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Archive for the ‘octomom’ tag

Infertility Podcast Series: Journey to the Crib: Chapter 32: Octomom

By David Kreiner MD

December 1st, 2013 at 8:26 am

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Thirty-Two: Octomom. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=146


A year ago, the Medical Board of California revoked the license of Dr. Michael Kamrava, finding he “did not exercise sound judgment” in transferring 12 embryos to Nadya Suleman, who already had six children at home. The ruling, while not surprising, was illuminating, and it’s worth reflecting on the five things we learned from Octomom:

 

1.      Know How to Say “No”: There is a point where physicians have to make a judgment call. Pregnancies with triplets – let alone eight infants – put the mother at high risk of serious medical complications and put unborn children at risk for developmental disabilities. Physicians need to rely on their professional expertise and experience to know when to turn down a patient request no matter how vehemently it is made.

 

2.      Beware the Patient with Tunnel Vision: Often when a patient comes to a fertility doctor, unsuccessful pregnancy attempts have made her anxious and determined. She might want to get pregnant regardless of the risks that pregnancy may present.

3.      Less is More: In 1999, 35 percent of all transfers involved four or more embryos. In 2009, only 10 percent had four or more. And those high-number transfers are generally reserved for patients with significant fertility challenges. In contrast, Octomom already underwent multiple successful IVF (in vitro fertilization) procedures and had given birth to six children when she had her 12-embryo transfer.

 

4.      Know When to Deviate: While Dr. Kamrava’s deviation from guidelines was an extreme departure, deviations do occur for specific reasons, such as repeated IVF failure, age-related infertility and poor egg quality. It is important to know when implanting several embryos is appropriate.

5.      “Reduce” Risk: Dr. Kamrava complained that Octomom refused to undergo “selective reduction,” which would have reduced the number of embryos she carried to term. Here, again, is an argument for fewer transfers. Had he transferred fewer embryos, Octomom would not have had to face such a difficult decision.

 

* * * * * * **  * * * *

Was this helpful in answering your questions about what could have been done differently to prevent the Octomom case? How much weight do you give your doctor’s recommendation on the number of embryos to transfer?

Please share your thoughts about this podcast here. And ask any questions and Dr. Kreiner will answer them.

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Infertility Podcast Series: Journey to the Crib: Chapter 32: Octomom

By David Kreiner, MD

October 3rd, 2013 at 6:57 pm

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Thirty-Two: Octomom. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=146

Octomom

 

A year ago, the Medical Board of California revoked the license of Dr. Michael Kamrava, finding he “did not exercise sound judgment” in transferring 12 embryos to Nadya Suleman, who already had six children at home. The ruling, while not surprising, was illuminating, and it’s worth reflecting on the five things we learned from Octomom:

 

1.      Know How to Say “No”: There is a point where physicians have to make a judgment call. Pregnancies with triplets – let alone eight infants – put the mother at high risk of serious medical complications and put unborn children at risk for developmental disabilities. Physicians need to rely on their professional expertise and experience to know when to turn down a patient request no matter how vehemently it is made.

 

2.      Beware the Patient with Tunnel Vision: Often when a patient comes to a fertility doctor, unsuccessful pregnancy attempts have made her anxious and determined. She might want to get pregnant regardless of the risks that pregnancy may present.

3.      Less is More: In 1999, 35 percent of all transfers involved four or more embryos. In 2009, only 10 percent had four or more. And those high-number transfers are generally reserved for patients with significant fertility challenges. In contrast, Octomom already underwent multiple successful IVF (in vitro fertilization) procedures and had given birth to six children when she had her 12-embryo transfer.

 

4.      Know When to Deviate: While Dr. Kamrava’s deviation from guidelines was an extreme departure, deviations do occur for specific reasons, such as repeated IVF failure, age-related infertility and poor egg quality. It is important to know when implanting several embryos is appropriate.

