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Amy Demma, Prospective Families; Andrea Bryman, LMFT; and Pamela Madsen, The Fertility Advocate: The Eggsploitation Controversy

The filmmakers promote it as “the fertility industry’s dirty little secret.” In the trailer, several former egg donors describe horrific experiences resulting in permanent health damages and how they were lured into making poor decisions with offers of hard to resist compensation. The music, ironically scored by the group Thieves and Liars, is dark and foreboding, reminiscent of a horror film. And the name of the documentary – Eggsploitation – implies its intentions, which is to let the world know about the “trade” in human eggs and “older women with money targeting younger women.”
So is this documentary a wake-up call for the infertility field or is it a narrow-minded attempt to push an agenda, with the truth lying somewhere between the hyperbole and the criticism? The Surrogacy Lawyer Theresa Erickson will explore these issues on Thursday, September 2.

Ms. Erickson will be interviewing three leading infertility and collaborative reproductive specialists, including Andrea Bryman, LMFT, a marriage and family therapist specializing in egg donation and surrogate assessment and support; Amy Demma, a New York attorney and founder of Prospective Families Egg Donation Agency; and Pamela Madsen, infertility blogger and patient advocate who wrote several posts about the movie on her blog The Fertility Advocate that steamrolled into a lively Facebook discussion.

“We are excited to have the opportunity to move the robust discussion that started on Facebook into the real-time, interactive realm of radio, “ says attorney Erickson. “As a former egg donor during college and now as a third party reproduction professional who has dedicated my career to this field, I want to insure that the absolute best practices are established for the welfare of both egg donors and parents via egg donation. So regardless of the public’s or field’s perceptions of the documentary, I am glad we have this chance to move the discussion forward.

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Posted under "Eggsploitation", Egg Donation

Yesterday, I blogged about “Eggsploitation: The Fertility Industry Has a Dirty Little Secret” And then I did what I do – and put it on Facebook and Twitter.  I have all kinds of “friends” – people that I know and don’t know which include many “insiders” in the fertility industry. And  what I saw was the beginning of what has been a gradual self examination practice when it comes to the business of egg donation – and the beginnings of a discussion about how the industry educates egg donors. I would love to help encourage that discussion to continue.

The education of egg donors has been important to me for a very long time.  I may have told this story before – but it is worth telling again.  It also speaks to how money controls public education.  In my day of running patient organizations I had to get funding for all of my educational fact sheets (because there is no federal funding of patient organizations as there exists in some countries like The Netherlands). Getting industry funding for fact sheets at patient organizations is a practice that continues today across the board at many non profits.  Just check the fact sheets – you will see sponsorship listings.  There is no big secret there.

So once upon a time, I wanted to do a fact sheet for potential egg donors – and I asked a big famous doctor at a big famous IVF Center to sponsor it.  I got a big fat yes – and I began the process of writing it. When the doctor got a hold of the fact sheet – he screamed that he was withdrawing the funding because the fact sheet was going to encourage the egg donor to ask too many questions – and answering these questions would take precious time away from the business of running his program.  Would I like to pay him for the time lost in answering egg donor questions that the fact sheet would provoke?

That fact sheet was never created because no one wanted to fund it. It was bad for business.

No matter how conflicted I feel about “Eggsploitation” (you can read their press release here) – especially their portrayal of the egg donor recipient as shown in the trailer on their website, I am glad that The Center For BioEthics and Culture Network produced it. Because while it may be extreme in it’s point of view – it is telling a point of view that needs to be told – and is not being told anywhere else. We need to make room for this perspective on egg donation – because it is real. These young women who are telling their stories are real – even if they don’t represent the majority of the egg donor experiences – it doesn’t make their experience any less valid or important. We need to hear them.

Everyone in the baby making world wants to feel like they are doing the right thing by egg donors, egg donor recipients, and most of all – the children that are created from that match. But money influences the waters. And without egg donor compensation there would be no egg donors. We all know that.

And money influencing the fertility field is not unique to the fertility field – it is a constant factor in every field – that is why big Pharma can’t buy dinner, or even give out pens anymore. We have all begun to acknowledge that fact.  It doesn’t matter how big or how small the donation is – money has this awful habit of controlling things.  And I have no answers – because every one needs money – and money pays the bills to keep the doors open for everyone. Even The Center for Bio Ethics and Culture Network has funders with a point of view.

But I do get disturbed with I see patient organizations with more professional/industry invested board members than patient board members.  And I do get even more disturbed – when I look deeper at who is running the ships – and there is an over abundance of board members in one part of the industry that we as a fertility community depend on for our unbiased information.  It is not that folks who serve in the industry or on non profit boards are evil doers – it is just that we need balance.  And without that balance of professions and areas of interest – there is an  influence in very quiet ways in regard to  the information that the consumer receives.

