ivf forum – in vitro fertilization and infertility discussions

Tune in and listen to PFC’s Dr. Carl Herbert talk about the History of ART, Genetics and ART, Fertility Preservation and Egg Banking on The Fertility Forum radio show Monday, October 17^th from 6-7 pm PST.

To listen, you can call in live to 877-864-4869 or go to The Fertility Forum webpage and listen there.  You can also click the LIVE CHAT button on the website to IM live during the show!

If you can’t tune in on Monday, you can download the audio AFTER the show from either the site above OR iTunes.

Don’t miss it!

This article was written by Vadivu Govind and published on 7 August 2011 at www.happiness.sg Play@Work “You don’t get the best ideas in front of the PC!” I just lit up when Angela Koch of Invitro Innovation said this. It certainly looks like we’re productive when we sit for long hours in front of the computer. I used to [...]

Embryo freezing is a routine part of the IVF process.  Approximately 60% of patients have embryos in frozen storage after their cycle is complete.  These embryos can be used at any time; but it is common that some embryos remain after couples have completed their families.  This situation leaves patients facing a very difficult decision regarding the final disposition of any embryos still frozen.  Quite often patients are not prepared to make such a decision, nor are they aware of their disposition options. Patients were so focused on simply getting pregnant, they had not considered what to do with any remaining embryos after the cycle was complete. This article provides a brief explanation about the three disposition options available at PFC for surplus frozen embryos: disposal, research (and then disposal), or donation to another couple for use in achieving pregnancy.

Disposal of your embryos means they are removed from the storage tank and placed in a biohazard waste disposal container. Once the embryos are removed from the liquid nitrogen storage tank, they lose all viability in a matter of seconds. The embryos are not used for research purposes, not donated to any individual or company, and are not cultured beyond the stage of development at which they were frozen.  They are disposed of as medical waste.

Donating your embryos for use in research requires that the embryos be shipped to a company called Reprogenetics, LLC, based in New Jersey (www.reprogenetics.com). At Reprogenetics, the embryos are studied to understand normal and abnormal development.  Donating embryos specifically for stem cell research is also possible.  Reprogenetics offers a stem cell research option, however,  some additional paperwork must be completed directly with Reprogenetics  Whether donating to Reprogenetics for stem cell research or basic research, a PFC Research Disposition form must be competed.

Donating your embryos for use by another couple can be broken down into three sub-categories: known donation, open donation and anonymous donation. Known donation, also called directed donation, is the donation of your embryos to a person or couple that you know personally, perhaps a good friend or family member.

Anonymous donation of your embryos means that you donate your embryos to an organization, and the organization places your embryos with a family that you do not know and will not meet. The identity of both the donors and the recipients is not disclosed to either party. Through the PFC Embryo Placement Program, only anonymous embryo donations are accepted. Any stipulations about to whom or to what type of family situation the embryos are donated cannot be accommodated (i.e.: that the embryos be donated to a two-parent household, or a household of a certain income level, or living in a certain geographic area). The placement of anonymously donated embryos operates on a first-come, first-serve basis. At the moment, we have a very long list of patients wishing to receive donor embryos. Currently there is nearly a two year wait).

Open donation is the donation of your embryos to a party that you do NOT know, but wish to meet, and/or possibly remain in contact with, after the embryos are donated. Open donations require further legal expertise and overall guidance and handling beyond PFC’s current abilities. For these reasons, PFC is unable to offer open donations to our patients. For those interested in an open donation, or for those requesting certain criteria be met by the recipients, patients are encouraged to research third party agencies that facilitate embryo donations, both anonymous and open. One such program is the Snowflakes Frozen Embryo Adoption and Donation Program (www.embryodonation.org.

At PFC, all embryo dispositions are handled by our tissue bank manager Alexis VonAustin.  Her contact number is 415-249-3636. She can assist you with information, paperwork, and if necessary, with the shipping of embryos to the agencies listed above.

- Alexis VonAustin and Joe Conaghan, Pd.D., HCLD.

I liken our fertility journey to the story of the woman who thought she was traveling to Oakland, California but got off the plane in Auckland, New Zealand.  We, too, thought we were in for a much shorter trip! We had achieved a pregnancy naturally the very first time we tried, a pregnancy that ended in a painful miscarriage five weeks later. Despite the emotional setback, I followed the lead of my gynecologist and other friends and family members who said that the fact of conception was a very good sign. My husband and I overcame our grief and assumed the stance that having a baby would come rather easy for us. At the time of our pregnancy, I was 33 years old and he was 37.

