GIVF Fertility eNews
May 2009

Celebrating 25 Years of Excellence

 

 

GIVF Logo

 

Worldwide, GIVF is responsible for over 20,000 pregnancies.

Find out how we can help you. Call us today at 800.552.4363.

 
Click to Call 
 
 
 
to get updates on discounts and other special offers 
 
 
GIVF is Conveniently Located at Route 50 and the Washington, DC Beltway
ETHICS IN ASSISTED
REPRODUCTIVE TECHNOLOGYDr. Steve Lincoln

Stephen R. Lincoln, MD, FACOG
Reproductive Endocrinologist, Senior Physician
 


Recent public outrage and fascination with the "OctoMom," saga has refocused the spotlight on ethics in Assisted Reproductive Technologies (ART). Although the controversial story involving the California woman who recently gave birth to eight children is loaded with ethical missteps (should this patient have been treated at all, why did the doctor transfer so many embryos, who should take care of all these children, was this appropriate use of health care resources), the story has also allowed us to reexamine many other aspects of the field of ART from the viewpoints of patients, providers, society as a whole and, possibly, lawmakers.

 

When examining some of the ethical dilemmas we all face, it is important to be aware that advances in reproductive biology and techniques sometimes proceed faster than society can morally and legally grasp. Is it appropriate for society to make laws governing reproductive treatments today when a few years from now these laws may become obsolete? Take, for example, the number of embryos that should be transferred in In Vitro Fertilization (IVF). Ten years ago it was not uncommon for physicians to recommend transferring three to four embryos even in patients with a good prognosis for IVF. Today, our professional society, the American Society for Reproductive Medicine (ASRM), recommends transfer of no more than one or two in most cases. However, in older patients with poor prognosis, ASRM guidelines are flexible and allow physicians to transfer up to five embryos if the likely success rate for the patient is low. So if our lawmakers impose restrictions of no more than two embryos for transfer (as has been done in other countries), patients with poor prognosis will face an even greater struggle in trying to conceive. 

 

If providers and patients do not act responsibly, however, society may feel obligated to step in with legal regulations. As providers we have to do a better job of "policing our own," when other providers are clearly acting outside the standard of care. Patients and providers together have to be responsible with health care resources when requesting specific treatments. This is true when deciding how many embryos to transfer in a case with a good prognosis, but this can be particularly difficult in a situation with a very poor prognosis.   

 

More often than not, the dilemmas I face include whether to proceed with treatments when the chances of success appear to be extremely remote and other options, such as donor egg, adoption or stopping treatment. do not appear to be acceptable to patients. When providers and patients are at odds over the best course of action, it may be helpful to enlist the assistance of third party counselors. Physicians are learning that providing limited treatments, even in cases with a poor prognosis, may help a patient come to closure with their diagnosis and move forward. And all of us have anecdotes about the "one in a thousand" chance that resulted in the birth of a beautiful child. Still, it is most responsible if providers do not continue treatments over the long term for patients whose prognosis is extremely poor. 

  
The field of Preimplantation Genetic Diagnosis (PGD) offers incredible potential for eliminating or reducing the chances of a child developing one of a host of inheritable disorders. We can offer couples with family histories of conditions such as Cystic Fibrosis, Sickle Cell Anemia, Huntington's Disease, Muscular Dystrophy, as well as many others; the opportunity to have unaffected children. However, this same technology may one day make it possible to select traits such as eye color, and hair color, etc., which makes many people very uncomfortable. Should we, as a society, now make laws that govern such technology when we are not even sure exactly what the technology will be? I do not have all the answers today, but I hope together we can all move forward with morally sound judgments that do not eliminate fantastic treatments such as PGD for genetic disease.
 

What's New at GIVF

CYCLE IN THE SUMMERSM RETURNS! Due to overwhelming demand, GIVF is offering its highly affordable Cycle in the Summer program again for the third year. Under this program, patients can purchase up to two standard IVF cycles for a base fee of just $10,900, provided that they have their first retrieval before the last day of summer (September 22). For details, click here.
 
