The AFA Blog

You Only Get To Know People Over Time….

By Jamie Schenk DeWitt

 

Nobody sees a flower - really - it is so small it takes time - we haven't time - and to see takes time, like to have a friend takes time.  By Georgia O’Keeffe

Why am I quoting Georgia O’Keeffe at the beginning of my blog?  Well for one thing when writing about friendship, such a complicated and colorful subject, it seems poetic to begin with famous words from a prolific artist. And secondly, I am quoting her because she so eloquently sums up what my mother has been telling me my whole life about friends and relationships.  My mom says, “You only get to know people over time.” 

There is nothing like experiencing infertility to test the bonds of friendship between girlfriends of childbearing age, especially if you have only known that person for a few years.  Two months into my fertility treatments, I confided in a good friend about my fertility plight.  We had only known each other for a little under two years but I liked her and we had always related well to each other’s sensibilities, humor and values.  I can still remember the day clearly. We were out to brunch with our husbands and she asked me how I was doing.  Instead of giving the standard answer of “I am good.”  I decided to tell her the truth.  I said, “I am going through fertility treatments and it is really stressful and a lot to process.”

Well the floodgates opened.  She and her husband revealed that they, too, were having a hard time trying to get pregnant.  Six or seven months ago, she had a miscarriage and had not been able to get pregnant since. They were incredibly frustrated and scared.  We also confided in one another how difficult it was to be around friends who were getting pregnant while we were struggling.   

Over that brunch, the four of us bonded in our failed attempts to start families.  Our candidness brought us closer and we were able to relate more intimately with one another now that we were going through similar experiences.  During the next couple of months, my friend and I regularly emailed each other to check in and share stories about our own fertility trials and tribulations. We became a mutual source of comfort and support.

There were definitely things that I wasn’t sharing with her or for that matter anyone.  There would be days when I doubted that could get pregnant.  I would get depressed, sad and anxious.  There would be days when I would be at the hair salon and the woman next to me would be telling her stylist that she was pregnant and I would want to die because I felt like everyone else around me was getting pregnant. This scenario happened all the time…at the grocery store, at the movie theater, at the dry cleaner.  Wherever I went during the darkest hours of my fertility treatments, I would run into pregnant women or women who just found out that they were pregnant.

After months of this downward spiral, I eventually found balance and hope in my life through therapy, meditation, yoga and a lot of talking to myself to refocus my thoughts away from the negative.  I no longer felt sad when I heard about other people getting pregnant.  I was able to feel joy and hopefulness for myself.  I had turned my emotions around and it felt empowering.   

In the meantime, my friend underwent somewhat of a radio silence.  I wasn’t sure why, but then on July 2 at 8 am an email from her came in to my inbox.

“Everything's good here. So you may have guessed from my recent silence on the whole baby making issue and my not drinking when you guys came over to our house that I'm pregnant. I just wanted you to know.” 

She went on to write that she was sorry if this was hard news for me but that she totally understood if it was because she had been there herself months before with other friends.  She was hopeful and praying for us that it would happen soon.  She sent her love.

I started shaking. Not because she was pregnant, but because of the way she delivered the message.  Everything about it disturbed my equilibrium.  First of all, who wants to read about this in an email from a good friend?  Second of all, I felt like she was projecting her feelings about how she would feel in this situation on me.  Her words and tone assumed a fragility that I wasn’t experiencing anymore. I had worked so hard to feel good and not resentful about anyone else’s ability to get pregnant that I didn’t want to get sucked back into the black hole of fear, sadness and panic.   

I called her right away to congratulate her and discuss her email.  She listened and tried to explain her motivation, but we clearly did not understand each other.  There wasn’t too much left to say.  We periodically emailed each other, but our friendship was strained.

Three months went by before we saw each other again.  We went out to dinner with our husbands.  My husband and I announced that we were pregnant with twins right before the appetizers were served.  Our friends were excited for us, but there was awkwardness to our interaction. Our friendship had clearly not recovered.   

I knew that I wanted to talk with her about what happened, but it would be months before we saw each other again at a mutual friend’s holiday party.  She was two weeks away from giving birth.   As we started talking it was so clear that we both had the best intentions, but the intensity of each of our circumstances made it difficult to see what each other needed.  Thankfully we were both able to put more value in our friendship than in our feelings, which allowed us to work it out and put the incident behind us.