5.      “Reduce” Risk: Dr. Kamrava complained that Octomom refused to undergo “selective reduction,” which would have reduced the number of embryos she carried to term. Here, again, is an argument for fewer transfers. Had he transferred fewer embryos, Octomom would not have had to face such a difficult decision.

 

* * * * * * **  * * * *

Was this helpful in answering your questions about what could have been done differently to prevent the Octomom case? How much weight do you give your doctor’s recommendation on the number of embryos to transfer?

Please share your thoughts about this podcast here. And ask any questions and Dr. Kreiner will answer them.

no comments

Infertility Podcast Series: Journey to the Crib: Chapter 27: A Dozen Embryos, Who Will Stop This Madness?

By David Kreiner MD

August 12th, 2013 at 9:44 pm

 

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Twenty-Seven: A Dozen Embryos, Who Will Stop This Madness? You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=133

A Dozen Embryos, Who Will Stop This Madness?

When I wrote this chapter, the news of the day was that an IVF clinic had transferred 12 embryos.  In fact, it was learned weeks later that this was a hoax.  However, in the wake of Octomom, where 8 embryos were transferred, I felt there was still an important lesson to be learned especially since insurance companies often insist that a patient try multiple cycles of intrauterine insemination (IUI) before covering IVF… if they cover it at all. 

 

In fact, gonadotropin hormones in conjunction with IUI offers a 35% risk of multiple pregnancy including a 5% risk of triplets or more.  After obtaining six fetuses after one such cycle, I became very wary of offering gonadotropin IUI cycles to my patients.

 

Yet, this is what our insurance companies are covering rather than the safer IVF where only 1 or 2 embryos can be transferred at a time.

 

When we do an IUI, as many eggs that ovulate can implant resulting in a high risk multiple pregnancy.  I believe that it is not until we discourage the use of gonadotropins without IVF by offering a regulated covered alternative will we eliminate these risky multiples.

 

Until then, all of us including society, the government, insurance companies and employers are to blame for letting these dangerous multiple pregnancies occur.

 

* * * * * * **  * * * *

Was this helpful in answering your questions about multiple pregnancy risks in IUIs and IVF?

Please share your thoughts about this podcast here. And ask any questions and Dr. Kreiner will answer them.

no comments

Cloning and IVF

By David Kreiner MD

January 28th, 2013 at 11:57 pm

image courtesy of Victor Habbick/freedigital photos.net

First Octomom. Then a fertility doctor is denounced for claims of human cloning*. I get the impression there are fertility specialists out to ruin the reputation of IVF for the rest of us.

In the case of Octomom, there is some question as to how the patient was counseled. We focus on high success with least risk as possible. It is unfortunate that a few others aspire to something other than their patient’s best interests. It is very difficulty for a fertility specialist to deal with patients who insist on using up all their embryos in one attempt. We share with the patient a desire not to discard embryos but retain responsibility for not allowing for potentially dangerous outcomes.

Cloning is an ethical dilemma yet to be solved by society. Until then we do not participate in cloning since we are unsure whether to do so is ethically sound. Benefits of modified forms of cloning have been proposed. Multiplying high quality embryos in patients would theoretically increase their success rates. Women who had poor quality eggs (cytoplasm) could have their nuclei transplanted into the egg of a healthy young woman. Again, theoretically, this can improve success rates. Another proposed clinical use is to produce tissue for transplantation say in a child with cancer who requires chemotherapy.

The form of cloning that usually comes to mind however, is the creation of an identical being whether it be to replace a loved lost child or in our common vernacular a “mini-me”. It is this possible use of the technology that causes almost universal disdain in our society. We have yet to figure out whether there is a place for any of the aforementioned forms of cloning that is potentially more palatable.

IVF is a clinically useful form of technology that is allowing for greater than 40,000 more babies to be born each year who may otherwise never have been given life. But, as with all technology there are risks and potential downsides that need to be considered. Today, cloning as well as high ordered multiple embryo transfers moves the IVF technology beyond our comfort zone with our assessment of the potential risks and downsides. Let us not distort the relative benefit vs. risk of IVF technology by wrongfully applying it to cloning or high order multiple embryo transfer.