SPLIT CYCLE: THE MOST AFFORDABLE WAY TO USE DONOR EGG IVF.
GIVF has expanded its split cycle donor egg IVF program to now include a two cycle multicycle option. A split cycle is when two patients share the eggs from a single egg donor. Patients can choose to do a split cycle for single or multicycle base fees that ordinarily apply to donor egg IVF, but at only half the price for the donor fee. Split cycle is not only a more affordable option, but due to the large donor egg pool GIVF provides, we believe our program offers the fastest match for a split cycle or donor egg IVF cycle available anyplace in the United States. For details,
click here.
 
DONOR EGG IVF SEMINAR/FREE DONOR EGG IVF CYCLE.
GIVF will present a free seminar to explain Donor Egg IVF treatment options from 10:00 AM until noon on Saturday, May 30, 2009 at the Hilton McLean Tysons Corner. One free single Donor Egg IVF cycle will be given away at the seminar. All attendees will receive a 15% discount off the base fee for a single Donor Egg IVF cycle. To register or learn details, go to
click here.
 
GIVF TO HOST ANNUAL BABY REUNION.
GIVF is hosting its annual Baby Reunion on Saturday, May 9. This highly popular event, which will be even more exciting as we celebrate GIVF's 25th Anniversary this year, was attended by around 1,000 adults and children last year.  The party is an opportunity for GIVF to share the joyous Mother's Day weekend with the families that GIVF has helped. This party is the signature event for GIVF for the entire year and many families come from hundreds of miles away to celebrate with the staff.  If you are interested in more information email
babyreunion@givf.com.
  
FREE IVF AND DONOR EGG IVF CONSULTS.
Through May 31, GIVF is offering free in-office consults to patients who schedule before that date, even if the office appointment happens to take place after that date. For a free consult with one of our expert physicians, call 800-552-4363.
 
 
Click to Call
 
GIVF ACHIEVES 20,000 PREGNANCIES WORLDWIDE! Since its first year, 1984, GIVF has now helped patients achieve over 20,000 pregnancies.
 
 
 
Ask a Question  
 
"What causes irregular periods?"
 

Sunita Kulshrestha, MD, FACOG
Reproductive Endocrinologist
  

 
The time interval between menstrual periods is determined by the rate and quality of the growth and development of the follicle (fluid filled structure containing and supporting the egg) and the duration of the luteal phase (period of time after ovulation). Women who have normal ovulatory cycles generally have intermenstrual cycle lengths ranging between 25-35 days. Only 15% of cycles in reproductive aged women are actually 28 days in interval.

 

There are a variety of factors that can temporarily or chronically alter this time interval. Environmental factors such as stress, strenuous exercise and extremes of diet (anorexia, bulimia) can inhibit ovulation and cause a delayed or missed period. Hormonal imbalances, including thyroid disorders, excess prolactin, excess androgens (male hormones ex/polycystic ovary syndrome) can do the same. These conditions can be treated with medication.

 

As a woman ages and the number and quality of eggs declines, the time from one period to the next declines at first, and then starts lengthening again eventually leading to menopause. A thyroid abnormality or a progesterone deficiency (luteal phase defect) also can cause a shorter intermenstrual cycle length.  

 
Sad Couple
 
Managing Relationships:
Infertility - the Uninvited Visitor
 
Phyllis Martin, MEd, LPC
Counselor, Leader of GIVF Donor Egg & IVF Support Groups

 
Have you ever had to put up with a house guest who stayed too long? Perhaps a friend of your spouse's that you really don't like? Imagine this: Bill pops in and says he is in town! You are surprised initially, but quickly adjust and decide he can stay for a bit.  What are a few days? You tell your partner that is OK, but no more. So soon you and your spouse are fighting because you don't know what to do with Bill. He doesn't seem to have any intention of leaving. He always has another excuse to stick around. He is eating your food, running up your bills and affecting your social life because he tags along to events.

