There is a lot out there right now in the traditional and social media about egg freezing. In fact just this past weekend The Boston Globe entered the conversation with a piece called “The Big Thaw”. Actually – it’s really all about the” Big Freeze” right now in fertility preservation technology. That’s the issue. There isn’t a lot of actually thawing going on in real live patients.  And that’s primary because of who needs egg freezing in the first place.  The women who are freezing their eggs – are usually cancer patients who are not ready to build their families (sometimes not for quite some time) and women who are facing the end of their biological potential who are not ready or able to start their families yet.  What that means is a lot of hope on ice.  And let’s be clear that is exactly what it is – hope.

But is that any different than anyone else accessing reproductive technologies ever?  Yes – we know more today about IVF success rates than we ever did – but that has taken time. Back in the day – when I did IVF -all we had was hope. We were being given a chance at hope – at possibility. But we weren’t discouraged from taking that chance – as I think women are in some circles  being discouraged from egg freezing because it is still experimental. I wonder if I would have done IVF when I was a going through infertility – if ASRM had released a statement about it being so unproven when I was a patient.

If I was a patient facing cancer – or a woman nearing the ledge of fertility decline (not yet ready or able to build my family) – and I knew that I wanted children someday – I would absolutely freeze my eggs today.   Yes – women need to be told that this is not an insurance policy – that this is experimental – and they need to be consented. But egg freezing holds real promise – and for those women who are at a place in their lives where it is take a chance or no chance – I would look them straight in the eye and say go for it.

We already know what not trying will give you – so why reach for the chance?

Posted under Egg Freezing, Fertility, Fertility Preservation

So in case you missed it – right now in Rome is the  26th annual meeting of the European Society of Human Reproduction and Embryology (ESHRE).  The studies are coming fast and furious – as are the press releases.  I loved the title of this one:

“Studies of women’s attitudes to ’social egg freezing’ find that young professionals put career ahead of motherhood, while older women are still waiting for Mr. Right”

Ya think?  I could have told them that! But it is always good to have a study right to confirm what we already know to be true. And it was a good study.  I have been talking about preserving fertility, and “social egg freezing” for years now – way before the technology caught up with the need and the language.  I predict that one day – women will freeze their eggs when they are in college as routinely as young girls put on braces in middle school.  It’s about preparing for the social reality of being a woman in today’s world.

According to the press release:  ” Women of different ages differ in their reasons for wishing to undergo egg freezing, show two studies presented to the 26th annual meeting of the European Society of Human Reproduction and Embryology today (Monday). A large number of female university students would be prepared to undertake egg freezing in an attempt to combine career success and motherhood, said Dr. Srilatha Gorthi, a research fellow at the Leeds Centre for Reproductive Medicine, Leeds, UK, adding that her team’s research emphasised the importance of educating young women about their biological clocks in order that they could take informed decisions about future reproduction.

Dr. Gorthi surveyed 98 medical students (group A) and 97 students of education and sports studies (group B) from the University of Leeds. Information regarding egg freezing was provided, including the fact that they would have to finance their own egg freezing. The average age was 21 with age range from 18-30 years in both the groups; 63.3% of the medical students were not in a relationship, as opposed to 25.8% in group B, probably reflecting the level of commitment and time needed for their courses.

While 85.7% in group A said that they would be prepared to delay starting a family, only 49.5% in group B said they would consider this. Eight out of ten from group A said they would undergo egg collection and freezing, compared with only half as many (four out of ten) from group B. In group A, 85.3% were prepared to undergo up to three cycles of egg collection to bank enough eggs to give them a realistic chance of pregnancy. In contrast, the majority (79%) of those who would bank their eggs from group B said they would be prepared to undergo only one cycle of egg collection.

“Career considerations were given as the commonest reason to delay starting a family in group A, followed by financial stability and marriage or a stable relationship,” said Dr. Gorthi. “However, in group B, financial stability came first, followed by a stable relationship and then career reasons. We think that this is the first time that young women’s attitudes to egg freezing have been studied in this way.”

Egg freezing is still a relatively new technology; a woman has to go through an IVF treatment cycle, which takes two to four weeks and carries certain risks: ovarian hyperstimulation, haemorrhage, infection and a possible, albeit small, effect on future natural fertility.

Until a few years ago, egg freezing was largely restricted to women undergoing chemotherapy for cancer because the chances of an egg surviving the slow freezing and thawing process was as low as two percent. Now, thanks to new techniques such as vitrification, where water from the eggs is removed and they are flash-frozen, frozen eggs are as good as the fresh ones. Women seem to have a realistic prospect of delaying motherhood if they wish to do so, similar to men. The average cost of egg freezing is around £3000 per attempt and some women may have to undergo up to three cycles in order to cryopreserve a good number of eggs.

At a time when women are increasingly delaying having children until their late 30s and even 40s, clinics offering egg freezing are in need of information on the attitudes and expectations of young women in order to enable them to tailor counselling more appropriately. “There has been a vogue for offering freezing for social reasons to women, especially those embarking on their careers, or those who haven’t found their Prince Charming, as a kind of insurance policy for later life. Research has proven that young eggs have a better genetic competency than older ones, and the chance of egg freezing working also declines with age. While the best results are likely to be in those under 30 years old, in reality it is predominantly women in their late thirties who are requesting egg freezing,” said Dr. Gorthi.

“There is still a lot of misinformation about the age at which the women could start their families, the likelihood of success of treatment and the number of oocytes that need to be retrieved and frozen in order to give a realistic prospect for future success. Women thinking about undergoing this procedure must be provided with accurate information and have counselling to both the benefits and limitations of oocyte freezing compared with other options. This will enable them to take the decision which is right for their circumstances,” she said.