My friend just had her second baby and I couldn’t wait to go over to her house to meet him.  It is hard to imagine the friends we were two years ago when this incident happened compared to where we are today, but we are closer and better friends because of it. Georgia O’Keeffe and my mom are right…you only get to know people over time.

Intended Parents: Miracles Do Happen (A Mother's Day Story)

by Sandra Watson Rapley

After years of struggling with infertility and feelings of hopelessness my brother Clive and sister-in-law Victoria offered Victoria to be our surrogate mother. My husband Craig and I were extremely happy with their offer but we never ever thought we would have to take them up on it. I still held on to the hope that I would become pregnant and that my body would not let me down. Another IVF attempt failed and after some time of coming to terms with the fact that I could not have children, we decided to accept Clive and Victoria’s extremely generous offer. We wondered how it would work out because Clive and Victoria lived in California and Craig and I lived in New Jersey.  In the end there was no reason to worry about this.

The IVF procedures we’d been through confirmed that I could produce eggs and they could be fertilized by my husband’s sperm so having a child genetically related to both of us was still a distinct possibility. After completing the required medical testing, psychological evaluation, and legal aspects, we were ready to start. Clive and Victoria have two children and did not want any more children so that requirement by our fertility center was met.

We flew out to California for the egg retrieval. Six eggs were retrieved and I had high hopes that they would all fertilize in vitro. Out of six only two fertilized and made it to day three. Having gone through prior failed IVF treatments with more embryos I began to feel despair. Surely it would fail again. We hoped and prayed that at least one of the embryos would implant. A week after the transfer we found out that Victoria was pregnant! We could not believe it. I was in complete shock. Six weeks later we found out that we were pregnant with twins! We felt so fortunate and grateful that both embryos had implanted. We were also lucky enough to have the sonogram recorded on a video cassette. Craig and I watched it over and over again.

Victoria suffered with pre-term labor and extreme morning sickness. Fortunately I had a flexible job which allowed me to work anywhere as long as I could communicate by telephone and by email.  So at week 16 I had already flown to California for one of the doctor’s visits when I had to rush Victoria to the emergency room because she started to feel contractions. One of the better parts of being in the ER was that they had very sophisticated sonogram equipment so we were able to view a very clear and detailed sonogram which revealed that we were having two boys! She was immediately put on bed rest at week 16 and would remain this way until the babies were born.

Throughout the pregnancy we were filled with every emotion in the book – from worry to happiness, and from feelings of guilt to joy. I rushed Victoria to the emergency room on another occasion when the fear of early delivery scared us again. I decided to fly out and stay with them for the rest of the pregnancy. When I saw Victoria she looked grey. I had never seen her look this way before.

It was during this time that I realized how bad her morning sickness was. I was racked with guilt and teary eyed every time she got up from the couch and waddled to the bathroom. I would sit there and wonder why on earth she had offered to do this for us. She assured me that she knew exactly what she would have to go through. She suffered terribly with morning sickness during her pregnancies with her own children. It was then that I understood why it was a requirement of the fertility center that a surrogate mother should already have children.

Fortunately for us, Victoria managed to carry our babies until week 36. Our fraternal twin boys were delivered by C-Section and weighed 6lbs 15oz and 5lbs. I will never forget when they came into the world – kicking and screaming. I was able to be in the delivery room and I saw exactly how and when they came into the world. I was filled with shock, joy, and fear. After the boys were swaddled they were handed to me and both my arms were filled. A new worry came over me when I began to wonder how I would feed them at the same time. Craig arrived the following morning and saw our babies for the first time. He asked “Where have you been? We have been waiting for you”. Our sons are healthy and strong and are now eight and a half years old.

Clive and Victoria - thank you both for your extreme generosity and kindness.

Sandra Watson Rapley is also the author of “Intended Parents: Miracles Do Happen” 

Everyday is Mother’s Day!

by Jamie Schenk DeWitt

 

Okay, please don't roll your eyes at me.  I am not delusional.  Nor is my life a Hallmark card.  I do not get cards, flowers and phone calls everyday wishing me “Happy Mother’s Day.”  My one-year-old twin daughters sometimes push my nerves to the limit.  Lately they have been throwing fits on the changing table.  You would think that I was taking their rectal temperature every time I want to change a diaper.  After I’ve changed one baby sometimes I dread the thought of having to change the other.  

