Posted by Ryszard Chetkowski on Sat, Jan 28, 2012 @ 08:27 PM
By Madeline Feingold, Ph.D.
If you’ve been diagnosed with infertility, you are not alone. Infertility strikes approximately one in six couples and provokes painful feelings that may interfere with your daily life. From diagnosis through interventions and treatment, infertility places tremendous stress on relationships. The following tips may help couples prevent conflict and increase intimacy.
Men and women are affected by infertility equally with roughly 40% of infertility attributed to a male factor, 40% to a female factor, and 20% to unexplained or mixed causes. Infertility often causes many men and women to experience a sense of inadequacy and low self-esteem, which may leave them feeling damaged and unworthy of their partner’s commitment.
- Don’t blame yourself or one another. Regardless of whether infertility is due to a male or female factor, recognize that it is your shared difficulty and not one partner’s fault. Stay focused on your love and dedication and view infertility as a problem you must face together in order to build your family.
Men and women often have different ways of communicating that may lead to feeling disconnected and alienated. Women generally reach out to others for support and want to talk to their partner about their feelings. Men, on the other hand, may withdraw from others and focus conversations with their partner on problem solving rather than emotional expression.
- Do recognize that although you may act differently, you share similar feelings. Both of you are likely to feel depressed, anxious, angry, and grief stricken. Set aside a time and time limit everyday to talk about your experiences of infertility and accept each other’s style and responses without judgment. There is not a right or wrong way to feel. Communication and compassion will break down walls and build bridges.
Infertility treatments may begin to govern your lives. Your desire to become a parent is paramount and your fear that it may not happen may be overwhelming. It is easy to focus all of your attention on getting pregnant and to have difficulty thinking of anything else. This may leave you feeling hopeless and helpless as your mood and happiness becomes dependent on circumstances that are out of your immediate control.
- Don’t live cycle to cycle. Even though it is emotionally difficult to do, take some time off between treatments. Talk about all the other aspects of your life and relationship that have always been important to you and act on them. Think of enjoyable activities and make plans to do them. Try hard not to let becoming pregnant be the sole key to your happiness.
Infertility produces stress on many levels. Undergoing diagnostic tests and medical procedures may cause embarrassment and create logistical problems that interfere with work. The financial impact of treatment may be daunting. Watching friends become pregnant may be excruciating, and your family may not understand your grief. In short, infertility may have a negative impact on all areas of your life.
- Do practice stress reduction strategies together. Exercise, meditation, yoga, and attending a mind-body program all may be helpful. Reach out to others for support and try not to withdraw from social contact. Consider talking to a mental health professional that specializes in infertility.
Although infertility poses a significant life crisis, following these tips may help you support one another and increase your closeness and intimacy. As with any crisis, there is an opportunity for growth.
Posted by Ryszard Chetkowski on Wed, Oct 26, 2011 @ 05:04 PM
Patients frequently ask whether there is a clear-cut advantage to having two
IUIs in one cycle rather than just one. Published studies vary in their design and conclusions but the balance show little, if any, benefit to having a second IUI.
Our primary approach is to focus on pinpointing the time of ovulation as precisely as possible. We then deliver the sperm into the uterus either close to the time of ovulation or shortly before it. There is strong evidence that insemination a day or two after ovulation has already occurred does not lead to pregnancy.
Preparation of semen for IUI includes gentle spinning in a centrifuge in order to separate motile normal sperm from immotile dead sperm, debris and seminal fluid which can irritate the uterus.
In most cases, we do not recommend two IUIs because of the increased cost and inconvenience. However, on rare occasions, after several well-timed single IUIs without conception, we have performed two inseminations in a single cycle especially when frozen-thawed sperm is used.
Posted by Ryszard Chetkowski on Mon, May 30, 2011 @ 11:20 AM
An egg donor, Lindsay Kamakahi, filed a class action lawsuit in April 2011 against the American Society for Reproductive Medicine (ASRM), the Society for Assisted Reproductive Technology (SART), and the Pacific Fertility Center (PFC) in San Francisco. She claims that the defendants have conspired to fix the compensation paid to egg donors in order to "reap anti-competitive profits for themselves".
The first defendant, ASRM is a non-profit professional organization dedicated to the advancement of reproductive medicine. SART is an affiliate organization of ASRM. More than 85% of clinics that perform IVF and related procedures in the USA are members of SART.
The ASRM guidelines for the compensation of oocyte donors state that the “total payments to donors in excess of $5,000 require justification and sums above $10,000 are not appropriate”. Members of SART are expected to follow those guidelines or face possible loss of membership. The complaint states that the amounts in the guidelines have not been raised since their publication in 2000.
According to the complaint, egg donors receive an “average hourly compensation of between roughly $75 and $93 for time spent in a medical setting, about the same as hourly sperm donor rates." The complaint concludes that since “the process of donating eggs is far more painful and risky than is the process for donating sperm, a price paid for donor services that does not account for those differences must be artificially low.” The inconveniences suffered by eggs donors include painful hormone injections, frequent blood tests and ultrasound exams and surgical retrieval of eggs which “may require several days of restricted activity to recover.”
