What’s Causing the Decline in Fertility Rates?
What’s Causing the Decline in Fertility Rates?
Sometimes our recipients and donors have a “letter love affair” that is channelled through us – it is really heartwarming, especially when the donation has a happy and positive ending. Here’s what we mean:
We think you might have started your injections a few days ago and we wanted to know that we are thinking of you, and that we are so so grateful to you, more than words can express. Having been through many IVF cycles myself I know that the drugs can make you feel a bit rough so I really hope that you feel OK on them and we are thinking of you all the time.
We can’t really believe what you are doing for us. We are having trouble taking it in. After nearly 20 years of wanting a child so much and 10 years of fertility treatments and really an endless cycle of despair and depression, always feeling like something is missing from our lives, you have given us hope again. I realised that I have been feeling spontaneously happy for the first time I can remember for the last week, just suddenly dancing around the house or starting singing for no reason.
We are feeling very emotional, and quite scared, but also very excited. We loved everything about you that you wrote in your profile, we immediately connected with you and there was no doubt in our minds that we wanted you to be our donor. We were over the moon when you accepted us.
We hope that the treatment goes OK for you and you feel OK with everything. I’m crying as I type this just feeling so emotional and I can’t really believe this is happening. This is the first time we have tried egg donation and the first time that we have gone into treatment, with any real concept that it might actually work. It goes without saying that if it doesn’t work, we would like to keep trying. It also goes without saying that if it doesn’t work, we would be so grateful to you for trying and that the fact that you are happy to put yourself through all this makes us think that there are wonderful people in the world. We are thinking about you all the time and sending you lots of love.
“Thank-you for the well wishes, it’s good to know that a part of me is going to a lovely couple that clearly deserves the help. It’s because of couples such as yourselves that I’m more than happy to be a donor I’m glad that I can give you hope, and know that I will be holding thumbs, toes and any other body parts that I can for you. Giving life is something all women should experience at least once in their lives and I will be keeping you in my thoughts and prays that this is your time.
Don’t worry to much about me though, I’m quite used to the donation process I look forward to receiving good news in a few weeks that everything went well and you have a bundle of joy on the way. I think you will make beautiful parents, you clearly have a lot of love to share and any child would be blessed to be a part of your lives.
I promise to give your eggies lots of love and care for the next week and a bit. Good luck for everything on your side.
My stomach is bloated and uncomfortable. I sit and it cramps, I stand and I experience the most excruciating spasms in my abdomen. The day of the operation has arrived. My eggs are ready and soon this will all be over. The waiting room is buzzing as usual with all the happiness in the world, but I am sitting here in complete silence thinking back on the past three months of my life.
It all started on the night of 28th April 2012. A night never to be forgotten. Sitting among friends when my cellphone vibrated on my leg as I received an email. An email that I had been craving for a long time: “Fabulous news! YOU have been selected by a recipient as their egg donor…” Little did I know that what was going to follow was a ride of emotions and pain that I could never have imagined.
The beginning of my journey started with an interview. I was shaking from head to toe as I made my way to a beautiful little coffee shop, to meet the woman who would be by my side as the process of donation continued. I wanted to make a good first impression. So many thoughts were running through my head; what to say, how to sit, watching my language and minding my manners. Everything my mother had ever taught me about being a lady I was going to put into practice.
I arrived at the entrance and glanced across the room and there she was. Melany, with long curly brown hair and I was guessing about forty years of age. She stood up as we made eye contact and I moved towards her. I felt as though I was floating. My body was moving as a whole, yet at the same time my hands were warm and sweating, my heart pounding in my chest.
I shook her hand, the lady that would get me to the finish line. Introduced myself and from that moment onwards we spoke as if we had known each other for years. We laughed and exchanged thoughts and opinions and she explained exactly what I would be going through in very intense detail. I became nervous at times, but she was very quickly able to make me feel secure and completely sure about what I was doing.
Following that interview was an appointment with a clinical psychologist at the fertility clinic. Now never having been to a psychologist before, I had a very anxious feeling as I sat there. The room was bare. The only thing that made it feel warm was the smell of burning vanilla incense. As I breathed it in the smell brought a calming feeling over me.
I thought to myself that this is not another interview; it is simply a conversation between two adults, to give a perspective as to whether I am mentally prepared for everything, which I felt I was. I had nothing to fear. I was asked a series of questions about myself and my past, which is apparently normal in that environment. She then proceeded to enquire about my perception on egg donation, asking questions like “Do you not think that your inquisitive side might get the better of you in the years to come?” as what I was doing was completely anonymous. I felt these questions to be rather unnecessary as I had given this decision years of thought, however I answered honestly and she seemed pleased. I look back now and realise that the session is very important and gives the psychologist an opportunity to separate the weak from the strong. I am the strong.
The next and final step was my very first appointment with a gynaecologist. It was uncomfortable to say the least. A Belgian man with silver grey hair came to collect me from the waiting room. He lead me to a very upmarket room where he instructed me on what to do. I proceeded to get undressed and lay down on the bed covering my legs with a towel. This was a moment in life where I could not control the earthquake going on inside of me. I was sweating, my mouth was incredibly dry and when he entered through the curtains, my heart rate tripled instantly.