Source: www.ivf.net

* * * * * * * *  * * * * * * *

Do you think cloning should be available, and if so, in what circumstances?

 

Photo credit: http://www.freedigitalphotos.net/images/search.php?search=cloning&cat=

 

1 comment

Infertility Podcast Series: Journey to the Crib: Chapter 32: Octomom

By David Kreiner, MD

October 18th, 2012 at 6:47 pm

Welcome to the Journey to the Crib Podcast.  We will have a blog discussion each week with each chapter.  This podcast covers Chapter Thirty-Two: Octomom. You, the listener, are invited to ask questions and make comments.  You can access the podcast here: http://podcast.longislandivf.com/?p=146

Octomom 

A year ago, the Medical Board of California revoked the license of Dr. Michael Kamrava, finding he “did not exercise sound judgment” in transferring 12 embryos to Nadya Suleman, who already had six children at home. The ruling, while not surprising, was illuminating, and it’s worth reflecting on the five things we learned from Octomom: 

 

  • Know How to Say “No”: There is a point where physicians have to make a judgment call. Pregnancies with triplets – let alone eight infants – put the mother at high risk of serious medical complications and put unborn children at risk for developmental disabilities. Physicians need to rely on their professional expertise and experience to know when to turn down a patient request no matter how vehemently it is made.

 

  • Beware the Patient with Tunnel Vision: Often when a patient comes to a fertility doctor, unsuccessful pregnancy attempts have made her anxious and determined. She might want to get pregnant regardless of the risks that pregnancy may present.

 

  • Less is More: In 1999, 35 percent of all transfers involved four or more embryos. In 2009, only 10 percent had four or more. And those high-number transfers are generally reserved for patients with significant fertility challenges. In contrast, Octomom already underwent multiple successful IVF (in vitro fertilization) procedures and had given birth to six children when she had her 12-embryo transfer.

 

  • Know When to Deviate: While Dr. Kamrava’s deviation from guidelines was an extreme departure, deviations do occur for specific reasons, such as repeated IVF failure, age-related infertility and poor egg quality. It is important to know when implanting several embryos is appropriate.

 

  • “Reduce” Risk: Dr. Kamrava complained that Octomom refused to undergo “selective reduction,” which would have reduced the number of embryos she carried to term. Here, again, is an argument for fewer transfers. Had he transferred fewer embryos, Octomom would not have had to face such a difficult decision.

 * * * * * * **  * * * *

Was this helpful in answering your questions about what could have been done differently to prevent the Octomom case? How much weight do you give your doctor’s recommendation on the number of embryos to transfer?

Please share your thoughts about this podcast here. And ask any questions and Dr. Kreiner will answer them.

 

no comments

Can Twins Be Born Years Apart?

By Tracey Minella

January 19th, 2012 at 2:14 pm


Unless you’re the Octomom, chances are that if you’ve done IVF, you may have frozen…or cryopreserved… a number of embryos above and beyond the number you elected to transfer back on your fresh IVF cycle. If you were lucky enough to have an excess, that is. (Alas, my first few IVFs back in the dark ages, never produced enough for cryo. But later cycles did.)

So, let’s assume you had a baby from that fresh cycle. You breathe a sigh of relief at your motherhood dream coming true and proceed to enjoy a few years of normalcy with your little miracle. So you’re out there doing the play date thing, having great birthday parties, doing Disney. Not to mention suffering–happily–  through Yo Gabba Gabba  as you catch yourself singing things like “Don’t bite your friends”…

All the while in the back of your brain there’s some security  knowing you’ve got “potential” children…literally frozen in time from when your eggs were younger than they are today. No guarantee, but some level of security nonetheless. They do cross your mind at times.

So the time comes to revisit the clinic with the hope of a successful cryo transfer. Imagine it works again.

The question: Are your two children “twins”?