Yes – it is time for us to go deeper and really look at what information is shared with the consumer – how the information is being positioned – and who in the end – the creation of the educational materials are truly serving.  We must always keep in the front of our brains that consumer education is not marketing.

Posted under Advocacy, Egg Donation, Egg Donor Compensation, Facebook, Fertility, Fertility Blogs, Fertility Education, Fertility Marketing, IVF, In Vitro Fertilization, Infertility, Infertility Funding, egg donors, eggs, patient advocacy

A colleague of mine sent me a link to “Eggsploitation: The Fertility Industry Has a Dirty Little Secret” late last night – her email simply had the link – and word “WOW”.

I sat watching with my mouth looking like a bass fish  – open and gaping – as several young women told their horrifying story of being an egg donor in the United States. They spoke of feeling enticed by the money into donating their eggs – the poor explanations of what they could experience – and the tragedy of the complications that they unexpectedly faced as egg donors. The trailers on the website are riveting – and appalling.

It is certainly not a view – that recipient couples, egg donor coordinators, fertility specialists, and egg donor agencies will likely be comfortable seeing. But does that make it any less valid an exploration?

That is the struggle that those of us who live inside the fertility “industry” really have to grapple with.  So often – when these types of images of the fertility field are presented – we shout “foul play”! We pound our chests – and blog our hearts out about how unfair the media is to our field. You can hear us shout that
the entire story is never told – that the world of infertility is highly sensationalized  and distorted in order to sell magazines – or this evening news story.

Quite frankly – there is a great deal of truth in that opinion and outrage.  Frankly – even in the title of the documentary – calling the experience of egg donors a “dirty little secret’ is beyond over of the top. But the producers of the film  are marketing a documentary! If there is no dirty little secret – why buy a ticket?

And there will be people who will watch the clips – and perhaps even go see the documentary – who will come out drawing an analogy of these young women to aviation safety records – “You know – airplanes land safely every day across the country – thousands of them – and you never hear about that! But if ONE plane goes down – boy does that make the news!”  That’s because there is tragedy when even one airplane goes down – and we need to hear about it.

That is how I feel about “Eggsploitation” even where it fails in it’s own sensationalism. I am still wanting to hear the stories of these young women. It’s that important.  Look -  I didn’t like the trailer featuring the “experts” who said that egg donation is about rich older women taking advantage of younger women with good eggs. That is really horse shit – and shows a complete lack of understanding about the women who need donor egg.  I have never met a woman who needs donor eggs who is anything but grateful to donors. And the majority of the women who need donor egg are not rich.  That characterization was frankly wrong and horrifying – and in my mind brings down the messages that perhaps “Eggsploitation” is trying to get out.

We have to be very, very careful – with the young women who step up to donate their eggs.  We need to be careful about donor compensation being so high that young women feel enticed. We have to do a better job educating donors about the risks of egg donation – no matter how good everyone in the fertility field feels they are already doing it – we will have to do it better. These young women are making what I call “life time decisions” when they decide to donate their eggs. Even when their cycles go perfectly well (and most of them do) – these young women are giving up their genetic material forever – and exposing their bodies to a lot of unknowns in the process at a very young age.  That is simply real.

And we all have to cop to the fact – that no matter how careful we are – no matter how much time is spent – and how carefully these young women are consented and educated in the best of circumstances – people make all kinds of informed  decisions – for all kinds of reasons.

And sometimes – things just don’t go as planned.  And all we are left with is regret, pain and anger.

Posted under Egg Donation, Egg Donor Compensation, Fertility, egg donors, eggs, infertiity

I recently spent a rainy Saturday afternoon watching “Food Inc.” a documentary on the American food industry.  And while I thought I knew a lot about food sourcing, how corn has impacted our diet, eating within 100 mile radius, and sustainable foods, I really had no idea about how much of the food is produced in the United States until now.

I wondered if it was too much to be a fertility advocate, a sex advocate and a food advocate too? I mean why not?  After all, this issue has been on my radar for awhile, and I have written on “Food, Family and Fertility” before.  You really can’t separate out food from fertility – and you can’t take sex out of fertility (although we do try!).  It’s all connected. What we eat directly affects our health and can impact reproductive diseases such as PCOS and sometimes there is nothing sexier than a great meal! But there are great food advocates out there already who don’t need me to do their job – but I bet they sure could use support in defeating what now feels like an evil food empire to me.

Meet food safety advocate, Barbara Kowalcky who became an advocate the way most advocates are born – through a life changing occurrence. In her case it was the tragic and preventable death of her two year old son through eating contaminated hamburger meat.  Ms. Kowalcky is now working with her husband and mother to pass “Kevin’s Law”.

