, again even if an egg donor was used.
What people have to remember is that almost all people have the desire to be a parent, even Michael Jackson, so we need to remember his intentions to be a father, instead of focusing on the drama surrounding these children. Let’s hope they can move forward without their father in their lives and become successful adults without the media making it worse
See more on Channel 10 News and my interview.
Theresa Erickson, Esq.
Erickson Law
Categories
Adoption •
Donor Egg •
Family Building •
Surrogacy
(0) Comments • (0) Trackbacks • Permalink
Child-Free Living on Father’s Day
June 22, 2009 - Monday
Posted by admin
About 10 years ago, I received a call from my dad just before Father’s Day. My mom had recently died from her second bout with cancer, and my dad and I had become extremely close as a result. After the usual check-in conversation (how are you feeling, how are the dogs, etc…) he asked if my partner and I had thought about having children, and if so, when he might look forward to that blessed event.
I was caught a little off guard, and all I could say was “why?”
My coming out about a decade earlier was not initially well-received. For my mom, who told me she had known since I was a teenager, it removed any plausible denial that she had left, and solidified in my mind that mothers are truly psychic. For my dad, it was an event of seismic proportion, but not for the reasons that you might imagine. I was a baseball fan (go Giants then, go Diamondbacks now) and a private pilot - two activities that he in no way associated with being gay. “But you like sports!” was a phrase I got used to hearing over and over again as he sought to come to terms with my announcement.
Though everything smoothed out very quickly thanks to our nieces and nephews immediately accepting us, we had never broached the topic of having children with our parents. Not that we hadn’t thought about it. In fact, we had been giving it serious consideration for about six months when my dad popped the question. And that’s really the point of my writing today. Because everyone that I know who considered having children, the decision was not a casual one. As a gay couple, we considered adoption. There are many worthy organizations out there, the Dave Thomas Foundation for Adoption being one of the best. What about surrogacy? Growing Generations which was one of the pioneers of surrogacy for the gay community, offered another option.
In looking back, our wrestling with the question was about us getting to the place where we recognized that child-free living was an equal option to having a child, so the decision could be made from that perspective. There were many considerations that went into our process, many of them purely emotional and all of them highly personal. My partner was - and still is - a second grade teacher. He has a brilliant way of interacting with children that most parents only aspire to and genuinely loves being with kids and teaching them. For my part, every time I held one of our friends’ babies, something inside me felt great. I kind of melted into the little one in my arms. We thought about how happy it would make my dad and my partner’s parents to have another grandchild. We looked at the practical side as well, knowing the costs involved, both financial and emotional. We looked at the rewards of guiding someone from infancy to adulthood and to deep satisfaction that we imagined in seeing our child live out his or her full potential. Perhaps most importantly, we asked ourselves what was as the heart of the matter, and the answer was creating family.
Ultimately, we opted for child-free living. And we realized that we had constructed a family around us that fulfilled our needs and that allowed us to contribute to others. A family that included our parents, our sisters and brothers, our nieces and nephews, our godchildren, our friends’ children, our friends at church, and yes - even our dog. Because for us family is that most special group of people that we choose to surround ourselves with, and that may or may not be related to us through birth. It is the group that we want to accompany us on our journey on earth. It was not an easy decision, but for us, it was the right one, and ten years later, it still feels right.
I’m going to give my dad a call in a few minutes to wish him a Happy Father’s Day, and to thank him for the answer to my oh-so-simple question 10 years ago when I asked him “why” he wondered if we were going to become parents. “Because,” he replied, “I think you and Bob would make great dads.”
Happy Father’s Day, dad. I love you.
Ken Mosesian
Executive Director
Categories
Adoption •
Donor Egg •
Egg Donation •
Family Building •
Surrogacy •
Third Party Reproduction
(1) Comments • (0) Trackbacks • Permalink
| July 2010 | ||||||
|---|---|---|---|---|---|---|
| S | M | T | W | T | F | S |
| 1 | 2 | 3 | ||||
| 4 | 5 | 6 | 7 | 8 | 9 | 10 |
| 11 | 12 | 13 | 14 | 15 | 16 | 17 |
| 18 | 19 | 20 | 21 | 22 | 23 | 24 |
| 25 | 26 | 27 | 28 | 29 | 30 | 31 |
eNewsletter and Updates