Throughout the appointment he continuously asked me if I was doing alright – I must have looked like a nervous wreck. We then sat at his desk as he handed me a little navy blue briefcase which contained several injections and hormone treatment. This little blue case would be my wakeup call every morning for the next two weeks.
Never in my life have I experienced the ups and downs, both physically and emotionally, that I have gone through. My hands are holding each other tightly as I await the scrub nurse. Once again my cellphone vibrates and the alert light flashes red. “Another message of well wishes from a friend?” I thought to myself. No. an email from the recipients I was donating to. The world closed up around me as I read the black text. Well wishes, thanks and praises for three whole pages. As I read, my smile grew bigger; I felt a feeling of pride that is entirely indescribable. I am about to allow a couple a chance to become a family. There is no greater gift to give.
The scrub nurse walked in and without hesitation I stood up and felt the world release itself off my shoulders. The pain, the nerves and all the uncomfortable new experiences I had endured were all about to come to an end. That one email made every moment of this journey worthwhile. The anesthetist takes my hand. “Count to ten and sleep tight.”
For a group of teenagers, Lauren, Fazana, Flora and Mackenzie are remarkably knowledgeable about fertility. Sitting in the library at St Marylebone school in central London, they’re explaining what they’ve learned. These year 10 girls know how common infertility is, how female fertility declines with age and they understand that IVF doesn’t always work. The discussion ranges from egg donation and surrogacy through to the dilemmas they know they may face later in life trying to balance careers with the desire for a family; “There’s never a time that’s exactly the right time to have a baby,” they explain.
It’s something every girl at St Marylebone will cover in their religious studies lessons, where the curriculum covers religious attitudes to family, relationships and family planning, as well as the ethics of fertility treatments. But in some other schools this highly topical issue barely gets a mention. IVF may be covered as a technological advance in science, but infertility isn’t part of the sex education curriculum, where the focus is on preventing pregnancy and sexually transmitted infections. This may seem sensible when dealing with young people, but the reality is that pupils are far more likely to have a fertility problem in the future than they are to get pregnant while they’re still at school. The teenage pregnancy rates for England and Wales are the lowest they’ve been since the 1960s, but infertility rates are rising; one in six of the population will experience problems getting pregnant – that’s about five pupils in each class of 30.
Prof Michael Reiss, of the Institute of Education, who founded the journal Sex Education, says infertility isn’t covered because it hasn’t been seen as a priority. “It’s not wilful, but these things are determined by the previous generation’s issues. The situation was always portrayed as if everyone wanted to be a parent at 15 or 16, and as if the major job was to stop them doing so or being infected with an STI and that has dominated the discourse. It’s just that people don’t think about infertility.”
Jane Knight is a fertility nurse specialist who has been invited in to schools to talk to teenagers about fertility awareness, but her lessons are usually one-off sessions, squeezed in wherever a school feels they may fit. “There is no cohesion when it comes to fertility education in schools, nothing joined up,” she says. “I try to give teenagers information in a way that is relevant to them and I talk about protecting fertility. They have learned about IVF, but it’s so far removed from where they are at that it’s almost irrelevant.”
Of course, it isn’t easy to get teenagers to think years ahead, but there is clearly room for improvement when it comes to fertility awareness. When the sexual health charity FPA investigated young people’s knowledge about sex and reproduction, they found widespread confusion, as Rebecca Findlay, of FPA, explains. “Our research revealed many very basic misunderstandings about fertility. It showed that sex and relationships education is letting young people down, and that they are aware of that – just 4% rated the sex education they’d received as excellent.”
When it comes to fertility, it isn’t just young people who are confused. Despite what can seem like a constant stream of media messages about the impact of age and lifestyle on fertility, many people still don’t really appreciate that a woman’s fertility begins to decline rapidly at 35, or that obesity, eating disorders, smoking and drugs can all affect your chances of having a family. A recent study of undergraduates in the US found that most thought female fertility declined far later than it does and that they overestimated both the chances of getting pregnant after unprotected intercourse and the likelihood of success after fertility treatment. Attempting to redress this balance is something they are taking seriously in Scotland, where plans for a Fertility Education Project are under way, with funding for two part-time workers who will help to raise awareness of infertility among students and the wider community.
For those elsewhere in the UK, knowledge about infertility looks set to remain patchy. This has led fertility specialists to call for a change to the school curriculum, as Dr Allan Pacey, senior lecturer at Sheffield University and chair of the British Fertility Society, explains. “I don’t think we do sex education well enough in schools. We don’t give people the skills they need for fertility planning. I understand that from the point of view of teenage pregnancy it is essential to focus on contraception, but that is only one side of the coin. We could do so much more for young people – most are very naive when it comes to fertility. I would package it as fertility advice rather than infertility advice, but I do think it should be part of the sex education curriculum.”
