Thursday, November 21, 2013

Infertility Becoming Parents

By Harry H. Hatasaka, MD

Few things in life are as anxiety-provoking as having the overwhelming desire and need to have children, but being emotionally devastated month after month when the much anticipated event doesn’t happen.  Infertile couples often develop resentment and jealousy when they see other women who get pregnant without any effort.  One of the first things that the infertile couples do is to turn to family and friends seeking advice.  Yet, often nobody seems to understand the intense personal pain that they are enduring.  Many times friends and family are quick to offer up well-meaning (but often misguided) advice that may actually hinder the couple’s attempts.

Over the ages, the treatment of infertility has been slowed by the widespread circulation of numerous old wives’ tales and folk remedies, many of which persist today.  Fortunately, the study and practice of reproductive medicine has made dramatic advances in the past 30 years. Indeed, because infertility is so distressing and common (approximately 1 in every 10 couples are affected by infertility) an entire subspecialty of medicine has been established to address it.  Reproductive endocrinologists are ob/gyn physicians who have gone through an additional 3 years of fellowship training after their OB/GYN training, focused on treating disorders of the reproductive systems of men and women. The best things that friends and family can do are to be supportive and understanding, resist the temptation to offer up homespun solutions, and to assist their loved one in getting some professional guidance.

When is it Time to Seek Help?

Infertility is most often defined as the inability to conceive after one year of regular intercourse without using contraception.  However, it is critical to understand that because a woman’s fertility slows substantially with age, that the American Society for Reproductive Medicine has recommended that women over 35 should begin a fertility evaluation after only 6 months of attempts.

Women are born with all the eggs that they will ever have and each appears to have its own internal biological clock dictating when it will be released. In general, the genetically better quality eggs tend to come out first when a woman is younger which helps to explain decreased fertility in the later reproductive years and why abnormal chromosome disorders such as Down’s syndrome, birth defects and miscarriages are more common in older mothers.   An alarming statistic is that by age 41, with every pregnancy a woman conceives with her own eggs, nearly half will end in miscarriage. Therefore, the message is clear that if a woman is 35 or older and having difficulty conceiving she shouldn’t waste time before seeing a specialist in order to maximize her chances of success.

Where to Get Expert Help? 

Couples can go directly to a reproductive care center where men often feel more comfortable compared to going to their partner’s gynecology office for evaluation.  However, many women prefer to start with their OB/GYN with whom they have established a long-term bond.  Many OB/GYNs are well-trained and comfortable initiating an infertility investigation.  They can also manage some office infertility treatments that can be highly effective, such as prescribing fertility tablets for women who do not ovulate on their own.  Most often if conception has not occurred after 6 months of treatment or if the OB/GYN diagnoses other infertility factors that are unlikely to respond to office treatments (such as low sperm quality, diminished ovarian reserve, blocked fallopian tubes and severe endometriosis) then they generally choose to refer to a reproductive care center at that time.

What to Anticipate When at the Reproductive Care Center?

When a couple meets with a reproductive endocrinologist, a thorough investigation begins with a careful history to account for all important variables that may impact fertility.  The essential components needed to make a baby include healthy sperm and eggs along with a healthy home (the uterus) for a baby to implant and grow in.  Other necessary items needed to make a baby the old-fashioned way include open tubes and the presence of all of the hormones that orchestrate the reproductive process.  Making sure that all of these components are present and working well is the main focus of the evaluation.  Semen quality, ovulatory function, egg quality, hormone levels and female reproductive anatomy are evaluated.  This process has become quite efficient and streamlined.  Fortunately, many of the expensive and invasive tests that were used to evaluate infertility just 15 or 20 years ago have now been retired after we determined that they just weren’t very helpful.  Now, the whole evaluation process can often be completed in about a month’s time.

Then, with all the tests in hand we can determine which problem or problems may be contributing to the infertility. Only then can a rational plan of action be drawn up for each individual couple.  Here, we can take advantage of decades of clinical research into infertility treatments which has shown us which treatments work and which ones don’t for a particular infertility problem.   Often there are treatment options available and it is important for couples to actively participate in the decision process along with the physician so that they can balance their preferences with the risks, expenses and expected success rates of each option.

What Treatments Are Available For Infertility?

