The Massachusetts delegation of volunteer advocates on Advocacy Day 2013

By Erin Lasker, Executive Director

This past Wednesday, May 8, 2013, I attended RESOLVE: The National Infertility Association’s Advocacy Day in Washington, DC. I was surrounded by 115 people ready to share their personal, professional and emotional stories of how infertility has touched each of us. Speaking for the 7.3 million Americans – 1 in 8 couples of childbearing age – dealing with infertility, we descended on Capitol Hill after an inspiring morning hearing from Senator Murray and a number of other speakers to get us motivated for the day.

But if you are anything like me, we didn’t need the motivation; having gone through infertility is motivation enough to let our U.S. Senators and House Representatives know about the two important bills currently proposed that will help those dealing with infertility: The Family Act (S 881/HR 1851) and the Women Veterans and Other Health Care Improvement Act of 2013 (S 131/HR 958). Read more about both of these bills here.

The day itself was amazing; walking the halls with other constituents, staff members and U.S. Senators and House Representatives is an experience unlike any other. To know that you are making a difference for others that can’t be present, to know that you are helping to shape our government policy, and to have your voice heard is empowering.

Advocacy Day is once a year, yet that doesn’t mean that we should be silent the remaining 364 days of the year. One day is not enough and that is why we ask you to speak up for yourself and let your government officials know how infertility impacts you and your family.

I met an inspiring woman at Advocacy Day who brought letters from over 100 people that couldn’t make it to Washington, D.C. yet they wanted to have their voices heard. I wanted to share one of the letters from her husband and I do believe that we are making a difference!

Dear Congressperson,

Best,
Brian

If you want to have your voice heard, please visit RESOLVE New England’s Advocacy Page to learn how you can make a difference.

We’re also always on the lookout for more volunteer leaders in all communities and cities within New England; if interested in becoming a Peer Leader, learn more here!

This Wednesday our Executive Director, Erin Lasker, joins RESOLVE: The National Infertility Association as they head to Capitol Hill to lead volunteer advocates from all over the country to advocate for the infertility community.

This year, the focus issues are on getting an infertility tax credit reintroduced into Congress and getting the Women Veterans and Other Health Care Improvements Act passed this legislative session. You can learn more about this year’s Advocacy Day issues here.

By Keiko Zoll

What is Advocacy Day?

RESOLVE: The National Infertility Association brings delegates from every state in the nation to Washington D.C. once a year to talk to legislators and staffers about key infertility community issues. Those delegates are regular men and women just like you and me. RESOLVE provides training, talking points and resources to help these volunteer advocates engage with their elected officials.

Why does infertility advocacy matter?

When we think of infertility, sometimes we think about all the things it has taken away from us: our fertility, our sense of control in our lives and of our bodies, sometimes even our hopes and plans. Infertility can make us weary, stressed, sad, numb, frustrated, jaded, angry, confused, scared, restless… the list goes on. For some, infertility leaves a sense of emptiness inside them. For others, infertility is less a sense of emptiness but more of a constant reminder that shadows them wherever they go.

Raising awareness and advocating for infertility treatment, coverage, and research has given me back a lot of the things that felt taken from me. I feel like I’ve regained a sense of control and that I’m engaged in meaningful, purpose-driven work. I know advocacy isn’t for everyone, but I can’t deny how much of a positive impact is has not only made on my personal infertility journey, but in my life.

Why does Advocacy Day matter?

It might seem intimidating and overwhelming to head to our nation’s capitol to speak to legislators about our needs as a community, but it can be a powerful, incredible experience for those who participate. There’s incredible power sitting in a room full of advocates from around the country, all focused on talking to their legislators about what matters to this group. Even if you don’t get to meet every single person there, just sitting in that room and sharing that energy – it’s amazing.

And the most important thing: our legislators want to hear from us. They are in fact, willing to listen to our concerns, so Advocacy Day is so vital to making sure that our elected officials actually listen and hear our voices on the issues important to this community.

How can I get involved?

There are plenty of ways to get involved with Advocacy Day whether you’re headed to Washington or participating from your own local community!