It is in fertility clinics that our failure to get the message across is really felt by those who discover that their chances of getting pregnant are not as good as they had hoped. Clare Lewis-Jones, chief executive of the charity Infertility Network UK, sees at first hand the distress this can cause. “It is vital that we get information out there so that people make informed choices at the right time in their lives and avoid the heartache infertility can cause,” she says. “Of course, not all fertility problems are caused by lifestyle choices, but we do hear from those who would have done things differently if they had known more about how lifestyle choices would affect their chances of having a family.”
There are sensitivities surrounding the idea of teaching young people that getting pregnant isn’t always easy, perhaps due to anxieties that this could water down messages about teenage pregnancy prevention, but Sarah Swan, assistant head at St Marylebone, believes it is important to give their girls the full picture. “You’ve got to give young people the facts and educate them about the realities to help them make the right decisions. You can’t decide not to give them information because you are worried that it might lead to problems.”
Far from leading to problems, Reiss suggests that giving young people all the facts could bring benefits. “Teaching about infertility in schools wouldn’t increase teenage pregnancy rates. In fact, if it was part of a coherent, high-quality sex education programme, I would expect it to lower teenage pregnancy rates.”
With ever-increasing numbers seeking medical help to conceive, and warnings that infertility rates may rise yet higher, it seems that ensuring our teenagers are properly educated about fertility might not only help to prevent future problems, but could be beneficial in the present.
Via The Guardian
5 tips to improve IVF success
Eating avocados and foods high in monounsaturated fat can triple the success of your in vitro fertilisation (IVF) treatment. But is there anything else you can do to improve your IVF success?
A new study carried out by researchers at the Harvard School of Public Health found that eating monounsaturated fat – found in olive oil, sunflower oil, nuts and seeds – could help women trying to have a baby through in vitro fertilisation (IVF). It’s believed that these “good fats” – which are already known to protect the heart – could improve fertility by lowering inflammation in the body.
In contrast the research revealed that women who ate a diet rich in saturated fat (found in red meat and butter) produced fewer healthy eggs for use in fertility treatment. Another study showed that drinking five or more cups of coffee a day halved the chance of successful IVF treatment.
Dr Ulrik Schixler Kesmodel, from the Fertility Clinic of Aarhus University Hospital in Denmark, said: “Although we were not surprised that coffee consumption appears to affect pregnancy rates in IVF, we were surprised at the magnitude of the effect.”
But along with eating a healthy diet, what else can you do to improve your chances of conceiving under IVF? Tertia Albertyn, Owner of Nurture Egg Donor and Surrogacy Program, provided the following tips:
5 tips to improve your IVF success
1. Make sure you are at the best fertility clinic for your needs. “Best” can be defined in many ways – highest success rate, best bedside manner, most value for money. You are making an enormous financial and emotional investment, so make sure your expectations are met.
2. Make sure your expectiations are realistic. If you are 45 years old and you are using your own eggs, your chance of success is probably only around 5%. Your chance of having a baby through donor eggs is around 65%. If you only have the resources for one attempt, make sure you maximise your odds.
3. Prepare yourself emotionally. Know that IVF takes a huge toll emotionally; be prepared for the roller-coaster ride. You will feel so many emotions at once: hope / fear / excitement / terror. Have someone to support you through the process. Go online and join a fertility support forum, it can be done anonymously if you are keeping it private and confidential. Don’t be ashamed to seek professional support if you need it.
4. Prepare yourself physically. Stop smoking, cut down on the wine. Eat well. Drink water. Stick to one cup of coffee a day. Don’t eat fatty foods. Step away from the cheese cake, burgers and fries. But don’t punish yourself, have that glass of wine on a Friday night. Enjoy that rare cappuccino. Infertility is hard enough without denying yourself the occasional indulgence.
5. Go alternative: Just because you are doing something high tech / traditional medicine, doesn’t mean you can’t use alternative approaches to maximise your chances. Investigate things like fertility acupuncture, fertility reflexology or fertility astrology. Make sure you go to someone reputable who has experience in this area. Always check with your doctor first.
Lastly, always have a Plan B, said Albertyn. “Having a Plan B (another IVF / another option like donor eggs) kept me sane. If this one doesn’t work, then we will do XYZ or try ABC. Knowing that this wasn’t the end of the road made the failures more tolerable for me,” she said.
The pioneering surgeon behind the world’s first ovary transplant says women could use the same technique to delay childbearing and the menopause.
Dr Sherman Silber predicted that ovarian transplants for social reasons were a realistic option for preserving fertility.
The US microsurgeon transplanted a whole ovary from one identical twin to another in 2007, who had been made infertile when her ovaries failed at the age of 15. The 38-year-old woman gave birth following year.
The drugs used may destroy the ovaries, so slices are taken in advance and stored in the deep freeze. They can be re-implanted when the woman is ready to start a family and so far 22 women have given birth after having their own ovarian tissue restored.
The latest success was achieved in Italy seven years after a 21-year-old woman had ovarian tissue frozen prior to cancer treatment.