Well, they were conceived at the same time, as fraternal twins would be. But one has been out living its life for a few years. A big head start. The other was tossed in the freezer. (Oh, I’m just kidding…) But the reality is that one… merely through the judgment call of an embryologist … was ever so carefully placed in a frozen state of existence. It’s potential for life on hold. For years.

So are they “twins”?

Is it defined at conception? Is it occupying the same uterus at the same time?

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

What do you think?

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IVF and Cloning

By David Kreiner MD, and Tracey Minella

January 10th, 2012 at 12:45 pm


We’ve all jokingly commented at one time or other how we’d love to clone ourselves, so we could accomplish more things in less time. But as progress in technology continues to advance, we find ourselves on the brink of a potentially dark place. Cloning technology is no longer science fiction. It is here. It is controversial. Now what?

Dr. Kreiner takes a look at the possible implications of cloning to the field of ART:

First Octomom. Then a fertility doctor is denounced for claims of human cloning*. I get the impression there are fertility specialists out to ruin the reputation of IVF for the rest of us.

In the case of Octomom, there is some question as to how the patient was counseled. We focus on high success with least risk as possible. It is unfortunate that a few others aspire to something other than their patient’s best interests. It is very difficulty for a fertility specialist to deal with patients who insist on using up all their embryos in one attempt. We share with the patient a desire not to discard embryos but retain responsibility for not allowing for potentially dangerous outcomes.

Cloning is an ethical dilemma yet to be solved by society. Until then we do not participate in cloning since we are unsure whether to do so is ethically sound. Benefits of modified forms of cloning have been proposed. Multiplying high quality embryos in patients would theoretically increase their success rates. Women who had poor quality eggs (cytoplasm) could have their nuclei transplanted into the egg of a healthy young woman. Again, theoretically, this can improve success rates. Another proposed clinical use is to produce tissue for transplantation say in a child with cancer who requires chemotherapy.

The form of cloning that usually comes to mind however, is the creation of an identical being whether it be to replace a loved lost child or in our common vernacular a “mini-me”. It is this possible use of the technology that causes almost universal disdain in our society. We have yet to figure out whether there is a place for any of the aforementioned forms of cloning that is potentially more palatable.

IVF is a clinically useful form of technology that is allowing for greater than 40,000 more babies to be born each year who may otherwise never have been given life. But, as with all technology there are risks and potential downsides that need to be considered. Today, cloning as well as high ordered multiple embryo transfers moves the IVF technology beyond our comfort zone with our assessment of the potential risks and downsides. Let us not distort the relative benefit vs. risk of IVF technology by wrongfully applying it to cloning or high order multiple embryo transfer.

*Source: www.ivf.net

* * * * * * * *  * * * * * * * 

Do you think cloning should be available, and if so, in what circumstances?

no comments

Donor Eggs or Their Own: Are Older Celebrities Lying?

By David Kreiner, MD

September 22nd, 2011 at 3:25 pm

The Fertility news is constantly highlighted in sensational headlines, such as “49 year old woman conceives with own egg through IVF”. In the past, readers have been entertained with “Octomom”, “a woman pregnant with a supposed dozen”, “Jon and Kate plus eight” and “a 62 year old mother through IVF” not to mention the numerous over 45 and sometimes over 50 year old celebrities having babies supposedly with their own eggs.

Reading these “news” stories one may get the impression that Fertility is a thriving business bearing little resemblance to the medical specialty of reproductive endocrinology requiring seven years of post medical school training.

The medical pioneers Drs. Steptoe and Edwards in the UK and Drs. Howard and Georgeanna Jones Jr. in the US envisioned a world in which couples inflicted with the curse of an inability to procreate, would, with the benefit of this technology that they developed, give these couples the ability to build their own families.

They were excited that as the technology improved and became more efficient and the cryopreservation of embryos became routinely available that risky multiple pregnancies could be eliminated. They believed that insurance companies would pay for an IVF benefit that had a high success rate and could deliver healthy singleton pregnancies with far greater confidence than any alternative treatment especially intrauterine inseminations (IUI).