Let’s support her.

And then there is Joel Salatin, a farmer in rural Virgina who owns and runs Polyface Farms. Move over Hugh Jackman – I think that this man may be the sexiest man alive.  I want this man to feed me, but he won’t because I don’t live in his buying club regions. The story of my life.  But, the way he talks about the food industry, how we source our food, and his own personal food philosophy stirred passion in my veins.  And the cowboy hat wasn’t bad either! So if you can’t buy food from this man you can read his blog and become inspired.

So, buy or rent “Food, Inc” and check out many of the people that are profiled – and don’t forget them.  They are our food advocates – and they need our help. And what is going on in the food industry reminded me so much of the fertility industry. I know, this may feel like a stretch to you, and perhaps parallels  can be drawn to any industry that is both consumer driven and industry driven.  But I eat and I work in fertility – so this is that I saw through my not so rose colored glasses. Let me connect the dots for you.

Perhaps it was the powerful people in the food industry who wear two hats that reminded me so much of my world in the fertility community. The power wielders that sit on the food companies board of directors and also serve our government in the role of consumer advocate.

Is it so different in “Fertility Inc?” The blatant conflicts of interests that go ignored because either people don’t know what is going on, or don’t care about what is going on enough to go past rumbling under their breath at conventions to actually speaking out and rocking  the boat. Some folks also simply don’t get it.

You know what I am talking about; the people who sit on the board of directors of our patient fertility advocacy groups who also are members of the fertility industry.

In the current state of “consumer advocacy” groups in charge of advocating, educating and speaking for the patients in the United States – the members of their board of directors who are industry based far out number people who sit on these “consumer” organizations who have no ties to the fertility industry. Does that shock you? Just go read the board lists.

And then there is the professional community organizations that are supposed to be run for and by professionals branching out and developing “patient education websites” instead of supporting our patient groups to do a better job by offering resources such as funding or man power. But that’s not what is happening. Instead I have heard that the main professional organizations who is so much richer than our struggling patient groups are actually charging our patient non profits organizations fees to run events when they are held in the same town as their conventions!  We are talking the same town as the conventions not in their convention space!  There is something icky about all of this on a deep visceral level.

Best intentions do go astray when industry is in the role of advocate.  We are becoming like the food industry with only a few people in power who wear many hats.

Is this what we want? Where is your voice?

Did you know that the FDA does not have the power to close down a meat packing plant that has had contaminated meat again and again? How did that happen? Did you know that people who worked for the meat companies advise and work for these government agencies?

And then there is the issue of carbon foot prints.  In our food industry – that carbon foot print is corn. In fertility it is gonadotropins and the transfer of too many embryos.  Why hasn’t Micro IVF and Single Embryo Transfer become standard of care at at IVF centers the country?

Is it because just like big business in the food industry it doesn’t serve the pharmaceuticals and the big IVF centers to restructure how they supply infertility treatment to the millions who need it?  When did we (the medicine of fertility) become like Wall Street? Isn’t it okay for us to make less (and still do very well) – and supply the best possible care for fertility patients without over burdening our society with multiple births? Why wouldn’t we create a delivery system of fertility care that is standard to all IVF centers, and across the board  would save our struggling health care system over 1 billion dollars a year? And why would it even occur to us that these costs should be eaten by the struggling fertility patient instead of by the very centers themselves that have gotten fat over the years?

Yes it is admirable for ASRM to put out guide lines to recommend the transferring of fewer embryos. But that alone will not change the problem.  We need a restructuring of our delivery system – and that means touching doctor’s pocket books.  Will the “trade associations” whose members are made up of industry speak to that? Will the patient advocacy organizations whose boards are filled with industry and sponsored by industry speak to that? Who will speak to a change in our model that requires centers to make less money?

Consumers have power.  You vote everyday in the food industry by the food you buy.  Every time a item goes over a scanner you vote for organic, free range or high fructose corn syrup.  Consumers have a voice in the world of “Fertility Inc” too.  Investigate who is running the show that helps shape the decisions that effect your family building dreams.  Ask questions about how your centers can make your fertility care more affordable and safer.  Ask about Micro IVF when you are told that you need an IUI or if you are a PCOS patient that is being directed to standard IVF.  Ask about how your IVF center is making Single Embryo Transfer an affordable option for you to choose.

Shouldn’t’ less fertility drugs and fewer multiple births be something that our field does more than talk about? Perhaps, it all starts with people that have big dreams which they turn into little miracles: One step at a time.