But as quickly as my frustration arises, it passes.  Diapers get changed and my girls return to smiling and playing.  Peace is restored.  Yes, we have daily cries and drama, but all of that pales in comparison to the absolute, overwhelming joy and satisfaction I get from being their mother.       

I know that my profound appreciation for motherhood has emerged from several sources.  The first is that after experiencing infertility treatments and the complete despair and joy that comes from coping with my biological malfunctioning, I am eternally thankful for every day that I have with my daughters.  The two IUI’s and two rounds of IVF along with the sometimes heart-wrenching pain followed by self-actualization and personal growth has in fact made me a healthier mother.  We cannot always choose our path, but we can decide how to deal with it.  Every day, I am grateful that I chose to persevere and not give up hoping that I would have children.     

The second source of gratitude towards motherhood does indeed come from my daughters. Not just because they love and appreciate me on Mother’s Day but because when I walk into their bedroom at 6:15 AM their eyes light up and they are clearly excited to start their day.   They bounce up and down making joyful sounds.  They are truly ecstatic to see me, and the feeling is completely mutual.   This mutual feeling happens throughout the day whether I am observing them playing or catching their glances when they don’t think I am looking.  Every day, my daughters appreciate, trust and love me.  It is an intense responsibility that I honor and cherish    

The third source comes from the respect and love that I have for my mother.  My mother has always been there for me from helping me pack up my apartment so that I could move halfway across the country, to picking up the phone in the middle night when I called in a panic because I learned that I would need fertility treatments.  If it weren’t for her unwavering support and love, I would not be the patient and nurturing mother that I am today.   I respect her and rely on her to help me be grounded, and seek her well-rounded advice.  She has been a role model for me and has instilled in me the confidence to mother my two beautiful girls so that they can grow into accomplished and loving women.     

The fourth source actually comes from my beloved cat Julep. (Now I know some people aren’t cat people or pet people so please bear with me).  In October of 2009 – seven months after my human daughters were born -- my 14-year-old cat, Julep, died.  Julep and I had been together since she was 6 weeks old. She was my first baby who I had the privilege of loving and who gave me the honor of loving her.  I was 23 when Julep came into my life.  I had never taken care of another living being besides myself.  Julep was precious.  She was lovable and friendly and my little girl.  She would greet me at the door when I came home at night and snuggle with me.  She taught me how to love and nurture, as well as understand what it means to be sacrificing and patient.  Julep would have been 15 years old this month.  Last year, I was blessed to have spent my first mother’s day with all 3 of my girls.   This year I am definitely experiencing a loss and sadness.  Yet with that sadness, I value and appreciate the opportunity to be Julep's mother.    

This brings me to the last and final source, which is Mother’s Day in all of its original glory.  Mother’s Day also means having a deep respect and love for all children and their mothers.  I say this not only because I am a mother and daughter, but also because of what Mother’s Day was intended to represent.  Julia Ward Howe, who was a prominent American abolitionist, social activist and poet, created Mother’s Day back in 1870 with her poem a Mother’s Day Proclamation. http://www.peace.ca/mothersdayproclamation.htm.   Her call to action was in response to the carnage she witnessed during the American Civil War.  In her poem, she proclaims that all women have a responsibility to shape their societies and take action.  I believe that as people, it is our duty to look out for one another, be mindful, caring and compassionate and remember that we are all children with mothers.  It is a great responsibility but one that -- especially in this day when peace is so precarious -- can help ensure that our world is a safer place.  

 Happy Mother’s Day!  Love Jamie

Cancelling IVF, Converting to IUI, and a Few Other Things.

by Fred Licciardi, M.D.

What if you are on drugs for an IVF cycle and there is a low number of follicles? Should you do cancel and have an iui (provided there is sperm and at least one tube is open) or should you have the retrieval?

The number of eggs is less important the younger you are. So at age 31, 4 eggs still results in an excellent pregnancy rate. At age 41, 3 eggs is much worse than having 10. So is there a “cutoff” number? Not really, and if there is it will vary from program to program. There are no strict guidelines for who should be retrieved and who should not. In most cases, when there are 1-4 eggs developing, the doctor will say that the odds with IVF become so low that it’s not worth the cost and effort of the IVF, so the better thing to do is the iui.

