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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

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Dear Toronto Sun Editor

July 14, 2009 - Tuesday
Posted by admin

A columnist with The Toronto Sun provided some very concerning and damaging advice to one of the publication’s readers, basically saying there’s no need to worry about having a baby now and that 40 is the new 30.  Her remarks could mean the difference between having a baby and not being able to conceive.  Please read the article and then the response below written to The Sun by AFA’s Communications Director, Brian Armentrout.

+++

Dear Toronto Sun Editor,

As a former journalist of nine years, I was a bit surprised to see journalist Robin Anderson so presumptuously jump to conclusions regarding one’s fertility in the recent column entitled Biological Clock Tick-Tockin’ Away.

While the title is accurate her statements within the piece are completely and entirely contradictory and go against the point made in the article’s title.  As a journalist, I constantly upheld my honesty, integrity, and credibility by thoroughly investigating and researching everything I wrote and took the ten o’clock news.  It’s clear Ms. Anderson’s standards are much lower.  Let me explain.

“These days, 40 seriously is the new 30. Many women are waiting until they are more “mature” to marry and have children.”

This statement is inaccurate.  A woman’s fertility begins to decline substantially at age 27.  Ms. Anderson has fallen into the mindset for which we can thank Hollywood.  All of these 40 something actresses are getting pregnant; what they fail to tell you is they probably spent thousands of dollars on infertility treatments and medicine, not to mention to emotional agony experienced by someone dealing with such a horrible problem.  The truth is 40 may already be too late.
 
“I would, however, caution you to examine why you want to have a baby before you do anything. If it is because you think a woman needs to be a mom to be whole, or because you want something to nurture and love, please reconsider.”

If a woman wants to have a child to be whole, or want something to nurture or love, what’s so wrong with that?  A woman’s decision to become a mom is her business and her business only.  It’s not up to a columnist to tell her to not have a child because she wants something to love.

“Give yourself six months to think about things.”

Seriously?  That’s like telling a smoker to keep smoking for twelve more months before you decide to quit, not to mention the possibility of getting cancer in the meantime.  Or telling an alcoholic: go ahead keep drinking, give yourself a half a year to think about quitting and only hope your liver doesn’t fail during that time.  A woman’s fertility is constantly declining and six months could mean the difference between being able to successfully conceive child and not being able to get pregnant.  You must act quickly.  Infertility is a huge problem.

My New Career

I mentioned I’m a ‘former journalist.’  Since July of 2008 I’ve been the Communications Director of The American Fertility Association.  We strive to create fewer patients; not more.  Our mission is simple:

To help people prevent infertility whenever possible and help people build families of choice, particularly when faced with infertility.

The AFA has been around for more than a decade and we’re doing better work now than we’ve ever done.  Our biggest push in 2009 is infertility prevention in men and women, which is why it disheartens me, the entire AFA staff, and our constituents, to see this type of inaccurate editorial.  In a perfect world, I’d like to see a retraction.  While that may not be necessary, I’d like this letter to at least be forwarded to Missing Out on Motherhood.  I’d also make the request that you post this letter in its entirety in your Letters to the Editor section.  Please accept this letter in the spirit for which it’s intended.

Best,

Brian Armentrout
Communications Director
The American Fertility Association
[email protected]
o: 205-425-3644

About The AFA

The American Fertility Association, a 501 (c) (3) national non-profit organization is a lifetime resource for infertility prevention, reproductive health and family building. AFA services and materials are provided free of charge to consumers and available to everyone without reservation. These services include an extensive online library, monthly online webinars, telephone and in-person coaching, a resource directory, hosted message boards, daily fertility news, a weekly newsletter and a toll-free support line.
http://www.theafa.org or 888.917.3777.

