Personhood: An Extreme Attack on Freedom

As a lawyer and a mom of twins conceived via in-vitro using a gestational surrogate, it is with deep personal interest I read about the “personhood” petitions being introduced in all 50 states.  On November 8, Mississippi will be the first state to vote on such an measure, Initiative 26.

Positioned as a “civil rights” issue, these extreme measures target abortion and women’s rights – reaching even further into the private life of women by insisting that all fertilized eggs be defined, and protected, as a person – even  before a pregnancy is validated by a physician.  The consequence of this type of legislation is that it may result in outlawing not only all abortions – but also some forms of contraception and assisted reproductive technologies such as in-vitro fertilization.

The ethics of reproduction is complex and nuanced – as is reproduction and sexuality itself.

When Jennifer and I started our journey to parenthood, we knew we had some intrinsic challenges in out parenting quest – but never in our wildest dreams did we imagine we would go through failed IVF, miscarriage, failed adoption, and finally have a gestational surrogate (name) to bring our babies into the world.

Imagine if such a law were in place in our state or on a federal level. Our dream of parenthood would never be fulfilled. This is not only an issue that involves us individually – it is an issue making headlines in the the presidential race.

Like most Americans, we want to see fewer abortions and believe in adoption. We also stand with a recent nationwide survey where 80% of likely voters that agreed with the statement that “government should not be getting involved in the decision to end a pregnancy, it’s better left to a woman, her family and her faith.”

Jennifer and I deeply believe in the sanctity of life.  We also believe that defining a fertilized zygote as a “person” does nothing to enhance that sanctity – it only serves to devalue the living breathing men and women faced with individual choices about their futures when a pregnancy is contemplated, a possibility, or established.  And with full legal rights, the loss or destruction of a fertilized egg could be classified as murder. This is a truly frightening prospect.

To learn  more about the important and timely issue, check out recent blog posts and articles by RESOLVE, Sarika Bansai,  Mississippians for Healthy Families, and NARAL.

Natural IVF: A tested and affordable option with fewer side effects

At a 50th birthday party last weekend for my friend Maggie, I noticed one of the guests, Kristin, receiving quiet congratulations. I quickly deduced she was newly pregnant: 6 weeks. I knew Kristin had been trying to conceive for at least a year, and I was naturally pleased and curious to learn about how she “got to baby” — or at least to pregnancy.

I went over and offered Kristin my own congratulations and we started chatting about her journey and swapping war stories. I was intrigued to learn she was successful with natural cycle IVF, a low-medication alternative to standard IVF. (Another alternative is called minimal stimulation IVF or Mini-IVGF  Mini-IVF uses Clomid, an oral medication that has been in use since the 1960s.) I did some quick investigation and learned that natural IVF has been around since the late 80’s early 90’s — but it’s not the first option offered by many clinics.

 Natural cycle IVF is similar to standard in vitro fertilization but doesn’t rely on expensive and painful follicle stimulating hormones (FSH) medications to stimulate the ovaries to make multiple eggs. In natural cycle IVF,  follicle development during a normal ovulatory cycle is tracked by blood work and ultrasound, and when the follicle is ready to release, it is retrieved and fertilized using conventional IVF procedures. Natural cycle eggs are typically considered to be of a higher quality than traditional IVF.  Like traditional IVF, not all eggs result in an embryo. But when an embryo is produced and transferred successfully to the uterus, the pregnancy success rates are similar to conventional IVF.

With a new generation of infertile women pursuing holistic health solutions, it’s little wonder that natural cycle IVF is attracting new clients and researchers. The University of Southern California (USC) is recruiting participants today to take a fresh look at how advances of the last 20 years may influence outcomes (no discount on treatment, but this is a way to help other women know if this is a better option in the future).

 This is a safer, less costly approach for IVF. It’s not for everyone, but according to several clinics it’s a good option for many women, including those with elevated FSH (lower ovarian reserves), failed conventional IVF cycles, tubal disease, or male factor issues.

