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Archive for January, 2014

Embracing Chinese New Year While Infertile

By Tracey Minella

January 29th, 2014 at 1:44 pm

 

credit: feelart/freedigitalphotos.net

Chinese New Year is coming on Friday, when the year of the Horse will be ushered in. But you don’t have to be Chinese to appreciate their rich culture and traditions…especially the mystique of the Chinese methods of enhancing fertility.

The Chinese zodiac consists of a cycle of 12 years, with each year being named for a different animal, and supposedly bestowing upon those born in that year certain characteristics which are similar to the traits of the featured animal.

According to Chinese beliefs, children born in the Year of the Horse have these qualities: “Very hardworking and independent. Will work on and on until a job is finished. Very intelligent, ambitious and expect to succeed. Can cope with several projects at once. Easily fall in love.”* Incidentally, my first born IVF baby, born in the last year of the Horse completely fits that bill.

In the early years of my own fertility battle, I was working near Chinatown with Mai, a friendly Chinese girl. Whenever she spoke of her family’s traditions, I listened in fascination…especially whenever anything related to good luck or fertility came up. I didn’t matter that I was Italian and Irish. I was game for almost anything to get pregnant!

Here are four tips and suggestions (along with Mai’s wisdom) for all those trying to conceive at this enchanting time in the Chinese calendar.

  1. Eat Dumplings. On New Year’s Eve, the Chinese often celebrate by eating dumplings called “jiaozi”, which translates literally to “sleep together and have sons” according to http://www.theholidayspot.com. Mai was adept at making these challenging dumplings. I, was lame and ordered wonton soup instead. (No wonder it took me so long to conceive…)
  1. Sweep out the Old. Grab a broom and sweep out the house from top to bottom and give it a good cleaning. It symbolizes the sweeping away of all the bad luck of the past year so the good luck can enter. I do this religiously every single year. It feels empowering. So much easier than jiaozi, too. You must try it.
  1. Wear Red. On New Year’s Day, wear something red… the color of good luck and symbol of wealth. Mai’s older relatives used to give her and her siblings red envelopes with money inside on Chinese New Year. Maybe you can break out a red envelope, start a new tradition, and get your relatives to contribute to the IVF fund! (Wish I’d thought of that one sooner…)
  1. Avoid Knives. Put away the knives…this is good advice for hormonal women anyway. Using knives and scissors at this time symbolizes the “cutting off” of the good luck and is an omen of bad luck in the year to come. Remember this one at mealtime and go for finger foods or use chopsticks.

Remember, you don’t have to be Chinese to embrace some of the Chinese culture and have some fun. Wear red. If you’re feeling adventurous, try making a batch of jiaozi from an internet recipe. Or do the wonton soup thing.  Try your hand at chopsticks. Surround yourself with the richness of red and gold. Sweep out that old bad luck and embrace the New Year that awaits.

Allow hope to take root.

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Do you celebrate Chinese New Year or follow any other cultural traditions with fertility-related traditions?

* http://bit.ly/1k7eRSq

Photo credit: Feelart http://www.freedigitalphotos.net/images/agree-terms.php?id=100140204

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The Dilemma of Excess Embryos

By Tracey Minella

January 25th, 2014 at 9:32 am

credit: wiki commons public domain

 

There is so much to focus on when beginning IVF. Insurance and financing issues. Learning about all the medications, as well as how to inject many of them. Understanding the processes of daily monitoring and blood work, of retrievals and transfers. Deciding how many embryos to transfer back and whether to cryopreserve the others.

Most people do cryopreserve the embryos which are not transferred back on a fresh IVF cycle. These frozen embryos are often thawed and used in a later cycle, either years later after a successful fresh cycle or sooner if the fresh cycle was unsuccessful.

Sometimes, especially in cases where patients only transfer back one embryo, like patients in Long Island IVF’s Single Embryo Transfer Program http://bit.ly/1jjvr3y patients may obtain enough embryos from their first fresh IVF cycle to satisfy all of their family-building needs through subsequent frozen embryo transfers. They may have one baby, then another a few years later, and then yet another…all from one retrieval. Yes, they are the lucky ones.

I remember… almost casually… signing off on the cryo consent, my primary focus being on all the matters that had an immediate effect on my first fresh cycle. I wanted to be pregnant now. I’d worry about what to do with any leftover frozen embryos… after I had all the children I wanted … later. It took a few cycles before I finally had any embryos left over to freeze, but the moment I did, I set in motion a decision more complicated and emotional than I initially imagined.