“In addition, support from society is warranted for young women who choose to have a family when they are ready without compromising their careers. Experience from clinics who offer egg freezing for social reasons has shown that the use of frozen eggs is considered the last resort when women fail to conceive naturally,” Dr. Gorthi said.

In a second study, Dr. Julie Nekkebroeck*, a senior psychologist at the Centre for Reproductive Medicine, UZ Brussel, Brussels, Belgium, found that a group of highly educated and financially secure women with an average age of just over 38 years had applied to have their eggs frozen because they had not yet found the right partner with whom to have children. Dr. Nekkebroeck and colleagues interviewed the 15 egg-freezing candidates in order to ascertain their reasons for wishing to undergo the procedure.

“We found that they had all had partners in the past, and one was currently in a relationship, but they had not fulfilled their desire to have a child because they thought that they had not found the right man,” she said. The women found out about the possibility of egg freezing via the internet; before that, 46.7% had thought about becoming a single mother through the use of donor sperm, and 26.7% of them had considered adoption or staying childless.

The main reasons for opting for oocyte freezing were taking the pressure off the search for the right partner (53.3%), and giving a future relationship more time to blossom before bringing up the subject of their desire for a child (26.7%), whereas for 33.3% it was an insurance against future infertility. All 15 candidates had shared their intentions with their family and close friends and none of them felt discouraged by their entourage.
Out of the 15 women, 53.3% felt that the financial cost was a disadvantage of undergoing treatment, and 26.7% considered that the use of hormones was a deterrent. However, all of them accepted that they needed to undergo treatment while they were still healthy and fertile and they were also willing to repeat the treatment at least twice.

“The average age that the women thought they would use their frozen oocytes was 43.4 years, an age at which, for most women, there is considerable difficulty in achieving a spontaneous conception. But if they found a suitable partner, most of them would prefer to try to become pregnant spontaneously, rather than perform IVF with fresh material or, in the last instance, use their frozen oocytes,” said Dr. Nekkebroeck.

If the women did not need their oocytes, 46.7% said that they would donate them for scientific research, 13.3% would donate them to another woman, and 26.7% were unsure about what to do with them.

“We intend to continue interviewing these women in order to confirm our preliminary results and will also arrange follow-up interviews after their egg collection and freezing, and when they return to the hospital to collect and use their vitrified eggs. Because women have only just gained access to this efficient method of preserving their fertility, we believe that our results will add to the continuing debate about egg freezing for social reasons. Such research seems to indicate that social freezing might be added to the list of preventive measures to be taken against future age-related subfertility in women, besides fertility awareness campaigns, but only on the understanding that these women are properly counselled and educated about success rates, fees, treatment procedure etc.,” Dr. Nekkebroeck concluded.”

Really it’s about making egg freezing technology accessible, reliable and affordable.  The need is clear.

Posted under Egg Banking, Egg Freezing, eggs

Lately I have noticed that my fellow bloggers, and fertility educators are looking at the sociological issues that are raised by the advances in reproductive science.  There is lots of talk about egg freezing and it’s how there is the possibility that through egg freezing women may have a more complete ability to have reproductive choice.  Specifically, that egg freezing may allow women the possibility of having children when they were ready.

But there are those that ask the question “is anyone ever really ready to have children – and what exactly does being ready to have kids mean?”

What if we became a culture  where frozen gametes was the standard – and everyone could choose when they would conceive? What would the world look like?  Would the world be filled with middle aged first time Mom’s?

Well, the world is currently filled with many middle aged first time Mothers through the miracle of egg donation.  The fact is that (don’t you love it when people say “the fact is”!!!) as women our biological lives have not kept up with our sociological lives.  Mother nature is not a feminist. There is a reason why the best egg donors are college kids!!! But do you want your college kid to have a baby? Or be an egg donor? How would you feel if you daughter wanted to be an egg donor?  Does that give you pause? It’s complicated, right?

Is college kids being recruited as egg donors for women who didn’t know about their biological clock really a  better idea than teaching college kids about their own fertility window and offering them egg freezing so that they could be their own egg donor when the time was right for them to parent? I think so….

The evolution of egg freezing is not going to change the fact that many women want and need to have children later in life than their biological clocks allow. In my tour around the country even the nurses at ob/gyn offices think that fertility BEGINS to decline after age 37! They are only off by ten very important years!!! How women view themselves and age is very different than our realities. And often the choices that women are making fit much better with their lack of understanding about their fertility than with raw facts about ovarian reserve. That is one of the reason’s that I want all women to get Fertility Evaluations as routinely as they get pap smears!

So….back to the core question! Are you ever really ready to have a baby? I guess that would mean that you really, really understand what it is to parent. And as a parent – I would say that no one is ever completely ready for the challenges of parenthood!!! Kids certainly know how to throw those curve balls! But I certainly wanted certain things in place before I jumped off that particular ledge – even if I didn’t totally understand that parenting meant more than the fantasy of a beautiful, chubby baby to hold.

Many women want a life partner in their lives before they start building their families. And sometimes finding that person takes time – even if that person does not always work out! Many of us want to start out in the world of parenting with that certain special someone. With egg freezing – women would not have to feel that biological pressure to run that partner down with a truck and drag them home by the hair to procreate. Many women in today’s world have careers – and often they don’t feel like they are in a place to take a break for child bearing until they are older than what mother nature had planned. Egg freezing would also help these women out tremendously.  Egg donation is a wonderful family building option – but if I had the choice to use my own previously frozen eggs over donor eggs – I would be my own egg donor. I think that many women would feel the same way as I do.