Naturally, the goal of infertility treatment is to achieve a healthy pregnancy quickly, using the safest, least invasive and most economical methods possible.  Surprisingly, sometimes the best approach turns out to be one of the assisted reproductive technologies even though their up front costs are pricey.  The costs of repeatedly using less effective treatments can certainly add up to more than the cost of an advanced infertility therapy and just as importantly, may lose precious time.  It is worth reiterating that for peak fertility using a woman’s own eggs, time is of the essence once a woman approaches age 35.

Many times it is obvious which infertility treatment should be used. Donor sperm are necessary when a man can not make any sperm, and donor eggs when the like situation happens in a female partner, and IVF is a great option if the fallopian tubes have been removed or damaged beyond repair.

The term “assisted reproductive technologies” (ART) includes all of the infertility treatments in which sperm, eggs and/or embryos are handled.  In vitro fertilization (IVF), and the injection of individual sperm into egg cells (termed intracytoplasmic sperm injection or “ICSI”) are two of the most common examples. Other ART procedures range from relatively low tech procedures such as artificial inseminations clear up to major projects such as the use of gestational surrogacy.  Other ART treatments that are available at the Reproductive Care Center include the use of donated eggs, sperm, and even embryos (“embryo adoption”). 

Until recently, we have only been able to freeze sperm and fertilized eggs (embryos).  However, freezing eggs has proven much more difficult because they are relatively large cells with a high water content that expands upon freezing which causes damage or loss of the eggs.  The ability to successfully freeze and thaw eggs, although still considered investigational, is beginning to come of age and we have already had success.  This technique offers the hope to preserve some eggs for women who need to undergo cancer chemotherapy or radiation (which most often eradicates the eggs).  Also, some women will be able to bank their eggs in the freezer while their eggs are still of good quality when they know that it may be years until they are in a position to have children.

IVF has been the cornerstone of the ART procedures.  The first IVF baby was delivered in 1978.  Since then the technique has become more effective and far easier for women to go through.  It was originally used to bypass blocked fallopian tubes but has since been found to be effective for a number of other infertility problems such as ovulation disorders, endometriosis and most sperm problems (with the help of ICSI).

In vitro fertilization also offers the advantage of condensing time by allowing the retrieval of multiple eggs that would otherwise take months to ovulate out one by one.  For couples where the causes of their infertility may be unexplained even after extensive testing, IVF usually yields invaluable information as to what the infertility problems may be by allowing scrutiny of every step of the process in detail.

The process of IVF involves having a woman take injectable medications for about two weeks in order to stimulate the development of multiple eggs from each ovary. During this time, several visits are needed to monitor the development of the egg sacs (called follicles) within the ovaries using blood hormone levels and ultrasounds. When the follicles have grown large enough, indicating the likely presence of maturing microscopic eggs within them, the eggs are collected during a quick outpatient procedure. The eggs are then introduced to sperm in the laboratory the same day they are collected. If they fertilize, the resulting embryos are then grown in the laboratory for several more days until the best appearing embryo or embryos are selected to transfer back into the uterus.  The ability to sort through the embryos to select the ones most likely to become babies is yet another important advantage that IVF allows.  Altogether, the active part of IVF takes several weeks to complete and the entire process is done as outpatient treatment.

What Are My Chances?

Every individual and every couple have different fertility capabilities depending on their diagnosis or combination of diagnoses.  Therefore, specifying a single overall pregnancy success rate for a given treatment such as IVF can be quite misleading.  So for each couple, a full assessment of all their pertinent infertility variables must first be made to be able to make the most educated prediction about their prognosis.  Bear in mind that of all the infertility variables, the most important remains the age of the woman.  For example, women who are less than age 35, on average will have greater than a 50% chance of delivering a baby with each try of IVF compared to women who are over 43 where, with all other factors being equal, can only expect a success rate of about 2%.  If the couple is quoted a 30% chance of success, it may sound low to them and unworthy of consideration, yet most people are surprised to learn that even for young, healthy, fertile couples, their monthly chance of conceiving using their own eggs is only about 20%.