Details were released at the annual meeting of the European Society of Human Reproduction and Embryology in Istanbul, Turkey.
Dr Silber, who practises at the Infertility Center of St Louis, Missouri, presented his own data on three women who had frozen and thawed ovary grafts and nine women who had fresh ovary grafts, usually donated by relatives.
One woman had ovarian tissue implanted to treat premature menopause caused by cancer drugs, while another had a graft to treat a naturally premature menopause. Eight babies have been born in total to the women, with one graft lasting seven years so far.
Dr Silber said: ‘Transplanted cryopreserved or fresh ovarian tissue can robustly restore menstrual cycles and fertility and may even in the future be used to postpone the normal time of menopause or to alleviate its symptoms.’
It was a remedy for severe bone loss caused by premature menopause because the new ovary would supply the body’s missing hormones, he said.
At present women going through a premature menopause in their 20s or 30s are offered Hormone Replacement Therapy to alleviate the symptoms. Dr Silber has previously claimed ovary transplants could be a solution to growing fertility problems caused by delayed childbearing among career women. He said: ‘It is the modern way, It is not just England and the US – in every society women are putting off childbearing.’
In 2008 he predicted that women who had an ovary frozen in their 20s could look forward to the best of all worlds. They would have their own young eggs in storage that were superior to donor eggs, he said.
‘It’s very realistic. Women can always have egg donation but this is so much nicer and more convenient if it’s safe. ‘A young ovary can be transplanted back at any time and it will extend fertility and delay the menopause. You could even wait until you were 47.
‘I don’t see any problem with it at all, I don’t see a dilemma’ he added. However, British experts said ovarian transplant techniques were originally developed to help women facing infertility through cancer treatment and this was likely to remain the case for the foreseeable future.
Professor Nick Macklon, medical director of the Complete Fertility Centre, Southampton, and chair in obstetrics and gynaecology at Southampton University, said ovarian tissue freezing for cancer patients was beginning to become established in the UK. He is starting the third centre and is ‘optimistic’ about getting NHS funding for the service.
He said ‘The technique is novel but not experimental.
‘It’s very important for girls who have no other option and who face losing their fertility because of cancer treatment at the age of eight or nine.’ But, he added, using the technique for social reasons raised ethical issues that would need to be debated by society as well as doctors.
Via The Daily Mail
According to ABC, women in their 30s and 40s who undergo multiple infertility treatments may be nearly as likely to deliver a baby as women who conceive naturally, according to new research that provides men and women with a more realistic view of their chances of becoming parents.
Until now, the success of in vitro fertilization and other assisted reproductive technology (ART) was based on live births following a single course of treatment, called a cycle. However, researchers for the first time have calculated cumulative success rates for women undergoing several treatment cycles. Among nearly 250,000 U.S. women treated with ART in 2004-2009, 57 percent achieved a live birth, they reported. In addition, 30 percent of all ART cycles were successful, they found.
“This study shows that if you keep at it …your chances of becoming pregnant continue to rise with continuing treatment,” said lead researcher Barbara Luke, a professor of obstetrics, gynecology and reproductive biology at Michigan State University’s College of Human Medicine in Lansing. “The takeaway message from this is you may need to look at infertility treatment over a course of cycles.”
Luke noted that about 25 percent of women drop out after their first cycle for a variety of reasons that may include cost (about $7,000 to $15,000 out-of-pocket per treatment cycle) and stress. Many insurance plans will only cover a couple of cycles; Luke and her co-authors said they hoped their finding might encourage insurance companies to reconsider those limits.
Success depends on many factors, most importantly a woman’s age and the quality of her embryos, which are related, Luke said. “As we age, our eggs age, and the quality of the embryo may be less. That’s why using a donor egg, from a younger woman, greatly improves the live birth rate among older women.”
Donor eggs give women “a 60 to 80 percent chance of live birth, regardless of your age,” Luke and her colleagues reported in today’s issue of the New England Journal of Medicine.
Choosing the donor egg route represents “a very personal decision,” Luke suggested. Although it may seem cold to advise women in their 40s that their best chances of becoming pregnant lie with the eggs of younger women, she said they might want to think about egg donations “within families,” with a younger sister donating to an older sister.
Luke and her co-authors found that for women under age 31 undergoing ART, the live birth rate is 42 percent for the first cycle; 57 to 62 percent for a second cycle; 63 to 75 percent by a third cycle and 66 to 83 percent in the fourth cycle. Among women 43 and over, the chances of a live birth with their own eggs are about 4 percent for the first cycle; 6 to 8 percent for the second; 7 to 11 percent for the third; and 7 to 15 percent for a fourth cycle.
For comparison, Luke and her co-authors noted that among the general population, the odds of a couple conceiving spontaneously are 45 percent at one month, 65 percent at 6 months, and 85 percent at 12 months.
“This study provides patients with important and encouraging information,” said Dr. Glenn Schattman, president of the Society for Assisted Reproductive Technology, which compiled the patient data that Luke and her colleagues analyzed. “While tracking outcomes by cycle started or single embryo transfer is a valuable method for assessing quality, having cumulative data linked to individual patients better estimates the prospect for success when they start a treatment cycle.”