We have already changed the land scape of age and parenting through egg donation, surrogacy  and expanding the ages that people can adopt. That particular change has already happened – and I prefer the idea that women bank their own eggs when they are younger - rather than recruiting young women for fees – to donate for them later.

The right time to have a baby? Well, that is a very personal choice – just like using birth control – or abortion. The right time means many different things to many different people. For some folks there will never be a right time – and for the mother of 16 kids on a reality TV show that I some times flip by – the right time seems to be all the time!!!

I love the idea of women having reproductive choice. I love the idea that reproductive technology is helping mother nature along in giving women the ability to be able to make better choices for their lives. Will it all be perfect? No – it will probably not be. The technology may in the end not work for them. The eggs may remain frozen until they decide to discard them….because for some – the right time may end up being never. And those pesky kids – I for one may never have been ready – if I knew the full scope on parent hood!

But I will continue to advocate for women to get the facts about safer sex, birth control, issues of choice, fertility evaluations, egg freezing, and biological clock education.  I don’t have daughters – I have sons. And one day – they will each hopefully meet a beautiful woman and give me grand children!!!  This will only happen if my future daughter in laws have had the education and opportunities to make informed decisions about their reproductive lives. And if they decide that it is the right time for them to have a baby!!!

Posted under Egg Freezing, Fertility, Fertility Education, IVF, In Vitro Fertilization, Infertility, Uncategorized

I have been speaking to women who are struggling with infertility for what feels like a life time. From my time as the President and then Executive Director of RESOLVE NYC to my time as the founder and first Executive Director of The American Fertility Association.

Now, I am hearing again from woman through this blog. The stories are all different and they are all the same. It is the regret that always gets me – that rips my heart. The level of self punishment that many of the women are putting themselves through because they blame themselves, even while they tell me that nobody ever offered them education about their fertility. And the pain that vibrates through the phone or an email is palpable. Often the woman makes apologies for the life that she had lived. There might have been an abortion. There was waiting too long to start trying once she was married….If only she had been better…if only she had been “a good girl”.

What I want to say here – is that the system has failed so many women. They have not failed themselves. Where were they supposed to get this information? From the air? When I was in school – I was taught about sex, STDs’ and birth control. That was it. Sex Education was about pregnancy prevention. That was it. Woman need to be given all the facts about reproduction starting from a young age. We need the complete story and that does include safer safe, information about STD’s, birth control and information about our reproductive potential as women.

These days – I spend about as much time directly with gynecologists as I do patients.  I drop in – and chat with them about fertility – and also the importance of talking to women about the getting a fertility evaluation.

Recently, I met with a young female GYN – and in the beginning the gynecologists agreed with us that the woman that they see have no idea of their biological clock – and they understood why giving them this information is important. And then, as it sometimes happens – this lovely female gynecologist got nervous about getting her patients nervous about their biological clocks. I told her that I really get nervous going for my mammograms and my pap smears – but that I go – because the information obtained from those tests can change my life.

I talked to her about the importance of women getting this information so that they could plan their own reproductive lives and perhaps stay out of reproductive endocrinologist’s offices. It is all about the possibilities that women now have – that if they learn that they are in a borderline place when it comes to their fertility – and they are not ready to start their families that they can freeze their eggs.

By the time that I left that office – I knew that I had created change. I had brought this office more than bagels and coffee – I had brought them information and a point of view that this office had not heard before – and it was a big office. By making these house calls of GYN’s, perhaps I  had changed the course of the reproductive lives of some women. I know that this sounds dramatic – but it is dramatic. This one practice with several gynecologists literally sees hundreds of women. By enrolling these doctors into our quest for better education for women around their fertility. I feel like we are building an army of educators one office at a time. We even talked about ways to introduce this information. And before the coffee and bagels were finished – they got it.

When I got home there was a letter from a woman waiting for me. She was full of regret. She was sure that how she had lived her life was the reason for her struggles to conceive. I wrote to her and I told her about all of the possibilities that still awaited her…for there were still many possibilities…the world still had much to offer up. That this was not about some notion that she had not lived a good life. That the infertility that she was now struggling with was not some kind of punishment. Why do we always go there? Why do we as women always blame ourselves? I wish that she had gotten information earlier – but that was my only regret for her – but that was it. And then I sent her this poem by Mary Oliver – perhaps this poem will touch you too…perhaps it is for all of us…no matter where you are in your life….

Wild Geese
by Mary Oliver

You do not have to be good.
You do not have to walk on your knees
for a hundred miles through the desert repenting.
You only have to let the soft animal of your body
love what it loves.
Tell me about despair, yours, and I will tell you mine.
Meanwhile the world goes on.
Meanwhile the sun and the clear pebbles of the rain
are moving across the landscapes,
over the prairies and the deep trees,
the mountains and the rivers.
Meanwhile the wild geese, high in the clean blue air,
are heading home again.
Whoever you are, no matter how lonely,
the world offers itself to your imagination,
calls to you like the wild geese, harsh and exciting –
over and over announcing your place
in the family of things

Posted under Egg Banking, Egg Freezing, Fertility, Fertility Education, Fertility Preservation, Fertility Support, eggs

Did you know that March 8th was International Women’s Day? Did you know that according to Wikipedia that International’s Women’s Day is “s a major day of global celebration of women. In different regions the focus of the celebrations ranges from general celebration of respect, appreciation and love towards women to a celebration for women’s economic, political and social achievements.