We tried to conceive again on our own for a year following the miscarriage. Then we sought external help. We underwent fertility analyses to determine what might be getting in the way of another pregnancy and discovered a problem with sperm motility and morphology. We engaged in Eastern medicinal treatments, using herbs and acupuncture to augment fertility as we geared up for an IUI (Intra-Uterine Insemination). When this was unsuccessful, we decided to switch gears. I was quickly edging towards 35 and my gynecologist agreed that it was better we move quickly. I also felt strongly that I wanted help from a specialist that would take my husband and my situation in a more holistic way.  That is when we found Dr. Herbert at the Pacific Fertility Center.

In November 2009, Dr. Herbert informed us of his analysis that, due to the condition of my husband’s sperm, we would have to resort to IVF to conceive a child. In addition, I would have to undergo a procedure to remove a large uterine polyp that might get in the way of a developing embryo and hence create another miscarriage. My biggest fear- that we would have to undergo invasive and painful procedures to have a baby- had come true. I felt robbed of my dream of a natural conception. My husband felt only lucky that there was a solution to our fertility problems. Our differences in the way we regarded this situation created tension in our relationship. But at each step, he gave me courage and showed me that we would get through this together.

In early January 2010, I checked into the surgery department at the hospital. My husband held my hand tightly and wiped away my tears as we waited for my turn in the operating room. I looked around the surgery prep room and reminded myself that a polyp removal was minor compared to what other people were going through. However, it was the very first time I had an IV in my arm, much less been in the hospital. I was terrified.

The polyp removal, which went well, was a test of my strength. I felt proud of myself for getting through it and began to see it as preparation for the procedures that lay ahead. A few weeks after the removal, we returned to see Dr. Herbert. My uterus had been cleaned out and prepared, and had time to recover. Or so I thought. I was ready to move forward with IVF but the results of the ultrasound showed that my uterus was still not ready.

The months to follow were ones of great introspection for me. For the first time in my life, I was at the mercy of a situation that was completely out of my control. I was humbled. I come from a family of doers who put a great emphasis on perfectionism and achievement. Because of my background, I had always pushed myself hard and been very self-critical, never knowing when I had given enough.

The process of conceiving a child is so different. You don’t get to choose when or how quickly things happen, as the body has a rhythm of its own. The more you push the worse you make the situation. After waiting for a child for almost two years, the final months leading up to IVF felt impossibly long. I was terrified that I was never going to have a baby, and felt unspeakably frustrated and anxious. I had no choice but to master these feelings and allow my body the time to prepare and heal. I also had to trust that this was all part of a process. We would have our baby, but it was going to take time.

In April we were finally cleared to begin using the fertility drugs. The results of our egg retrieval were very fruitful: 30 eggs and 9 embryos. Unfortunately, the results of our embryo transfer were less so. I remember getting the call from the nurses at PFC. “We are so sorry. We know how much this means to you.” To make matters worse, another polyp had formed in my uterus that needed to be removed before we could try again.

I took a huge step back from the fertility process at this disappointing news. I let go entirely and shifted gears, getting back into hobbies and activities that I enjoy but had been pushed to the side in my pursuit of a pregnancy. I hiked, I read, I cooked, I traveled, and I reveled in my relationships with my husband, friends and family. Sometime in late summer, when I felt whole again, I went back to the hospital and had the second polyp removed.  A few months later, my husband and I decided it was time to try another embryo transfer. This time, I was greeted with a “Congratulations” by the nurses at PFC. After two and a half years, we had achieved another pregnancy!

Our baby girl is now 6 weeks old. Difficult as it was, I feel blessed to have gone through what we went through to have her.  It taught me the value of patience, and the hard lesson that we don’t always get to have what we want when we want it. It has also allowed me to be more kind to myself, which helps me be more in the moment with my baby. Most importantly, I learned that sometimes you need to take steps back to move forward, and that all steps, no matter how small, are still steps in the right direction. Now that’s something even our baby girl will appreciate!