There was a very interesting paper presented at the last meeting of the American Society of Reproductive Medicine. One IVF center compared the pregnancy rates for women who decided to cancel to IUI vs. those who decided to have the retrieval, when 1-2 eggs were present. Those women who continued on and had their retrieval had a higher pregnancy rate than those who had the IUI. Now the rates for IVF were still in the single digits, but the rates were better than the iui numbers. So IVF is better than cancelling to IUI, but the odds of getting pregnant from that retrieval is quite low. Would you have a retrieval if your odds were 2% with IUI but 5% with IVF? Some patients would, some would not.

I have mentioned before that we all know or suspect that there are IVF programs who cancel the 3 eggers because they are worried about lowering their statistics. I think there is less of that going on. I see patients being informed of their odds and then be allowed to make the decision. And the threshold may be different depending on your perceived potential. If it’s your first try and the doctor really thinks that a different protocol will do you better, cancelling makes more sense. If you have been cancelled for 3 follicles, and after protocol changes you make 3 again, well you make 3 and that’s it, so retrieve away.

What about multiple egg issues at the same time?
For example there are some women who make a large percentage if immature eggs, have low fertilization rates and have low embryo quality. Others have different mixes such as high rates of polyspermy, low rates of normal fertilization and poor embryo development. Others have mature eggs that do not fertilize without ICSI despite normal sperm, and then poor embryo quality. Is there one basic problem with the eggs that is leading to a completely bad scenario? This may be, but we don’t know what it is. The reality is that most women with a large percentage of immature eggs do pretty well with the ones that are mature. And women who have polyspermy, do pretty well with the eggs that fertilized normally. But for some of you, everything seems to be wrong despite protocol changes and changes with icsi, in hcg timing and day of transfer. Yes there may be a missing link resulting in multiple problems at once. It’s a matter of trying a few times and keeping all of your options open.

Persistently elevated prolactin levels need a full workup, which usually means an MRI of the pituitary.

What if your FSH is a little high and your AMH is a little low, but you have a good number of resting follicles and make a good number of eggs for IVF?
Those hormone tests are more about predicting egg number than quality. I believe the numbers have less of an effect on egg quality. Others may disagree, ask your doctor.

What if you suffer from autoimmune disorders and are having trouble conceiving? Is there a relationship?
Overall women with autoimmune disorders seem to be as fertile as anyone else. High risk OB practices are busy dealing with pregnancy complications of Lupus, RA and others. However, there are so many unknown factors related to fertility and the immune system, it does make one think that there may be a relationship when pregnancy is not occurring. I have seen a few cases of relatively young women with autoimmune disease who are very poor responders. I think there is a relationship between their disease and antibodies to their ovaries. Unfortunately there is still no good test to measure ovarian antibodies. There are good tests for thyroid antibodies, adrenal gland antibodies, but not yet for the ovary.

Here are a couple sperm questions.
Sperm counts that go from 100 million to zero then up again? He needs to be evaluated for intermittent obstruction: a blockage somewhere that occurs some of the time. Also could be intermittent retrograde ejaculation. Send him to a reproductive endocrinologist.

What if the urologist finds low counts and motility and does a thorough workup and tells you the numbers are what they are, can’t be increased and recommends IVF. You are always welcome to get another opinion, but it sounds like this guy is honest and he is telling you what most men are told. I believe in seeing a urologist because sometimes surprises are identified, but in most cases of very low counts and or motility, nothing is found and the only answer is IVF.

Yes ovarian hyperstimulation and ovarian torsion are related.
Torsion becomes more likely as the ovaries enlarge and become heavier. This increases the chances of the ovary rolling over and twisting on its stalk. Torsion with clomid can happen, but it’s much rarer because the ovaries have fewer follies and are smaller and stay lighter.

Is Fermara a safe alternative to Clomid? Medications and their off label uses.

by Danny Shapiro, M.D.

 A recent article circulated by Reuter’s and seen on MSNBC and its webpage  detailed the off-label use of Femara (Letrozole). The article made further reference to a 2005 Canadian study which suggested that babies born after Letrozole use had a three-fold increase risk of birth anomalies. The article went on to suggest that as much as 30% of anovulatory patients treated for infertility had been given Letrozole.

