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.

—–

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.

PBS profiles “Made in India,” a documentary film on surrogacy

A new documentary, “Made in India,” has just been released and was recently profiled on PBS NewsHour. The film, directed and produced by Rebecca Haimowitz and Vaishali Sinha, featured Lisa and Brian Switzer, a couple in Texas who struggled for several years to have a child. Then, due to a medical condition, Lisa had to have a hysterectomy. Unwilling to give up their dream of parenthood — and unable to afford a surrogate mother in the United States — the Switzers sold their home and spent their life savings on PlanetHospital, a medical tourism company that works with surrogate mothers in India.

Also highlighted in the film was Aasia, the woman in Mumbai, India who served as the surrogate for Lisa and Brian. Aasia, who lives in dismal poverty with her three children, was paid $2,000 to carry the Switzer’s child. She could not use her last name and appeared on camera only with her face hidden by a veil to keep her identity a secret from her community.

“What should I say about myself?” said Aasia in the film, through an interpreter. “I used to clean people’s homes before. I’m not educated. I don’t know how to read or write. So this is my life… I’m doing this for my children. A son can earn anywhere, but I want to save this [money] for my daughter.”

The film showed Lisa and Brian rejoicing first at the news of Aasia’s successful pregnancy, and again as they brought home their twin daughters. But when their story was told on The Today Show, they were surprised and hurt by negative comments from others on the Today Show’s website. Several comments accused the Switzers of exploiting Aasia.

In response, Brian Switzer said, “The surrogates are well-compensated in line with their local economy. I have seen poverty unlike anything I could have imagined. And knowing what this process is going to do for the surrogate and her family in the long run makes me realize that this is a very good thing for all parties involved.”

“This woman is carrying a life that I can’t carry. She’s giving me the family I can’t create. I will never, never be able to thank her enough,” said Lisa Switzer.

The filmmakers told PBS, “At the time when we started filming, we noticed that any mainstream conversations around this issue tended to be very polarized: either promoting or condemning the practice. We wanted to bring a nuance to the story that would offer the audience a closer understanding of the intended couple’s and the surrogate’s choices behind their decisions. We wanted to take this intimate journey with all the players involved. Of course, we had no idea how the story would end up, but we trusted that if we let events unfold on their own, all the questions we were interested in exploring would emerge organically. As a result, the film really challenges viewers to come to their own conclusions about the practice.”

Learn more about the film here, and watch a short video of own story on www.gettingtobaby.com.

 

 

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.”

Do it by the book

We know what it’s like to want a child so badly you’d do just about anything to have one. But when it comes to adoption or surrogacy, you absolutely must follow all the rules. The laws involving adoption and surrogacy vary by state — and with surrogacy, in some states, there simply aren’t any laws on the books. We cannot recommend more strongly that you work with a qualified attorney to ensure you are following the law at each step in the process.

Unfortunately, there are unethical people out there. A recent case currently receiving a lot of media coverage centers on Theresa Erickson, a nationally recognized surrogacy attorney, who pleaded guilty to being involved in a baby-selling ring.  According to news reports, Erickson and two accomplices recruited women to travel to the Ukraine to be implanted with embryos created from the sperm and egg of donors. Erickson and her partners would then tell prospective parents that a child had become available because another, fictitious couple had backed out of an adoption. They charged the adoptive parents, who had no idea they were being misled, more than $100,000, and paid the surrogates up to $45,000.

Erickson could receive up to 5 years in jail and be ordered to pay hundreds of thousands of dollars in fines. Fortunately, the innocent adoptive parents who were victims of this fraud will not have their parental rights terminated.

As an attorney, Theresa Erickson obviously knew that what she was doing was wrong. But sometimes, things aren’t quite so clear.

When we were going through the adoption process, we were contacted by a woman whose friend was pregnant. They would allow us to adopt the baby if we paid for the birth mother’s college tuition, along with some other financial arrangements. They did not want to use lawyers or an agency. When you have a situation presented to you in that way, you might think, “Well, if we save on lawyer’s fees and agency fees, it’s okay to put that money towards to her college instead. We’re helping her, and she’s helping us.” It’s easy to rationalize. If we weren’t lawyers ourselves, we may not have initially realized this is illegal — but it equates to buying a child. If we had agreed, it could have resulted not only in our losing that child later, but also in criminal charges.

Play it safe, and use a qualified adoption attorney or surrogacy attorney as you go through the process of getting to baby.

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.

Treating the whole problem

Infertility — the inability to conceive — can often be successfully treated. If you suffer from fertility problems, first realize you are not alone; as many as 20 percent of couples have difficulty becoming pregnant. Second, be sure both partners get a thorough examination to determine the cause of the problem. Men and women are equally likely to have a physical condition leading to fertility issues, but because the testing is more expensive and time consuming for women, you might want to have the male partner tested first.