An amazing statistic is that by the year 2002, 1% of all children born in the United States were conceived with the help of ART and this figure has only climbed steadily since then and is now approaching 2%.  This has lead to an estimated 3 million babies born world wide with the help of ART.  During this ART “revolution”, another remarkable transformation has taken place in the United States.  The Pew Research Center recently reported (May 2010) that more children are now born to women beyond the age of 35 than to teenagers.  Advancements in reproductive medicine have contributed to making this possible.  But realistically, IVF can help speed up the time it takes for a woman to get pregnant but it doesn’t solve the problem of poor quality eggs.  Many people have received a false sense of security by seeing a number of celebrities in their forties having children, but the truth of the matter is that many of the stars have turned to the use of donor eggs.  So if a couple has their heart set on having children only from their own sperm and eggs, they need to pay close attention to their biological clocks. 
Other couples just want to be parents.  In that case, beside adoption, ART procedures open up some wonderful opportunities.  Compared to adoption, using any combination of donated sperm eggs or embryos affords a woman the ability to experience a pregnancy, provide good prenatal care, be able to nurse, and to nurture and bond with her child starting right from the moment of implantation.  It is comforting to know that if a couple can avail themselves of all the treatment techniques that are possible in this day and age, then we can help the vast majority to become parents.

What Happens if ART Fails. Whats Next? When the News Is Bad…What’s Next?

by Heather Riley, RN 

The day patients receive negative pregnancy results can be one of the most challenging faced by infertility patients.  Feelings of guilt, anger, grief and hopelessness are common.

Many patients dread the day of the pregnancy test feeling almost unable to answer the phone when we call with results.  While some patients are able to process the bad news and move on quickly, most feel an overwhelming surge of difficult emotions like sorrow, depression and anger. 

Another common response is to question “What did I do to make my cycle unsuccessful?”  “Should I have remained on strict bedrest?”  “Should I have taken more medication?”  “I was so stressed out – I know that’s why I didn’t conceive.”

In reality, elimination of all stress just isn’t possible and bedrest has not been shown to improve pregnancy rates.  It is important to remember that patients who are following the protocol set out by their physician are doing everything they can to work towards a successful outcome. 

So your news was bad what’s next?

Give yourself permission to grieve in your own way.  Everyone transitions through the grieving process in unique ways.  Some find talking helpful – others do not.   Activities they previously enjoyed may be a welcome distraction for some while others cannot imagine doing things that seemed fun in happier times.
 Seek support.  Some patients mistakenly assume that once they are not pregnant the clinical staff is no longer interested in them or willing to help them.  This could not be farther from the truth.  The nurses and physicians at Reproductive Care Center realize that often after disappointing news we are needed more then than ever.  Spending time with our patients on their journey, we become very attached to them and truly share not only their joy but their disappointment when the results we were all hoping for are not achieved.  At Reproductive Care Center we are here to provide emotional support to our patients through all phases of their treatment.  Many patients find comfort in friends and family but for some this is a source of additional pain.  Surrounding yourself with only those people who are supportive and understanding may be possible at least in the short term.  Remember that it is okay to excuse yourself from activities such as baby showers or family gatherings where pregnancies are announced when it is more than you can handle.  Seeking professional help with a caring therapist can also provide an excellent outlet for working through the challenging issues that accompany fertility treatment.  At Reproductive Care Center we are happy to provide referrals for counseling at any stage of therapy.

Share with your spouse.  Remember to keep communicating with your spouse but allow each other the freedom to grieve individually.  Men and women often respond to emotional issues in very different ways.  Women may want to talk extensively about their experience while men may not want to discuss things as much, preferring to move on more quickly.

Complementary therapies and creative outlets provide a welcome source of  comfort for many.  Massage, creative visualization, acupuncture, journaling or blogging about your experiences are some of the activities patients have found helpful.

Utilize resources.  There are a variety of resources available for fertility patients at every stage of their treatment process.  The following websites provide access to  information and support materials:

Give yourself as much time as you need to grieve the loss of your dream, then when you are ready to move on make a plan.  Moving on may be easier if you feel you have a path  to follow.  Regardless of whether or not you plan to continue treatment, a follow up appointment with your physician will allow you to plan for further treatment or can help you achieve the closure needed to move on in a healthy way.  Appointments are available to follow up at any point in your treatment, and a follow up appointment within 3 months of the IVF cycle is included (in all the prepaid cycle plans) for all unsuccessful IVF cycles at Reproductive Care Center.

The journey through infertility treatment can be a difficult one but it doesn’t have to be one you take alone.  Remember to lean on your sources of support whether it’s your family and friends, a caring professional, or one of the staff at Reproductive Care Center.