The article concluded that significant cost savings could be realized if patients could only get insurance coverage for a medication if was used for an ’on-label’ indication. In the case of Letrozole, only patients taking the drug for its original purpose (breast cancer treatment) would be eligible for reimbursement. In the mind of the writer this would discourage off-label use of the drug and also protect patients from the ill effects of the drug. Letrozole works by blocking the enzyme aromatase, which converts male hormones to estrogens. Patients taking the drug will block production of estrogen in fat, a common problem in patients with ovulatory disorders. As the circulating estrogen level falls, the pituitary escapes the suppressive effect of estrogen on FSH secretion. This in turn leads to an increase in FSH which drives egg production from the ovary. Et Voila! An egg is born…or at least released. There are problems galore with the assertion that Letrozole is a problem child of a drug. There are also many flaws in the logic that off-label use of a drug is somehow inherently bad. Similarly, there is a widespread attitude that Letrozole is preferable to the old standby Clomiphene (clomid)….which is probably not true with regard to pregnancy rates.

Patients who read articles of this nature need to remember several points. First, off-label use of drugs is remarkably common. This is generally a good thing. Lupron for instance is indicated for treatment of prostate cancer and the Depot form of Lupron for pretreatment of myomas before surgery. It is rarely used for either indication anymore. Instead, Lupron is used primarily as co-treatment with FSH in IVF and IUI stimulation protocols, for which it never received approval. Without the ability to use Lupron ‘off-label’, IVF success rates would be MUCH lower.

Letrozole has been shown to cause ovulation to occur in anovulatory women, but its indication is for breast cancer treatment only. The concern that the drug may be associated with an increase in birth defects may be true but the single paper out of Canada doesn’t confirm this. In fact, the cause and effect relationship implied by the Canadian group doesn’t follow simple biology: the drug is LONG GONE out of a woman’s system by the time an embryo is at risk from any drug exposure. Furthermore, there are almost no instances in which a drug can damage an egg in such a way that the egg makes an abnormal baby. Egg damage usually, if not always, means no baby at all.

The last point to consider is why Letrozole is so popular. Clomiphene, the gold standard oral ovulation drug for over 40 years has a very well defined track record and reliably initiates pregnancy in about 35% of the patients who do up to six cycles. Per cycle pregnancy rates are about 13-15% in anovulatory patients and about 8% in patients who ovulate by themselves with unexplained infertility. Letrozole performs no better than Clomiphene in the statistic that matters…babies born…but it may be easier to take than Clomiphene. Letrozole is not associated with mood disturbance or hot flashes like Clomiphene and it doesn’t thin out the uterine lining like Cloimphene can. These are real and theoretic advantages, but they don’t change the final delivery statistics for anovulatory patients. So, here’s the final skinny: Off label use of a drug is not a bad thing. Off-label use of Letrozole is probably safe BUT Letrozole offers very little advantage over the old gold standard Clomiphene. I’d need a chapter’s worth of blog to cover this fully but in the end patients with anovulation or unexplained infertility should be encouraged to try oral agents as first line therapy, but because of low success rates, not the risk of the drug, patients should abandon oral drug therapy quickly for more aggressive management when the pills fail to make a baby

Why Nature Wants You To Get Laid Right Now....

by Ken Mosesian

It's 11.30 at night, I'm back in my hotel in New York City, and happily exhausted. Corey Whelan, AFA Program Director, and I had the pleasure of presenting information about the biological clock to a group of about 50 students at Yale University during Sex Week at Yale (SWAY).

A completely student organized event, the SWAY http://www.sexweekatyale.com/ website states: "Sex Week at Yale is a campus-wide interdisciplinary sex education program designed to pique students’ interest and spark dialogue through creative, interactive, and innovative programming. SWAY is at the cutting-edge of college-aged Sex Education. We aim to push students to think about sex, love, intimacy, and relationships in ways they never have before with a week full of guest lectures, panel discussions, hands on workshops, parties, presentations, and student productions." You can follow them on Twitter @sexweekatyale.

We were both so appreciative to have been invited to speak to people in their late teens and early twenties about this issue. This is a time when they are actively considering how family and career can work together. We had an amazing conversation lasting an hour and a half, and it was great to be in a room with really bright and inspired young men and women.  