Posted under Advocacy, Diet and Fertility, Egg Freezing, Fertility, Fertility Education, Fertility Support, Food Inc., IVF, In Vitro Fertilization, Infertility, Micro-IVF, PCOS, Single Embryo Transfer Program, high order multiple births, sexuality

You know – I go back a long way in the field of fertility education. I have run more monthly meeting for infertility then most people have attended movies over a life time. So – I have been witness to a great deal of change in how professionals in the industry of fertility and patient organizations have worked to promote meetings. Back in my day – we put out fliers in the waiting rooms of IVF Centers and community centers. They were simple – they said things like “Are You Trying to Have a Baby?” and then they listed the name of the speaker and location which was usually in a community center or some other rented space that belonged to another organization. There was always a line on the flyer that said “Refreshments will be Served”.

The refreshments were usually cookies, coffee and tea. No one cared what was served. They were coming because these people wanted a baby more than anything in the world. Coming to a fertility meeting – was all about that. The information that was being served. Nothing else. And before the days of the Internet we used to pack them in. Sometimes 200 patients will fill a room on a Thursday evening to hear a doctor or adoption expert speak.

Well – times are changing. And apparently it is way hard to get any patients to come out in person to a monthly meeting simply to get information on how to build their family!

Now we offer up free martinis and manicures – special drinks – dinners in fabulous restaurants, organic exotic cupcakes and hold the educational meeting on  beautiful estates with ocean views that most of us could only dream about owning.

The local community center and store bought cookies apparently won’t bring infertility patients out anymore to get them the information that they need or want to build their families. We feel like we have to entice them goodies other than the promise of a child.

I look at these events – which look fabulous – and are run about quality professionals and organizations – and I wonder about it all.

What does this say about us? When I read tweets about cupcakes and not babies – I wonder where I am and what this is really all about.

And then I wonder if I just a grumpy old woman who really need a cupcake and should loosen up! I do love cupcakes and the ones being advertised at the most recent fabulous infertility patient event that is being promoted sound amazing.

But – my gut reaction to this new “we are having a glamorous party” marketing of fertility patient education events have been “Really? No they are not!”

Grumpy old geezer that I am – I can’t help it that a part of me is turned off by the idea of marketing infertility patient education in this way. It’s all about the menu – the location – oh the fun we will have together as opposed to “We will help you have your baby” , “We get the struggle and we want to help” and refreshments will be served.

I am reminded of the fights that I used to have with one of the other volunteers back in the day of the cookies and coffee at Jewish Center where we held RESOLVE NYC’s monthly meetings. I wanted chocolate cookies because infertile people deserved good cookies if they were coming to an infertility meeting – and the other volunteer wanted to save money and always bought vanilla wafers. I always won – and bought the chocolate. So on a basic level – I get it.

I understand the desire to make these meetings that are so not fun to attend a more a pleasant experience for the patient that has no desire to go to an infertility meeting.

I asked myself the question again. Was I now turning into the vanilla wafer volunteer? Where was my sense of fun?

Did I need a special exotic organic drink and a cup cake? Would that fix it? Maybe.

Posted under Fertility, Fertility Education, Fertility Support, Infertility

So there are Fertility Quiz’s and there are Fertility Quiz’s! The kind that you might expect is like the one that has been recently released by researchers at Cardiff University “‘Do You Know About Your Fertility?’ It is quite lovely – and could be republished in any women’s magazine. It is a lifestyle checker – you take the quiz and find out if you are at risk for infertility. Yes – that is one kind of “Fertility Quiz”.

The other kind of fertility quiz is one that I just made up! Let’s call it “Do You Really Need That Infertility Procedure?”

Sorry, but I don’t have a nifty link for my made up quiz! You will just have to read it here.

So let me fill you in on a bit of inside “fertility industry” dirt. While, the treatment of infertility is medicine – medicine is also big business. Now – the fertility industry (hate calling it an industry) is not different than the “Cancer Industry” or “Addiction Industry”. People are working in fields because they dig it – and because they are creating a livelihood. The problem comes in when people include a lot of different procedures that up the ante on the patients bill at the end of the day.

Question One: “Do I need iCSi when we don’t have male factor?”

Answer: Probably not.

Many centers are now doing iCSi rountinely on all patients – some are actually including it in the fee – but most charge for it. They are doing this because they don’t want to get to the lab and then not be able to fertilize the eggs. And yes – sometimes it happens! So to make sure that you don’t have a fertilization disaster – they ask you to do iCSi. Yes – in most cases your bill will increase.

Question Two: “Do I need antibody testing?”

Answer: Probably not.

There are doctors and IVF Centers who deeply believe in some core reasons for infertility that other doctors don’t buy into – such as autoimmune reasons for infertility – so they perform antibody testing. If they decide that you have an autoimmune issue the resulting treatment can be very expensive. Do you need antibody testing? Most of the world says no, that there isn’t any proof (no studies), but if you are at a center that believes in this – you could be in for sticker shock.