What to do with excess embryos is about as personal a decision as there is. If you don’t have too many, do you keep transferring them until they are gone? Do you donate them…full genetic siblings to your other children…to another couple? Do you donate them to research if your state allows? Do you just keep them in storage and pay the fees? Do you discard them?

I was reminded of the difficulty of this decision when I read about New Zealand’s law limiting the amount of time that embryos can remain in storage to ten years. http://bit.ly/1f7uypm . Fortunately, there is no such law in New York. It is stressful enough for patients to decide what to do with excess embryos without the government imposing an arbitrary time limit on them.

There is no single right answer. Just a right answer for you.

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If you cryopreserved embryos, are you comfortable with your initial decision on how they should be handled? Or are you undecided?

 

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Infertility and the Snow Day

By Tracey Minella

January 22nd, 2014 at 7:48 am

 

image courtesy of adamr/freedigital photos.com


The sting of a snowball to the face is nothing compared to the pain infertile couples feel over snow days.

While many realize that child-focused holidays like Halloween or Christmas can stress out infertiles, few folks think twice about how painful a simple snow day can be. On many levels actually.

First, snow days effectively shine a spotlight on the childless at work. As the news announces the never-ending list of school closings, the workers with children start calling in sick or personal days to be home with them. Infertiles are often left manning half empty offices as the stark reality and unfair expectation looms “You have no children, so you have no excuse. They are mothers.”

Second, snow days leave infertiles empty on the home front as well. Facebook posts are killers on snow days. You have the complainers who moan about the inconvenience of staying home with their children. Or you have the moms-of-the-year who boast of sledding, cookies, and hot cocoa play dates with their kids. All of it hurts.

What we wouldn’t give to be making cookies and cocoa for our kids. What our partners wouldn’t give to be building snowmen or to have a helper to shovel the driveway.

And to add insult to injury, the blizzard-like conditions just add more stress to the morning routine of those currently in a treatment cycle. More stress on the way to morning monitoring and lab work. Getting in to work even later (and on a day when there’s likely fewer people to cover for you.)

Here’s hoping that those of you who want to… and can do so… get to stay home and pamper yourself with a well-deserved mental health day. And for those who must go out, may you find a path that is not only clear of snow, but also of sleigh-riding, cocoa-toting, cookie monsters.

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What is the worst part of snow days?

Photo credit: adamr / http://www.freedigitalphotos.net/images/agree-terms.php

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Infertiles Have a Dream, Too

By Tracey Minella

January 20th, 2014 at 6:40 pm

 

As Americans celebrate the late, great Dr. Martin Luther King, Jr., we usually remember his most famous quotation from his 1963 speech for racial equality.

“I Have a Dream…”

Those trying to conceive a baby live by these same words. They are the mantra of the suffering, infertile woman.

To be clear, infertility is not on the same “life-and-death” level as the civil rights movement.  Yet there is no mistaking the parallels that do exist between the passion MLK felt for his cause and the passion infertile women feel for their quest for motherhood.

When you are infertile, you are ever-aware of a different unfairness and inequality in the world. How fertile couples take their fertility for granted. How others have what you’ve been denied. You suffer unimaginable pain and despair at what is effectively a denial of your right to the pursuit of happiness. And you passionately dream your dream…of a day when you will hold a baby in your arms.

MLK’s peaceful protesting of the injustices of segregation and racial inequality ultimately changed a nation. But for the infertile woman, there is no protest that can make that dream of motherhood come true. Sure, we can and must demand the government do more to help infertile women… such as re-grouping and continually advocating for legislation like the Family Act tax credit, or mandating more comprehensive medical insurance for infertility treatment. But ultimately, your plight is based on individual circumstance, not oppression by others. New legislation may help financially, but it alone won’t guarantee you get pregnant. So how do you deal with the frustration over the situation? How do you keep your dream alive?

Dr. King…a spiritual man and motivational speaker…gave us more than that one famous quote.  Here’s another one, which speaks to the heart of the infertile woman:

“Faith is taking the first step, even when you don’t see the whole staircase.”

So when you remember the courage of this great man, think about becoming an advocate for political change that will advance the cause for infertile women. Keep the faith.

And never give up on your dream.

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How do you keep your dream alive? What’s the biggest obstacle?

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Is Clomid for You?