All of the questions had merit. Some were deeply complex, like the morality of so-called "fertility tourism." Others were somewhat humerus, but nonetheless heartfelt, like asking what we thought about freezing sperm and then getting vasectomies. For all of them, we could feel that life was like a blank canvas, and they were writing their own stories on it. And hopefully, we added information into the mix that will help in the process. 

A few important "thank you" shout-outs are in order: to Dr. Harvey Kliman http://www.med.yale.edu/obgyn/kliman/pages/klimancv.html, who introduced us to Yale and to George Norberg, one of the student members of the Board of Directors of SWAY. A big thank you to George for extending the invitation to us to speak. And to Dr. Harry Fisch http://www.harryfisch.com/, whose work on the male biological clock was an invaluable resource to me. 

There's a lot to worry about these days, if you choose to look at it. There's also a lot  that's right with the world. Yesterday, spending time at Yale with those students made us feel pretty damn good about the future. 

January is Thyroid Awareness Month. If You Can't Get Pregnant, Should You Care?

 by Corey Whelan

Your thyroid, that little gland at the base of your neck, is the master glad of your metabolism, and plays a significant role in many areas of a woman's reproductive life, from conception through to delivery.  59 million Americans, mostly women, currently have thyroid abnormalities in the U.S.  A significant percentage of these women are currently trying to conceive a baby.  Could you be one of them?

Thyroid problems fall along two specific lines, 1) hyperthyroidism, when the thyroid gland is overactive and producing an overabundance of thyroid hormone and 2) hypothyroidism, when the thyroid gland is underactive and not producing enough. 

Ironically, both extremes can present problems for women who are trying to get and stay pregnant.  Women with hypothyroidism may produce too much prolactin, which is the hormone that helps to create and maintain breast milk.  Too much prolactin can adversely affect fertility by inhibiting ovulation and therefore, conception. 

Women with undiagnosed hyperthyroidism may be at greater risk of miscarriage or premature birth, making it hard or impossible to maintain a healthy pregnancy.

It should be a no brainer that your thyroid is tested when you are first experiencing difficulties conceiving but unfortunately that is not often the case.  The reason is simple. The symptoms of both underactive and overactive thyroid are often vague and attributable to a wide variety of other disorders and include sleeplessness, weight loss or gain, constipation, memory loss, or hair loss.  

A good rule of thumb is simply this.  If you are having trouble getting or staying pregnant, ask for a full battery of thyroid tests.  These include the TSH (Thyroid Stimulating Hormone) Test, the T4 test, the Free T3 test, and the Autoimmune Antibodies Test.  In addition, make sure that your physician is a reproductive endocrinologist or other specialist who can accurately  analyze the results of these blood tests and integrate them into your diagnosis, by evaluating your symptoms, taking your medical history and performing a clinical exam.  Follow up treatment is key, particularly if you are placed on medication, as your dosage will need to be carefully evaluated over time.

That little butterfly shaped gland called the thyroid affects virtually every system in your body.  If you are  trying to get pregnant, particularly if you are over the age of 35, make sure that a full battery of thyroid tests are part of your initial infertility workup.

For more information on this story, check out these important links and the video below:

http://www.thyroidawarenessmonth.com/ebook.htm

http://www.thyroid-info.com/pregnancyguide.htm

http://www.thyroid-info.com/articles/fertilitythy.htm

http://thyroid.about.com/cs/basics_starthere/a/couldyou_2.htm

http://www.examiner.com/examiner/x-24753-Infertility--Miscarriage-Examiner~y2010m1d14-January-is-thyroid-awareness-month--If-you-cant-get-pregnant-should-you-care

http://www.examiner.com/x-14154-Raleigh-Infertility--Miscarriage-Examiner~y2009m11d23-Hypothyroidism-and-infertility?cid=examiner-email

http://thyroidawarenessmonth.com/

http://thyroidawarenessmonth.com/allyson-averell-facepainting.htm

Photo courtesy of Allyson Averell, thyroid artist

Octuplets Mother's Beverly Hills Fertility Doctor Accused of Gross Negligence by the State

Reprinted from L.A. Now - blog of the Los Angeles Times 

The Beverly Hills fertility doctor who helped Nadya Suleman give birth to 14 children, including octuplets, has been accused by the California Medical Board of repeated gross negligence.

