Happenings...

I read a few interesting articles lately:

Fertility experts will meet in Arusha, Tanzania, this weekend under the auspices of the European Society of Human Reproduction and Embryology to discuss the challenges of infertility in Africa at the first conference on infertility in developing countries. Their goal is to develop a low-cost version of IVF, making in vitro fertilization available to couples worldwide - including those in developing countries, where infertility is often so strong a stigma that it often results in social isolation & sometimes even in suicide. Perhaps this research will help make IVF more affordable and safer everywhere.

A 48-year-old Minnesota woman is pregnant after using an egg that was frozen, thawed and fertilized before being transferred to her uterus. Dr. Jacques Stassart of Reproductive Medicine and Infertility Associates in Woodbury, Minnesota said that the technique is still experimental but that his clinic will offer it on a case-to-case basis. There have been other cases like this, but not too many. I think egg freezing is an amazing option, but that care needs to be used in choosing the women to be treated. Someone needs to be looking out for the future children as well - those who may be born to women at practically any age.

A change in Victorian law will now allow access to IVF treatment for single moms and lesbian couples. It seems to make more sense to allow them access to insemination - why go straight to IVF if there are no fertility issues?

And last, but definitely not least, I really enjoyed Bea's posts about the value we place on being parents (she actually asked how many years of our lives we would be willing to give up to successfully become parents). I chose the odd-woman-out answer (as I often do) but I really enjoyed reading all of the other answers as well. In many ways, this reminds me of how frustrated I felt reading Stumbling on Happiness (by Daniel Gilbert) in which he presents research showing that we're actually less happy once we have children, but doesn't compare it to the alternative of not being able to have children.


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P.S. Tomorrow's our growth scan. This will be the first in over 10 weeks(!) I 'get' to do it a week early because despite having done two 100-gram-GTT's this pregnancy, I am still at risk for gestational diabetes.

Swapped Babies - Update

In October, I posted a scary story about babies in the Czech Republic who had been swapped at birth. Since discovering the mistake, both sets of parents have been trying to find a solution that everyone involved would feel comfortable with. A few days ago, both girls went to live with their biological families.



On another topic, Malky wrote yesterday about my being open with my kids about having gone through fertility treatments to have them. I never thought not to share it with them... and they probably do know more about IVF than the average adult. Easier to talk about than sex, no? :-)
What will you tell your child(ren)?

I lost a client!

I just got a call from someone who's been buying pregnancy strips from me for nearly 2 years, in packages of 10 (just once every few months). He called to tell me that his wife had gotten an early positive, waited another day & went to take a blood test. It was positive :-) He said that at first they were sure the test must be off (been there myself :-))... I'm so happy for them.

In other news, I read an interesting article about the use of IVF in HIV-discordant couples - particularly where the husband is HIV positive and the wife is HIV negative. Apparently, with the use of ICSI, they can guaranteed that the baby will not have AIDS.

Up (in the night) dates

My yeast infection (if that's really what it was) seems to be long gone (yay!) I must really have caught it early because I didn't have any of the typical symptoms and it was gone after about a day (don't worry, I'm continuing the full course of treatment because I really don't want it to come back).

I wake up about 3 times during an average night. Either I'm connected to an IV without knowing about it or I drink much more than I think I do... I could say it has to do with pressure on the bladder or something, but the truth is that this has been happening to me ever since I moved out of the dorms (about 20 years ago), when I probably should have gotten up in the middle of the night, but was too lazy to.

One thing I'm thankful for is that in my pregnancies with both Abigail & Nomi, I was wearing a very sexy pregnancy belt by this point (no, that is NOT me in the picture though it is about the size of my belly). Fortunately, this time, I'm not suffering (so far) from symphysis pubis pain (I had it on the debilitating side & the belt really did make it possible for me to do things like walk.) What you can't see in the picture is that it has these two huge velcro straps that you have to undo anytime you need to use the ladies' room. I am enjoying every day that I don't need it...

On another note, I read Bea's cross-fertilization post (great, as all her posts are), which spoke about the idea of just letting her belly tell all and it reminded me of two things that happened to me last week - first, when I went to pick up the prescription, the pharmacist told me not to used the medicine during my period. I nearly cracked up in her face, but decided not to embarrass her, so I just smiled. Second, my neighbor (who I see almost every day) stopped by and suddenly, mid-sentence her jaw fell when she noticed...