Question Three: “Will PGD Really Increase My Chances at Conception?”

Answer: Probably not.

Pre Implantation Genetic Diagnosis(PGD) is a wonderful technique that was developed to sort out embryos that had genetic diseases – but what is going on with IVF Centers that are offering PGD as a way to increase success rates? Now this is much more controversial and has been recently debated several times in public forums such as ASRM who put out recent guidelines about the marketing of PGD as a use for increasing success live birth success rates. This controversy has surfaced again, and has been recently profiled in The Wall Street Journal. This piece of reporting once again points to the belief held by many that using PGD to increase success rates won’t do anything but raise your bill.

Well, thanks for taking my Fertility Quiz on “Do You Need That Procedure?”

And now for the medical disclaimer!

Please talk to your doctor about any testing, or procedures that you are thinking of adding on to your treatment. They are the best ones to discuss with you why they believe that you may need certain testing or procedures. I am not a doctor . What has been offered here is a little information to help you start a conversation with your own health care provider – and perhaps save you a little money along the way.

Posted under Fertility, ICSI, IVF, In Vitro Fertilization, Infertility, PGD, The American Society for Reproductive Medicine, male infertility

Let me warn in you in advance – this post is about me and my work in the ”fertility industry”.

I don’t always love change or transitions. I am a nest builder.  That doesn’t mean that I don’t love excitement – because I do! But moving on – that can be hard for me. I remember Christmas 2007, that is when I knew that I was going to leave The American Fertility Assocation.  I had been so sad during the holiday and I was at my sister-in-laws house with all of the Madsens gathered from the four corners of the world. It was a very hard time for me. I was in the kitchen at the crack of dawn pouring coffee and Julie (the sister in law) came in.

“What is going on with you, Pamela? You are so sad this Christmas!”

I took a deep breath and uttered the words that I had not uttered aloud yet. “I think that I am going to leave The American Fertility Association.”

Julie’s face lit up in a great big smile. “Oh is THAT all? Oh my God, Pamela – you have been leaving The AFA for years now! We all knew that! You are just the last to know – we thought that you were leaving Kai! We have all been so upset!”  Wow. That really threw me. She thought that I was leaving my husband of 26 years! Really? But that was how big a move this was for me. It was like getting a divorce of sorts. I was leaving a part of my family, and a part of my life. It was hard. I guess leaving always is.

I was also surprised that she knew that I had been detaching emotionally from the organization that I built for years. Well – apparently I was the last to know.

But I wasn’t detaching from the field – and I was not sure how to keep what I loved about what had become my life’s work, and give up what I hated the most – the constant begging for funding, and the political rat’s nest of the fertility industry. I was so done with that part of things.

The stress was too high – and it had  became harder and harder to focus on what I cared about most which was speaking my heart to the fertility community about this field that I had literally grown up in. I wanted to focus on creating programs – not soothing egos and making sure that the “ROI” (return on investment) was big enough for our supporters to run our programs.  The times were changing – and it was rough in non-profit land.

But, I had a platform at The AFA for my voice – and my biggest concern about leaving was that I was going to lose my ability to advocate for people going through infertility, learning about fertility – and the impact of sexuality on all of the above. I was a fertility and sexuality educator and an advocate before all other things. I was scared because I thought that I was going to lose my voice.

I was wrong.

The role of a Founder and Executive Director is to bring vision to an organization – and I started to bring that energy to my own life.  I saw myself still doing what I cared about in my past – but in a new way. And so,  The Fertility Advocate was born. I have to tell you that I never expected the volume of readership and interest that this blog has gotten.  It has truly been extraordinary, and I guess it is indicative of the change of how we get our information in 2009.

People are going to new places to find support, information and education. They want to hear the real deal – and they don’t want to be fed politically correct information that has “ROI” as it’s bottom line. They want the raw, uncensored truth. And it is hard to find that – because everyone has a bottom line.  I guess the trick to the bottom line is trying not to care too much about it.  And that is hard in this economy. I was very blessed to have had wonderful unfettered support for this blog right from the beginning.

Geoff Sher, MD of the Sher Institutes For Reproductive Medicine never once asked me to write anything – and never once told me that I was too controversial in my views.  “Pamela – it is YOUR blog” – he would say to me.  That support allowed me to create a no holds barred vehicle for commentary in the field that has taken off like lightning.

Dave Kreiner, MD of East Coast Fertility told me when he hired me that he wanted me to keep doing what I was doing. So this renegade fertility advocate doesn’t have to worry about my voice – I just get to use it.  How incredible is that? And in my new age spirit – I express gratitude every day for the opportunities that have come my way.