Depending on the nature of the problem, tests could be conducted by a gynecologist, urologist, endocrinologist, or an internist. There are many causes of infertility, so treatments vary as well — but they include things like improving the overall health of the patient with better diet and exercise, increasing hormone levels, and surgical removal of obstructions.
The psychological and social factors of infertility must not be overlooked. For anyone who desperately wants a child and seems unable to have one, there is pain, anxiety and stress. Unfortunately, these factors only make it harder to conceive. Among some religious groups and cultures, these emotional factors are compounded by a traditional importance of having blood descendants; adopting children is not acceptable, and infertility is a cause for shame.

Finding ways to reduce your stress and emotional difficulties can help overcome fertility problems. There are many cases where an infertile couple adopted a child — and once they were relieved of their emotional pain of not being parents, they became pregnant. Other potential stress relievers, like moving to a new location or changing jobs, have also helped couples conceive.

So, while you are treating the physical causes of infertility, be sure to also treat the emotional ones. Talk to a trusted friend or counselor, exercise, meditate or pray, sing at the top of your lungs — find what helps you relax, and do it often.

Treatment Options for Secondary Infertility

Even for a healthy couple with no reproductive problems, it can take time to conceive. About 20 percent of couples who wish to conceive do so within a month. During each subsequent month, about 20 percent of the remaining couples conceive, meaning there is an 85 percent chance of conceiving within six months.
One in seven couples experiences primary infertility, which means they have problems conceiving their first child. But many couples don’t have trouble conceiving until after having their first biological child. This is known as secondary infertility.
Couples under the age of 35 who fail to conceive after trying for more than a year should consult a specialist and undergo a complete check up — even if they have had a child previously. Those over 35 should see a specialist after six months on unsuccessful attempts at conceiving.

Whether you are struggling with primary or secondary infertility, initial testing is usually the same. It includes a Pap smear to check for abnormalities in the uterus and ovaries, and a blood test to measure your level of follicle-stimulating hormone, which is responsible for release of eggs from the ovary. High levels of the hormone indicate that body is working more to stimulate your ovaries.

Stress
Stress can be a major factor in failing to get pregnant. The stress hormone cortisol interferes with ovulation, leading to decreased fertility. In addition, stress can cause elevated blood pressure and other conditions, which can create complications in a pregnancy. Research has shown that 77 percent of women who were able to reduce their levels of cortisol restored their ovulation abilities.
Reducing stress can be done in different ways. Exercising more and improving your diet are often all it takes. Meditation can also be effective as a stress buster. Many doctors may recommend taking a short vacation to relax and rejuvenate your body.

Decreased fertile period
As women get older, the amount of time during each monthly cycle in which they are fertile decreases. Finding your fertile period every month is critical, because once an egg is released into the ovary, it remains fertile only for around 12 hours. Ovulation kits may be used to determine when you are ovulating and have the best chance at conception.
Vitamins

Iron and folic acid have been shown to improve fertility, and are available over the counter by themselves or as part of many multivitamin tablets. Read the labels and talk to your doctor to ensure you are taking the right amount to assist you in conceiving. Iron and especially folic acid are not only beneficial for conception, but also prevent your baby from suffering certain birth defects.

Secondary infertility can often be treated, just like primary infertility. If you suspect you have a fertility problem, get it checked out. The sooner you discover the cause of the problem, the sooner you can get back on track to having your second, third or fourth child.

Secondary Infertility

It is a common misconception that if you have had a child, you will have no problem getting pregnant again. After all, haven’t you proven your fertility? But the fact is, secondary infertility — which means a couple has had at least one biological child before experiencing fertility problems — affects about 20 percent of women.
Secondary infertility may happen at any time, even after you have had two or more children. The causes are often identical to those of primary infertility, and can lie within the woman’s reproductive system, the man’s reproductive system, or within both partners.
But, because fertility decreases with age, secondary infertility becomes more likely as a woman gets older. Fertility typically begins to decline at age 27, and the most pronounced decline occurs after age 40.
Lifestyle can also be a significant factor. Weight gain, dietary changes and changes in activities can all play a part in secondary infertility.
Other common causes include:
• Ovulation problems
• Uterine fibroids
• Endometriosis
• Infections in either partner
• Decrease in egg or embryo quality
• Changes in sperm count, morphology, motility, etc.
Some of these issues, once determined, can be altered or treated. If you have had at least one child but now seem unable to conceive, see a fertility specialist.

In Touch With Your Feelings

Misgivings? Be honest about them.

I had some friends, a married couple, who were having fertility issues while Jennifer and I were trying to conceive. When they discovered they were unable to get pregnant, like many couples, they began considering their options. And like many couples, they started looking at adopting a child.

The woman was completely comfortable with adoption, and even started to like the sound of it. After all, her body wouldn’t have to go through everything a body endures during pregnancy. Her husband, however, had misgivings. And although those misgivings might offend some readers, they illustrate an important point.

He shared with his wife that he feared he wouldn’t be able to control his anger or frustration as easily without a genetic bond between himself and a child. Although he said it almost as a joke, he wasn’t kidding.

When you’re dealing with infertility, you might feel as though you’d bond with any child, regardless of genetic links. Whether you agree with the husband or not, though, he was right to share that concern with his wife. It’s important for both partners to be all in, no matter what path they’re pursuing.