• Join RESOLVE on Capitol Hill on Wednesday, May 8th!
  If you can make it to D.C., you can still get involved by meeting with your legislators and their staffers on Capitol Hill this Wednesday. Head to RESOLVE to sign up!
• Donate your Facebook and Twitter status to RESOLVE on Wednesday.
  Using Thunderclap, you can quickly log on and sign up to donate your Facebook or Twitter status in a unified social media blast on Advocacy Day! Thunderclap will go ahead and post for you, showing your support for the Advocacy Day issues. Click here to join the Thunderclap movement!
• Write or call your elected officials on Wednesday.
  Even though you might not be able to meet them in their Washington offices, you can still email or call or elected officials on Advocacy Day. Talk to them about the infertility tax credit and Women Veterans and Other Health Care Improvements Act and why these pieces of legislation are important to you.

If you’ve reached a crossroads in your family building journey and aren’t sure which path is right for you, register today for our Adoption, Donor Conception and Surrogacy Connect & Learn Seminars this Saturday, May 4th in Waltham, MA. Financial assistance is available – register today!

By Andrew Geller, Ph.D.

photo credit: timtom.ch via photopin

Question: We have been in infertility treatment for a while, without having any success. Now my spouse and I can’t agree on which path to take next. One of us wants to continue in treatment through one last IVF cycle. The other wants to stop and explore what other choices are possible for us. How do we stop feeling so “stuck?”

Answer: You’ve clearly come to a decision point. There may still be a number of options left such as using a donor, adoption, a gestational carrier, or some further adjustment to your last IVF effort. The challenge is finding ways to move past your disagreement.

You and your partner face each other as veterans of a prolonged siege and, needless to say, despite “holding the fort,” there has been some fraying around the perimeter. You come to realize that, while the two of you are still in the same battle, you may have different ideas about tactics and direction. One of you seems to want one last attempt with IVF, even if the chances are slight. The other single-mindedly asserts that third party reproduction, or adoption – with guaranteed success – is the only way to go.

A first crucial step is to have a frank talk with your R.E. who can present his or her thoughts about the next best steps to take. Be aware, though, that typically physicians don’t see their role as helping couples work out their differences and understand what’s behind their impasse. You very well may have some strong reactions to the options suggested, and you may be asked to go home and give them your full consideration. Candid, heart-to-heart discussion may help you and your partner find your way to a mutually agreeable plan.

I also strongly encourage you to gather information about whatever options are available to you. There can be many misconceptions about them, and attending a RESOLVE of the Bay State program is an excellent way to educate yourselves and try things on for size.

If it appears that you and your partner still cannot agree on how to proceed, I can’t stress enough the usefulness of taking your situation to a psychotherapist who is knowledgeable about fertility and third party issues. Here are some of the important issues that will likely be discussed in sessions with a mental health professional:

Following either multiple failed cycles with only single digit success rates, or following multiple miscarriages, a woman may not be able to bear going through all that another cycle entails. It may then be the most humane option to explore as a couple why her partner cannot accept a third party conception or a non-genetically related child. Sometimes additional information and careful inner exploration can identify misconceptions or fears that can be addressed. Not infrequently, the husband may not truly appreciate the impact of age on fertility.

One or both partners may have concerns about their ability to bond with a child or feel like a legitimate parent to a child not genetically related to them. A man agreeing to use an egg donor may feel like he’s betraying his wife by having a child with another woman; likewise, a woman may feel she’s betraying her husband if she wants to use donor sperm. Looking through some actual profiles of donors may provide a reality check and highlight distortions or misconceptions. Similarly, fears about using a gestational carrier may be put to rest after you speak with someone knowledgeable about this option.

With all of these choices, many of which are second choices, there are losses to be grieved. A skilled therapist can provide the setting for people to gather information, clear up erroneous ideas, and reflect on the meanings that different choices hold for them. A skilled clinician can help the couple grieve their losses and decide to either be childfree or arrive at a way to fulfill their desires to parent.

RESOLVE New England maintains a directory of psychotherapists who are knowledgeable about these matters, and it can be a good form of insurance to bring your specific situation to the attention of an informed psychotherapist. Many clinics also have their own in-house mental health staff with whom you can discuss your concerns.

About the Author

Andrew Geller, Ph.D., is a therapist in private practice in Newton, MA.

This article originally appeared in our Spring 2007 Newsletter.

Today’s the last day of our National Infertility Awareness Week blog series! Every day this week, we’ve featured one of our Circle of Support Sponsors as they share helpful information and advice about infertility, your options and coping. Today’s post to round out the week is brought to us by Bronze Sponsor Women & Infants Center for Reproduction & Infertility.

photo credit: Kara Allyson via photopin

By Emily Spurrell, Ph.D.

