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The American Fertility Association Blog

Returning to the Well

June 8, 2009 - Monday
Posted by admin

By: Lori Holden

Awhile back, my friend Crystal offered to have my children come play at her house for a few hours. Rob had been out of town, and some down time for me sounded reealllly good.

It was a no-brainer. Responsible child watcher? Free time? Of course!

But I had to stop to think a moment.

Because Crystal is Tessa’s firstmom.

“Is this weird?” I thought. “It doesn’t feel weird. It should feel weird. Other people would find it weird. But I am definitely not sensing weird.” The thoughts chugged through my head as I searched for some rain on my parade.

I brought Tessa and Reed to Crystal’s house for an afternoon with her, her son (11) and her stepson (4). I knew Reed (5) would be in heaven with all the weapon-wielding that was about to take place, and I suspected Tessa would find Crystal’s purse endlessly fascinating.

I told the kids to behave, double-checked that Crystal knew she could call me no matter what, and left, almost giddy at the open hours laid out in front of me.

Now, let me expand a bit on my relationship with Tessa. We are going through what seems like teen years, in spite of the fact that she’s not yet 7. She and I butt heads on everything from too-long showers to homework, from talking on the phone to doing her chores. I am hopeful that we will not duplicate this tension when she actually becomes a teenager, but rather that we will have already been-there/done-that (please—don’t be the one to burst my bubble). We each seem to “miss” each other often, and I am reminded of this post about an adoptee’s feelings of being trans-familied. I am frustrated with our disconnect, and I imagine Tessa is, too.

When I returned after my Me Time, Crystal had trimmed Tessa’s hair (they have the same wispy hair, and hairstyling is Crystal’s line of work), painted her nails, and had given her a pair of hand-me-down spiky-heeled purple boots . A beaming Tessa cuddled in my lap while Crystal and I talked.

Once we got home, Tessa said, “Mom, I’m a new person!” I’m not sure if she meant the beautifying activities or what. But for days afterward, SHE WAS DELIGHTFUL, and the fight in her was gone. Witness this:

Tessa wanted to wear the spiky boots to school the next morning and began to have a meltdown. I said, “I’m telling you that those shoes are not appropriate for school. You do what you think will get you the consequences you want.” I was fully expecting her to wear the shoes to school, which would earn me the Bad Mother of the Week Award, and then I would have to throw the boots in the trash after we got home.

But Tessa came to breakfast, smiling and cheerful, wearing her sneakers. I can’t tell you how out of character this is. I was so impressed with her response that I brought the boots when I picked her up from school so she could wear them to the dentist (not as inappropriate there).

Tessa and I are simply more sympatico since her time with Crystal. It’s as if Tessa has been to the well.

I must admit I am pleased with myself that I don’t feel hurt or threatened. I don’t know how to pull teeth, so I take Tessa to the dentist. I don’t like to play house for hours at a time, so I arrange for playdates with friends. I simply can’t fill this emotional need that Tessa seems to have, and another woman can, so I wholeheartedly support these trips to the well.

It works for all of us.

--
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Categories
Family Building

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My Sister’s Keeper

June 5, 2009 - Friday
Posted by admin

The very first book that I ever shared with my daughter Caitlin was My Sister’s Keeper, by Jodi Picoult. This was very meaningful for me because my mother and I used to read books together all the time and it was so special for us, like being in a private book club for two. Much of our conversation was spent on things we were reading, and therefore sharing. So passing on that family tradition made me miss my mom, who died in 2002, a little less.

Family has always been the cornerstone of my life, so My Sister’s Keeper was an interesting choice for Caitlin and I; it is the story of a girl whose older sister has leukemia. Her parents, through the use of Preimplantation Genetic Diagnosis (PGD) conceive her not because they want another child, but because they need another child to be a donor for her sister, who is guaranteed to die if she does not have one.

I remember in the early days of controversy over PGD, I could never understand why this was objectionable. I always thought to myself that a person would feel special, and valuable, knowing that their life had enabled another person to live. That this was the best possible way to start out, as a hero. Especially if the person you were saving was a brother or a sister.