“Having the data to demonstrate that medically assisted conception can nearly match rates of natural conception is an important milestone,” said Dolores J. Lamb, president of the American Society for Reproductive Medicine, which represents more than 8,000 health professionals focused on reproductive biology.
Olivia Tullo was 28 when she and her husband decided to start a family. They’d bought a house; they had a puppy. They were ready.
“We started trying, and several months went by. I just had a feeling,” Tullo said. “I just knew something wasn’t right.”
Her OB-GYN recommended a fertility specialist, who eventually recommended surgery for what was determined to be endometriosis. After that, there was more trying, more tests and the discovery that she had premature ovarian failure.
“My ovaries were shutting down,” Tullo said. “And I was only 29.”
Age is one of the main factors that can drive up a woman’s risk of infertility, which affects approximately 10 percent of women between the ages of 15 to 44. By 40, a woman’s chances of becoming pregnant drop from 90 to 67 percent; at 45, a woman has just a 15 percent shot.
But the Centers for Disease Control and Prevention estimates that in 2002, the most recent year for which data is available, 11 percent of married women under 29 also experienced infertility. In that age group, infertility is defined as one year of trying and failing to conceive.
“You are really still in your fertility peak until 31 or 32,” said Dr. Pasquale Patrizio, director of the Yale Fertility Center. Most healthy young women in their 20s can rightly expect that they will be able to conceive, he said. Which can make it all the more shocking for women who cannot.
“I never thought our 20s would be so consumed and obsessed with dealing with these treatments,” said Mary Roberts, now 27, who has been trying to have a baby for almost four years. “No one says their vows — ‘through sickness and health’ — and thinks that right after you say them you’ll test that.”
Roberts is now in the very early stages of her second round of in vitro fertilization. Her first round was successful, but she miscarried at four weeks. She has been told that an autoimmune disorder is at the root of her infertility.
“It drives me insane,” Roberts said. “When did it happen? How did it happen? I don’t have answers. I just know that infertility is a symptom.”
There are many diagnoses offered to women like Roberts to explain their infertility: diminished ovarian reserve; ovulatory dysfunction; pelvic inflammatory disease; endometriosis (when the tissue that normally lines the inside of a woman’s uterus grows outside of it and can prevent an egg and sperm from uniting). Polycystic ovarian syndrome is the most common cause of female infertility, resulting from a hormone imbalance that can disrupt normal ovulation.
“Usually in that young age group, a common factor is a tubal disease, like the fallopian tubes are blocked,” said Dr. George Attia, director of the Reproductive and Fertility Center at The University of Miami Miller School of Medicine. “The other cause is the partner may have a low sperm count, or poor sperm motility.” (According to Resolve: The National Infertility Association, one third of infertility is a result of male factors.)
Some studies have focused on the role that environmental exposures, like pesticides and heavy metals, as well as behaviors such as drinking and smoking, can play in declining sperm counts, largely because those effects are easier to see and track in men.
Although many women may be labeled infertile without a clear reason behind it, one bright spot for women experiencing infertility in their 20s is that they may be more likely to get an answer to that wrenching question: “Why?”
“With younger patients, there’s usually a cause rather than ‘unexplained fertility,'” said Dr. James Grifo, director of the New York University Fertility Center.
But their treatment options are largely the same as those available to women who are no longer in their 20s.
Women are often prescribed drugs to promote ovulation, or they try artificial insemination or IVF. Artificial insemination is significantly cheaper (at an average of $865, according to Resolve) than the $8,000-plus per cycle paid by women doing IVF. Yet some young women do take the more expensive option.
According to the Society For Assisted Reproductive Technology, women under 35 underwent nearly 40,000 cycles of IVF using fresh embryos from non-donors in 2010, up slightly from years past.
Several fertility experts said they had never heard of a young woman being turned away from IVF or denied coverage because of their age, as is reportedly the case with a 24-year-old woman in the U.K. who says she was denied coverage for it until she turns 30. But they do say they are likely to be more conservative with younger patients.
“We might be less aggressive,” Dr. Attia said. That could include taking time to work on weight loss if they think obesity is hampering ovulation, he said, or spreading each treatment out a little longer.
Occasionally, however, a woman’s young age can work against her.
“The very first doctor we saw said ‘come back in a year,’ and he excused us out of his office without doing one single test,'” Roberts said. At that point she and her husband had already been trying for at least that long.
“I had a lot of people say, ‘Well you’re lucky, because you’re so young,'” said Katie Schaber, 27, who started trying when she was 23. “It upset me because in the end, it didn’t work. I was young and it still didn’t happen.”
After four artificial inseminations and continued cysts and other health issues, she and her husband stopped pursuing treatment and put themselves on adoption lists. Schaber blogs about her experience and says the Internet can be a key resource for women seeking comfort and understanding at a time when so many of their friends are settling down and having babies.