By David Kreiner MD

January 16th, 2014 at 6:51 pm

 

 

It has become commonplace for women who have been frustrated with repeated unsuccessful attempts to conceive naturally on their own to see their gynecologist who often times will try clomid therapy on them.

Clomid, the traditional brand name for clomiphene citrate, is a competitive inhibitor of estrogen. It stimulates the pituitary gland to produce follicle stimulating hormone (FSH) which in turn will stimulate the ovaries to mature follicle(s) containing eggs. Estrogen normally has a negative effect on the pituitary: Clomid blocks estrogen and leads to pituitary FSH production and ovarian stimulation.

Infertility patients — those under 35 having one year of unprotected intercourse without a resulting pregnancy and those over 35 having six months without pregnancy — have a two to five percent pregnancy rate each month trying on their own without treatment.

Clomid therapy increases a couple’s fertility by increasing the number of eggs matured in a cycle and by producing a healthier egg and follicle. The pregnancy rate with clomid therapy alone is approximately ten percent per cycle and 12 -15 percent when combined with intrauterine insemination (IUI). Women who are unable to ovulate on their own experience a 20 percent pregnancy rate per cycle with clomid, the equivalent to that of a fertile couple trying on their own.

Clomid and Your Cervical Mucus

Women who are likely to conceive with clomid usually do so in the first three months of therapy, with very few conceiving after six months. As clomid has an anti-estrogen effect, the cervical mucus and endometrial lining may be adversely affected.

Cervical mucus is normally produced just prior to ovulation and may be noticed as a stringy egg white-like discharge unique to the middle of a woman’s cycle just prior to and during ovulation. It provides the perfect environment for the sperm to swim through to gain access to a woman’s reproductive tract and find her egg. Unfortunately, clomid may thin out her cervical mucus, preventing the sperm’s entrance into her womb. IUI overcomes this issue through bypassing the cervical barrier and depositing the sperm directly into the uterus.

However, when the uterine lining or endometrium is affected by the anti-estrogenic properties of clomid, an egg may be fertilized but implantation is unsuccessful due to the lack of secretory gland development in the uterus. The lining does not thicken as it normally would during the cycle. Attempts to overcome this problem with estrogen therapy are rarely successful.

Side Effects

Many women who take clomid experience no side effects. Others have complained of headache, mood changes, spots in front of their eyes, blurry vision, hot flashes and occasional cyst development (which normally resolves on its own). Most of these effects last no longer than the five or seven days that you take the clomid and have no permanent side effect. The incidence of twins is eight to ten percent with a one percent risk of triplet development.

Limit Your Clomid Cycles

Yet another deterrent to clomid use was a study performed years ago that suggested that women who used clomid for more than twelve cycles developed an increased incidence of ovarian tumors. It is therefore recommended by the American Society of Reproductive Medicine as well as the manufacturer of clomiphene that clomid be used for no more than six months after which it is recommended by both groups that patients proceed with treatment including gonadotropins (injectable hormones containing FSH and LH) to stimulate the ovaries in combination with intrauterine insemination or in vitro fertilization.

Success rates

For patients who fail to ovulate, clomid is successful in achieving a pregnancy in nearly 70 percent of cases. All other patients average close to a 50 percent pregnancy rate if they attempt six cycles with clomid, especially when they combine it with IUI. After six months, the success is less than five percent per month.

In vitro fertilization (IVF) is a successful alternative therapy when other pelvic factors such as tubal disease, tubal ligation, adhesions or scar tissue and endometriosis exist or there is a deficient number, volume or motility of sperm. Success rates with IVF are age, exam and history dependent. The average pregnancy rate with a single fresh IVF cycle is greater than 50 percent. For women under 35, the pregnancy rate for women after a single stimulation and retrieval is greater than 70 percent with a greater than 60 percent live birth rate at Long Island IVF.

Young patients sometimes choose a minimal stimulation IVF or MicroIVF as an alternative to clomid/IUI cycles as a more successful and cost effective option as many of these patients experience a 40 percent pregnancy rate per retrieval at a cost today of about $3,900.

Today, with all these options available to patients, a woman desiring to build her family will usually succeed in becoming a mom.

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Did you start out with Clomid? Did you have success with it or did you move on to IVF?

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Is “Paper Gown Subway Ride Sunday” Next?

