Monday, February 27, 2006

Infertility Tourism & The Baby Business

At breakfast this morning, an article about infertility caught my eye in our local paper. It was about a new book by Debora Spar - The Baby Business: How Money, Science, and Politics Drive the Commerce of Conception. The book (from what I read in the article) discusses the people who gain from the "infertility business" and mentions that there is a price for everything (sperm, eggs, womb rental, etc). I tried to find the article online. Instead, I found this review of the book, which was no less interesting.

Another thing I found during my search was an article about "Infertility Tourism" in the New York Times. Felicia Lee mentions people flying to various places around the world to find cheaper egg donations, to have IVF less expensively, etc. Travelling to go through in vitro fertilization makes a lot of sense - get to visit a foreign country and hopefully come home with a really special souvenir... There are additional advantages like the fact that the experience is much more likely to be a positive one, even if the fertility treatment is unsuccessful.

As mentioned in the New York Times, in Israel, IVF is covered by the national health service. It took me time to realize how lucky I was not to have had to pay for the treatment. I was already an Israeli citizen when I started battling infertility, so once they approved my file, all I had to do was pay about 10% of the cost of the medications that I took. It was about $100 - $150 per cycle. I have tried to imagine what it would be like for money to be the obstacle between having and not having a baby. The decision for those going for expensive infertility treatments is like buying a high risk stock (sometimes repeatedly), but with the desire to have a baby being such an obsession (for most), I don't know how couples can decide to stop.

Saturday, February 18, 2006

Pregnancy and Parenting After Infertility

Fortunately, this subject comes up a lot. Women who've been ttc (trying to conceive) for a long time finally find themselves pregnant and they're shocked it's even possible. It takes a while for it to sink in and then, once it does, come the fears that something will go wrong. I think those of us who have gone through infertility are much less likely to take a healthy pregnancy for granted.

Apparently, at least from my experience, you're more likely to bleed when you're pregnant from IVF. This could be because sometimes more than one embryo begins to implant and the other(s) "miscarry" early on or just because the hormones aren't natural (because the corpus luteum or "yellow body" doesn't always produce hormones to support the pregnancy as it would in a natural cycle). So with me, I was finally pregnant, then I had horrible, scary bleeding (cramping and all) and only after that I saw the heartbeat for the first time. It made the first months very stressful. This happened to me in both my first and second IVF pregnancies (see my story). In both, it was suspected that I had a "miscarriage" though the pregnancies continued to full term, resulting in healthy babies.

So you're pregnant. And then you get nauseous. And you're supposed to be so thrilled that you're pregnant that you don't even feel the nausea. In fact, it's a pleasure. You love every minute of it. You're proud when you rush to vomit. You're over the moon when you can't sleep because you've got morning sickness so badly... except... um... it isn't really all that much fun, even when you really waited for the pregnancy. Even when you made a thousand pacts with G-d about what you would do if you were ever lucky enough to finally be on your way to becoming a mom. You still feel sick as a dog and you'd really like to feel better. Soon. Now. You get the same stretch marks from pregnancy whether it's IUI, IVF or natural. You feel tired and swollen and heavy toward the end of the pregnancy whether you've waited 5 years or 5 minutes... Is it legitimate to complain? Of course it is. Just like it's going to be legitimate when your contractions are killing you or when you're going to be tired if your baby keeps you up all
night.

It seems like (and is) such good fortune to finally have a baby after you've wanted one for so long, but I wonder if it makes the experience of being a parent a different experience? Maybe you're more likely to take a long period of maternity leave to be with your baby or you feel more protective than other parents do. Maybe while you waited to have the baby you had a lot of time to dream about the things you want for him, her or them... and then those dreams lead you to do more things with your child than you would have otherwise. Maybe you had time to save money and you have better financial resources so that you can provide additional enrichment to your child. Maybe you're more patient. Maybe there's no difference at all...

I'm starting my 35th week tomorrow. My ankles are so swollen that I was surprised I was able to put on my shoes this morning.

Tuesday, February 14, 2006

IVM - In Vitro Egg Maturation. A Way to Avoid Ovarian Hyperstimulation Syndrome

I just read an interesting article about IVM - in vitro egg maturation. The method, according to the article, isn't new, but so far only about 300 babies have been born using it. Its main advantage is that it allows a short treatment cycle (3 days of medications) after which the immature ova are obtained. This significantly reduces (or perhaps completely eliminates) the risk of ovarian hyperstimulation syndrome (OHSS). For women who have suffered OHSS and are afraid to go through another IVF cycle or have been told by their doctor that it is too risky, IVM can be a last-resort by which they could still have a baby of their own.

The article specifically mentions women with polycystic ovarian syndrome as good candidates for IVM. I actually never knew that having PCOS put women at higher risk for ovarian hyperstimulation, but apparently, as mentioned in this article (by a center offering IVM), it does.

