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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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The Bad News Island:  An Interview With Tour Guide Melissa Ford

June 24, 2009 - Wednesday
Posted by admin

In MY day, when people found out they couldn’t have children, they gave up their power to the men in the white coats. We allowed the men in white coats to poke and prod us without completely understanding the whys. We suffered alone, isolated. And we liked it! We loved it!

Today, modern people confronted with infertility will have a much easier time of it, thanks to the recently released book, Navigating the Land of IF: Understanding Infertility and Exploring Your Options.  The Land of IF is a guidebook for a place just off the mainland, a place where one in six people find themselves marooned. Author Melissa Ford, has explored every nook and cranny of this formerly insular jungle-of-a-place, and she indulged me in a few questions about her journey to parenthood and to authorhood.

***

You decided to become a tour guide for an island where no one wants to go. Huh?
Well, someone had to do it! Actually, there are a lot of really good books out there for infertility, but they were all missing items here and there. I wanted to cover the basics, but also make sure that all of the questions I still had after I put those books down were answered. Such as what happens if you hit a blood vessel during an injection? Or what are the various IVF protocols?

I also wanted one book for everyone: primary, secondary, situational, biological, young, old, single, or married. This doesn’t mean that everyone will love the book because they may hate my writing style, or how inclusive it is, or any other reason. But I wanted the door to be open to everyone who wanted to walk through by using inclusive language, considering a plethora of situations, and including information for everyone in the community.

You call this island the Land of IF. What does IF mean?
IF is the online abbreviation (on bulletin boards and blogs) for infertility, but “if” is also a huge part of infertility. “If” also conveys the uncertainty and leaps of faith one needs to take daily with infertility.


You’ve done a lot of actual travel. What did you look for in a good guide book? And how did you incorporate this into the Land of If?
I looked for consistency between chapters/cities and information I could use. I love Lonely Planet and Let’s Go because they both skip the pictures and essays about the place (well, they contain that in a small amount) and instead use the space to list the important information you need while you’re there, keeping in mind all people and not just a small subsection of the traveling population. They don’t make assumptions about your financial situation or your interests. They just throw it all in there along with a few helpful tips that will help you bypass difficulties while on the road.

Everyone gets off the island eventually, one way or another. What neighborhoods did you hang out in and what was your path off the island?
It’s an interesting question because I had the neighbourhood I lived in (and most of us only own one home), but many neighbourhoods that I visited due to friends or family members living in other spaces. Many of my childhood friends ended up going through infertility with me, and, of course, I met people along the way through Resolve and now blogs.

In addition, I think the way off the island is really an emotional journey. You can have children and still not resolve your infertility or you can stop the family building process and still not resolve your infertility. There is a saying with Resolve that children resolve childlessness, not infertility. And I find that to be very true.

So my path off the island was a lot of self-searching and finding peace with the journey. But my neighbourhoods while on the island (and I’m still living over here because we’re not finished with our family building) were primary infertility and early loss, with our apartment building being the Injectable IUI Cycle Towers.

When did it first strike you to write the Land of If? What was that a-ha moment where you thought, “This must be written?”—was it a sudden or gradual realization?
It actually started out as a very different book—a book for non-infertile men and women to read to understand the infertility experience. I came downstairs one morning and my husband, Josh, was angrily writing a response to an advice columnist. He had followed an intriguing sentence from the “front page” of the online newspaper to read a question about adoption. And her advice was crap. We were talking about it with my parents that night and they said, “well, you can do something about this. You could write something. You’re both writers.”

I started writing that book, but realized after a chapter or two that it wasn’t a good fit. It wasn’t flowing and it didn’t feel comfortable. I switched it to being a book for me, for my community. And that’s when it clicked.

Would this book have come about if not for your blog, Stirrup Queens?
I don’t know. I don’t think so. I guess one thing that makes this book very different from all other infertility books is that it has this living, breathing counterpart—the blog—and the author is completely accessible. I tell you to join a community and vent your frustrations, but then I also participate in said community and make sure you’re welcomed inside by maintaining the blogroll and Lost and Found. I hope people who read the book then step through the fourth wall that sometimes exists between the author and the reader and communicate with me, either through the blog or by emailing or meeting me at a reading.

Why would someone who is NOT experiencing infertility want to pick up this book?
To better understand someone they know who is experiencing infertility. I don’t know how many people who are not experiencing infertility will pick up this book, but that’s okay. The words are there for everyone to use who is experiencing infertility and they can pass them along in conversation with people outside the experience.

How different would your own IF journey have been if you’d had this book?
I probably would have felt less lonely. The exercises in the book I used to make decision and I included one of the real decision webs we made before we started treatments. And I took my sister’s advice to heart a lot and still do in living my life. But I wish I had known about the online community back then. It was small, but still existed. I wish I had known about blogs and read them.

There is a lot of humor in your book. Can you talk about the importance of levity while putzing around on the Isle of If?
If you don’t laugh, you’ll cry. And even as you laugh, you’ll still cry. I think it’s important to note that having a sense of humour doesn’t mean that you’ll laugh your way through every insemination or egg retrieval or meeting with the adoption facilitator. It means that you’ll bring whatever levity you can to every situation while also honouring the enormity of the situation.