By Tracey Minella

January 13th, 2014 at 9:33 am

credit: feelart/freedigitalphotos.net

Yesterday, straphangers all over the world celebrated the 13th annual No Pants Subway Ride Sunday. That’s right. Thousands of people rode the subways…all over the world…in their underpants. Social media is flooded with the images this morning.

Seven guys in New York City, with no apparent agenda, unintentionally started a worldwide phenomenon about a dozen years ago. Laughs aside, what a wasted opportunity to raise awareness for some worthy cause.

Like infertility.

It makes you wonder what the infertility community can do that would increase awareness… or better yet, raise money… for our cause. Something big and bold. Something viral that easily crosses the globe and spreads through social media. Something inexpensive so financially-strapped infertile folks can actually participate.

Do we need a Paper Gown Subway Ride Sunday?

Or maybe we could have Empty Stroller Sunday, where thousands of infertile folks (and their supporters) push around empty strollers to raise infertility awareness? Add sponsorships to such an event and raise some funds.

We could incorporate these ideas into National Infertility Awareness Month in April or Advocacy Day in May. Or we could spread awareness in autumn and make our mark near back-to-school time.

Look what seven guys started just by dropping their pants. (And we are already experts at that!) I can only imagine what impact thousands of infertile women… united …could do if we got creative.

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What do you think? Would you participate in a national or international awareness movement? Do you have an idea for an infertility awareness event?

 

Photo credit: Feelart  http://www.freedigitalphotos.net/images/agree-terms.php?id=100218870

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Is “Paper Gown Subway Ride Sunday” Next?

By Tracey Minella

January 13th, 2014 at 9:25 am

photo: Feelart/freedigitalphotos.net

Yesterday, straphangers all over the world celebrated the 13th annual No Pants Subway Ride Sunday. That’s right. Thousands of people rode the subways…all over the world…in their underpants. Social media is flooded with the images this morning.

Seven guys in New York City, with no apparent agenda, unintentionally started a worldwide phenomenon about a dozen years ago. Laughs aside, what a wasted opportunity to raise awareness for some worthy cause.

Like infertility.

It makes you wonder what the infertility community can do that would increase awareness… or better yet, raise money… for our cause. Something big and bold. Something viral that easily crosses the globe and spreads through social media. Something inexpensive so financially-strapped infertile folks can actually participate.

Do we need a Paper Gown Subway Ride Sunday?

Or maybe we could have Empty Stroller Sunday, where thousands of infertile folks (and their supporters) push around empty strollers to raise infertility awareness? Add sponsorships to such an event and raise some funds.

We could incorporate these ideas into National Infertility Awareness Month in April or Advocacy Day in May. Or we could spread awareness in autumn and make our mark near back-to-school time.

Look what seven guys started just by dropping their pants. (And we are already experts at that!) I can only imagine what impact thousands of infertile women… united …could do if we got creative.

* * ** * ****** * * * * * * **

What do you think? Would you participate in a national or international awareness movement? Do you have an idea for an infertility awareness event?

 

Photo credit: Feelart http://www.freedigitalphotos.net/images/agree-terms.php?id=100218870

 

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Is Your Biological Clock Running Out?

By David Kreiner, MD

January 10th, 2014 at 10:35 pm

 

image courtesy of photo stock/freedigital photos.net

Tears start to course down the cheeks of my patient, her immediate response to the message I just conveyed to her. Minutes before, with great angst anticipating the depressing effect my words will have on her, I proceeded to explain how her FSH was slightly elevated and her antral follicle count was a disappointing 3-6 follicles. I was careful to say that though this is a screen that correlates with a woman’s fertility, sometimes a woman may be more fertile than suspected based on the hormone tests and ovarian ultrasound. I also said that even when the tests accurately show diminishing ovarian reserve (follicle number), we are often successful in achieving a pregnancy and obtaining a baby through in vitro fertilization especially when age is not a significant factor.

These encounters I have with patients are more frequent than they should be. Unfortunately, many women delay seeking help in their efforts to conceive until their age has become significant both because they have fewer healthy genetically normal eggs and because their ability to respond to fertility drugs with numerous mature eggs is depressed. Women often do not realize that fertility drops as they age starting in their 20s but at an increasing rate in their 30s and to a point that may often be barely treatable in their 40s.

A common reason women delay seeking help is the trend in society to have children at an older age. In the 1960’s it was much less common that women would go to college and seek a career as is typical of women today. The delayed childbearing increases the exposure of women to more sexual partners and a consequent increased risk of developing pelvic inflammatory disease with resulting fallopian tube adhesions.