-RLS

I was born and raised in Shanghai.  My father, a university mathematics professor, was one of the first generation of college graduates in China after the Cultural Revolution.  My mother, though intelligent and bold, never had the opportunity to pursue higher education.  They were “tiger parents” long before that term even existed.   This was the era before China had opened its door to the West, and disposable income was limited.  Nonetheless, they spent every penny towards my education and broadening my horizon.  I was the only child in my neighborhood to take private lessons in Chinese calligraphy and classical Chinese painting.  We spent weekends touring art exhibits and museums.  To ensure that I would succeed in school, my father taught me English and algebra during my summer breaks.

My childhood years spent holding the calligraphy brush played a critical role in helping me stay connected with my cultural roots after my family’s immigration to Canada when I was twelve.  Through the mastery of this traditional art form, I gained a deeper understanding of Chinese history and culture.  It has given me a platform with which I was able to continue my study of the Chinese language and literature long after English had become my primary language of learning.

My family’s immigration to Canada was serendipitous.  My father initially took us abroad for a one-year visiting fellowship at the University of Manitoba in Winnipeg.   It was the summer of 1989, when the communist regimes throughout Europe fell like dominos and in Beijing the bloody suppression of student demonstrators for democracy occurred in Tiananmen Square.  Although we were not politically involved, my family was given the opportunity to seek asylum in Canada. My parents decided to stay.

What followed was the classic immigrant story, filled with the hardships of survival in a foreign country away from loved ones, and, at the same time, the never diminishing hope and optimism for the attainment of the “American dream”. 

After attending junior and high school in Canada where I excelled in math and science, I applied to colleges in the U.S. with a vague plan to have a career in the sciences.  With this in mind, I was convinced that MIT offered the strongest programs in virtually every scientific discipline.  My years at MIT were the most formative period in my professional and personal development.  My professors and research mentor opened my eyes to the wonders of biology and inspired me to pursue a career in the study of the human body.  I became fascinated by how the body functions, especially the mysterious process by which a single stem cell develops into a complete organism.  At the same time, I continued to pursue my interest in Chinese by taking graduate level courses at Harvard and obtained a minor in Chinese literature along with my S.B. in Biology from MIT.

My interest in the human body led me to study medicine at Harvard Medical School.  During medical school, I conducted research in developmental neuroscience, which led to my honors thesis.  In addition, I became clinically interested in women’s health, a multifaceted discipline with broad psychosocial, political, as well as ethical implications.  I realized that I wanted to take care of women, promote reproductive health, and be a part of building families.  To that end, I completed a residency in Obstetrics and Gynecology at the University of California, San Francisco (UCSF).  During my residency, I learned to treat women of all ages and with every type of ailment from morning sickness to ovarian cancer.   It soon became clear that while I enjoyed delivering babies, I resonated most with patients who could not conceive.  Furthermore, the combination of advanced technology and cutting edge research in reproductive medicine perfectly matched my long held passions in science and technology.  Having come to that realization, I decided to pursue subspecialty training in Reproductive Endocrinology and Infertility, and was accepted into the fellowship at Columbia University Medical Center in New York. 

At Columbia, I was fortunate to be taught by some of the pioneers of the field, Drs. Roger Lobo and Mark Sauer, who have trained many respected Reproductive Endocrinologists around the country, including PFC’s very own Dr. Chenette.  Under their guidance, I conducted research on how follicular hormones affect human oocyte and embryo quality, which has led to several published manuscripts in peer respected journals, as well as my fellowship thesis.  Clinically, I became interested in treating patients with polycystic ovary syndrome (PCOS) and other endocrine disorders, as well as fertility preservation, for patients who desire to delay childbearing for either medical or social reasons.

While I was a resident at UCSF, I met and fell in love with my husband and we welcomed the birth of our daughter last year.  We both love the Bay Area and decided that San Francisco is the place where we want to raise our family.  I have always had the highest regard for the physicians at PFC, one of the most respected fertility centers in Northern California.  Therefore, it is my pleasure and privilege to be able to join Drs. Herbert, Schriock, Givens, Chenette, and Ryan in their mission to help women and families of the Bay Area and beyond in achieving their reproductive potential.

Throughout all these years of training and research during which I learned many exciting new skills and technologies, I still derive the most profound joy and satisfaction from the very first glimpse of a beating heart on ultrasound and the accompanying excitement in my patient’s eyes.  It was not until I held my own daughter and she flashed me one of her toothless gummy grins that the notion finally hit home: life is precious and the love for one’s child knows no boundaries.  I am truly lucky to be in a profession where I have been granted the privilege to take part in the creation of a family, a privilege that I will honor and treasure throughout my career.