Started as a Socialist political event, the holiday blended in the culture of many countries, primarily Eastern Europe, Russia, and the former Soviet bloc. In many regions, the day lost its political flavour, and became simply an occasion for men to express their love for women in a way somewhat similar to a mixture of Mother’s Day and St Valentine’s Day. In other regions, however, the original political and human rights theme designated by the United Nations runs strong, and political and social awareness of the struggles of women worldwide are brought out and examined in a hopeful manner”. Who knew? I didn’t.

But you learn everything in life on Facebook! And that is where i found out that I had indeed missed International Women’s Day.  I kind of felt a little bit better when I realized that I wrote about being a Fearless Woman yesterday.

Being fearless has been kind of a theme for me in the past few weeks ever since the “Fertility Authority” featured my blog and they described me by calling me “Fearless”.  It kind of made me smile because I had never thought of myself as fearless – to me I was perhaps shameless.  But fearless?

What I do know is that, like so many women around the world, I have had an incredible and varied life.  I live full out. I play full court – and I make no excuses for myself.  And for so many women, we live in a time where we can finally integrate our lives.  Now, once upon a time – I didn’t integrate my life. Because women are never actually encouraged to do this. We are expected to be one thing or another….We are either “professional” or “homemakers” – we are either “Madonnas or Whores”.  But what if you were allowed as a woman to have a fully integrated life? What if you could have a professional life, and still have a family? What if being a successful lawyer didn’t mean that you could still also be around to cook for your family if that pleased you? What if you could be wearing sexy lacy panties under  your business suit – and was meeting your lover for some fabulous sexual adventure after work? Could women truly have it all?  Isn’t this what we have been saying with the introduction of egg freezing? That it is okay to freeze your eggs now – and have your children later while you were figuring the rest of your life out? That you didn’t have to choose? That everything could happen in it’s own good time and that women could integrate their lives as they saw fit?

Was this possible? Maybe not everywhere in the world right now perhaps – but I do believe that this possibility does exist right now in many places of the globe.

Think about it. Could we actually be mothers, Madonnas, workers and sexual beings all at the same time? Would society know how to wrap their arms around that?  What is going on with women who are hooked up to machines in a study to look at their sexual response – and their bodies register a response to the visual stimulation but the woman’s mind does not? What is going on? How do we help women connect these dots? There is something incredibly broken in that.

I think that we are getting closer to putting the pieces together. But we will never get there if a woman’s sexuality is still used to punish her.  And even today – it is. But like New Hampshire passing gay marriage – we are a country in transition. And I believe that we are closer than ever to supporting women living fully integrated lives.

Sociologists and sex perts are finally writing about the new integrated woman – and that’s a start. But who are the brave women out there who will do it and speak it?

Can you wear something sexy to work and still be taken seriously? For a good long while – before Katie Couric showed  her legs on The Today Show – the answer was no. But I have been watching those anchor women in the morning – and their sexuality has been starting to bloom – even as they have interviewed Presidents and talked about the issues that their kids were having in school. I love that.  They are all people – and they do not hide their sexuality – their  motherhood or their professional  smarts. They are clear that all of those pieces of themselves is a part of who they are as women.

And I have been as guilty of it as the next person. There was this one pharmacy rep that sent out this really sexy picture of herself in a Christmas outfit last year – and everyone was tearing her apart. How dare she? Who did she think she was? How could she show herself as sexy and playful? She was after all a “Professional”!!!! Oh well. Perhaps we were all a little jealous of her carefree, youthful  and yes – sexy spirit! What is it that gets us all fired up? Is it that we think that we are supposed to be this judgmental? Or were we simply happy to dismiss her as a slut? It was after all so much easier than seeing her as a full person.

I love that Oprah is getting on the band wagon. Several recent shows have explored a woman’s sexuality – and she has even taken sex toys to the stage. Oprah is saying that she cares about women being  integrated beings when she does these kinds of shows. And I love that.

But women are still persecuted today for being sexual beings. Recently one of the Miss America’s made big news when some topless photos showed up of her – you see – she was allowed to look sexy – to tantalize us in her bikini body – but not actually show us her breasts. Kind of interesting huh? In the end – The Donald realized how silly it all was – and the girl has her crown for a little while longer!

I love that we have a first lady who has the right to bare arms and those fabulous legs.  Our first lady – and frankly our President are clearly sexually integrated people. They are alive – and that aliveness permeates everything that they do. Mrs. Obama can be sexy and serious – and be a parent.  She is able to be a full woman – and I love that she is being a role model for other  women in this regard.

I have been talking a lot lately about how confused we are as a nation when it comes to our gender roles, our sexuality, and what is allow able and what is not.  We get glimpses of celebrities who are under the full view finder of the camera being sexual beings – and it freaks us out in the moment. Whether it is Brittany Spears forgetting her panties – or Paris  Hilton’s private sex tape (by the way I recently saw that in the Museum of Sex). But I am hoping that this too shall pass.

Look to France where a nude portrait of French President Nicolas Sarkozy’s wife Carla Bruni will go under the hammer in New York next month, according to auctioneers Christie’s.

The 13 x 10 1/8 inch gelatin silver black and white photograph was taken in 1993, when Bruni was one of the world’s top fashion models, and is being sold by art collector Gert Elfering.

Carla Bruni who is now beloved by all – started her public life as a mistress, actress,  and as a model that sometimes posed nude. Yet she looked quite lovely when she met the Queen of England. Yes – my dearies – we can live in full color and have integrated lives. Nothing is stopping you but a little bit of fear – and concern about whether or not you will be taken seriously if you dare be all of the parts of you.

And it just one day past International Women’s Day!  Take my hand – the water is fine.