In many ways, I still feel that way. But the thing for me, that made this particular book so significant, was that it made me look at this situation through a completely different lens - the point of view of the person who is not only conceived to be a donor, but who lives their life at the level of donor. Someone who will be on call, always, to donate platelets, blood, organs even. Who spends tons of time in a hospital bed, or an operating room, even though they are not sick. Someone whose main reason for being is to keep someone else alive, to the exclusion of all else. And that for some, this could be devaluing instead of the other way around.

I never thought about it that way. And Caitlin and I spoke about it a lot.

I believe, still, that PGD is one of the most valuable contributions that has been made to the world, allowing people to avoid heart breaking situations and save children’s lives.

So the moral of this book for me, personally, is this. There is always a point of view that we don’t think of, or focus on, that someone else might feel. That no matter how strongly you hold a position or a belief, your point of view may be experienced differently by someone else. And that all points of view have value, and deserve to be heard. I was grateful for that reminder. And I was grateful to be able to share that with my child. I think my mom would agree.

Corey Whelan
Program Director
The American Fertility Association

Categories
PGD

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Georgia House Bill 388, The ‘Option for Adoption’ Act.

June 3, 2009 - Wednesday
Posted by admin

By: Daniel Shapiro, M.D.

Georgia recently enacted Georgia House Bill 388, the ‘option for adoption’ act. The bill provides legal basis for patients using donated embryos to ‘adopt’ them under the Georgia family law code. This bill is the first of its kind to be enacted and represents one of many attempts by right to life groups to establish ‘personhood’ of embryos. By all prior legal standards and in all reproductive medicine clinics practicing embryo donation, embryos are considered property, not people.

The moral standard implied by this bill is likely to be unconstitutional because it violates the 1st amendment’s establishment clause (separation of church and state). Though reasonable people can certainly argue for the ensoulment of a pro-nuclear embryo, the civil pacts by which we live in this country prevent the supremacy of one religious view over any other or over any irreligious view. Since the concept of personhood is inherently a religious question, this law violates our nation’s constitution. The law also probably violates the 14th amendment (equal protection under the law) since it establishes a special class of human being with rights that supersede the rights of others in the class. Why should an IVF embryo have the right to be adopted and treated as an ‘individual’ while a naturally conceived embryo has no similar protection?

I had the privilege to testify before the Georgia committee hearing this bill before it passed. First let me say that what was originally written was so egregious and foolish that had the original language passed Georgia’s legislature would have looked plain stupid. An attorney with extensive experience in Georgia family law and third party reproduction rewrote much of the bill and eliminated the expressed intent to make all IVF embryos into full grown people. She also crafted the language in a way that makes the bill superfluous in that it only created the option for an expedited adoption process but does not require it. In effect the law does nothing except answer to the rantings of the religious right.

Because the law is vague as to how it is we are supposed to actually proceed with these cases, we in the REI community in Georgia do not foresee any change in our practice. Our consents and contracts with patients have provided for rescission of parental rights in the case of embryo donation from time immemorial. Unless a recipient patient actually tells outside parties how she achieved pregnancy, all anyone would see is a pregnant woman anticipating delivery. Since the overwhelming majority of embryo donations are anonymous, the donor would not know if a) her embryos became pregnancies or b) who actually got pregnant. It is hard to imagine a case where a willing embryo donor would come back and sue for parental rights since said donor wouldn’t know if or when a donation took place. Even if she could discern the above from the unavailability of her former property, she would not know if the procedure actually worked. Someone would have to show a compelling reason for us to violate someone else’s right to privacy and reveal their identity and the circumstances of their embryo recipiency. Ain’t gonna happen. I defy anyone who claims to believe in freedom and autonomy (many are in the same party as the religious right) to explain why the state of Georgia has a compelling interest in unmasking HIPPA protected patients.

Dr Shapiro is board certified in Reproductive Endocrinology and is the former medical director of Reproductive Biology Associates (RBA). He is currently the clinical director of RBA’s egg donor program and the RBA egg bank.

In cases where the embryo donor is not anonymous (a rarity) the bill allows for expedited adoption. Though this may afford a greater level of protection for the recipient’s claim to parentage, the physical reality of labor and delivery is probably a good enough standard under which a couple may establish their claim. To the best of my knowledge, there are no cases of willing embryo donors coming back to claim parental rights. It is equally hard to imagine what would happen if they did. For this law to be applicable at all, the donation, gestation and residence of all the parties would probably have to be in Georgia. If any of the parties, especially the recipient lived out of state, the existing property laws and family statutes of the resident state would likely apply.