Isolation was a real problem for Tullo, who said she lost touch with many of her friends who just couldn’t connect to her experience. She and her husband have a two-month-old daughter through adoption. They stopped pursuing fertility treatments after she miscarried with identical twins last fall.
Tullo said she would like to see more frank, honest information out there for young women to help them make informed family planning decisions. But you can’t force it, she said. Women have to wait until they are ready.
After all, even the best laid plans can go awry.
“Infertility at any age is difficult, but I do hold a special weakness in my heart for people in their 20s,” Tullo said. “That’s true infertility, when your body fails you at an age when you should be able to get pregnant.”
Via Huffington Post
Women preparing for fertility treatment typically get a series of daily, sometimes uncomfortable hormone shots to kick their ovaries into over-drive — but a new review of previous studies suggests one long-acting shot may work just as well.
For in vitro fertilization, extra follicle-stimulating hormone, or FSH, is used to trigger the ovaries to grow and release multiple eggs, which are then fertilized outside the body and re-implanted in the uterus.
In an analysis of four past studies including over 2,300 women with infertility, researchers found the women were just as likely to get pregnant — and didn’t have any more complications — when they got a single, long-acting dose of FSH rather than daily shots.
“Long-acting FSH (weekly injection) is a good and safe alternative to daily injections in the first week of ovarian stimulation for IVF,” Dr. Jan Kremer from Radboud University Nijmegen Medical Center in the Netherlands, who worked on the review, told Reuters Health in an email.
However, he said there is still limited data on how the weekly hormone shots work in certain groups of women, including older women with less of an ovarian response and those with fertility problems because of polycystic ovary syndrome, whose ovaries might over-respond.
The long-acting shot is used in Europe but not currently available in the United States, because it hasn’t been approved by the Food and Drug Administration.
The new findings are published in The Cochrane Library and include all high-quality data Kremer and his colleagues could find on the shots.
Out of 2,335 women included in the analysis, 987 got usual daily FSH shots for a week and 1,348 had one long-acting shot at a range of doses, along with the usual course of other IVF hormone injections.
In studies that used the lowest dose of the long-acting hormone — between 60 and 120 micrograms — fewer women in the one-shot group got pregnant than in the daily FSH comparison group.
However, at slightly higher doses (150 to 180 micrograms), pregnancy and birth rates didn’t suffer: 343 out of every 1,000 women getting one long-acting shot had a baby, compared to 336 out of 1,000 in the daily-shot group.
And the long-acting shot didn’t seem to come with a higher risk of miscarriage, having twins or developing a pregnancy-related complication, including swollen ovaries.
IVF typically runs for about $15,000 a cycle. Kremer said the cost of the two types of injections is “more or less comparable.”
Dr. Samuel Pang, medical director at the Reproductive Science Center of New England in Lexington, Massachusetts, said the main advantage of the single shot is convenience. FSH shots are simple injections that women can give themselves, similar to insulin, he said, but the process can still be a hassle for some.
“In my mind, based on the studies that have been done and based on my own experience, it is a safe and effective product,” Pang, who wasn’t involved in the new review, told Reuters Health.
“The only caveat is it really needs to be used in well-selected patients.”
Like Kremer, he cautioned against using the long-acting shot in women who are unlikely to respond to the hormone — or those who may over-respond.
A week after getting the long-acting shot, many women still need a few daily injections of FSH before they’re ready to have their eggs harvested, he added.
Pang worked on research that has been submitted to the FDA on the hormone shot, but says it’s at least a year or two away from being available in the U.S.
“At this point in time, while it’s very promising based on the studies that have been done and the experience in Europe, it’s not anywhere near market here.”
So-called post-marketing studies in Europe and Australia continue to suggest the drug is safe and works well, according to Dr. Arthur Leader, from the University of Ottawa and Ottawa Fertility Centre who also didn’t participate in the review.
“It simplifies the whole process, makes it easier for the woman while not compromising her health or the health of the children that are born,” he told Reuters Health.
There is a lot of love in the Cavin-Green home.
A lot of love, and a lot of baby stuff. There are four bright baby bouncers and four tidy high chairs. There are four plush pillow animals arranged on a living room shelf, waiting for playtime. Outside, the family minivan holds four sets of car seats and a sign that reads “Quads On Board.”
There’s also a stroller built for four. Getting the 70-pound stroller in and out of the van is always a bit of a spectacle; Laura Cavin compares it to a tank. And once quadruplets Brianna, Derrick, Anthony and Cason are settled into the stroller, the spectacle is just starting.
Laura recalls taking the babies to a Halloween event last year. Each baby was dressed as a tiny banana.
“I could not walk five feet without being swarmed by people,” Laura says. “I am telling you, I could not move. People would just stand there. And they would take pictures with their cellphones.”
Then the questions would start. Are they all yours? Are they quadruplets? How old are they?
Where is the dad?
For the last one, Laura has a clever retort ready: “The bastard ran off when he saw there were four.”
LAURA AND SHERI
Nobody really ran off, of course.