Both Suleman and Dr. Michael Kamrava made international headlines last January, after the Southern California woman gave birth to only the second set of octuplets ever delivered in the United States.

Her babies, who will turn 1 on Jan. 28, are the longest-surviving set. Suleman is a single mother who was unemployed and living with her parents. All her children were conceived through in vitro fertilization. At the time, Suleman said she continued having babies because she couldn’t face destroying her frozen embryos.

But, according to the accusation filed Dec. 22 by the Medical Board, Kamrava continued administering fertility medication to increase egg production and retrieving eggs to create fresh embryos even though Suleman still had frozen embryos from previous cycles.

In addition to accusations of gross negligence, the board said Kamrava also failed to refer Suleman to a mental health professional and negligently administered high doses of fertility medication – which could lead to ovarian hyperstimulation syndrome.

Kamrava could not be reached for comment at his Beverly Hills clinic, which remains open.

-- Kimi Yoshino

Bloggers Unite TODAY to fight for Premature Infants

On November 17th in support of Prematurity Awareness Day, bloggers from around the world will be posting and tweeting in an effort to raise awareness about prematurity.  The American Fertility Association is participating in this extraordinary effort.  Please read The AFA blog post below, which I wrote about my own twins prematurity over this past summer.  We have chosen to re run this piece, and urge you to support this effort through your own blogs, twitter accounts, and facebook pages.

Looka!  Looka!

Reprinted from July 27, 2009 - Monday

by Corey Whelan

Tonight I am going to Coney Island with my kids to see the fireworks.  We will ride the Cyclone first (at least they will, you can’t get me on a roller coaster to save my life) and then Nathan’s, and after that we’ll hang out on the board walk until the display starts a little after sundown.  I love Coney Island, I’ve been going there since I was a kid.  My dad used to take me to the chick hatchery and put me smack in the middle of the fluffy little yellow things until I had my fill of patting their soft downy coats.  I used to love that, and I cried bitter tears when it closed.

But there was a place my dad didn’t take me, a place I didn’t even know existed until this week, my friend Barbara saw a TV show on PBS about it. 

Ironically, had my own kids been born in 1945 instead of 1995, I would have known about this place all too well.

The most popular attraction at the Coney Island Freak Show, next to the midgets, bearded ladies, and other assorted poor souls that we as a society could not find in our hearts to accept in those days, were the incubators.

For human infants, born too soon.

Like mine.  Connor and Caitlin were born on the first day of my third trimester.  I never made it to a LaMaze class and didn’t have time to paint the nursery.  My babies were 2 lbs. 3 oz (Caitlin) and 2 lbs. 6 (Connor) and lived in state of the art incubators for over two months.  The incubators that helped to save my babies lives cost $4,000 a day each and were not covered by my health insurance. (Did I mention that I’m divorced?)

But from 1903- 1945 there was only one place premature babies could be cared for and that was in a side show, not in a hospital.  Doctors from around the country rushed premature infants to Coney Island for treatment. There was no other option available for these most fragile of souls. 

File this under Where There’s A Will, There’s A Way.  He was a visionary, he was a failure.  He was a showman, he was a man of medicine.  He was a savior, he was a public joke.  Sometimes revered, sometimes ridiculed, but he didn’t stop.  Dr. Martin Couney was determined to save premature babies, when the world assumed they did not have a chance, when infant mortality rates were so high that these tiniest of the tiny were not even an afterthought.  Even, unbelievably so, for their parents, who often abandoned them at birth.  Dr. Couney continued to experiment and refine the incubator system in the only place he could, among the barkers and cotton candy sellers.  6,500 out of 8,000 babies lived, because of The Incubator Baby Exhibit in Luna Park.  The development and application of an important, ground breaking technology was paid for with each sticky handed admission, ten cents at a time.  There was no other way for him to fund his work. 

Eventually hospitals caught up to Coney Island, with Cornell being the first, and of course the rest of the world followed.
So tonight when I’m oohing and aahing at the fireworks I’ll be hearing the barkers yelling “Looka Looka!  See the Babies no Bigger than Chickens!” and remembering a time when my own babies looked like a two pack of Cornish hens.  I’ll say a silent thank you to Dr. Couney, and remember to never give up.