Infertility requires endurance. By definition most couples have been trying to conceive for at least six months but the process can span years. The experience feels even longer as women live with infertility, wishing every day that it was over yesterday. Continuing with the process of trying to conceive they risk repeated disappointments with no guarantee that their years of trying, postponing other aspects of their lives, will lead to the fulfillment of their wish to have a child.

So, if infertility requires endurance, women may be better able to navigate the experience by planning for a longer course. If we know we have to pace ourselves for an extended journey we prepare ourselves differently than if we think it is only a short trek. Sometimes, the journey is shorter, but if you expect it to be brief, and think that the journey will be over any minute it can seem catastrophic and debilitating when it is not. It becomes hard to go on.

There are strategies to achieve an outlook and balance in life that can assist women in the time that they are engaged in the process of trying to become parents. Let’s call these endurance builders.

First, for most women, infertility leads to a feeling of helplessness with a sense of loss of control that can encompass their entire self-experience. This emanates from many different places: the plan one had in place to have a family is not working, the equation of work hard and you will succeed is suddenly inaccurate, your body is not doing what it is supposed to do, and your entire peer group is getting pregnant easily.

Add to this that women often don’t feel like themselves during the process “I used to be happy for other people, and now I hate that I can’t feel the way I want towards them”. Finally, women’s bodies and mood can be impacted by medications associated with treatment so even their bodies feel unfamiliar or out of their control. Clearly, finding ways to rebalance and regain a sense of control in one’s life during the process is helpful to endure a potentially long process. Taking charge diminishes helplessness as well.

There are multiple ways to achieve a greater sense of control. Making sure treatment does not take over all aspects of one’s life or schedule is one important way to gain control. Don’t postpone vacations, job changes, or educational opportunities. Seeing progress and success in other endeavors can balance the disappointments and lack of control that comes with treatment.

Do things that make you feel good about yourself, or like the person you are accustomed to being. If it is too hard to attend a best friend’s baby shower, offer to help her clean up afterward, or ask her to go to lunch just the two of you instead. You can be the caring friend while also taking control of a difficult event.

With regard to your body, discover the ways that it works and is healthy. You can improve your diet, try yoga, meditation or acupuncture. You can practice relaxation techniques or increase your physical strength. There are many ways to exercise, set goals and improve health and well being that are complimentary to the treatment process. It is important to focus what you can do, not what you don’t have.

Another factor that can lead to fatigue with infertility is low mood, usually accompanied by a sense of hopelessness. Women experiencing infertility have had successive disappointments from month after month of not conceiving. Repeatedly experiencing “failure” is a sure path to low mood and hopelessness. These repeated disappointments lead women to fear that they will not achieve their aim of parenthood, that their lives will not be fulfilling and that they will live in perpetuity with the sense of loss and injustice. Clearly, if we are trying to achieve greater endurance to reach the destination, carrying the enormous burden of low mood is a handicap.

One way to manage mood is to differentiate between feelings and facts. You may feel sad, and hopeless, but the facts are that often pregnancy will occur, you will have choices ahead, and parenthood is achievable. This is not to imply that getting there is easy, but if you focus on the present, the burden of the present and a single disappointment is much less than the aggregate of infinite ones you anticipate in the future.

Future losses are fiction, not fact, they have not happened yet and may well not occur. To lessen the load of loss, why add more than you need to? Choose to take care of yourself in the present, identify what helps now and what doesn’t and pay attention to your negative thoughts anticipating more failures.

Infertility is a challenging and complex life stressor that requires strategies to manage the process over time. Learning endurance strategies can help couples not only survive the experience but negotiate future challenges, and expeditions, with greater confidence and resolve.

After 15 years of working with women and couples experiencing infertility, I have a deep respect for the arduousness of the journey. I also know that taking it a step at a time, and adjusting as circumstances require, everyone can reach their destination stronger and fulfilled.

About the Author

Emily Spurrell, Ph.D. graduated from Yale University and completed post-doctoral training at Beth Israel Deaconess Medical Center and Harvard Medical School. She is currently an assistant clinical professor at The Warren Alpert Medical School of Brown University and the staff psychologist at the Center for Reproduction and Infertility at Women and Infants’ Hospital. Her areas of specialization and research are infertility and eating disorders.