When patients have endometriosis, delaying pregnancy allows the endometriosis to develop further and cause damage to a woman’s ovaries and fallopian tubes. They are more likely to develop diminished ovarian reserve at a younger age due to the destruction of normal ovarian tissue by the endometriosis.

Even more important is that aging results in natural depletion of the number of follicles and eggs with an increase in the percentage of these residual eggs that are unhealthy and/or genetically abnormal.

Diminished ovarian reserve is associated with decreased inhibin levels which decreases the negative feedback on the pituitary gland. FSH produced by the pituitary is elevated in response to the diminished ovarian reserve and inhibin levels unless a woman has a cyst producing high estradiol levels which also lowers FSH. This is why we assess estradiol levels at the same time as FSH. Anti-Mullerian Hormone (AMH) can be tested throughout a woman’s menstrual cycle and levels correlate with ovarian reserve. Early follicular ultrasound can be performed to evaluate a woman’s antral follicle count. The antral follicle count also correlates with ovarian reserve.

By screening women annually with hormone tests and ultrasounds a physician may assess whether a woman is at high risk of developing diminished ovarian reserve in the subsequent year. Alerting a woman to her individual fertility status would allow women to adjust their family planning to fit their individual needs.

Aggressive fertility therapy may be the best option when it appears that one is running out of time. Ovulation induction with intrauterine insemination, MicroIVF and IVF are all considerations that speed up the process and allow a patient to take advantage of her residual fertility.

With fertility screening of day 3 estradiol and FSH, AMH and early follicular ultrasound antral follicle counts, the biological clock may still be ticking but at least one may keep an eye on it and know what time it is and act accordingly.

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Did you realize that aging is not the only factor in the biological clock race? Did you know that certain conditions, like endometriosis, can play a part, too?

 

Photo credit: http://www.freedigitalphotos.net/images/agree-terms.php?id=10049499

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Grieving Lost Embryo Siblings

By Tracey Minella

January 7th, 2014 at 9:51 am

 

image: anankkml/freedigitalphotos.net

 

Is it common for those born through IVF to grow up to grieve their “sibling embryos” that were not born…either because they were never transferred or because they failed to survive the transfer or at some point thereafter?

As an IVF mom, I was intrigued by an article I read this week in LifeNews.com* about a woman who grieves her lost embryo siblings. The woman complained that no one understands her overwhelming grief… including her own parents… and that there are no appropriate support groups for IVF children who feel like she does. Will my IVF children feel this way someday? Is there anything I can do to prevent that from happening?

I wonder how many IVF children suffer from this grief and guilt. If given a name, would we call it “Survivor Embryo Syndrome”? Does it occur more often in only children born through IVF…children who may be longing for a sibling? Or is it extremely rare and that’s why support groups don’t seem to exist?

There are countless grown women and men who were conceived long ago through this miracle technology and could possibly be struggling with such feelings.

These adults were conceived before today’s recommended single or double embryo transfers…probably back when four embryo transfers were the norm. Imagine being the only one out of four embryos that survived?  Wouldn’t it seem natural to often wonder “Why only me?”

Then again, sometimes all four embryos survived. In past decades, selective embryo reduction was often used in high order multiple pregnancies. A difficult and personal decision (and a controversial topic not without its own risks) selective reduction may be used to reduce the number of a high order multiple pregnancy, from quadruplets to twins or from triplets to a singleton, for example. It’s hard to imagine the conflicted feelings some of the surviving children of such cases might experience.

Why am I here and they are not?

Hopefully, IVF parents who may understandably be blinded to the plight of their lost embryos by their extreme thankfulness for the one that did survive will be mindful that their miracle may grow up with some survivor guilt issues.

If my own IVF daughter shares these feelings with me someday, I will certainly acknowledge them and help her process them in the same way we’ve always discussed how she came into this world. Age-appropriate information shared in many open discussions that always focus on our determination to have a baby and how very much we loved her even before she was born. I tell her that it was fate that she was the one we were meant to have at that given time, even if it’s sad that so many other embryos with the potential for life did not come to be. I tell her there is a reason she is here and to live her life to the fullest, use her talents, be happy, be charitable, and do good things. And if she still needed more help than I could give her, I’d encourage her to talk with a professional counselor with experience in infertility-related issues, such as Long Island IVF’s Bina Benisch, MS, RN. http://www.longislandivf.com/mind_body.cfm

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What do you think about this survivor guilt issue? How would you comfort your IVF child or what would you do to prevent them from feeling any guilt over being survivors?