One time, when we were at the beginning of a very early loss, we stopped at a rest stop while driving and when I saw the blood in my panties, I instinctively took off my glasses and threw them. In this very dirty gas station bathroom. And after I had cried and cried and cried, I realized that I couldn’t see anything without the glasses—especially in the dim bathroom light—and didn’t know where they were outside the stall and feared that I would step on them in my attempt to find them. So I could cry but still see the amusement in having thrown my glasses—the ridiculousness of it all.

What is your marker of success with this book. I mean, how will you know when you’ve accomplished your goal(s) in writing it?
If someone writes me and says that it helped them breathe. That it made anything easier or shed light on something that had been muddled in their brain prior to reading it. If people feel that it is inclusive and respects everyone in the adoption/loss/infertility (ALI) community. I wish it could also speak to those outside the community and hopefully the book is respectful to other members of the adoption triad, doctors, nurses, surrogates. It is hard to write balancing everyone, but if I did so overall, I will think the book is a success.

What other projects are you working on, books or otherwise?
Right now, I’m finishing up a work of fiction. I needed something lighter and less research driven this winter/spring. As I complete that project and release that, I have three more non-fiction ideas that I’m tossing around. It is interesting because at the same time, I thought up four non-fiction projects that sat well with me and four fiction projects. So I would love to weave back and forth between the two—with the heavier topics being balanced by the lighter ones.

You’ve tweeted that you’ve been writing sm.ut. Is writing sm.ut as much fun as writing about timed intercourse and hormone levels?
Oh, timed intercourse wins out every time. There is nothing more joyous than writing about timed intercourse EXCEPT writing about home inseminations.

Give us the sales pitch. Where can we get your book?
Navigating the Land of If has its own website where I post information such as readings and where to purchase the book. You can get it at any bookstore in the US as well as online from sites such as Amazon, Barnes and Noble, or Borders.

Lori

Weebles Wobblog ... mindful living amid chaos.
All Thumbs Reviews ... get your sass on.

Categories
Infertility • IUI • IVF

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Story of the Three Must-Haves

June 19, 2009 - Friday
Posted by admin

When my partner and I decided to get pregnant, the first step was finding a sperm donor who would help us conceive a child. Over the course of our attempt to get pregnant, we used one known donor and 5 anonymous donors.

We initially focused on finding a known donor because we wanted our child to have the potential to know this person when they were older. We established a few criteria: they must be in a monogamous relationship, should have children, and who was willing to be identified as the donor. We didn’t want him to co-parent, but we did hope he would be open to being in our lives as a friend. We approached a few of our friends, and a couple even approached us.

Not surprisingly, many declined because they didn’t feel they could remain uninvolved, especially those with children. These men are great fathers, and though they wanted to help us, they were afraid of remaining uninvolved with a child that was biologically related to them. A couple times, it was the female partner who offered their male partners’ gametes. These conversations often originated after a few drinks, and both time the men rescinded their partners’ offer. Many times, these conversations were light-hearted and respectful, but didn’t progress beyond the initial inquiry. After a year, we finally found someone who was interested in helping out and he underwent testing. We hired lawyers specializing in family law to draw up the legal contracts which would protect everyone’s rights, but we found out he would still have to sign over his parental rights after a child was born so that Barbara could adopt. We ended the agreement when no pregnancies occurred after a year of trying at home inseminations with fresh semen, and we remain friends with him to this day.

Rather than re-initiate the whole process of finding a known donor, we decided to turn to an anonymous sperm bank to provide the missing gametes. We started the process with a long list of criteria which included a decent sense of humor, not too religious, blue or green eyes, no family cancer history, between 5’9” and 6’2,” European descent, and willing to be known when the child turned 18. Many sperm banks offer a range of information for free and for a small fee. Most even offer a photo matching service where the non-biological parent (male or female) can send a picture and a donor with similar features will be suggested. Sperm banks are pretty similar in policies and information, but there was tremendous diversity in costs, free online information, and availability of donors. In addition to having a wide range of choices, there were clear legal benefits to using an anonymous donor that protected us from a potential parental challenge we could have faced from a known donor.

We used five different donors from two banks before we finally got pregnant via IVF and ICSI. The longer it took to get pregnant, the shorter our criteria list got until we ended up with three “must-haves.” Those must-haves included no family history of cancer, a height range, and someone willing to be known in the future. The earlier list reflected our personal values and physical characteristics, but in the end, our number one goal was to have a baby. We achieved that goal, met the three must-have criteria, and realized that it didn’t really matter if the donor had a sense of humor or a happy childhood. The only things that really mattered were that our son would be loved, nurtured, and cared for by two loving parents thanks to the help of a third person’s generosity. I don’t know if the young man knows the joy he has brought to our life, but I hope we get a chance to meet him some day and thank him in person.