Our National Infertility Awareness Week blog continues! Every day this week, we’ll feature one of our Circle of Support Sponsors as they share helpful information and advice about infertility, your options and coping. Today’s post is brought to us by Bronze Sponsor Cardone Reproductive Medicine and Infertility.

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By Rita Sneeringer, MD

The option of donor egg or donor sperm treatment may be offered to provide significant improvement in the odds of achieving a pregnancy. These treatments involve several important steps. The following summary is meant to provide an overview of this process.

When is donor egg or donor sperm treatment indicated?

There are several potential indications. Donor eggs may be used when a low egg supply is associated with a low chance of pregnancy using one’s own eggs. For example, women who have not been successful with multiple prior IVF cycles, who have a poor ovarian reserve testing, or who have been diagnosed with premature ovarian insufficiency (premature menopause) are good candidates for donor egg treatment. Similarly, donor sperm might be indicated for a man who has severely impaired or absent sperm production. Genetic considerations are also important. In situations in which either partner has a genetic mutation, having an egg donor or sperm donor would help prevent inheritance of a genetic disease in their children. Finally, single or same-sex couples use donors.

How do I choose a donor?

One of the first decisions is choosing between an anonymous or known donor. Anonymous donors have had initial screening by agencies and have profiles available to review. A donor can be selected based on personal information (ethnicity, appearance, education), medical history, and/or family medical history. Sperm donors have usually also been screened for infectious diseases (required by the FDA) and sometimes have had ethnicity based genetic mutation carrier screening (eg. cystic fibrosis). Egg donors, by contrast, may or may not have been pre-screened for infectious diseases and predicted response to the egg retrieval cycle. This depends primarily on whether fresh or frozen donor eggs are selected. With frozen donor eggs, the screening is generally already completed. With fresh donor eggs, the screening usually is done after matching with a donor.

Some people prefer to have a donor that is known to them. Most clinics require similar screening of known donors which includes considerations for age, medical history, family medical history, psychological screening, and FDA-required infectious disease screening.

What is the timeline for treatment?

The timeline depends on the specific type of treatment elected. For anonymous frozen donor sperm or donor egg cycles (pre-screened) there is generally little delay in starting treatment. However, for an anonymous fresh donor egg or known donor cycle, screening can take several months to coordinate testing and consultations for medical screening, psychological screening and legal contracts. In addition, it is possible that the first donor selected may not be a suitable donor and a second donor would need to be selected and screened. Thus, the timeline is highly variable, but can take 4-6 months.

What are the associated costs?

Total cost depends on the specific treatments chosen and possible insurance coverage (partial or complete). Potential costs include the following: procedure fees for IVF or IUI treatments, recipient screening fees, agency fees for donors, donor screening fees including FDA required testing, medical consultation fees, psychological screening consultation, and legal consultation. As there are many variables, I recommend meeting with your clinic to discuss the specific estimated costs of your individual treatment.

Will it work?

The likelihood of treatment with donor egg or donor sperm leading to a live birth depends on the type of treatment and patient characteristics. For donor egg treatment, success rates are estimated at approximately 50% per cycle. For donor sperm, success rates for insemination approach natural fertility at up to 20% per cycle and for IVF are dependent on the woman’s age. It is important to note that donor egg and donor sperm do offer highly effective options, but do not guarantee pregnancy.

As you are considering your options, a supportive and informative environment is essential to help you make the decision that is right for you. I hope that this brief overview was helpful to get started. More information is available from clinics that provide donor treatments.

About the Author

Dr. Rita Sneeringer is a board certified Reproductive Endocrinologist at Boston IVF and Cardone Reproductive Medicine. Dr. Sneeringer’s clinical interests include infertility, polycystic ovarian syndrome, amenorrhea, premature ovarian failure and hyperprolactinemia. Dr. Sneeringer also has an interest in the medical and surgical treatment of fibroids and endometriosis. She performs minimally invasive surgery (laparoscopy and hysteroscopy) for the purpose of optimizing fertility.

Cardone Reproductive Medicine and Infertility, LLC, (CRMI) provides the best of both worlds: cutting edge technology in reproductive sciences offered in a caring atmosphere where each client is treated in a compassionate manner. Medical Director Dr. Vito R.S. Cardone has 20 years of experience providing all types of advanced treatment for individuals faced with fertility challenges.

Still have questions about pursuing the donor conception option? Register for RNE’s Donor Conception Connect & Learn full-day seminar on May 4th! Financial assistance is still available to attend.