 

* http://bit.ly/1dLdiHM

photo credit: anankkml/ http://www.freedigitalphotos.net/images/agree-terms.php?id=100140080

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Overweight and Infertile

By Dr. David Kreiner and Tracey Minella

January 3rd, 2014 at 1:41 pm

 

image courtesy of OhMega 1982/free digital photos.net

Raise your hand if you made a resolution to lose weight this year…again. C’mon, get that hand up, sister.

To a woman TTC, nothing is worse than being told you can’t have a baby without medical intervention…unless you’re then told you’re too overweight to have the treatments.

Fortunately, there are compassionate RE’s out there who are willing to give overweight patients the respect and the treatment they deserve.

Dr. Kreiner brings this prejudice and injustice to the forefront in his thoughtful, compassionate post:

The most shocking thing I’ve experienced in my 30+ year career in Reproductive Endocrinology has been the consistent “resistance” among specialists to treat women with obesity. This “resistance” has felt at times to both me and many patients to be more like a prejudice. I have heard other REI specialists say that it is harder for women to conceive until they shed their excess weight. “Come back to my office when you have lost 20, 30 or more pounds,” is a typical remark heard by many at their REI’s office. “It’s not healthy to be pregnant at your weight and you risk your health and the health of the baby.” Closing the door to fertility treatment is what most women in this condition experience.

An article in Medical News Today, “Obese Women Undergoing Infertility Treatment Advised Not To Attempt Rapid Weight Loss”, suggested that weight loss just prior to conception may have adverse effects on the pregnancy, either by disrupting normal physiology or by releasing environmental pollutants stored in the fat. The article points out what is obvious to many who share the lifelong struggle to maintain a reasonable Body Mass Index (BMI): Weight loss is difficult to achieve. Few people adhere to lifestyle intervention and diets which may have no benefit in improving pregnancy in subfertile obese women.

The bias in the field is so strong that when I submitted a research paper demonstrating equivalent IVF pregnancy rates for women with excessive BMIs greater than 35 to the ASRM for presentation, it was rejected based on the notion that there was clear evidence to the contrary. Here’s the point I was trying to prove: IVF care must be customized to optimize the potential for this group.

Women with high BMI need a higher dose of medication. Those with PCOS benefit from treatment with Metformin. Their ultrasounds and retrievals need to be performed by the most experienced personnel. Often their follicles will be larger than in women of lower weight. Strategies to retrieve follicles in high BMI women include using a suture in the cervix to manipulate the uterus and an abdominal hand to push the ovaries into view.

Most importantly, a two-stage embryo transfer with the cervical suture can insure in utero placement of the transfer catheter and embryos without contamination caused by inadvertent touching of the catheter to the vaginal wall before insertion through the cervical canal. Visualization of the cervix is facilitated by pulling on the cervical suture, straightening the canal and allowing for easier passage of the catheter. The technique calls for placement of one catheter into the cervix through which a separate catheter, loaded with the patient’s embryo, is inserted.

Using this strategy, IVF with high BMI patients is extremely successful. With regard to the health of the high BMI woman and her fetus, it’s critical to counsel patients just as it is when dealing with women who live with diabetes or any other chronic situation that adds risk.

We refuse to share in the prejudice that is nearly universal in this field. It’s horrible and hypocritical to refuse these patients treatment. Clearly, with close attention to the needs of this population, their success is like any others.

Women who have time and motivation to lose significant weight prior to fertility therapy are encouraged to do so and I try to support their efforts. Unfortunately, many have tried and are unable to significantly reduce prior to conception.

What right do we have to deny these women the right to build their families?

It can be hard to deal with obesity and even more so when combined with infertility. If you are feeling sad or depressed, it may help to talk to a counselor or to others who have the condition. I advise you to ask your doctor about support groups and for treatment that can help you including fertility treatment.

Remember, though this condition can be annoying, aggravating and even depressing, seek an REI who is interested in supporting you and helping you build your family and reject those who simply tell you to return after you have lost sufficient weight.

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Have you been turned away from an RE because you’re overweight or obese? Do you think that’s fair?

 

Photo credit: Ohmega 1982 http://www.freedigitalphotos.net/images/agree-terms.php?id=10073481

 

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