Posted under Egg Freezing, Facebook, Female Sexual Desire, Fertility, Fertility Authority, Fertility Preservation, Integrated Woman, International Women's Day, Self Image, Sex, Sex Education, Shameless, inspirational thoughts, sexual health, sexuality

“As your professional infertility consultants, we’ll provide you with a comprehensive and individualized plan to help you reach your goals of family-building. We will create for you a customized step-by-step action plan that addresses your unique needs and concerns. Want to know the best clinic for you? We’ve analyzed the clinical success rate data and we’ll show you what those stats really mean. Need help understanding your insurance? We can do that. Need to travel for cheaper treatment? We’ll walk you through it,” promises Best-Boss.

Posted under "IVF Companion", A T.I.M.E., Advocacy, Angie Best-Boss, Egg Freezing, Fertility, Fertility Authority, Fertility Blogs, Fertility Coach, Fertility Consultants, Fertility Education, Fertility Support, Fertility Ties, IVF, In Vitro Fertilization, Infertility, Infertility Consultants, My Fertility Plan, infertiity, sexuality

The fact is that most people still do not have insurance coverage for in vitro fertilization (IVF), forcing many patients to make treatment decisions based on their budget and not on best practices. And then comes the question – what IS best practices? Do they simply live in the ASRM guidelines? Or are best practices something that is still influenced by the dollar in IVF Centers around the country. Unfortunately, fertility clinics have not made care more affordable to assist their patients in making better decisions.

Most people do not have insurance coverage for in vitro fertilization (IVF), forcing many patients to make treatment decisions based on their budget and not on best practices. Unfortunately, fertility clinics have not made care more affordable to assist their patients in making better decisions. Without good options, patients often resort to less expensive treatments including ovulation inducing hormones that stimulate multiple eggs to ovulate resulting in high risk, costly multiple pregnancies. IVF can avoid these multiple pregnancies by limiting the number of embryos transferred. In this way, affordable IVF saves money with less need for hospital beds, NICU beds and disability care.

“It is my strong belief that every infertility center in the United States needs to restructure their costs in some way even if means making less money,” says David Kreiner, MD FACOG| Medical Director at East Coast Fertility (ECF). “Our clinic’s Single Embryo Transfer Program incentives transferring one embryo at a time so patients don’t have to feel they must hedge their bets and transfer more embryos to increase the chance of pregnancy.”

A patient in the ECF program pays only for the initial fresh cycle. Thereafter, the cryopreservation of the embryos, the storage of the embryos and unlimited frozen embryo transfers are free. This eliminates the financial need for the patient to put all her eggs in one basket.  In my view – this is a program that should be adopted at IVF centers around the country. I would love to see this as the standard of care.  And all it would take for this to be  the standard of care is for more IVF Centers to be willing to reduce their income by a very little bit.

ECF also offers a minimal stimulation program, MicroIVF, that not only is affordable ($3900) but eliminates the risk of hyperstimulation syndrome, uses fewer medications and minimizes the risk of developing a multiple pregnancy. MicroIVF is essentially the cost of IUI with ovulation inducing medications without the risk and better than twice the success.  The only reason that I can see that so few IVF Centers around the country offer Micro IVF is that is needs to be reported to SART and The CDC as a regular IVF Center – and therefore has the power to lower a IVF Clinic’s overall success rates because while it has higher outcomes than an IUI without the multiple births – it has a lower success rate than standard IVF.  In this day of high marketing and stiff competition for patients- doctors aren’t willing to give up their marketing edge. It has nothing to do with best practices for the patient when it comes to offering Micro IVF.

I am so proud to work with a clinic who is a leader not just in reproductive care but in reproductive ethics.
“My wish is to assist all patients in need with creating that healthy family of their dreams without adding unnecessary risk,” says Kreiner. “Our programs help them in their quest. Until the government and insurance companies step up with coverage, it is up to the IVF programs themselves to help patients get the IVF that they need to build their families.”

How is that for a call to action for IVF Centers around the country?

Posted under Dave Kreiner, Dr. Dave Kreiner, East Coast Fertility, Egg Freezing, Fertility, IVF, In Vitro Fertilization, Micro-IVF, Single Embryo Transfer Program, The CDC, eggs, infertiity, patient advocacy

I started to work with Claudia Kalb on the piece that appears in Newsweek online  today, “All That Remains”, in August 2009 – that features my family – and follows us through the journey of finally donating our four excess embryos to stem cell research.

I really like Claudia. I have worked with her several times before, through the years – including this great piece called “Should You Have Your Baby Now” that was published in 2001 and is just as timely today.  I have always found her to be honest, smart, with great insight into the field of reproductive medicine. So when she called me about this story that she was researching on couples donating their embryos to stem cell research – I knew the time had finally come for me to follow through on my word.

You see, I have been a vocal advocate for stem cell research, and I had embryos that needed donating. My husband and I appeared on 60 Minutes talking about this issue in 2008,  and I had even done an op/ed for the Boston Globe called “Don’t Tell Me What to Do with My Embryos” that was published in 2005. I know that there were many, many other interviews on the subject – including an appearance on Capitol Hill. But somehow my embryos never left their storage tanks.  Oh yes – one day soon – we would donate them. That was the decision – but it was so hard to do.  And my heart – well – my heart just wasn’t really in it.

Donating my embryos were as complicated as our infertility treatment. And to me, those embryos represented so much more than the tiny cluster of cells that I had never even seen.  Here I was in Peri Menopause – the days of ripe eggs and babies behind me.  I was not in control of that – mother nature did her dance. But I had a secret – a little stash of potential life – stashed away.  You never knew – right?