Our National Infertility Awareness Week blog continues! Every day this week, we’ll feature one of our Circle of Support Sponsors as they share helpful information and advice about infertility, your options and coping. Today’s post is brought to us by Silver Sponsor The Massachusetts General Hospital Fertility Center.

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By Abby MacDonald, LICSW

With the recent surge of surrogacy in media and in celebrity magazines, those who consider building their families through gestational surrogacy now sense some legitimacy of this pathway to have the child (or children) for whom they have yearned. However, media presentation of a complex paradigm creates a challenge. In broad form, media glosses over the practice, which minimizes or distorts the medical process and psychological adjustments a person or couple must make in building a family.

What makes gestational surrogacy a family building option for some? The American Society of Reproductive Medicine (ASRM) supports surrogacy when there is a medical contraindication for parents to biologically reproduce and a gestational womb is required for genetic parenthood (for at least one of the intended parents). It is essential to point out, however, that there are two forms of surrogacy – one of which is infrequently practiced in modern, American medicine.

We might call surrogacy the original form of assisted reproductive technology (ART). The Judeo-Christian bible is full of stories in which a woman bares a child for another. These surrogacy arrangements did not come with the technology, counseling or legal contracts from which we benefit today. In today’s terminology, we would describe these pre-ART arrangements as “traditional surrogacy”– the person who carries the pregnancy bares a genetic relationship with the baby as well. Since in “traditional surrogacy,” the surrogate is carrying her own biological child, the courts have examined the legality of a person “signing away her rights” prior to pregnancy (see the case of Baby M). “Traditional surrogacy,” is a very uncommon option due to the psychosocial and legal complexities involved. That being said, it is important to differentiate this type of controversial surrogacy to what is now commonly practiced, which is called “gestational surrogacy.”

Gestational surrogacy is one where the child has some genetic tie to the parents who will raise him or her, but the gestation occurred in another woman’s body. While the child has at least one point of genetic connection to the parents who will raise him or her, a sperm or egg donor may be used as well. This is accomplished through the stimulation of the intended mother (or donor’s) ovaries; at the same time the gestational carrier’s uterine lining is developed. When the time is right, an embryo is created (though the fertilization of the egg with the partner or donor’s sperm) and transferred to the gestational carrier.

We say it takes a village to raise a child, and in this case, it takes a village to create one. Prior to pregnancy even occurring, the gestational carrier, her partner (if she has one) and the intended parents undergo extensive medical testing, psychological consultation, assessment and screening, and have consulted with reproductive attorneys, surrogacy agencies, insurance companies, and many hours of asking themselves, “Is this the right path for me?”

As someone who is regularly involved with the counseling of intended parents and gestational carriers, I am often amazed at the resilience and fortitude of all involved, and the mutual wonderment of each other’s roles in this unique formation of a family.

The logistics of managing a family-building process beyond the members of the family has to be examined. We frequently visit the natural tension that is created when a process that may have once been considered intrafamilial (parent-child) becomes interfamilial (parent-child-gestational carrier and her family), and decisions that get made have to consider the health, safety and well-being of a third party.

The counseling that I offer couples who choose surrogacy as their family building option requires a careful examination of how their infertility has impacted them emotionally. For many, we attend to the feelings of loss related to not having the experience of the intended mother carrying their baby. For others, it may be a question of better understanding the experience of a carrier, and the needs and boundaries that are helpful to be mindful of in these arrangements. The common thread for most patients I see is worry about the process, pregnancy and parenting beyond surrogacy. This is best approached with open-hearted awareness of one’s feelings. Families deserve thoughtful support from clinicians and organizations familiar with the dynamics of families created through gestational surrogacy in order to prepare for the journey ahead and support feelings that emerge throughout the process.

About the Author

Abby MacDonald, LICSW is the clinical social worker for the Massachusetts General Hospital Fertility Center. In this role, she offers counseling, education and consultation to individuals and couples who need support related to their family building journey. In addition to her role at MGH, Abby has a private practice treating individuals and couples in Cambridge, MA.

Still have questions about pursuing the donor conception option? Register for RNE’s Surrogacy Connect & Learn full-day seminar on May 4th! Financial assistance is still available to attend.

Our National Infertility Awareness Week blog continues! Every day this week, we’ll feature one of our Circle of Support Sponsors as they share helpful information and advice about infertility, your options and coping. Today’s post is brought to us by Silver Sponsor Fertility and Reproductive Health Department at Harvard Vanguard Medical Associates.