Sierra Hansen

Categories
Donor Sperm • Family Building • IUI • IVF • LGBT • Sperm Donation

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From the Outside, Looking In

June 18, 2009 - Thursday
Posted by admin

The questions, statements, and facts surrounding infertility prevention never cease to amaze me.  Each time I hear something on the topic which I’ve heard a dozen times before, it still drops my jaw.  Tuesday evening we had a delightful group of 27 women take part in a discussion about infertility prevention, led by Dr. Brian Acacio, of Acacio Fertility Center in Laguna Niguel.  It was the latest, in a string of very successful Manicures & Martinis events, The AFA’s national infertility prevention series.

Questions asked at previous events were asked Tuesday night; the discussion went well past sixty minutes; and the women (including and especially the manicurists) were enthralled with Dr. Acacio’s wit and sense-of-humor used to deliver information on such a serious topic.  So, besides the obvious, like the speaker and location, what made this one different from the rest?  There are plenty of differences which, frankly, are hard to explain.  But, a few come to mind: one being Joanne Brown.  Ms. Brown enjoyed a Fertilitiini™, enjoyed a manicure, and enjoys life.  You see, she struggled with infertility and is now the proud mama of a five month old baby boy, thanks to Dr. Acacio’s help.  Her reason for attending was to make herself available to the group of young women for questions.  You could tell she has a strong and unique bond with Dr. Acacio and his staff.  Whether it’s Dr. Acacio or another fertility specialist - she was there to reassure the ladies there is help out there, when and if they need it.  Hopefully they won’t. 

Most grandparents (and parents, of course) proudly display photos of their prized possessions on their desk, or in this case on their manicures station.  When the event was over one of the manicurists raced over to Mary Garbarino of Acacio Fertility Center with a large picture frame in hand, housing a photo of a beautiful young boy and girl, and said, “these are my two frozen embryo grandbabies,” as her eyes welled up with joy.

Or how about the couple Dr. Acacio mentioned hearing about.  The couple attempted intrauterine insemination (IUI) five times, only to discover it was male factor infertility which accounts for some part in 40% of all infertility cases.  A tremendous amount of money which could have been saved, had only the guy gotten a simple a simple sperm test (a whopping fifty bucks).

Joann, the manicurist, and the IUI couple have already been there, done that.  Their stories not only provide hope, but their experiences also serve as an incredibly valuable educational tool.  Furthermore, The AFA is committed to making sure you’re well aware of all facets of family building.  I provided live Twitter updates throughout the evening with some tidbits of information I’ve heard a dozen times before, but never cease to amaze me (if you missed them, check out our twitter page at http://www.twitter.com/amfertassoc).  Since my wife and I aren’t trying to have a child yet, the infertility prevention series is of incredible value to me - each time I attend.  At this point, I’m simply an outsider looking in, and by doing so from this vantage point, I may one day look back and think this is the best lesson I’ve ever learned. 

Categories
Family Building • Fertility • Fertility Preservation • Frozen Embryos • Infertility • IUI

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Kate Gosselin Has PCOS and It’s None of Your Business

May 28, 2009 - Thursday
Posted by admin

May 27, 2009
11:30 p.m.

I’ve successfully avoided watching Jon & Kate plus 8 since the series started.  Yesterday, I wasn’t so lucky.  My daughter Caitlin came home from school dying to watch the show because her middle school - middle school!  - was all abuzz about the infidelity angle and she wanted to see what the deal was.  So last night, along with about half the population of the United States, I tuned in. 

Oy vey.  Now I get why I avoided it so stringently for so long. 

According to Wikpedia, Kate has pcos, the same diagnosis as me.  I didn’t know that.  Women with pco are very inclined towards hyperstimulation syndrome and multiple births and since Kate did IUI’s, not IVF, she was way more likely to conceive high order multiples, which she did.  Just like me.  I talk a lot about my twins in this blog space but the truth is, Connor and Caitlin are not twins.  They are surviving triplets.  So the high order multiple thing really flips me out.  And that’s why I’ve avoided this particular show for so long.  Anything that glorifies, and therefore misrepresents multiple birth, truly upsets me.

On top of that I am not a fan of reality TV.  I am not a shy person by nature.  But this voyeuristic need to see all, and this self focused need to show all, totally baffles me.  Why does everyone need to know, and see everything? And most importantly, for crying out loud, what about your kids?  No matter what the potential financial gain might be, what you put out there for the world to see, frankly, gets seen by the world!  And children are often the collateral damage of their parent’s need to show and tell their whole lives for all the world to see. 

So this is where it all lands for me.  These very real people, Jon, Kate, and their children, whose names are impossible to find on line, (what does that tell you?) are a family. 

These heartbreakingly adorable children were clearly wanted, and their parents worked very hard to conceive them.  So please. Remember why you had them, and protect them. 

Unfortunately, parents can’t always be trusted to do right by their children.  We all know that. 

Laws must be put in place, now, that eliminate the possibility that children can be exploited through their participation on reality TV shows. 

Life is hard enough.  Having your life plastered on a national stage without your consent is no way to grow up, no matter how you were conceived.

Corey Whelan
Program Director

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
Infertility • IUI • IVF • PCOS

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