But really….really? I didn’t want any more babies.  I hadn’t wanted any more babies for a long time. And Kai and I had wrestled with this decision like those men of the WWF.  There would be no more babies.  Instead we were left with cleaning up what was left of our reproductive medical treatment.  It was emotional. It was upsetting.  I felt pressure from everyone – hence the op/ed.

Donating during the Bush Years was complicated and difficult. And I always found a reason to put it off.  When Claudia called – I knew it was a sign – I would have accountability – I would have to go through with each awful step – and I would have to sign the papers.  So Claudia and I went on a trip through infertility memory lane together.  I cried a lot. When the papers came for us to fill them out – long after the interview was over they sat on the table for weeks.  I could not open the envelopes.  It wasn’t that I didn’t want to donate my embryos to stem cell research – it was just that it was still so hard to say good bye to maybe babies even when I didn’t want them anymore.

I looked at my beautiful sons – and I wept.  I knew that those embryos even if transferred had a great possibility of not becoming a baby.  I get it. They are the starter kit of a child – and starter kits don’t always work out.  And I didn’t even want more babies – not really. But it was the act of saying absolutely no more that was so hard. Closing that door forever that made me feel so emotional.  I forced myself to open the envelopes. This was continuing to be incredibly embarrassing.  My G-D, if I was having trouble with this no wonder there are literally thousands of embryos forgotten in storage tanks around the country.

I was deeply aware that the article in Newsweek would come out – and my embryos would not be donated! I looked at all the paper work and called my husband. “You are going to have to fill out the paper work. I can’t do it. It’s not that I don’t want to do it .  I am not backing out – I just can’t.”

So Kai came home and filled out the pages, upon pages of documents.  Then, we still weren’t done.  We had to get them notarized. It was always another step. He gave them to me to mail. He told me to get a receipt – I  just threw them in the mail box, receipt-less,  and wept.

When Claudia called months later to see what happened – I had to tell her that I didn’t know. I had never followed up.  This is me -right? The big powerful patient advocate! Once again, I was embarrassed.  I called Harvard – no they hadn’t picked up my embryos yet from Mount Sinai. They were waiting for some change in the paper work or something like that. Nothing for me to worry about. My job was done. My kids would not be left with what to do with their parent’s embryos after we had died.  One day soon, I was reassured, the embryos would be transferred to Harvard.

So how do I feel now? Well – I cried again when I read that “The Madsen embryos had been claimed at last” in the Newsweek piece.  I am no longer embarrassed that I had not followed through with my word that I would donate them to stem cell research – and that one of the best known fertility advocates in the country had embryos lost in storage in the bowels of a hospital somewhere.  But I don’t have any shame about how long it took me to do this.

We are dealing with incredibly complicated, emotional human issues – and we still don’t make it easy for people to donate.  Donating couples have to jump through a lot of hoops. And when you are feeling conflicted and ambivalent at best – the hoops can feel really challenging.  It is simply easier to push the papers aside – and pretend that they don’t exists.

I wish “The Madsen Embryos” G-d’s Speed.  I know that they will not be another baby in my family – but it  is my belief, a belief that I share with my family – that they will do the world some good. It is our hope that they will help someone else’s baby live a healthier and longer life.  And for that – we are incredibly grateful.

Posted under Claudia Kalb, Egg Freezing, Fertility, Fertility Support, Frozen Embryos, In Vitro Fertilization, Newsweek, embryos, infertiity, stem cell research

Everybody is writing about celebrities and infertility - and why it is that most celebrities don’t fess up to have fertility treatments. And if they do fess up to having fertility treatments – most of them don’t divulge the entire scoop on what they did.  This notion that celebrities simply do everything better than us continues to live in the world of unobtainable beauty, wealth and in some cases, super human fertility. How else do you explain twins after the age of 47? The Fertility Authority started an interesting conversation on all of this in one of their blogs, “Community Claire”, called “C’mon J-Lo!” Jack in, blog, and join the conversation!

I love technology, and I am completely addicted to my Blackberry – with no plans to switch to an iPhone. But I just stumbled onto a great entry at ConceivingConcepts which might have gotten me to switch phones if I was still going through infertility treatments.  Angie Best-Boss their blogger extraordinaire gives the low down on  iPhone Fertility Apps! IPhone Fertility Apps? Who knew? Now you do!

Looking for a new book on infertility? Check out “Silent Sorority” By Pamela Mahoney Tsigdinos. You can read a great review here.

Struggling with PCOS? Check out this “Ask The Expert” video featuring Dr. Dave Kreiner, Medical Director at  East Coast Fertility. Want more on PCOS? Check out the video series “Journey to The Crib” where I co-star with Dr. Kreiner! I think that this particular conversation on PCOS is very helpful.

Looking for 24/7 peer  infertility support? Great information? More “Journey to The Crib?” Have you checked out Fertility Ties yet? How about now?

A friend of mine just sent me a link to a great woman’s sexuality website, called “A Woman’s Touch”. Where they celebrate pleasure and sexual health.  I just love that. You will too – check it out. And Susie Bright has just released a collection of her best audio interviews – as she calls it a “Little Bit Unforgettable”! Love Susie Bright. Don’t you?

So, that’s it for this week. I hope that I have turned you onto some valuable resources, interesting articles, and new ideas to get your moving into your weekend. I have got to go and listen to some of those interviews! And if you want more Pamela Madsen, why don’t you friend me on Facebook? Or follow me on Twitter – just key in PamelaMadsen! Be a part of my community and don’t miss a thing!