 

Categories
Family Building • Fertility • Fertility Drugs • Fertility Preservation • Infertility • Infertility Drugs • Pregnancy

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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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Welcoming Jesse

May 27, 2009 - Wednesday
Posted by admin

By:  Sierra Hansen

When my partner announced 7 years ago she wanted to start a family, I was speechless. We never really talked about getting pregnant because we knew it would require money and effort and we simply weren’t ready to initiate the whole process. She was 37 and I was 31, so it was obvious she would go first. We announced our plans to get pregnant to all of our friends, asked for tons of advice, found a friend willing to be our donor, and tried to get pregnant.

And tried, and tried, and tried. We adopted a laissez faire attitude because like many women our ages, we thought as soon as we decided to get pregnant, it would be a snap.  It wasn’t. After 7 years, we used 6 different sperm donors (known and unknown), underwent ~30 IUIs, 18 which were medically assisted with drugs, and finally one IVF procedure which culminated in a happy 9 month old boy.

At first, we were giddy with excitement every time we tried to inseminate, and we held our collective breath for the two weeks between trying and the first pregnancy test. After a year, we began to wonder if we shouldn’t talk to a specialist. We did, and it was eye-opening. We thought we were well-informed and educated about our fertility. Boy, were we wrong. So, we initiated a much more strategic, medically-assisted plan with a great physician who shared the startling truth about reproductive health. He brought up concerns about my partner’s age, and suggested we only try 6 IUI’s before we consider IVF or switching to me. We began to dread the two week wait, especially when our friends were constantly enquiring how the baby-making was coming along. We finally told people that no news was bad news, and most got the hint.

Meanwhile, we watched a number of our straight and gay friends have one and two babies. We rubbed pregnant bellies and babysat as much as possible hoping some good luck would rub off on us. After the 6 IUI’s with our doctor wrapped up the second year of trying, my partner had given up and it was my turn. She tried to keep her chin up, but I knew she was devastated. I did my best to support her, and we turned our hopes to my getting pregnant quickly. We took a few months off to recoup our energy and spirits and started again.

When I started, we didn’t tell anybody except for our closest friends. We just couldn’t handle the monthly barrage of questions, and the seemingly inevitable “No news is bad news” response. Our best friends tried to be supportive, but after 11 cycles of drug-assisted IUI’s, we began to isolate ourselves from them. One day, about 2 months before we knew we would have to make the decision to go forward with IVF or remain childless, we invited our neighbors who were walking by in for a glass of wine. She announced no wine for her because she was expecting, patting her belly to reinforce the announcement. A month earlier they were not even sure they wanted kids and all of a sudden they were pregnant. I wanted to yell at them, slam the door, crumple into a ball and cry. I didn’t. Somehow, I found the courage to invite them in, offer her a glass of water, and toast their good fortune. We did pull back from them, and our close friends, after letting them know we were really struggling with the inability to get pregnant. Our friends understood when we crawled into our shells.

When we initiated the IVF, our physician was incredibly optimistic. The most optimistic he had been in a long time. While my inability to get pregnant via IUI stumped him, he thought I would be a good candidate for IVF success. He was right. After all the shots, pills, ultrasounds, and blood tests, my doctor harvested 21 eggs, fertilized 14, and eventually 5 made it to blastocyst. We froze three, and two were transferred. One took, and when a beautiful 8lb, 6oz baby boy was born 9 months later, we named him Jesse. I had the easiest pregnancy in the world and Jesse is an amazing baby. Today we feel very lucky and grateful that we have a child with big blue eyes who sleeps through the night. However, we try to educate our friends who seek information about getting pregnant at every opportunity. If our experience can help shorten the time it takes another couple, we’ll consider it a bonus.

Best,

Sierra Hansen

To read more about Gay Moms Doing Well Despite Prop 8, click here

http://www.huffingtonpost.com/elizabeth-gregory/gay-moms-doing-well_b_207455.html

Sierra Hansen and her partner, Barbara, have been together for 14 years, and last August she gave birth to a baby boy. She is currently a graduate student at the University of Washington researching on infertility genetics, policy, and law.

 

 

Categories
Donor Sperm • Family Building • Fertility • Fertility Drugs • Frozen Sperm • Gay and Lesbian Family Building • IUI • IVF • LGBT • Pregnancy • Sperm Donation

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