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By Christine Skiadas, M.D and Sharon Steinberg, RN, MS, CS

Family members and friends can unintentionally hurt the feelings of couples struggling with infertility. Although it may seem natural to ask couples when they plan to have children, even this question can be hurtful. If you ask and don’t get a straight answer, drop the subject. If your friend confides in you about fertility issues, listen without judgment.

Here is a “top five” list of things NOT to say or ask someone trying to get pregnant.

5. “It’s just stress.”

Stress may not help the baby making process, but—infertility is a medical condition. Stress doesn’t cause tubes to be blocked, sperm counts to be low or ovarian reserve to be diminished. It is very stressful to try to get pregnant and most patients are already trying to minimize stress.

4. “Is it you or your partner that has/is the problem?”

This question may be asked innocently, but it is not helpful. Although the source of infertility may determine what treatments are indicated, it is private information and generally not supportive of the couple or their attempts to build a family together.

3. “Maybe you should stop doing…”

(…insert “exercise, drinking milk, eating soy, drinking coffee, working, etc.”) Infertility patients ask themselves these questions all of the time and work with their physicians to identify factors that may help their individual circumstances. Taking away some of these factors (such as exercise or working) may either increase stress or diminish self worth for patients.

2. “Have you considered adoption or egg donation?”

Patients may think about adoption, but may not be ready to consider alternatives to conceiving with their own eggs/sperm. Egg donation brought up at an inappropriate time may be devastating to the female patient, if she isn’t comfortable with the idea or hasn’t explored all options for using her own eggs. If you don’t have complete knowledge of where your friend may be in the decision-making process, avoid bringing up alternative options for parenting.

1. “Are you sure you really want to put yourselves through all of this?”

This question is one of the hardest that my patients mention to me. No one wants to put themselves “through all of this.” I have yet to meet a single patient who is hoping that they need IVF to get pregnant. People undergoing treatment for infertility—by definition—are not getting pregnant the way that they wanted to and are making the best decisions that they can.

It is clear that there are many unhelpful things to say and do, but having a few key people to confide in may be invaluable to infertile couples.

Ways to support a couple struggling with infertility include:

• Listen. Give your friend space – don’t bombard with questions. Share your concern and support. Wait for them to tell you what is going on, and listen to what the couple is experiencing.
• Offer to be a source of support, but respect their need for privacy.
• Recognize that infertility treatment can take years to resolve—and that resolution can have many forms. Don’t minimize the pain and grief, and don’t offer false hopes.
• Reassure your friend/family member that you love them no matter what—and this is not related to their ability to have child.
• Try to make time for activities with friends that don’t involve children.
• Cut your family some slack around family/baby centered events and holidays. Don’t take it personally if couple decides to skip family events. The winter holidays, anniversaries of pregnancy losses, Mother’s day and Father’s day all are often hard for couples with infertility.
• Support whatever decisions couple makes regarding treatment. A patient told me that one of the most supportive things a friend said to her was, “Whether it is through pregnancy or adoption, I know that you will be a great mom someday.”

About the Authors

Christine Skiadas, M.D. is a board-certified Obstetrician and Gynecologist and Reproductive Endocrinologist. She completed her training in Obstetrics and Gynecology, as well as Reproductive Endocrinology and Infertility at Brigham and Women’s Hospital. Dr. Skiadas has been at Harvard Vanguard Medical Associates for 2.5 years and focuses on prioritizing the patient experience while delivering focused medical care with a personalized, caring approach to treatment.

Sharon Steinberg, RN, MS, CS is a psychiatric advanced practice nurse. She is the mental health consultant to the Center for Fertility and Reproductive Health at Harvard Vanguard Medical Associates and has worked with fertility patients for over 20 years, in addition to running our Mind/Body program.

The Center for Fertility and Reproductive Health at Harvard Vanguard Medical Associates prides itself on providing comprehensive fertility care, including advanced Reproductive Surgery and IVF with a seamless transition to OB care and other specialty services. To learn more about our team, please visit www.harvardvanguard.org/fertility

Our National Infertility Awareness Week blog continues! Every day this week, we’ll feature one of our Circle of Support Sponsors as they share helpful information and advice about infertility, your options and coping. Today’s post is brought to us by Gold Sponsor Reproductive Science Center (RSC) of New England.