In other news, I'm currently in the early stages of writing a seminar paper that has to do with IVF - the specifics aren't closed yet, but it has made me wonder about women's desire for twins...

The Weird Thing About Telling So Late

When I was going through IVF, I told people even before there was a chance I'd be pregnant. I didn't particularly enjoy my family & friends going through the 2ww with me, but the whole process was so intense that everyone ended up knowing. Clearly, as soon as the results were in, everyone knew that too...

This time, Ohad & I really enjoyed having a secret (we didn't even really feel any need to tell when we did)... we knew I was pregnant when Yedda offered to send me to BlogHer & we knew when I ordered the tickets to take Lilach to Croatia. I was careful when I tore through the airport in Atlanta trying to catch my flight (I did) and I avoided riding a gondola in Venice because I get seasick easily even when I'm not pregnant... I was also careful not to volunteer for anything at the school...

When we announced this pregnancy at the end of the 16th week, it was still not obvious. I could still wear my normal clothes for a few weeks, but now (it seems way too suddenly) I'm wearing maternity clothes and it's clear I'm pregnant.

I guess a pregnancy becomes 'real' for me at a many different points:

- a positive home pregnancy test

- a positive beta test (blood)

- the first ultrasound when I see a heartbeat

- the first ultrasound when the fetus begins to look like a baby

- when my ordinary clothes stop fitting

- the first time I *definitely* feel the baby kick

- when people can tell by looking at me and...

- when we tell people.

But maybe this one (telling people, especially family) has more weight, because when other people know, it's no longer just a fantasy (that for some odd reason the ultrasound machine seems to believe), it's not only part of my life, but part of theirs too...

In any case, it's fun that it's gone by so quickly, just strange.

On Saturday, we finish 24 weeks.

First UK IVM Babies Born

On October 18th, the first babies created using the IVM procedure (which I blogged about in February 2006) in the UK were born - a set of boy/girl twins!

See some articles here and here.

I find this so exciting, as it's a real opportunity for women whose risk of OHSS is too high for them to go through standard IVF cycles.

Congratulations to the new parents & babies!

A week into the wait

Not that wait. The wait for the results of the amnio (expected to be 2-1/2 to 3 weeks). Since the amnio, I've been somewhat sluggish, suddenly feeling more tired than before. I can still wear most of my regular clothes, but they are beginning to get tight (total weight gain so far ~6lbs). I am feeling UI (ubar Inbar) move much more recently - many times a day.

Abigail (now 2-1/2) knows to say that the baby grows in the uterus. Today at dinner she told us that she has a little uterus and so when she has a little baby she will be able to put it there. I wanted to tell her that I hope she won't have to go through that :-)

I am pretty much back to doing everything I did before, though I've yet to wash the floor. You really don't want to see my floor when it hasn't been washed for 2 weeks. Maybe tomorrow. My doctor told me to keep things low key for a whole week.
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For anyone who's interested, I fixed up the download page for the free IVF guide. I think it actually makes it possible to understand where you're supposed to click.

Introducing me in 10 seconds...

The current task is to try to introduce myself in ten seconds or less... Here's my attempt:


I'm 38, married & a work-at-home mom. I've lived in Israel since I turned 16. I have more ideas than time & lots of dreams for the future.

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I started this blog as a platform to answer questions, discuss various infertility topics and present news and research. Sometimes (especially recently) I talk about my life. It's kind of tricky, because I write about infertility (of which I am a survivor) but I actually have a house full of kids (5, 3 conceived with the help of IVF).

I have really enjoyed becoming a part of the infertility blogosphere and as time goes by, more and more of the blogs I read have become mommy-blogs. I get teary-eyed just thinking about it.

Better late than never?

OK, so this was the week of the virtual world tour and it took me too long to get the pictures and then to transfer them to my computer. Here they are anyway...

On Tuesday, I drove to Hadassah Ein Kerem hospital in Jerusalem. This is where I had my first successful IVF.


We drove via Mevasseret, kind of the 'back roads' - closer & less traffic.