One disadvantage of in vitro egg maturation is that frequently the outer part of the egg becomes practically impenetrable - the sperm just can't get in, requiring intracytoplasmic sperm injection (ICSI) to be performed. Another disadvantage is that the ova are extremely sensitive and therefore need to be tracked very carefully as they are being matured in the lab. Both of these issues raise the costs associated with the procedure (compared to regular IVF), though the cost is likely to be offset by the much lower cost of medications used to stimulate egg production and the savings due to having less blood tests and ultrasounds (because of the shorter stimulation protocol).

IVM can also be used with regular IVF cycles, when despite a regular stimulation protocol many immature oocytes are obtained, so it can also give couples going through IVF more eggs, meaning that they will have more embryos to freeze for future cycles.

I'm always encouraged to hear that there are more and more solutions for infertility. If IVM can be perfected, perhaps someday in the not-too-distant future, it can replace today's method (usually 1-2 weeks of daily injections) that puts a great strain on women's bodies and consumes so much of their time and energy.

Tubal Reversals & Vasectomy Reversals

I recently got hooked on Yahoo! Answers (I have some great tips for anyone else who's into it). I hang around to answer questions about trying to conceive and about a variety of other things (my most recent answer was to a ridiculous question that asked whether you'd prefer to drown in mayonnaise or be stoned to death by pickles - yes, I'm serious) and I've come across quite
a few questions dealing with tubal reversal.

This morning I had another letter in my inbox - "I was married with 2 children (and) decided that I didn't want anymore children so I got sterilized (had a tubal ligation). 6 months later the marriage broke up. A year later I met my future husband who I would love to have more kids with, so my option is IVF.

We looked into a sterilization (tubal ligation) reversal but it has a high cost and lower success rate compared to IVF. We are now just beginning an eggshare IVF where I'm donating half my eggs to another lady. I am excited, frightened and nervous but I know this is the road I need to go down to get my end result."

I spent some time researching tubal reversals - different clinics claim different success rates, but overall - they're not highly successful. It seems that there are too many women who have had tubal ligations that they regret... and too many men who have had vasectomies that they regret. I find it ironic that people who felt they were "overly blessed" are now facing exactly the same issues as those who are going through (secondary) infertility.

After the original posting of this entry, I received the following question:

Q- I have had a tubal ligation, is IUI an option for me?

Unfortunately, the best I could offer was the following:

A - If you've had a tubal ligation, IUI will unfortunately not help you. With IUI, the fertilization still occurs in the fallopian tube, which, in your case wouldn't work.

IVF (in vitro fertilization), on the other hand, is an option. See more about
IVF.

Thursday, February 09, 2006

Stilettos & Infertility - Where Did This Come From?

I do my best to keep up-to-date on what's happening in the news in terms of infertility... It interests me and it helps me give better answers to people who ask me questions.

Not long ago a friend of my sister-in-law called me to talk to me about her daughter who was going through IVF. They live in a very tight community and the daughter didn't want anyone to know what she was going through - especially because the cause was male factor. At the time I first talked to her, the daughter had just found out that her first IVF was successful, but she was bleeding. I told the mom that I've had it go either way - twice the pregnancy went on, once I ended up losing the baby. (See my infertility success story.) I chatted with her a few more times & the last time she called (earlier this week), it was to thank me for having been willing to provide her with honest answers to her questions - and not just to say, "it'll work out OK." The daughter is now well into her 4th month of pregnancy and the bleeding stopped long ago.

Today I did a Google search for infertility in the news and one of the first things that came up was how Stiletto shoes can effect female fertility. It makes me wonder - who researched that? Having read the (very short) article, there's no mention of any statistics or any reasonable explanation to the claim... The article refers to the shoes as "killer heels" and discusses the way in which they shift the woman's balance. Where did this article come from and why would a generally reliable news source publish an article with no facts backing it up? As if women going through infertility don't have enough to worry about, now they have to think that maybe their fashion choices are to blame???

I don't believe what's written in the article, but, to tell you the truth, heels have never been for me anyway.

Sunday, February 05, 2006

Husbands & Sperm Donation

I got the following letter recently and I must say I found it infuriating. Fertility Stories has received many tens of stories from women (and even one from a man, Jim - which he updated recently, after the birth of his daughter) who either contemplated or went through with sperm donation and this is the first that expressed this opinion. Our page on donor thoughts also paints the picture entirely differently and I was very surprised to receive this:

"I have been prompted to share my experience following Joan's story (posted January 20, 2006). They have been married for almost 4 years and just discovered that the husband has no sperm.

Joan, and others struggling out there, I got married in 1994 and 4 years later the doctors said that I have no sperm and will not be able to father a child. We have been living in tears for more than 11 years in this condition. It is important to understand what your partner goes through, especially if it is only one of you with a problem. Let us not be selfish and try to get a solution that satisfies only one partner. Children are meant to be for 2 people - husband and wife.
Friends and family have offered many options, all of which will never replace biological children. While we could have gone for donor sperm, I feel that the child will be for my wife (and another man!!) and not ours. Adoption may seem neutral but such children usually find their biological parents when they grow up. And this can be so frustrating.