I am so proud to announce that this blog has gone into a “syndication” of sorts! EmpowHer – a women’s online resource has invited me to be a writer on their site and they have over 250,000 readers a month! I am thrilled about this opportunity to contribute my writing and my voice to their readership.

I am also so excited to be announcing that as of Monday,  I will be an expert on Fertility Ties. While EmpowHer has extraordinary traffic on their site – reproductive health and sexuality is only a part of what they do. Many of their visitors are there to find all kinds of different information – it is kind of like a Web MD.

What makes Fertility Ties so unique is that they have broken the 100,000 visitor mark per month and they are STRICTLY fertility!

I cannot tell you how extraordinary that is. We are talking page views here – we are talking unique visitors.  Remember when I asked where are all the fertility patients? Well – apparently they are on line at Fertility Ties chatting away! At Fertility Ties – their founder and visionary Veronica Alvarez has created a fertility community that simply has not exsisted before in quite this way.  Many of us have tried, and have been successful in varying degrees – but not like this!

What makes Fertility Ties so unique in the arena of fertility support is that it is an online social networking site (think FaceBook) where participants can share their infertility journey, find support, make friends and obtain important medical information from experts. Fertility Ties is a new concept that has taken off very quietly in this field. In fact I don’t see much fertility advertising on the site at all yet!

Is it really possible that the fertility industry has not gotten the 411 yet on where all the fertility patients are hanging out?

Oh yes, the field of fertility has been some ride for me. And after 20 years – it looks like I am just getting started. Thank you for not only supporting my voice – but asking for more.

Posted under Fertility, Fertility Blogs, Fertility Support, Fertility Ties

Full disclosure. I work with Dr. Dave Kreiner at East Coast Fertility and before that I worked with Geoff Sher, MD and The Sher Institutes for Reproductive Medicine – and before that I spent close to 20 years as a professional non profit patient advocate – and made my mark as the Executive Director of RESOLVE NYC and the Founder and Executive Director of The American Fertility Assocation. I have worked with countless members of the “fertility industry”.  Name a “Big Fertility Name” – and I have probably had dinner with the big name. I have been friends and not been friends at one time or another with most of them.

I have been dragged through more labs to “OOH and AAH” over cryo-tanks, micro scopes, and pipettes. And I have had to admire more exam tables than cashmere sweaters at Nordstroms.

I have heard the secret confessions of many a big name over a martini and watched a pharmaceutical rep feed a doctor a strawberry with her fingers during a presentation that I was making at a dinner in LA.  From priestess holding fertility industry confessions – to voyeur watching fertility industry indiscretions.

 So, as the saying goes, “I have been there – and done that”.  And sometimes – I didn’t get the tee shirt but I got the logo emblazoned pen. I am a dinosaur in this field that still has lots of flesh still on my bones.  I didn’t think that I could be surprised or moved by anything anymore – until I had lunch this week at a diner with fellow full fleshed dinosaur, Dave Kreiner, MD  in Plainview, Long Island.  He had the Greek salad with chicken and I had the Gyro Meat Greek Salad.  We were sitting with a reporter after a big interview that I will talk about in the coming weeks.  We were dishing about frozen embryos.

“Dave – tell her (the reporter) about The Single Embryo IVF Incentive Program that East Coast Fertility offers” I prompted. I just loved this program. But I didn’t expect what came out of Dr. Kreiner’s mouth.

“Sure. Well – I started the The Single Embryo Transfer Program about three years ago. We have a really great embryologist –  John Moschella.  I wanted us to be known for combining high success with minimal risk. I wanted to encourage good prognosis patients to limit the number of embryos transferred and thereby eliminate high risk multiple pregnancies.  So to encourage patients to transfer single embryos, I created a program that gave the patient for the cost of one IVF cycle free cryopreservation of their embryos and up to three free regular ECF frozen embryo transfers.  This represents a savings of up to over $12,000 and ensures a better chance of a healthy pregnancy and a healthy baby”.

The reporter looked at Dr. Kreiner quizzically.  Don’t you lose money that way?”  She didn’t understand.

“Look I am trying to do the right thing” Said Dr. Kreiner digging into his Greek Salad. I wondered if he was going to eat the olives. Did I know him well enough yet to steal his olives?

“Don’t you lose money?” she asked again.  Dr. Kreiner’s answer didn’t satisfy her.

“I make less. You have to understand” said Dr. Kreiner “ Those of us who practiced IVF in the beginning days – I trained with Howard and Georgeanna Jones at The Jones Institute when it was the only place in the United States that offered IVF. And through the late eighties and nineties most if not all of the fertility doctors across the country were responsible for incredibly high multiple birth rates. And I carry that in my heart. When I opened East Coast Fertility – I swore that I would never be responsible again for any conception over twins. I have had two sets of triplets since then. The embryos split and created the third baby.”