Here's Hadassah Ein Kerem (not to be confused with the other Hadassah hospital at Mount Scopus) up on the hill.

Getting closer...

The new Mother and Child Center. It's actually not that new anymore, but it wasn't around when I was doing IVF there.

The famous Chagall Synagogue (hiding behind the bus stop). We were kind of in a rush...

This is Hadas, my IVF baby that was 'made' and born at Hadassah Ein Kerem. (The similarity between her name & the name of the hospital is coincidental.)

Special thanks to Hadas who took all the pictures, except this last one :-)

Some really good news

Beth, after the most horrible pregnancy ever, welcomed her daughter on Thursday! Congratulations!!!

Amillia Taylor an IVF baby born at just 21 weeks and 6 days, was released from the hospital and her prognosis is good!

Faith's second beta looks good - this is her first IVF/ICSI cycle.

Other's I've missed?

Ovarian Transplants

Stacy sent in the most incredible story - at 25 she was diagnosed with premature ovarian failure & her FSH was over 100. She was told she would never be able to have children of her own. Fortunately, Stacy had a trick up her sleeve. She is an identical twin, so she asked her sister to donate eggs & went through IVF with the eggs that would hopefully give her and her husband children that, genetically, would be identical to those she should have been able to have naturally. But the IVF failed & Stacy and her sister were devastated, until they heard about ovarian tissue transplants.

Ovarian transplant is currently only available to identical twins and as far as I can tell, it's only being done at St. Luke's Hospital in St. Louis, Missouri. The most famous case is of Stephanie Yarber, who is the first woman to have delivered a baby after ovarian transplant (includes a video of the doctor who delivered the baby), but since then, at least 4 others have delivered healthy babies.

Wow.

IVF babies become parents

I was shocked to see this article (2 articles about the same birth) today. Not because it is shocking that the world's first IVF baby, Louise Brown, has become a mom, but because earlier today I was thinking that there must already be a second generation after IVF... Louise's sister, Natalie was the first IVF baby to become a mom. Pretty cool.

After dealing with all the "is she normal?" questions about my daughter, it feels like another reassurance that there isn't anything different about being a test-tube baby. (And believe me, I get the weirdest letters about the effect of light on the embryos in the lab.)

Congratulations, Louise :-) and a special congratulations to her parents who worked so long & made such an effort to have her & by doing so proved that it was possible.

IVF in a war zone

Picture this. You're supposed to go in for IVF early Sunday morning and the city in which you live is bombarded with Katyusha rockets on Friday night and Saturday... You get your trigger shot as you're anxiously watching the news and hoping and praying that things aren't going to be so bad by Sunday that your retrieval won't be able to go on as planned. (From what I understand you *have* to have the retrieval if you've had the trigger shot, so it seems that the retrievals will go on as planned.)

I went through my first IVF cycle at Haifa's Rambam Hospital. Picturing the women going in today was scary. I checked in at one of the forums I read - some messages were like this message from 'honey', "If you need a place to stay, I live in {name of city} and you're welcome to stay with me. My fridge is equipped with Decapeptyl, Progynova, Endometrin, and Pregnyl - so we're in good shape." or this from 'Lilach81' - "We live up north and are currently staying in the center of the country. I have an appointment today which I (obviously) can't make - I need advice from women in this area about a doctor who can perform an ultrasound and blood tests for me..." (At least there's socialized medicine in Israel, so cost won't be a factor in most cases.)

I can only imagine what these women are going through. Going through IVF is stressful enough without it being performed in a war zone... I want to send my best wishes to those women on both sides of the border who are going through IVF at this difficult time.

One in a million

3 million IVF babies have been born. Wow. Pretty amazing if you think of it. If you multiply that by the average number of cycles it took before viable pregnancies and then multiply that by the average number of shots each woman got... well... I don't even want to think of those numbers.

As I read the article I thought - one out of each million IVF babies born so far in the world is mine :-)

Today my oldest daughter (IVF, conceived after 3 years of infertility) had the Bat Mitzvah party for her friends. We rented a screening room at the new movie theater in town and the kids got popcorn & drinks & watched a movie. The mess stayed there - good thing too - I would have run out of bags for my vacuum cleaner...