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By Samuel C. Pang, MD, Medical Director

In recognition of National Infertility Awareness Week the following provides basic information about intrauterine insemination (IUI) and in vitro fertilization (IVF).

Intrauterine Insemination (IUI)

IUI is often a first-step of treatment when couples are having trouble getting pregnant through naturally occurring, unprotected intercourse. IUI involves the placement of sperm, either from the intended father or a sperm donor, directly into the uterus immediately prior to and during ovulation. IUI may be performed with or without the use of fertility drugs taken by the woman. When medications are used, the therapy is referred to as controlled ovarian hyperstimulation (COH). IUI with COH may result in an increased likelihood of multiple pregnancy (twins, triplets, etc.).

Those who benefit from IUI include:

• Couples with no identifiable cause of infertility (“unexplained infertility”)
• Women with ovulatory disorders who respond well to fertility medication
• Women with minimal or mild endometriosis
• Women using donor sperm

In Vitro Fertilization (IVF)

IVF is a process in which oocytes (human eggs), retrieved from a woman’s ovaries, are fertilized in an embryology laboratory with sperm provided by her husband, partner or a donor. When fertilization is successful, the resulting embryos are transferred into the woman’s uterus. There are four major steps in an IVF cycle:

1. Follicular stimulation and monitoring

Reproductive Endocrinologists (fertility specialist doctors) prescribe hormonal medications to increase the likelihood of collecting multiple eggs. Medication is also used to control the timing of a patient’s menstrual cycle. The patient’s progress is monitored through blood testing and vaginal ultrasound to evaluate the number of ovarian follicles in development. A follicle is a sac of fluid in the ovary that may contain oocytes. Just prior to egg retrieval, a patient takes an additional injectable medication to complete egg maturation. Egg retrieval only takes place if an adequate number of follicles are ready. If not, the cycle is cancelled and the patient’s treatment plan is evaluated by her fertility doctor and, perhaps, revised.

2. Oocyte Retrieval

Egg retrieval takes place under intravenous sedation at the patient’s fertility treatment facility. While sedated, the fertility doctor inserts a probe through the vagina under ultrasound guidance into the ovaries to withdraw follicular fluid from each follicle. (Not all follicles necessarily contain eggs).

3. Fertilization and Incubation

Once eggs have been retrieved, sperm (from the intended father or donor) and eggs are brought together for fertilization in the controlled environment of an embryology laboratory. The embryologist may choose from a number of insemination techniques including the microdrop method or a microinsemination technique called intracytoplasmic sperm injection known as ICSI (“ik-see”). In ICSI, a single sperm is injected directly into an egg under a microscope. Fertilized eggs are then incubated in the laboratory for two to five days prior to embryo transfer.

4. Embryo Transfer Procedure

If the embryos have developed normally, a fertility doctor transfers a predetermined number of embryos through the cervix into the uterus via a small catheter (hollow tube). No anesthesia is required for this procedure. To enhance the likelihood of conception, hormonal therapy follows embryo transfer. As in the natural reproduction process, a pregnancy may or may not result. If any excess embryos exist after the initial transfer, the patient may request evaluation for possible cryopreservation (freezing) and use for a subsequent treatment cycle.

Frozen Embryo Transfer (FET)

While pregnancy rates with frozen embryos are not quite as high as with fresh embryos, the success rates are still quite respectable and the preparation for a frozen embryo transfer is much simpler and less expensive compared with a fresh cycle attempt.

IVF with Donor Eggs

IVF with donor eggs involves retrieving oocytes from a young, healthy egg donor, inseminating them with the sperm of the intended father (or sperm donor), and transferring resulting embryo(s) into the uterus of the intended mother. IVF using donor eggs is a treatment option when there is an absence of ovaries, or ovaries that are unable to produce viable eggs. This treatment option can also be used to help couples with potential genetic abnormalities that might be carried by the woman.

Frozen Donor Eggs

Vitrification, an effective method for freezing and thawing human eggs, has been in development for nearly a decade. In October 2012, the American Society for Reproductive Medicine removed the “experimental” designation for this process. Today, IVF using frozen donor eggs acquired through egg banking services, is another option for those couples that need to use donor eggs.