They were unhappy that in the early years when IVF was inefficient, many embryos needed to be transferred in order to give a patient a reasonable chance for success. This resulted in multiple pregnancies, many of which delivered prematurely requiring expensive neonatal intensive care and unfortunately many did not end well. Today, we have control over this with IVF by transferring one embryo at a time but not with IUI.

They also did not believe that women should be subjected to the medications, blood work and retrieval process without a fair chance for a successful outcome.

The idea of subjecting a 49 year old woman to IVF for what may be a 1% chance of conception with a greater than 50% chance of miscarriage is not medically reasonable. Women of this age have a 70 to 80% chance for conception through egg donation.

This is how the 50 something celebrities are getting pregnant.

They are not using their own eggs. Misleading the public with news stories that feature these older pregnant celebrities gives patients the misconception that they too can create their families at the same age using their own eggs.

We have recently performed IVF on two perimenopausal patients with FSH levels over 50 at age 45 after days of counseling regarding the extreme low odds of pregnancy and a live birth. In both cases, they felt they needed to give it one shot before moving on to egg donation.

They had one follicle each and both resulted in pregnancies with a gestational sac seen on ultrasound. One has since miscarried and will now move on to egg donation where her odds of having a live baby jump from less than 5% to 60% per attempt. The other remains pregnant and is miraculously the exception to the rule.

IVF is a medical procedure that is part of a proud tradition of reproductive endocrinology. It is a medical treatment that can cure one of the cruelest maladies known to man, the inability to have a child.

This problem is featured in the bible with several references including from the woman’s perspective with Hanna weeping for a baby of her own. The Old Testament proclaims the commandment to procreate. This is part of the human condition.

Does it not make sense then that insurance companies provide the financial coverage to allow IVF, a treatment that can be controlled by transferring one embryo at a time to result in a singleton pregnancy? Regulations to prevent costly dangerous multiple pregnancies and the performance of IVF in patients with unreasonably low odds of success need to be instituted.

Financial programs that make it no more expensive to patients to transfer one embryo at a time such as our Single Embryo Transfer program at East Coast Fertility need to be the news highlight of the day not the 49 year old who conceived on her sixth try.

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

Do YOU think any of the older celebrity moms… who claim or imply that their children are not conceived through donor egg programs… are being untruthful?

Do you think their right to privacy is more important than the disservice such lies do to the public’s misconception about how old women can be and still conceive with their own eggs?

2 comments

IVF, Media Prejudice and the Redneck Mentality

By Tracey Minella

July 7th, 2011 at 12:42 am

Ever notice how just about every time IVF is mentioned in the news, it’s done in a negative way?

I freakin hate that!

There seems to be some kind of built in prejudice against IVF by news reporting agencies. Why is that?

Are they still spooked by the idea of creating life in a petri dish? Even after so many decades?  Do they still think IVF is a cross between sci-fi and Frankenstein?

Are there still nay-sayers who keep jumping at any chance to say, “See, I told ya so, Ethel! That in-veeter-o fertilizer is plain evil! Thems freaks of nature! I knowed somethin’ was wrong with them babies! It ain’t natural!” (That was my redneck impression….not that there’s anything wrong with being a redneck!)

Why is it that any IVF headline is negative? Sometimes, writers go way out of their way to play up some minor point in the whole article or study, just so they can create a negative headline about IVF. It’s like they want to scare people away. It’s irresponsible. It’s freakin mean.

One of our readers, Samantha, was infuriated by a recent news headline that read: “Study Links IVF to Down’s Syndrome” http://news.yahoo.com/ivf-downs-syndrome-test-raises-questions-230427261.html. The focus of the study was essentially to retrieve and do genetic testing on polar body by-product cells of women’s eggs to determine whether the eggs were abnormal or not before fertilizing them. The purpose was to help older women determine their odds of achieving a chromosomally normal pregnancy with their own eggs, or if the percentage of abnormal eggs was high, perhaps consider donor eggs.