Dave dug into his salad again. The emotion in his face was striking. I forgot about the olives. Here is a reproductive endocrinologist actually talking about how being a doctor in this field impacted his heart and his own conscious – in a real and uninhibited way – in front of a reporter! Dave was talking about the collateral  damage of the fertility field. Kreiner’s admission was so raw and honest, that I think that the reporter and I both stopped breathing for a minute. Wow. This guy really cared.

The reporter looked into Dr. Kreiner’s eyes. “So – the outcomes of those high order multiple births were mixed?”

Uh-oh. Icky reporter question. I found myself starting to squirm in my seat and fidget with my fork in the lettuce.  What was he going to say? The news of low birth weight babies – and other complications due to high order multiple birth was staggering and often used as an indictment aganist the fertility field.

“Sure they were mixed – but they were mixed in so many ways. There were so many divorces among the patients. The impact of those high order multiples on those marriages were huge. These couples weren’t ready for the emotional stress, exhaustion, and the financial burden. I don’t ever want to be responsible for anything like that again. Back then we didn’t know – today we know. There is no excuse for ‘The Octo Mom’”. 

I thought of Jon and Kate Plus Eight. They weren’t doing very well either- were they? So… Dr. Kreiner made a pledge?

It’s kind of like he made a pledge not only for the conception and healthy births of these longed for children – but for them to have intact families in which to grow up in.  I don’t think that I had ever heard a fertility doctor take responsibility for himself and his field in quite this way before. There was no indignant self grandicing and justifications being offered. He simply talked about the learning curve of this young field of reproductive medicine, the impact of reporting success rates to the public, and competition.

Listening to him speak on this topic in the way that he spoke on this topic,  was frankly way more surprising than the strawberry being hand fed in LA all those many years ago.

After 20 some odd years of being in the great big world of fertility – I had found something that was really worth writing about.

Posted under Dr. Dave Kreiner, East Coast Fertility, IVF, In Vitro Fertilization, Infertility, Single Embryo Transfer, high order multiple births, octuplets

So – I had breakfast with another fertility blogger yesterday in the upper east side of Manhattan. We were smack in the middle of the land of “The Nanny Dairies”.  We sat among perfectly put together women who pretended to eat breakfast as they asked for more coffee. These women came from a different tribe, and my friend and I were trespassing on their land. 

It was fun to sit down and actually meet one of my virtual friends and colleagues.  We were dishing about the fertility industry – and talking about our respective lives. My – we are interesting women!  And she was talking about how she had been reluctant to turn into a “cookie girl”.  For those of you who don’t know what the “Cookie Girl” is…..that is the rep. The marketing chick. The person who pops into GYN offices – brings lunch and does the marketing presentations – often along side the doctor that you are working with.

“You know – I just don’t have the ‘Cookie Girl’ look.  I don’t have the personalty or that young, sexy look that most of the reps have…..” She offered.

“Ya know – I think that I am ‘The Cookie’ girl for SIRM in so many ways.” And then I started to laugh.  “I think that I give ‘the rep experience’!”

I cracked up at my own joke….last weekend in the NY Times there was a review of a movie called “The Girl Friend Experience” – it was about an escort that provides her clients with the experience of having a girlfriend….and you don’t find out that she is an actually escort until money changes hands.

“You know – I walk in and they think that I am a Rep – and then I talk about what I have done – what I care about and why I am there – and they get it – that I am a fertility educator. And the attention they give me changes. But when I walk in….I am definitely giving the rep experience complete with the cookies!”

We both laugh. “You know – you are cute enough to give the rep experience too – I mean – if I could pull it off – so could you!” More laughter.

It’s funny how life turns out. How it twists and turns. And in the end – we are who we always are. Sometimes, we have to wear a certain outfit – or carry cookies – but by the end of the movie it is clear exactly what we are there for.  I am there for fertility education – but I promise that the cookies that I bring are always good – and I try not to cringe when I am introduced as ”the Rep”.

Posted under Fertility, Fertility Education

Okay. I admit it. I am an old war horse when it comes to the fertility industry. I have been a fertility patient advocate since the year of the flood, or the birth of my first son - twenty years ago in 1988. When it comes to the field of fertility – some might even consider me – well – a bit jaded.

It’s just that I have seen so much, and for better or worse - in some small way – I helped shaped the fertility industry.