Laura Cavin and Sheri Green have been a couple since 2007, when they met at Nova Southeastern University’s Physician Assistant Program in Fort Myers. Laura is originally from Naples, and Sheri hails from Miami. Even before they met each other, they knew they wanted children.
“That was one of the reasons we liked each other,” Sheri says.
At the time, adoption wasn’t an option in Florida because they are a same-sex couple. Plus, Sheri, then 35 and nine years older than Laura, wanted to have a biological child. She didn’t have a significant desire to experience pregnancy, though. Laura, then 24, had no objection to being pregnant.
The couple sought help from Dr. Craig Sweet, a reproductive endocrinologist and the medical director of Specialists in Reproductive Medicine and Surgery in Fort Myers. Dr. Sweet had helped another friend of the couple’s become pregnant.
With IVF as their chosen option and as a consideration to Sheri’s age and desire for a biological child, the couple donated Sheri’s eggs.
Dr. Sweet calls Laura and Sheri “an amazing couple.”
“Their optimism is contagious,” he says.
If selecting a doctor was easy, picking a sperm donor proved more challenging. Not only did they want a donor who had a good, solid background and a high level of intelligence, but they also wanted someone who looked like Laura and Sheri. In that way, it wouldn’t become apparent which woman was the child’s biological mother.
Nature, though, would have its way.
Since both women have green eyes, they sought a donor with green eyes — yet three of the four children have crystal blue eyes, just like Sheri’s mom. And one of the most common remarks made to couple is that raven-haired Brianna is Laura’s “Mini Me.”
“We both just laugh,” Laura says. “Genetically, she has no relation to me.”
In March 2009, Laura’s first round of reciprocal IVF proved more successful than anyone had expected. In IVF, a woman is given hormones to encourage her ovaries to produce multiple eggs, which are then retrieved and fertilized in a lab with a partner — or donor’s — sperm. The embryos are grown in the lab for several days and then transferred to the woman who will carry the embryo.
A traditional IVF procedure can cost anywhere from $14,000 to $17,000, Dr. Sweet says, although each case is different. An egg donation can range from $21,000 to $26,000.
Because of the high quality of Sheri’s eggs, Dr. Sweet counseled the women to transfer only one egg because if they transferred two eggs, there was a good likelihood both eggs would implant and result in twins, which Laura and Sheri didn’t want.
Their plan was simple, straightforward: They’d have one baby. Laura would be a stay-at-home mom, at least for a while. Then she’d go back to work and life would go back to normal.
Everything would be great.
AIDEN AND BRANDEN
Two what? Two ovaries? At first, Laura was genuinely baffled. But the nurse practitioner at Dr. Sweet’s office soon set her straight: There were two heartbeats. The implanted egg had split, and Laura and Sheri were having identical twins.
“I was so excited,” Sheri says with a broad smile.
“I remember, I sat up and I go, ‘What?'” Laura recalls. “There can’t be two. We went back and forth until it finally sank in, and I cried. And then we said, ‘let the fun begin.’ ”
The pregnancy was perfect, Laura says, even enjoyable. Then, at about 28 weeks, Laura started to experience some pain, but wrote it off as being related to the demands of a busy day. She contacted her obstetrician, who encouraged her to follow up with a trip to the delivery room. There, it was confirmed that she was in labor, but the doctors stopped her contractions.
As a precaution, their obstetrician ordered an ultrasound. The couple wasn’t worried, Laura says; they were still on Cloud Nine, convinced that this was just a minor stumble in an otherwise ideal pregnancy.
The reality was far harsher. The twins, who they’d planned to name Aiden and Branden, had twin-to-twin transfusion syndrome, a condition in which one twin is not receiving enough blood and the other twin receiving too much. The attending doctor told them that if Aiden and Branden even survived, there would be a chance of mental disabilities.
“Sheri and I were like, what the heck just happened here? Our world went from perfect to absolute hell after that,” Laura says.
However, one chance still remained: a specialist at Miami Jackson University Hospital. Laura and Sheri traveled to Miami, where Laura underwent surgery to correct the condition, but remained in Miami for weekly ultrasounds.
In the third week, Laura was waiting for the ultrasound tech when she found herself staring absently at the room’s wall. On it was one of the most awful paintings she’d ever seen, a still life of dull, waxy fruit and a glass of gray milk.
“I thought, this is the picture I’m going to have to look at when my life changes forever,” Laura says. “I knew something bad was coming. So when she said, ‘there’s no heartbeat,’ we said, ‘What? Branden doesn’t have a heartbeat?’ And she said, ‘No. Neither one has a heartbeat.’ ”
Laura promptly threw up. Sheri started yelling for a doctor.
A DARK AFTERMATH
After they lost Aiden and Branden in September 2009, Laura’s and Sheri’s relationship went to “a very dark place,” Laura says.
Laura made frequent trips to the cemetery to visit Aiden and Branden’s graves, or stayed home alone entirely. To honor the boys’ memory, the couple placed mementos of Aiden and Branden around the house. Together, she and Sheri leaned on the friends they had made in the Share Group, a local support group for parents who have lost a child before birth or in infancy.