Friday, November 1, 2013

Interview with IVF Patient

I recall the day I got the call from my OBGYN that my husband’s sperm were not able to penetrate my eggs.  We were devastated because having children was something that we had longed for.  I was faced with the hardest decision of my life because I either gave up our dream of having children, or we could wait to see if a miracle happened, or try IVF (which was the option given by my OB).

We decided to start preparing for IVF.  Our first thought was “how can we afford this financially?”  We made a hard decision and I went to work for Discover Card and we took out a second mortgage on our home.  This was very difficult because IVF is not a for sure thing and we didn’t know if we would be successful.

I felt like a train wreck.  Tons of emotions were going through me. One minute I was very angry, and the next I was sad because the one thing that I wanted most in my life might not happen.  This truly was an emotional rollercoaster.

We started our IVF journey with the Colorado Center for Reproductive Medicine in Lone Tree, CO.  After a failed cycle with CCRM in 2006, we transferred to Dr. Keith Blauer at Reproductive Care Center.

The entire process was very scary and stressful for us because we still didn’t know if we would ever reach our dream of being parents.  Through my tears and tons of tests we were blessed with an adorable baby boy.  Finally our dream had come true and we were so grateful.

If it wasn’t for the nurses, I would not have been able to get through the process.  They truly walked me through the whole process and what made it nicer was they were able to tell me their own personal experiences, since many had been through IVF.”

Since our successful cycle, we have tried another cycle, which wasn’t successful.  We went down the route of adoption and were blessed with two beautiful girls.  I now feel my family is complete.

We are so pleased that Leslie was successful.  We know IVF creates financial hardship and have instituted many programs to help patients afford the treatments needed. Many of our patients now choose the IVF Money Back Guarantee Program. In this multiple cycle program, you deliver a live baby or your money is refunded.  If you aren’t successful, these funds can be used to pursue other options, such as adoption. Some patients require more than one IVF cycle to achieve pregnancy and the guarantee program can be much less expensive.

Guarantee Programs

100% Money Back Guarantee - You Delivery a Baby or We Refund Your Money
Outcome (rather than procedure) based IVF pricing

Infertility is emotionally, physically, and financially challenging.  Reproductive endocrinologists use the latest technologies to diagnose and treat the many conditions that can cause infertility.  Fortunately, most couples become pregnant using treatments such as medications and intrauterine insemination. Advanced treatments, like IVF or frozen donor egg IVF, are sometimes required when the female is older (decreased ovarian reserve), she has failed other treatments, has tubal disease, in some cases of male infertility, and other situations.

Unfortunately, insurance companies have not recognized infertility as a “disease”.  This is difficult to understand when other treatments, such as chiropractic care, are fully covered.  Further, there is a tremendous amount of data supporting the effectiveness of infertility therapies.  Some companies will cover infertility consults and testing but rarely treatments such as IUI and IVF.

This lack of coverage creates financial hardship for many couples who need IVF to have the baby of their dreams. Approximately 50% of IVF patients will require more than one treatment cycle to conceive, further increasing cost.

Reproductive Care Center created the “IVF 100% Money Back Guarantee Program” to help couples cope with the cost of conception. Over 90% of couples will qualify for our program and the “take home” baby success rate is 94%.  We offer both “fresh” (patients eggs and sperm) and frozen donor egg cycle guarantee programs. Patients in the “fresh” program receive four IVF treatment cycles and transfer cycles for all frozen embryos.  Those in the “frozen donor egg program” also receive four frozen/thawed IVF cycles and transfer cycles for all frozen embryos.

A set price is paid before the first cycle begins. If the patient only requires one cycle to achieve pregnancy, the guarantee program is more expensive. This is because the guarantee program covers multiple cycles and there is no refund if conception occurs after the first cycle. However, the statistics demonstrate that at least 50%of IVF patients will require two or more cycles.

With a standard IVF cycle (no guarantee program), no money is refunded and if more than two cycles are required; the expense is much higher than the guarantee program. Delivery of a live baby (or refund of your money) is guaranteed.  If pregnancy does not occur after 2-3 standard IVF attempts many couples will not have the funds to pursue other options.

When a couple enrolls in one of the guarantee programs they will “take home” a baby or their money is refunded (some costs that are not paid to RCC, such as drugs or anesthesia charges are not refunded. See for full details.) They can use their refund to pursue other options, such as adoption.
We feel that the IVF Guarantee Program is an excellent way for couples to maximize success (a live baby) while preserving their treatment investment.