The first problem with the headline is that it makes people think they’re talking about IVF patients across the board. This would understandably frighten younger patients at first glance. In reality, buried in the body of the article, is that fact that the average age of the study participants was 40. So, maybe that meant women from 35-45. Of course, the cases of Down’s will be high in that population.

Further, instead of creating a headline which addresses the main point of the study, the chosen headline was sensational in nature. It seems meant to frighten. And it, irresponsibly in my opinion, says there is a link, when in the very body of the article it quotes the director of the study team as saying “But we have no direct evidence yet. And I don’t want to worry women.”

Then they go on to speculate on a  tangential theory that just emerged from this research, which has yet to be studied or tested, that some type of ovarian stimulation in some “older” women may sometimes have an effect of possibly “ungluing” DNA prematurely and may somehow be linked to chromosomal abnormalities such as Down’s. No explanation as to if or why only older women may “unglue”…or what even on constitutes “older”? Any idea what kind of stimulation meds we’re talking about? Of course not, this is just a preliminary theory…an unexpected off-shoot of the study at hand. How do you throw this unsubstantiated theory out there like that? Wouldn’t it be more responsible and prudent to commission another study directed specifically at these new issues before trumpeting this unsubstantiated theory to the world?

It’s just like the octomom, the cloning doc, the embryo mix-up, and any other chance the news outlets get to paint an ugly picture of IVF.

I reckon it may be this way til the cows come home…or til one of our IVF youngens makes it to the White House…whichever comes first.

* * * * * * * * *

Do these headlines scare you? Or do you believe there is a media prejudice against IVF and you just shrug it off?

no comments

Octomom’s Fertility Doctor Loses License

By Tracey Minella and David Kreiner MD

June 7th, 2011 at 1:16 am

Eight small steps for mankind; one giant leap backwards for reproductive technology.

According to ABC News*, Dr. Michael Kamrava has had his license to practice medicine revoked. His name may not be familiar. But he’s notoriously well known as the fertility doctor responsible for transferring 12 embryos at one time into the uterus of Nadia Suleman, thereby creating the American phenomenon known as the Octomom. That’s 6 times more than the current national average.

Her delivery of eight IVF babies in January 2009 shocked the world on its own, but when the whole story came out, including her being a single, unemployed mother of six other young IVF children, it sent up red flags to anyone with half a mind. And its negative press set back the IVF movement by showcasing the sensational event.

Thankfully, he can no longer put the lives of mothers and babies at risk with his poor judgment and wanton disregard of the standards and procedures followed by responsible and ethical reproductive endocrinologists.

Only time will tell if those 14 kids grow up to kick his butt.

Read on for a flashback to Dr. Kreiner’s original post on the horror of the Octomom experience and why you’ll never be an Octomom at ECF:

The American public has been stunned by the news of a mother of six giving birth to octuplets. This shocking news is compounded by the stories broadcast by the mass media regarding the woman’s family situation and that she used IVF for these pregnancies.

Physicians have known for many years the dangers of multiple pregnancies and have worked steadily to formulate evidence‐based guidelines for the number of embryos to transfer in IVF cycles. The current rate of triplets in IVF cycles nationally has dropped in 2005 to only 2% of cycles. At East Coast Fertility our triplet rate has been below 1% since 2002 and not one of these occurred from transfer of more than 2 embryos. In fact a financial incentive is offered to patients to transfer a single embryo. Cryopreservation of embryos is offered for free as well as storage for up to 1 year. In addition, up to 3 frozen embryo transfers are offered for free until a baby is born. Patients are encouraged by this program not to put all their eggs in one basket. Unfortunately, this was not the case for this woman. Success rates with IVF, especially, in the good prognosis patients exceed 50% even when 1 or 2 embryos are transferred. It is hard to imagine a situation where it would make sense to take such an extraordinary risk like was done in this case in California.

We should keep this case in mind when considering how many embryos to transfer. It is rarely worth the risk to put more embryos back when one can alternatively keep the embryos in frozen storage until a patient is ready to conceive again.

* http://abcnews.go.com/Health/wireStory?id=13735735

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