Many times, people around us do not understand what we go through. On several occassions we have been blamed for delaying childbearing (we are now 37). We have failed to forget the whole matter. Sometimes we feel desperate and other times we are so hopeful through prayer. But the desire for biological children is unquenchable.

As a way forward, we have decided to sink ourselves in prayer. There is nothing impossible with God. We believe that soon we shall have children and our tears of sorrow will be replaced with tears of joy. Let us continue the struggle prayerfully. Miracles still happen, and ours will happen soon. Keep your hopes high, irrespective of your age."

Though I can understand the desire to have the same biological connection to your child (as your spouse does), I find it difficult to comprehend how someone with such a strong desire for children could also be so against adoption.

Please feel free to share your comments.

Thursday, February 02, 2006

Donating Sperm for a Sibling? A Brother's Thoughts.

I got an interesting letter a while ago from a young man who I'll call Joseph.

"Hi. My sister & her (lesbian) partner have asked me to be a sperm donor. They joked about it five years ago. We kind of left it in the air for a bit then, as I was living abroad at the time. They turned to other possible donors, somewhat to my relief. Three possible donors later, each backing out after talks and meetings etc, they decided to try a fertility clinic.

We live in Ireland where no such service exists or (I think) is legal - for lesbians. In the last year they have gone 7 times. Each time was unsuccessful, each time with less and less trust in the system - there is no personal touch, no feeling of getting good service from the clinic...the prices are going up, and they feel - being 'foreigners' they are being ripped off. That's all tied up with the anguish and emotions, the fertility drugs etc., etc.

About five weeks ago they came back to me - their original first preference. I've grown up, am 34 and have very different views to 7 years ago, but I am very worried. Being a donor is one thing, being the child's uncle and father is another. They gave me a book which is very much from a woman's point of view. I'm not finding much sensitivity for the man, the donor. Even the donor's experiences seem to be coming from men who are very unattached to their sperm.

I don't think I sound crazy. But I am afraid that if I donate I will be part of something very real, a reality I will want to be part of. But what happens then? I want to help my sister, I want to help her partner. But what about my parents? What about me? I've never been given the opportunity to be a dad before. I thought that was taken from me once I came out to myself 17 years ago. I need to talk to someone who has had similar experiences, those who did it and those who didn't. I'd appreciate your comments.

Joseph - Ireland."


This was my response:

"Dear Joseph,

Thank you for contacting us. I read your story and I think that it's very good that you're taking the matter so seriously.

I would be happy to post your question on Fertility Stories along with any answers we receive. Let me know if you are interested.

Personally, I think that there are a lot of issues involved: You would be placed in an un-natural relationship with your sister, being a co-parent to her child (which, actually, biologically would be your child). What would your legal obligations be? What would your sister and her partner's expectations be from you? What would happen if your sister and her partner decide to dissolve their relationship? Would you have visitation with the child? Have to pay child support? What if you disagree with the education they choose for the child?

It seems the matter is very complicated and would have very long-term effects on your life.

I also think you are correct in that most donors have no desire to have any sort of connection with the children born of their sperm - this has its advantages, such as keeping just the 'parents' in the picture (particularly in heterosexual couples).

I look forward to hearing from you.

Rachel"


Joseph's response:

"Hi Rachel,

Thank you for your reply. I think posting my query may be a good thing, as I need some real life experience feedback. My friends are differing very much in their opinions. Some flat out no's. Others are envious.

I'm not sure if I was clear - I am gay as well as my sister. My sister is 2 years older than I and we are very alike in looks, mannerisms and personality - strong family line hey! No wonder I am their number one choice. Since I have taken on this consideration seriously my mind has wavered and weaved from positive to negative, from fear to excitement. Each step has ramifications in each and every direction. Yep, I'm feeling a little overloaded. I'm not under pressure, although a 'no' is not going to go down well.

The need, want, to have a child I think has heightened this year with the treatments and drugs, I think my sister's girlfriend is more than ready and 'wants a baby'. I was worried about my sister. I was leaning towards a negative gut feeling up until we actually sat and talked about it. I was concerned my sister was being pushed into this, her partner is persuasive and I wondered if, like me, my sister had never really thought about having kids before. It's so hard to know...maybe if I was lucky enough to be in a long term relationship and my partner was the family kind, and I loved him dearly, then yes I think I would want to have a family.

There is so much uncertainty… And that's before the legalities. I already know that there are no legalities. I mean, there is nothing in place to protect me, as a donor - to remain just a donor. No law exists in Ireland to prevent my sister &/or her girlfriend from claiming child welfare. Would I argue it? If things were to change? How could I? The child would be biologically mine. But trust is the bind. I trust my sister, her girlfriend. I trust their ability to bring a child up well. I trust them that should circumstances change, they would not turn on me.

I know to anyone reading this I may sound very selfish, but I am trying to get to the heart of why I want to do it, why I don't. Part of me thinks - stop thinking, just do it, you can't know the outcome - who knows the outcome of a child, the conception, the birth, the life. The changing of all relationships as time passes. None of it can be controlled. Is that a positive or negative?

Thanks for listening,
Joseph"

We look forward to your comments.