From a medical perspective, we could limit our donations only to embryos that came from egg donation and then offer them only to out-of state recipients. This is likely to be unnecessary as again the bill only provides for the adoption option. After the law is enacted on July 1st it would be prudent of us to be sure to document that we informed recipients of the adoption option. Beyond that we see no change to medical practice standards under this bill.

Categories
Adoption • Embryo Donation • Family Building • IVF • Pregnancy

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Georgia House Bill 388

June 2, 2009 - Tuesday
Posted by admin

By Melissa Brisman Esq. and Laurren Cuozzo Esq.

“The first ever embryo adoption act has passed and was signed into law in the United States. The repercussions of this very well may be far reaching and extreme, not only for individuals pursuing third party reproduction, but for the entire area of the law known as reproductive rights. We at The AFA will be covering this highly disturbing and important issue, as well as all of its ramifications extensively. As a first step, we determined that full understanding of Georgia House Bill 388 is important for our readers and we turned to Melissa Brisman, Esq. and Lauren Cuozzo, Esq. to clarify it for you, below. Please check The AFA blog often for updates.” - The AFA Staff

The Option of Adoption Act, Georgia House Bill 388, is the nation’s first ever embryo adoption bill. It passed the Georgia House by a vote of 108 to 61 and was signed into law by Georgia Governor Sonny Perdue. It will take effect July 1st of this year. Once enacted, this law will allow recipients of donated embryos to “adopt” those embryos. These recipients can petition the Georgia superior court for a pre-birth order of adoption or “parentage.” However, recipients will still need to enter into a valid contract with the current “custodian” of the embryos. Where the “custodian” of the embryos to be donated created those embryos through the use of another donor, the court order (that recipients receive from the superior court) will terminate the rights of the genetic donor as well as the donating individual or couple. As a general matter, this law does not simplify the process for recipients of donated embryos. It creates more paperwork, court orders, and costs in a process that is currently relatively painless and less expensive than an adoption.

The new law defines an “embryo” as “an individual fertilized ovum of the human species from the single-cell stage to eight-week development.” It is unusual to describe a fertilized egg as an “individual” at the “single-cell stage.” Most people, including scientists and medical professionals, would not use this definition. According to the language of this law, these embryos are no longer “donated” by a donor but instead are “adopted” from a “guardian.” Not every embryo results in a baby. Under this law, recipients could incur the expense of “adopting” an embryo that never results in a child.

Melissa B. Brisman, Esq., LLC, located in Park Ridge, New Jersey. Melissa Brisman can be reached at [email protected] and http://www.reproductivelawyer.com.

Lauren Cuozzo. Associate at the firm, Melissa B. Brisman, Esq., LLC. Ms. Cuozzo can be reached at [email protected].

Categories
Adoption • Donor Egg • Embryo Donation • Family Building • Frozen Embryos • Third Party Reproduction

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Pretty Woman

June 1, 2009 - Monday
Posted by admin

By: David Kreiner, M.D.

“We at The AFA have received a large number of emails from women who are confused by Kate Gosselin’s diagnosis of PCOS because, in their eyes, she is simply too pretty to have it. Many people seem to have the misconception that a woman with PCO is doomed to a lifetime of unattractiveness. AFA blogger, David Kreiner, M.D., has written about PCOS today in an effort to further educate women about this disorder” - The AFA staff

Polycystic Ovary Syndrome (PCOS) is a condition in which a woman’s hormones are out of balance. It can cause problems with your periods and make it difficult to get pregnant. PCOS may affect the way you look and can be associated with a variety of health problems including diabetes, hyperlipidemia and hypertension.

PCOS is the most common hormonal disorder of reproductive age women, occurring in over 7% of women at some point in their lifetime. It usually develops during the teen years. Treatment can assist women attempting to conceive, help control the symptoms and prevent long term health problems.