Posted under "Journey to The Crib", Advocacy, Dave Kreiner, Dr. Dave Kreiner, East Coast Fertility, Egg Freezing, Female Sexual Desire, Fertility, Fertility Advocate's Hot List, Fertility Authority, Fertility Coach, Fertility Education, Fertility Support, Fertility Ties, Fertility Videos, IVF, In Vitro Fertilization, PCOS, Sex, Sex Education, fertility evaluations, infertiity, sexual health, sexuality

The news about there being a female biological clock is not brand new information. From the infamous tee shirt that read “Oh! I forgot to have children!!!” to our aging eggs finding it’s way into movie scripts and television shows. The information that women and yes, even men have a biological clock is out there.

The problem is, an awful lot of what’s out there about fertility and reproduction is pulp fiction. The blurring of fact, opinion, myth and misunderstanding makes for a treacherous misinformation landscape. The knowledge gap has claimed millions of victims, people who learned about the fundamentals of protecting and preserving fertility too late to help them have genetically linked offspring they always assumed would be theirs.  Armed with essential and accurate information, you don’t have to join their ranks.

What is still not understood across the board is the time line of the biological clock.  And most of us don’t have a clue about our own.

So the big question is – what do you know about your fertility?

Well, if you’re like most people, the answer is not as much as you might believe. Just to give you a little perspective, a spate of recent surveys reveals that the overwhelming majority of U.S. women:

·        Don’t understand the biological clock – the trajectory of reproductive capabilities from its peak in the early-to-mid-20s to the age of inevitable decline beginning, typically, around 27.

·        Mistake overall good health for an indicator of fertility.  However wonderfully youthful and fit a 42-year-old might be, her eggs are operating on an independent and fixed timeline.

·        Believe they can get pregnant easily until their 40s. The stark truth is women at that age are more likely than not to require medical intervention.

·        Are unaware that men, too, carry a ticking reproductive timer.

·        Don’t know that lifestyle factors—sleep, diet, exercise and environment, for instance – can have a profound effect the ability to have a child.

Yet this basic information can make a critical difference in the life of every person who dreams of having a child this year, next, or 10 years down the road. If you know about your body’s reproductive lifecycle, you can take steps to protect and preserve your fertility. That way you can have the children you want– if and when you choose.

Start Where You Are: Get To Know Your Baseline

Statistics and general truths aside, every woman is unique.  Given just how complicated it is to make a baby in the first place, understanding your own body’s reproductive capability and the changes it might undergo from year to year is an invaluable planning tool. Consider an annual fertility evaluation or screening.

A what??

Simply put, the screening involves a few simple blood tests and an ultrasound to get a handle on your ovarian function.  These tests have been around for years, tried and true tools in the diagnosis and treatment of compromised fertility. The piece that’s different is using them in the context of preventative fertility.

Taken together with your individual and your family’s medical histories, the screening helps establish where you are on your personal fertility curve. The first screening establishes your baseline, subsequent annual evaluations will flag changes in key hormone levels and mature egg production that could signal potential trouble. Mind you, any warning flares are just that and may mean nothing. But they could indicate that follow-up with your doctor, gynecologist or a reproductive specialist is warranted. And if there is problem, you’re ahead of the game with the opportunity for early intervention and, where possible, corrective action.

More about the nuts-and-bolts of the screening later. First, let’s talk about why the evaluation is so important.

Marking Time: The Biological Clock and You

Let’s start at the beginning. Each woman’s oocytes (eggs) supply is finite. That means the body doesn’t produce new ones. So the 7 million or so eggs each female is born with is all she’s going to have. Ever.  By the time the average girl hits puberty, only about 250,000-300,000 oocytes remain in her ovaries.  With each menstrual cycle one egg become ripe enough for fertilization and is released. An additional thousand eggs each month are lost through a process called artresia, the natural breakdown of the eggs by the body.  After ovulating an average of 400 times through her life, typically around 50 years of age, the store of oocytes is tapped out. That’s menopause.

Then there’s the matter of oocyte aging. Eggs age along with the rest of the body. The older oocytes are more likely to have chromosomal abnormalities making them unlikely to become viable embryos. It’s important to note that a fertilized egg with abnormal chromosomes is the single most common cause of miscarriage. A woman in her 20s has only a 12%-15% chance (about one in every eight pregnancies) of having a miscarriage each time she becomes pregnant.  On the other hand, a woman in her 40s faces a 50% risk of miscarriage (that’s one in every two).

Despite the amount of ink and airtime that’s been lavished on the biological clock, most women still don’t know about the direct, inverse relationship between age and procreation.  The bottom line is the older we get, the less likely we are to conceive and have a successful pregnancy. What’s harder to grasp is that in this context, women qualify for “older” at 27.  You read it right. Statistically speaking, when a women hits 27, her fertility begins an exorable decline. When she hits 35, it take a sharp downturn.  At 40, fertility falls off the edge of the earth.

Of course, some women in their late 30s and a few in their 40s conceive effortlessly, carry and deliver healthy babies. But the likelihood of that happening without medical intervention becomes more remote with each passing year.  For women under 30, the estimated chance of becoming pregnant in any one cycle is between 20% and 30%.  When women turn 40, that probability plummets to approximately 5%.

OK, So Now That You Know, What Next?

Rest assured, this IS NOT a push of the panic button. It’s not a call to rush into loveless marriage, or drop out of school and give up your career in order to guarantee your bloodline continues.

Rather this is a call to arms. Women deserve to know the full truth about reproduction so they can take the family-planning reins and make informed decisions. The goal is to help you and every woman of childbearing years make the choices that help protect and optimize fertility.