IVF with Gestational Surrogacy

Gestational surrogacy with IVF is an option for women who are unable to carry a pregnancy to term. There are many reasons why this may be necessary including, among other reasons, the absence, scarring or deformity of a uterus, or when the intended mother has a significant medical condition. In many cases, IVF with gestational surrogacy can be done using the woman’s own eggs if she has normally functioning ovaries. Her eggs are inseminated with sperm provided by the intended father or a sperm donor. The resulting embryo(s) is/are then transferred to the uterus of a gestational surrogate, who carries the pregnancy and delivers the baby or babies of the intended parents. Using both donor eggs and a gestational surrogate is also an option.

About the Author

Dr. Samuel Pang, Board Certified in Reproductive Endocrinology and Infertility, has been the Medical Director at the Reproductive Science Center (RSC) of New England since 2007 and is also the Medical Director of the Third Party Reproduction Program at RSC New England, which provides IVF for patients needing to use donor eggs and/or a gestational surrogate. A leading advocate for education about and access to infertility treatment, Dr. Pang, in coordination with Resolve New England, was a chief author of the 2011 mandate requiring insurance coverage for infertility treatment in Massachusetts.

Celebrating its 25th Anniversary, RSC New England is one of the areas oldest and largest fertility treatment centers providing comprehensive diagnosis, evaluation and treatment for infertility. Among many commendations, RSC New England is the first and only fertility center in New England to be recognized by the American Society for Reproductive Medicine for its commitment to following guidelines regarding embryo transfer numbers in an effort to protect the health of IVF patients and their babies.

Welcome to our National Infertility Awareness Week blog series! Every day this week, we’ll feature one of our Circle of Support Sponsors as they share helpful information and advice about infertility, your options and coping. Today’s post is brought to us by Gold Sponsor Brigham and Women’s Hospital: Center for Infertility and Reproductive Surgery.

By Dr. Elena Yanushpolsky

As a couple, you’ve been trying to conceive for several months without success. Should you keep trying or should you see a fertility specialist? The correct answer is that it depends. Here are some things that can help you determine how soon to see a specialist:

Getting Ready

It’s important for both partners to have a general health evaluation with a primary care doctor before seeking fertility evaluation and treatments. Many illnesses can have an impact on a couple’s fertility.

I also recommend that my patients maximize their chances for conception by using urine ovulation predictor kits which can be purchased over the counter. Other ovulation detection methods, such as basal body temperature measurements and cervical mucous evaluations can be used, though they are less precise than urine ovulation predictor kits.

Age Considerations

A woman’s age is the main factor affecting a couple’s chances of achieving a successful pregnancy. A woman’s fertility peaks between the ages of 20 to 30 years. From 30 to 35 years of age, female fertility starts to slowly decline. Once a woman turns 35, her fertility begins to drop more rapidly. Over the age of 40, women have significantly lower chances for conception each month. The risk for miscarriage also increases.

A decline in fertility and an increase in miscarriage rates are related to changes in the genetic, chromosomal and metabolic characteristics of eggs that occur as women get older. These changes mean eggs are less likely to be fertilized by sperm. If fertilization does occur, the embryos are also less likely to become implanted in the uterus, resulting in increased miscarriages.

A man’s age may also affect a couple’s fertility. While men are known to have fathered children well into their seventies, changes in sperm characteristics and a drop in overall sperm counts occur as men get older, further reducing fertility.

As a result of these changes, evaluation by an infertility specialist should be considered if a couple has been unable to achieve a successful pregnancy after 1 year of unprotected sexual intercourse when the woman is younger than 35 years old, or after 6 months if a woman is older than 35 years; A man’s age should also be a consideration in whether to consult an infertility specialist.

Health History

Certain conditions may significantly increase a couple’s risk of infertility. For females this includes irregular menstrual cycles, history of pelvic infections, history of pelvic and/or abdominal surgery, and endometriosis. For men the risk factors for infertility are histories of undescended testes at birth, genital infections and/or trauma, use of illicit drugs and marijuana, as well as use of anabolic steroids. If either partner has any of these risk factors, a fertility specialist may need to be consulted after only a few months of trying to conceive.

If you’re still unsure about consulting a specialist, I advise seeing someone sooner than later, particularly if you or your partner is over 40 years old. Waiting can work against you due to age related fertility declines and cause needless worry and anxiety.

Learn more about the evaluation and diagnosis of infertility in both men and women.

About the Author

Dr. Elena Yanushpolsky is an infertility specialist with the Center for Infertility and Reproductive Services at Brigham and Women’s Hospital (BWH). Dr. Yanushpolsky is also the Director of the BWH Center for Infertility and Reproductive Services at South Shore Hospital in South Weymouth.