The most common cause of PCOS is glucose intolerance resulting in abnormally high insulin levels. If a woman does not respond normally to insulin, her blood sugar levels rise triggering the body to produce more insulin. The insulin stimulates your ovaries to produce male sex hormones called androgens. Testosterone is a common androgen and is often elevated in women with PCOS. These androgens block the development and maturation of a woman’s ovarian follicles preventing ovulation resulting in irregular menses and infertility. Androgens may also trigger development of acne and extra facial and body hair. It will increase lipids in the blood. The elevated blood sugar from insulin resistance can develop into diabetes.

Symptoms may vary but the most common are acne, weight gain, extra hair on the face and body, thinning of hair on the scalp, irregular periods and infertility.

Ovaries develop numerous small follicles that look like cysts hence the name polycystic ovary syndrome. These cysts themselves are not harmful but in response to fertility treatment can result in a condition known as Hyperstimulation syndrome. Hyperstimulation syndrome involves ovarian swelling, fluid accumulating in the belly and occasionally around the lungs. A woman with Hyperstimulation syndrome may become dehydrated increasing her risk of developing blood clots. Becoming pregnant adds to the stimulation and exacerbates the condition leading many specialists to cancel cycles in which a woman is at high risk of developing Hyperstimulation. They may also prescribe aspirin to prevent clot formation.

These cysts may lead to many eggs maturing in response to fertility treatment also placing patients at a high risk of developing a high order multiple pregnancy. Due to this unique risk it may be advantageous to avoid aggressive stimulation of the ovaries unless the eggs are removed as part of an in vitro fertilization procedure.

A diagnosis of PCOS may be made by history and physical examination including an ultrasound of the ovaries. A glucose tolerance test is most useful to determine the presence of glucose intolerance and diabetes. Hormone assays will also be helpful in making a differential diagnosis.

Treatment starts with regular exercise and a diet including healthy foods with a controlled carbohydrate intake. This can help lower blood pressure and cholesterol and reduce the risk of diabetes. It can also help you lose weight if you need to.

Quitting smoking will help reduce androgen levels and reduce the risk for heart disease. Birth control pills help regulate periods and reduce excess facial hair and acne. Laser hair removal has also been used successfully to reduce excess hair.

A diabetes medicine called metformin can help control insulin and blood sugar levels. This can help lower androgen levels, regulate menstrual cycles and improve fertility. Fertility medications, in particular clomiphene are often needed in addition to metformin to get a woman to ovulate and will assist many women to conceive. The use of gonadotropin hormone injections without egg removal as performed as part of an IVF procedure may result in Hyperstimulation syndrome and/or multiple pregnancies and therefore one must be extremely cautious in its use. In vitro fertilization has been very successful and offers a means for a woman with PCOS to conceive without a significant risk for developing a multiple pregnancy especially when associated with a single embryo transfer. Since IVF is much more successful than insemination or intercourse with gonadotropin stimulation, IVF will reduce the number of potential exposures a patient must have to Hyperstimulation syndrome before conceiving.

It can be hard to deal with having PCOS. If you are feeling sad or depressed, it may help to talk to a counselor or to others who have the condition. Ask your doctor about support groups and for treatment that can help you with your symptoms. Remember, PCOS can be annoying, aggravating even depressing but it is fortunately a very treatable disorder.

Sincerely,

David Kreiner, M.D.

Do Live in California?

To learn more about PCOS and how to control it, along with other steps you can take to prevent infertility, be sure to attend The AFA’s FREE Manicures & Martinis Infertility Prevention Series, which is coming to San Francisco and Laguna Niguel. Enjoy complimentary manicures and martinis and learn about the reality of the biological clock, how STD’s can compromise your fertility, and how certain environmental toxins can jeopardize your ability to conceive a child.

Manicures & Martinis San Francisco
Nova Nail Spa
811 Mission Street in San Francisco
Tuesday, June 9th, 6:00-7:30 PM
RSVP with Vivian: [email protected] or 646-861-3226
More Details

Manicures & Martinis Laguna Niguel
Accent On Nails
28121 Crown Valley Parkway in Laguna Niguel
Tuesday, June 16th, 6:00-7:30 PM
RSVP with Vivian: [email protected] or 646-861-3226
More Details

Categories
Fertility Drugs • Infertility • IVF • Ovulation • PCOS • Pregnancy

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