If you think of the world of infertility as a time line – the birth of my first born son, is almost near the beginning of recorded time – the medical break through of Invitro Fertilization. This occurred in the year of our lord, July 25, 1978 with the birth of Louise Brown.   Louise was born when I was a senior in high school – and IVF was just this weird “test tube” thing.  Just ten years later, I gave birth using the same method (I was a child bride). This was back in the days of baby books in IVF Centers. Bet you haven’t seen those!

So, effective Reproductive Medicine is relatively young – and advances have moved fast – much to the relief of fertility patients.  But the question has remained – how do we reach fertility patients and get to them the information that they need? How do we get to patients early enough, so that they have the information that they need to actually prevent infertility? 

It is a question that everyone in the field of fertility as been trying to crack for a long time.  Is the answer really small group gatherings? Is gathering a group of 10, 40, or even 100 women at a time at events across the country cost and education efficient? Does that old model still make it in 2009? Frankly it wasn’t cutting it anymore in 2002!

And yet – we do them. Perhaps we do them because it is what providers of fertility education, and services are used to. It is what we used to do – it used to work – so it is our comfort level. Or perhaps, for many of us fertility educators – we just want to get up close and personal with folks. We deeply believe that the face to face model is the best. For example,  In Dallas – on March 27th, 28th and 29th SIRM is hosting a free town hall seminar with Dr. Walid Saleh and Dr. Geoffrey Sher.  The topics will include the latest breakthroughs in Infertility treatment, a discussion of SIRM’s new CGH IVF Refund plan, and one-on-one question/answer with the doctors.  For patient’s in Dallas this is wonderful, and I hope that many show – and over at my old haunt The American Fertility Association, they are kicking back Martini’s and painting finger nails across the country in the hopes of attracting young women to come out and learn about their biological clock – 20, 30, or 50 women at a time. 

But is this really going to do it?  I get it – I really do – I spend a tremendous amount of time traveling around to Gynecologists and Oncologists to meet with small groups of professionals – in the hopes of educating them so that they will educate their patients.  And I am sure that all of this has some arching effect but it is small.  This type of education is like selling vacuum cleaners door to door. It works – but that was before the age of the Internet.

When I look at the statistics on my simple fertility blog that has only been up a short while – I get about 5000 readers a month!  In terms of cost efficiency and outreach – nothing beats the Internet.  It may feel less personal – but that is where the foot traffic is.  Even when you are working with relatively small numbers such as a blog like mine that is currently seeing a peak readership of 300 visitors a day (love it when CNN links to me!)  versus all of the incredible hard work and resources spent to pull thirty women into a room – traveling all over the place – putting up flyers – marketing and staff time – where is the efficiency in outreach in the comparison? It just isn’t there.  This old model is like pushing a wet noodle up a hill.

And then there is the issue of making fertility education compelling. I write five days a week for this fertility blog, and in order to come up with topics and stories of interest I troll the web – looking for something to captivate me.  I have to tell you – I think that much of what is out there is quite stale. It has been one big yawn for a long time – I don’t even see updates in patient education materials. It is like everyone out there is just trending water.  And trending water is not good enough – eventually you get tired and you drown.

There is even a lack when it comes to a strong leadership voice – I look over the land scape and I am looking for someone compelling to captivate me! I want someone to draw the media to this field – to draw patients – I want to see fertility patient education pop!

So, I guess you are getting it  – I have been none too impressed lately with the state of affairs.  Until the launch of a brand new vibrant website – swishing into the arena like a sixteen year old girl to the prom who just knows that she has the prettiest dress!

Oh yes..this site is getting my attention – because it is doing what needs to be done – making fertility education pop. And it is not in the land of patient or professional organizations. It is the commercial, for profit brain child of Gina Bartasi – and her new website Fertility Authority.

First of all, the venue is right on target. It is the Internet – and the Fertility Authority is pleasing to the eyes – even though I do get tired of watching their spokesperson, Martha’s Stewart daughter, Alexis Stewart yapping it up on the home page – but you can learn how to by pass her after the first go round of hearing what she has to say! The site is complex (subtext - interesting!), with well written up to date articles and information – blogs (not mine) – columns – videos – on line community – and so much more. If I was a fertility patient – Fertility Authority would be booked marked on my computer.

Look, Fertility Authority is not the only commercial website trying to make it’s mark on the web. The pharmaceticals have tried to make a go of it with their own patient education sites – where they try to look like a patient organization – yet not.   Somehow, these sites keep missing their mark – no matter how much money is invested in them. There is something flat about these sites – they lack authenticity – they lack flavor – and an independent style.  They smell vaguely of oh….pharmaceuticals. There is just no sparkle to them.

So, congratulations Fertility Authority! You even got a jaded eye like mine to wink!

Posted under Fertility, Fertility Authority, Fertility Education, Fertility Support, Infertility