For her part, Sheri was deeply angry. Seeing pregnant women or couples with newborns made her livid, she admits. Over and over, she wondered why this had happened, and she silently swore an oath not to hold another baby until that baby was their own.
“It’s not logical. But what made me feel good was that pretty much every other woman in our Share group felt the same way,” Sheri says.
What never wavered was Laura’s and Sheri’s desire to be mothers.
So in May 2010, eight months after they’d lost Aiden and Branden, Laura decided to make Mother’s Day her last one grieving for Aiden and Branden before returning to Dr. Sweet’s office.
This round, however, things did not go as smoothly. For various reasons, the implant process proved more time-consuming than before, and Laura and Sheri did what it took to make ends meet. They drained their savings accounts, spent their retirement money and maxed out their credit cards. To someone else, it may have been madness, but to Laura and Sheri it made total sense.
“I think we thought, we’re going to have a baby one way or another. That was our objective and we were going to do it,” Laura says.
That’s when Dr. Sweet introduced another idea: Why not implant Sheri’s eggs in both women? With both women trying, they would increase their chances of getting pregnant.
Sheri and Laura came up with more questions than answers for that idea. What would happen if Sheri got pregnant and not Laura? What damage would it do to their relationship? What would happen if they both got pregnant?
In the end, they decided to do it. And unlike last time, Dr. Sweet decided to implant two embryos instead of one. He admits this is not his usual style, that he’s typically far more conservative.
“It’s not that I’m a gambler,” he says. “But I just know that at blackjack, if you get two aces, you can split your hand and it doubles your chances of beating the house.”
Besides, he adds, taking into account all the possible risk factors, the likelihood that all four embryos would implant was 1 in 143, far less than 1 percent.
BRIANNA, CASON, DERRICK AND ANTHONY
The next day, Sheri knew with certainty she was pregnant.
“I said to her, ‘I’m pregnant. I’m telling you, I don’t know how I know, but I know,’ ” Sheri remembers telling Laura.
Laura didn’t want to hear it. She didn’t have any early pregnancy symptoms, and was convinced she wasn’t pregnant. When Sheri complained about nausea or mentioned pregnancy at all, Laura told her to zip it.
A home pregnancy test restored harmony for the couple. Laura’s was positive — and so was Sheri’s. Then, at the six-week ultrasound, Laura found that she was pregnant with twins again. It wasn’t unlikely, since she was younger and had carried twins before. That Sheri should be carrying twins came as a surprise, though.
In an instant, their lives changed again. Once they’d planned to have one child. Now, they were having quadruplets.
Five months along, for various medical reasons, both women were put on full-time bed rest. Then, at 31 weeks, Laura went to North Collier Hospital with flu-like symptoms.
It turned out to be labor.
Daughter Brianna and son Derrick were delivered May 9, one day after Mother’s Day. Sheri kept her promise, and Derrick was the first baby she held after losing Aiden and Branden.
But the stress of Brianna’s and Derrick’s delivery turned out to be too much for Sheri, and she went into labor, too. The doctors were able to slow he r contractions, but she stayed in the hospital and was able to deliver Anthony and Cason.
That time came two weeks later on May 23. Originally, the women thought they would have C-sections on the same day and everything would be tidy. Now, the quadruplets have different birthdays, even different astrological signs.
But the babies were healthy.
Finally, something had gone according to plan.
Son Cason was the first to come home from the hospital, about a week after delivery. The first night, Laura and Sheri were in heaven. Giddy with excitement, they took photographs and joyously made plans to do everything together — feed him, burp him, change him, rock him and watch him sleep.
“Boy, did that change quickly,” Sheri says.
Brianna came home next. Then Derrick. Then Anthony. Reality set in.
It took about 40 minutes to feed each baby and each needed feeding every three hours. By the time the total feeding and changing cycle was completed, it was almost time to start it again. Sheri and Laura went from enamored to exhausted — until they started taking shifts.
“It gave us each 2½ hours to sleep solid,” Sheri says.
Their five-bedroom house has become a bit of a baby care assembly line. One room is all cribs. One room is devoted to diapering and changing.
Last September, Sheri returned to work and Laura remained at home until the babies were 6 months old. Then, she accepted a physicians assistant position at their obstetrician’s office, Dr. Wallace McLean.
On Mondays and Saturdays, Laura still stays home with the babies. On Wednesdays, Sheri stays home. On Tuesdays, Thursdays and Fridays, they have two sitters who come to the home. Sundays are reserved for family days. Armed with three baby bags and the tank-like quad stroller — or sometimes, two double strollers — they head out for errands, shopping or fun time.
They’re not the conventional family. But they’re a good family, says Dr. Sweet.
“These parents are no different than any other parents,” he says. “They will do whatever they have to and love their children.”
Laura and Sheri’s lives have changed. Now, a trip to Walmart constitutes an exciting outing. There are no more quiet dinners out; actually, there are hardly any dinners out at all. Sheri leaves the radio off when she drives to work, preferring to savour the sound of silence.