The ASRM guidelines were created in response to reports of payments of up $100,000 to donors considered uniquely desirable. Since ASRM and SART are non-profit organizations, their finances are not affected by the amount of compensation paid to donors. The donors’ compensation is paid indirectly by the recipients through agencies and clinics which act as intermediaries. Physicians and fertility clinics aim to balance their responsibility towards the donors with their commitment to recipients both of whom are considered patients. Clearly, high donor compensation may render the entire procedure unaffordable for many recipients.
Proponents of regulation argue that excessive compensation may induce women to take on undue health risks which could amount to exploitation. In the absence of federal regulation, the ASRM guidelines fill a legal vacuum. Indiana is the only state with statutory caps on payments to egg donors while Spain is the only country in western Europe where donor compensation, albeit in much smaller amount of about 1,000 euros, is permitted.
Posted by Ryszard Chetkowski on Sun, Mar 20, 2011 @ 10:00 AM
Donor eggs offer the only chance of a live birth to a large number of women whose ovaries do not work, whose eggs are no longer viable, who may carry a genetic disorder or who have failed multiple other fertility treatments. While coming to accept the need for donated eggs can in itself be difficult, the high cost of the procedure adds yet another obstacle to the family-building journey.
Many couples and single women simply cannot afford the standard cost of donor egg IVF in the United States. In many centers the total cost of donor egg IVF approaches or even exceeds $30,000. To make matters worse, very few insurance policies include coverage for this highly effective but complex fertility treatment.
Human blastocyst
At the Alta Bates IVF Program we have developed several different strategies to make donor egg IVF more affordable. Expanding patient access to fertility treatments is central of our overall program philosophy: http://www.abivf.com.
Using a younger sister or a relative to altruistically provide eggs can greatly reduce the cost of treatment. These types of donations require careful psychological evaluation of all the parties involved but may be the right solution for many families. However, many women requiring donor eggs do not have relatives who can or are willing to provide the eggs.
Another approach widely used in our fertility clinic is to match two recipients to a single donor in the same treatment cycle. In an anonymous arrangement the recipients typically do not know or meet each other but they share the cost of donor treatment and compensation. The reduction in cost is about $9,500 for each recipient bringing the total donor egg IVF treatment cycle cost below $18,000: http://www.abivf.com/finances/donoreggs.html.
Since compensated egg donors typically provide more than 16 mature eggs, a recipient receiving half of the eggs is very likely to have several embryos for transfer or freezing. In our experience the live birth rate per transfer of fresh embryos is the same with 2:1 and 1:1 matching albeit the number of extra embryos available for freezing is likely to be lower with the 2:1 match.
Recent graduate
Posted by Ryszard Chetkowski on Fri, Feb 18, 2011 @ 10:00 AM
In vitro fertilization (IVF) was originally developed in the late 1970s as a treatment of last resort for severe tubal disease. IVF was used after microsurgery failed. While IVF success rates increased rapidly during the 1980s, surgical results did not improve. By the early 1990s it was clear that IVF was more successful than surgery in women with severely damaged tubes and IVF became the primary treatment.
Hydrosalpinx, a dilated tube occluded at the ovarian end, is the most common form of severe tubal damage. Although surgery can open such tubes, it is a short-lived solution because the tubes frequently close back up. The diagnosis of a hydrosalpinx is typically made on an HSG x-ray exam (see image below) and confirmed by laparoscopy.
HSG showing large hydrosalpinx
In 1994, Dr. Annika Strandell and colleagues observed that women with a hydrosalpinx had about 60% lower success rates with IVF than women with damaged but open tubes. It is the backflow of fluid from the hydrosalpinx into the uterine cavity that interferes with attachment of embryos to the uterine wall.
Fortunately, severing the connection between the hydrosalpinx and the uterine cavity either by removal of the tube or by tubal ligation restores success rates with IVF to expected levels. Since hydrosalpinges are usually present on both sides, severing their connection to the uterus leaves IVF as the only route to conception.
Some women with tubal infertility have a hydrosalpinx on one side only while the other tube remains open. In 2003 I and colleagues published an article repoprting a series of 25 women with a unilateral hydrosalpinx, 22 of whom (88%) conceived shortly after surgery without IVF. Since most conceptions occurred within 5 months, a one-sided hydrosalpinx appears to act as a contraceptive preventing implantation of embryos from the open tube.
A very recent article by Dr. Hong Jiang and colleagues from Hefei, China reports that drainage and chemical occlusion of a large hydrosalpinx visible on ultrasound with 98% alcohol also restores IVF pregnancy rates to normal levels.
For additional information about the diagnosis and treatment of tubal factor visit www.abivf.com/challenges/inftubaldisease.html.
As these ironic twists and turns in the hydrosalpinx story demonstrate, best practice in infertility does not rely upon a simplistic choice between either surgery or IVF but upon utilizing both techniques as most appropriate in an individual case.