 So why isn’t natural cycle IVF promoted more? Perhaps the main reason: it can statistically lower the overall success rate for a clinic, because clinic data on stimulated and unstimulated (natural) cycles are lumped together (although the CDC tracks each separately). Not surprisingly, clinics don’t want to skew their success rates, so natural IVF is not the go-to option for many clinics.

Infertility treatment is never fun, but it seems this method takes the “sting” — both physically and financially – out of a painful situation.

 Kristin? She got lucky. Worked on the first try. Congratulations to her!

 Meanwhile, we’d love to hear about your experiences au naturel IVF. We’ll keep an eye on the USC study and keep you posted on this perhaps overlooked and statistically disadvantaged approach to Getting 2 Baby.

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A few quick points from clinics specializing in the natural approach:

Advantages of Natural  / Minimal Stimulation IVF

  • Eliminates the risk of ovarian hyperstimulation syndrome (OHSS)
  • Significant cost savings: about half of most standard IVF procedures
  • No painful and expensive gonadotropin injections
  • Fewer office visits
  • Generally produces a higher quality egg
  • Produces one follicle, virtually eliminates risk of multiple pregnancies

Potential Problems

  • Cycle is cancelled, usually due to premature ovulation or LH surge.
  • Failure to retrieve the egg – in less than 10% of patients.
  • Failure to fertilize the egg – in less than 10% of patients.

Should IVF clinics be less aggressive with treatment?

Dr. Suheil Muasher, a board-certified Reproductive Endocrinologist who has been treating infertility for 28 years, recently published an interesting article on the potential benefits of minimal stimulation In Vitro Fertilization (IVF) to the medical journal of the American Society For Reproductive Medicine, “Fertility and Sterility.” In the article, Dr. Muasher compares the latest research on success rates of existing IVF methodologies, including minimal and mild stimulation IVF, as well as the driving factors behind his belief that more fertility clinics in the U. S. should offer minimal stimulation to their patients.

Minimal stimulation IVF uses oral fertility medications and low dose injectable hormones, while mild stimulation uses low dose injectable medications. While the article discusses both methods, Dr. Muasher says minimal stimulation is a better option because it not only reduces the overall costs and stress affecting all patients, but also presents significant advantages for all infertility patients — but especially to low and high responders — when compared to conventional methods of stimulation.

In the article, “Mild/Minimal Stimulation for In Vitro Fertilization: An old idea that needs to be revisited,” Dr. Muasher says both mild and minimal stimulation for IVF were initially abandoned for a more aggressive approach to assisted reproduction and fertility, which was believed to increase pregnancy rates. However, he emphasizes that current research and the overall impact on the patient no longer validate this way of thinking: “With improvements in all aspects of IVF methodology and transferring one or two eggs for most patients, the aggressive approach is no longer essential and has significant drawbacks in terms of cost, stress, and increased complications for some patients.”

Additionally, Dr. Muasher highlights the fact that there are no differences in success rates of mild or minimal stimulation per fresh transfer, and the more aggressive approach to IVF. He adds that many clinics do not offer this type of procedure due to the fear of reduced pregnancy rates, which he says are simply not substantiated by the data. “The driving factor was to offer a low cost IVF procedure that is more affordable, less stressful, more patient friendly, and less complicated; therefore, with similar success rates, minimal stimulation IVF becomes an even more attractive option.”

Is it time to find another OB-GYN?

If you have ever been very sick or seriously injured, or if someone you love has, you know how critical the doctor/patient relationship is. Your health and well being, your future — perhaps your very life — are in this person’s hands.

This is also true when you are seeing a physician not for an illness or injury, but in an effort to change your life another way: by having a child.

If you are undergoing infertility treatments, like artificial insemination or In Vitro Fertilization (IVF), it’s so very important to see a doctor you trust, and who will communicate with you about everything that’s happening. Does your doctor take the time to fully answer your questions? Does he or she make sure you completely understand what the treatments entail, and how they will affect your body? Is your doctor clear about what you can expect, and your chances for success?