Corey Whelan
Program Director

Please visit these links for more information:

http://www.americanheritage.com/articles/magazine/it/1994/2/1994_2_24.shtml
http://www.neonatology.org/pdf/NYT_BeardedLady.pdf
http://www.coneyislandhistory.org/collection/index.php?g=detail&object_id=602

 For more information on Bloggers United click here:

http://www.bloggersunite.org/event/fight-for-preemies/posts

http://www.examiner.com/x-4079-SF-Sexual-Health-Examiner~y2009m11d17-Blogger-unites-today-to-fight-for-premature-babies?cid=examiner-email

The Glorification of Multiple Birth in Popular Culture and Media

by Corey Whelan

The TLC Cable Television Network is unfortunately at it again.  Now that the Jon & Kate Plus Eight debacle is mercifully behind us, TLC has chosen to pump up the promotion of yet another one of their reality TV shows.  This particular show, "Table for 12"  glorifies the lifestyle of yet another large family created through infertility treatment.  TLC would like you to spend some time bonding with the Hayes family this season.  Parents Betty and Eric (stay at home mom and policeman dad) worked with an infertility doctor to conceive three sets of multiples.  While the details of the youthful Ms. Hayes'  treatment are not as yet clearly known, it is safe to assume that her physician was aggressive in the course of her treatment.

The Hayes family consists of twelve year old twins, ten year old twins, and four year old sextuplets.  Altogether that is ten children being raised in the American spotlight on prime time television.

Clearly the creation of this reality TV show is geared towards financial gain for the network, which is a reasonable goal for a TV station to have. However, while it makes sense for television networks to produce shows that will bring in large audiences, in this case, there is a more relevant moral imperative at stake.

The glorification of multiple birth gives women and men who are undergoing infertility treatment the misconception that this outcome  is safe, acceptable, appropriate, and frankly, cute.  It is none  of the above.  According to Brooklyn based reproductive endocrinologist Bradley Trivax, M.D. of Reproductive Specialists of New York, "The negative health repercussions of high order multiple gestation are many, affecting mom, babies, and our health care system in general.  The most common complication is premature delivery.  Early delivery results in low birth weight and contributes to the morbidity and mortality of the babies being born.  Multiples often require a high rate of admission to neonatal intensive care units and are at risk for a number of complications including cerebral palsy".

One of the Hayes sextuplets, four year old Rebecca, does in fact have cerebral palsy.

According to William Petok, Ph.D., a member of The American Fertility Association's Mental Health Advisory Council, "The major problem with twin pregnancies is prematurity which can result in breathing and digestive problems, underdeveloped organs, learning disabilities and developmental delays.  Of course, this will increase the costs for the delivery and subsequent hospital stay for the babies.  Some estimates for the hospital costs of premature multiples range between $1.5 million and $3 million".  The incubators alone that will house these babies cost approx $4,000 each per day, and then there are the additional costs for specialist's visits and medical tests. 

In addition, the emotional toll that prematurity takes on the parents is enormous, often resulting in post traumatic stress disorder. 

As reported in Science Daily, a better alternative that  Ms. Hayes' physician might have considered is single embryo transfer, or SET.  Single embryo transfer refers to the implantation of one embryo per IVF cycle.  The embryo can be either fresh or frozen.  SET has been shown to literally halve the rates of multiple pregnancy.  

According to Dr. Trivax, "Perhaps no issue in assisted reproductive technologies is as controversial as the selection of the optimal number of embryos for transfer.  Progress towards SET has been slow because of concerns that it may result in lower pregnancy and live birth rates.  However, data shows that transferring two or three embryos rather than one improves pregnancy rates only slightly, while dramatically increasing multiple birth rates.  All women under the age of 35 should be considered for single embryo transfer.  Once technology reaches the point where we can accurately distinguish between good and bad embryos with certainty, single embryo transfer will finally be welcomed with open arms."   

The Hayes  wanted a large family and they got it.  But when you are planning your own family, try to remember that reality is not the same thing as reality TV.  The sensible goal for anyone who is trying to conceive should be one healthy baby per pregnancy.  Be a proactive patient and let your physician know that one baby at a time is what you want..  If you do however choose to be aggressive in your treatment, work with your doctor to make sure that you know the risks and can prepare for the outcome.