Your family wants to know all about Bill and then offers opinions on what to do, even though you didn't ask. You feel uncomfortable talking about him to friends because it may reflect poorly on you. Bill makes you late for work because he is in the shower and you haven't had yours yet. Wife is mad at husband, who says she is over-reacting, Bill will be gone eventually; let's pretend he isn't here right now. Husband is mad at wife because he knows just asking Bill to leave won't work, there is no quick fix, and he is tired of being blamed. One morning at breakfast Bill says that he overheard your love-making. You cannot stop thinking of Bill, even when you are having sex. Your libido dwindles. You feel guilty and mad at your spouse because he/she does not understand. Eventually you stop having sex unless you know that he is out, which tends to be only a few days a month. The strain is making your marriage suffer, so you plan a nice dinner alone together. But during this romantic evening, all your partner wants to do is complain about how bad an experience it is to live with Bill. You are tired of talking about Bill and point out that there are other things to discuss, but Bill overshadows everything. Neither of you can remember life without Bill and neither of you really know what to do except look forward to the day he is gone.
 
Finally, Bill leaves. You thought you and your spouse were going to do the Dance of Joy when that moment arrived, but strangely you don't. Instead, you find that all the anger, all the hurt, all the inconvenience and annoyance is STILL there, despite Bill being gone. Now you realize the problem is not about Bill, but about the damage that was done and not attended to while Bill was there. Is it too late to reconnect?
 
Infertility affects all aspects of your life, including your marriage. But how, why and what can you do about it? Like coping with an uninvited guest, couples first have to adjust to the mere idea that they are going to have to use some sort of medical assistance to get pregnant. Many couples start by ranking what they will and won't consider. As a couple proceeds, they often find themselves drifting right into those options they said they would never consider. They frequently find themselves dealing with scenarios they did not even know existed. Usually, infertility is the first major life crisis a couple faces together. It is a time when you see your spouse and yourself in new ways. You may find it frustrating, maddening or sorrowful.  You may feel perpetually helpless at seeing what your spouse does or does not do under this kind of pressure. Infertility illuminates your different ways of coping when handling stress, grief, lack of control, depression and anxiety. For a couple, it exposes how you communicate with each other. Infertility teaches you things you may not have known about your spouse's assumptions and expectations. When all of these things differ, infertility can tear couples apart. Sometimes the damage is so great that having the longed-for child does not repair the damage because bitterness and hurt remain. Divorce occurs despite the resolution of infertility.

In order to pad the effect infertility can have on your relationship, remember the small things first. Accept your partner's differences in making choices, handling stress and grieving style. As the various areas of life become affected, a couples' communication often suffers most. Be patient with your partner and separate him/her from his/her communication style. Some people isolate and become very quiet. Others surround themselves with resources and people. They may seem to talk about it constantly, even after a decision is reached. Frequently, couples are accustomed to making decisions together rather than just sitting with difficult feelings. To communicate but not focus on fixing, acknowledge and validate what you are hearing. Do not try to fix it, or be a perpetual cheerleader for your spouse. Validate your partner's feelings. Infertility does not have to be a wedge. It can be a shared experience that actually becomes a strengthening bond.
 
It is important for couples to remember that there are many ways to experience intimacy and that sex should not be the only way to feel emotionally connected to your partner. Physical intimacy should be a focus during time you have together, without making a spouse feel that sex must result. Unexpected hugs, kisses just because, a foot massage, a shoulder massage while watching TV or a pat on the back all express caring. Sex in a different location can feel freeing as well. Non-physical ways to encourage intimacy include calling your partner in the middle of the day to say you are thinking of him/her/. Do not mention appointments, errands, and logistics and so on.

Laughing together is a release as well as a tool to put your stressor in perspective. Laughing together also builds a bond and gives couples something to recall and laugh at later. Text or email flirty messages, loving messages or funny messages. Use the element of surprise to break from feeling tied down to a treatment plan. I have had clients plan a living room picnic, go to a show, go for a weekend drive, and re-visit something that was a joy before infertility moved in, such as going to flea markets or a café for a favorite brunch.
 
Couples can use this phase of life to build a relationship that is more solid than ever before. Infertility can be a common bond, sort of a battle scar shared by soldiers in the same unit. By keeping your eye on each other, not just on achieving pregnancy, you will make it through and have your relationship intact once your fertility is resolved. When couples learn to accept that each person will react, feel and behave differently during this life phase, they are more understanding of their partner. Get help when you get stuck in these areas in order to learn new ways of communicating. When there is a sense of "us" trying to resolve our infertility, the experience itself helps cement relationships and increase the ability to count on your partner. There is a new perception that says "together, we can handle whatever happens and be okay."

Copyright © 2009 Genetics & IVF Institute