It’s also so important that your doctor is truly qualified to handle your specific case. Just because an OB-GYN offers fertility treatments doesn’t necessarily mean he or she is the right doctor for you.

Some fertility problems are tough to diagnose; it may require a specialist to determine what’s going wrong in your case, and how best to treat it.

If you have been seeing an OB-GYN who does not specialize in fertility problems, and your treatments haven’t been successful after a reasonable number of attempts, you should consider finding a specialist. The average number of attempts at artificial insemination before success is between three and four. How many times have you tried?

Yes, it can be tough to leave a doctor you like and trust — but if he or she is not the right physician to help you, it may be a necessary step.

Different paths to adoption

Most couples who struggle to have a child undergo fertility treatments, which are often successful. In those cases where they fail, however, many hopeful parents turn to adoption.

With an open adoption through an agency, or with the help of an adoption facilitator or attorney, the first step is matching with a birth mother. An open adoption means you might have the chance to experience her pregnancy with her, going to doctor’s appointments, seeing the sonograms and being in the delivery room when the child is born. It also means the birth mother may be a part of the child’s life, even after the adoption.

However, there is always a risk with adoption that the birth mother will change her mind and decide to keep the baby. Regardless of any contracts or agreements you have in place, many state laws protect the biological mother, leaving the intended parents heartbroken and without a child. Although this worst-case scenario is possible, and does happen, most adoptions go through as planned.

Another path to adopting a child is to work with a foster agency. There are many, many children in the foster care system without parents who are able to care for them. These are kids of all ages, and all races, and each is in need of a loving home. Not all foster children are available for adoption, however. Some are in the system because their parents have temporarily lost custody. Once the situation leading to that loss of parental rights has been resolved, the parents often regain custody. However, most foster agencies are happy to work with intended parents seeking children who are available for adoption.

Many couples also adopt children from another country through an agency that offers international adoptions. The agency handles the paperwork and legal issues, which can be quite complicated, to give you the best odds at a successful adoption.

No matter how you go about adopting, both child and the adoptive parents are getting a precious gift: the chance at a better, more fulfilling life as part of a loving family.

In-Vitro Fertilization

In-Vitro Fertilization (IVF) is a more invasive and expensive pregnancy option than simple artificial insemination, but has a higher success rate and has grown in popularity in recent years. In this process, a doctor carefully places a fertilized egg, or embryo, right into a very specific spot in the uterus. The patient remains awake during the procedure.

Not just any fertilized sperm and egg will do for In-Vitro Fertilization. Several eggs and sperm are fertilized in a lab, outside of the body, for a doctor to review. Only the strongest-looking embryos make the cut to be placed into the woman with hopes that the fertilized egg will grab on to the uterine lining. Many couples like the reassurance and feeling of control they get from knowing from the outset that fertilization has successfully occurred.

No method is fool-proof, and such is the case with IVF. The diciest part of this process is whether the embryo will attach and grow, rather than being absorbed into the uterine lining. There are processes, like physician assisted “hatching,” that can improve the odds of implantation, but that simply increases the chances. Nothing is certain, and the more specialized the procedures get, the higher the price tag is.

The process isn’t as simple as just inserting the fertilized egg. The woman who hopes to become pregnant has plenty of tests and medications to look forward to during the process, especially if she wants to use her own eggs. That’s the option we chose. That meant frequent hormone shots designed to grow a large amount of eggs, which were later extracted through a medical procedure.

Meanwhile, the woman who wants to carry the baby must take hormone treatments — that is, more shots — to prepare the uterine lining for pregnancy. In many cases, both the egg harvesting and the egg transfer occur in the same woman. In other cases, such as surrogacy or with many lesbian couples, each leg of the race is carried out by a different woman.

It isn’t easy, and it isn’t always fun. Hormone treatments can lead to a wide array of side effects, from the pleasant, like an increased sex drive, to the not-so-pleasant, including wild mood swings.

Be prepared. Fertility assistance isn’t a simple process. You need to be ready for multiple doctor’s visits, invasive procedures and other discomfort along the way.