·        The Contraception Contradiction. While all contraceptives prevent pregnancies with greater or lesser efficacy, some actually help preserve fertility. Oral contraceptives decrease the incidence of tubal disease because birth control pills make it more difficult for some infections to grow. They also minimize the growth of the endometrium (the lining of the uterus), reducing the incidence of endometriosis, a condition that can closely linked to infertility. Condoms and, to a lesser extent, diaphragms, protect against sexually transmitted diseases, which contribute to or cause compromised reproductive function and infertility.,

·        Weight of the World. When it comes to baby-making, you absolutely can be too thin. Or too fat.  A woman’s body is at its reproductive best when it’s within 15% of the ideal weight. And by ideal, we don’t mean runway ready. It’s the weight at which your body and its hormonal systems hum like a finely-tuned Ferrari. There are individual variations, but, many women experience problems when they’re less than 95% or more than 124% of that weight.  Using a standardized measure called the Body Mass Index (BMI) you can determine your “ideal” weight.

At less than 95% of the ideal weight, women might stop ovulating, having regular menstrual cycles – or any at all. On the other end of the scale, excess weight is associated with unpredictably long gaps between menstrual periods and superabundance of ovulation-interfering hormones.

·        Feed Your Fertility. Eat all the things you know you should but probably don’t, including fruits, vegetables and low-fat protein. In fact, adequate protein is absolutely essential because without it, estrogen breaks down into inactive byproducts more rapidly and menstrual cycles become longer.

·        The Drink That Refreshes? Sorry but you’ll have to cap your caffeine and alcohol drinks to one cuppa joe (or latte or cappuccino) a day and maybe the occasional glass of wine. Heavy drinking is a fertility wrecker for both women and men.

·        Get Exercised. Regular, moderate workouts are the gift of the fertility gods. They help keep your hormones happy, your weight under control and bring down your stress levels. Heavy exercise, say running 35-40 miles a week, can trigger amenorrhea (no periods), diminish progesterone levels so that an making it difficult for an embryo to implant.

·        Smoke Signals. Tobacco is no friend of fertility.  It increases susceptibility to sexually transmitted diseases in both men and women, increases the likelihood of tubal pregnancies, cervical cancer and pelvic infection.  It’s just plain bad.

·        Drug Drag. It’s not just the obvious culprits like cocaine and marijuana that spell trouble. It’s the pharmaceutical that people routine take to treat common diseases and conditions, such as Crohn’s Disease or ulcers or even psychological disorders, that could be problematic. If you’re contemplating getting pregnant in the near future, consult with your doctor.

Fertility Screening for Your Reproductive Life

Knowing what you know, you can actively in shelter your fertility from harm and even get it to optimal levels. Now there’s an important tool to help you identify where you are on your own fertility curve. Perhaps even more important, the screening can help pinpoint women whose ovarian function is on the wane so they can get timely treatment.

The screening itself is fairly low-tech. Part one consists of four blood tests to check the levels of FSH, estrodial, MIS (mullerian inhibiting substance), inhibin-B, all critical to conception and pregnancy. Ideally this is done on the third day of your period. Each blood factor is an indirect assessment of ovarian reserve. Any one of them is helpful. But the combination of all four allows for much greater precision in identifying potential problems.

Part two is a vaginal ultrasound to count the number of antral follicles in ovaries. Antral follicles are a good indicator of the reserve of eggs remaining in the ovary. In general, fertility specialists like to see at least eight antral follicles per ovary.

What you and your doctor are looking for is a dramatic shift in values from one year to the next.

Although none of these tests is in of and of themselves an absolute predictor of ability to get pregnant, when one or more come back in the abnormal range, it is highly suggestive of ovarian compromise. It deserves further scrutiny.  That’s when it makes sense to have a sit-down with your gynecologist or fertility specialist. Bear in mind, the “normal” range is quite broad. But when an “abnormal” flare goes off, you want to check it out.

It’s important to remember that fertility is more than your ovaries. If you have risk factors for blocked fallopian tubes such as history of previous pelvic infection, or if your partner has potentially abnormal sperm, then other tests are in order. And if, for example you do have blocked tubes, it’s better have the corrected sooner rather than later when the becoming pregnant is an urgent matter.

Precisely because your fertility profile is as singular as your fingerprint, it’s important to get a baseline as early as possible. Currently, specialists recommend that annual screening beginning at 21 years of age would be most helpful in establishing your own benchmark. If you are not 21 – don’t lose sleep.  Remember that these Fertility Evaluations are a new concept. If you are concerned about your ferility at any age – you can go find out the facts by having these simply tests performed.

Fertility Preservation: The Egg Freezing Revolution and The  Biological Clock

As so many women discovered late in life, procreation is a far more delicate and complicated process than most of us ever suspect. After all we spend so much time trying to avoid pregnancy, it never occurs to us that we may not be able to when we want.

So what do you do if you are in the midst of getting your degree or your career is on an upward trend that you don’t want to derail? Until recently, the options were few and unreliable.

But the world of reproductive medicine is on the fast track to breakthroughs in egg freezing which is giving young women the opportunity to put the best of their oocytes into a safe deep freeze until they’re ready to use them.

Some IVF Centers  claim that they are ready to provide state of the art egg freezing right now to women. Others like East Coast Fertility are in the midst of doing studies and offering discounts to patients who want to be a part of the Egg Freezing Studies. If you want to know more about your own reproductive potential, you could take advantage of a free consultation, and find out if participating the egg freezing study is something that is appropriate for you.

With careful attention to fertility protection, a program of annual fertility screening and the egg freezing option, for the first time young women really do have reproductive choice.   Not just the promise but the real thing.

Posted under Biological Clock, East Coast Fertility, Egg Freezing, Fertility, Fertility Preservation, IVF, infertiity