Anyway, earlier in the day I had taken her to a mall about 30 minutes from here (to buy something to wear), in a place where I had lived for a few months in 1997. The only thing that made my time living there bearable was my friend P. who had IVF-ICSI twins (they're 11 now). When I drove there today, I remembered how funny P. was when people used to ask her if they were 'natural' - she pretended not to understand and said things like, "they have candy once in a while"... I thought about her again today when I came across an article about a study done on children born by ICSI. It says that they've studied kids who are 8-years-old and that they're doing well. 8? I think ICSI's been around for about 15 years, so why are the oldest kids who are being studied only 8?

As opposed to IVF where the sperm fertilizes the egg naturally (albeit in a lab), with ICSI, a single sperm is injected into the ova. It's pretty easy to understand why this might be a riskier process... From the data presented, it looks like children born as a result of ICSI are pretty much the same as children conceived naturally - they mention that the higher incidence of malformations found among ICSI children is probably a result of the genetics of the parents who end up going for ICSI & not the process itself.

Happy Birthday to my IVF-FET Babies! Babies?

I can't believe it. It was almost exactly 11 years ago that I had my eggs aspirated for the fourth time. My oldest daughter, now 12-1/2 wasn't 2 yet and I was worried she would remain an only child forever. She was born after nearly 4-1/2 years of marriage, a result of my second IVF cycle.

When she was 6 months old, I was ready to try again. I had traveled to visit my parents in the US and I came back sick. It wasn't clear what it was I was sick with. Tens of tests and nearly a year later, a professor who headed the Internal Medicine ward was convinced it was Hodgkin's Disease. He sent me for bone marrow aspiration. As I expected, the results were fine. With no more ideas or tests left to run, the doctor finally diagnosed me with CFS – chronic fatigue syndrome.

I read up on CFS & understood that the fever might take years to go away. More surprisingly, I came across research that showed that pregnancy often cures CFS. (I looked for information about this now & found a question & answer session with Dr.Charles Lapp - where he was asked about his experience with pregnancy in CFIDS. He answered that about two-thirds of patients get better during the course of pregnancy.) With this information, I decided to go ahead with the IVF treatment despite the fact that the IVF department advised against it.

The first cycle failed (4 embryos, no pregnancy). The second cycle, on June 6, 1995, resulted in 8 embryos - four were transferred and four were frozen. The transfer failed. Next was the frozen transfer cycle. The frozen embryos had been graded B,C,C & D, but all survived the thaw and we transferred all four. On the 11th day after the transfer, I started bleeding. A pregnancy test showed a faint pink line... but when I went for the pregnancy test at the hospital a few days later, I was convinced it was over. Later that day, I was shocked to hear that my beta was 600.

In the first ultrasound, I saw three sacs. About two weeks later, on my daughter's second birthday, after a bout of heavy bleeding and cramping, I was amazed to see a heartbeat... and another heartbeat... twins!

My CFS did go away sometime during the pregnancy. Those little hearts kept on beating until they were born at the end of 39 weeks of pregnancy - on June 6, 1996 - exactly a year after they were formed.

I want to wish a very happy birthday to Harry and Judy, my miracle babies who are turning 10 on 06/06/06 :-)

How many embryos should I transfer?

I got the following question in my mail today:

"Hi, I'm in the process of going through donor egg after many failed IVF cycles. My doctor has advised that we have 2 embryos transferred but I am concerned of the risks - mainly of health issues that can occur from delivering premature babies which is usually the case with twins."

Tough question. I looked up the research that's been done on the topic and found the following review of research from The Cochrane Library, Issue 1, 2006(http://www.cochrane.org/reviews/en/ab003416.html):

In simple terms, when transferring two embryos you raise both the likelihood of achieving pregnancy and the likelihood of twins. Following is a quote with the statistical data removed:

"The clinical pregnancy rate per woman/couple associated with two embryo transfer was significantly higher compared to single embryo transfer. The live birth rate per woman/couple associated with two embryo transfer was also significantly higher than that associated with single embryo transfer. The multiple pregnancy rate was significantly lower in women who had single embryo transfer. "

In the research led by Dr. Ann Thurin, from Sahlgrenska University Hospital (http://www.brightsurf.com/news/june_04/ESHRE_news_063004_b.php) the transfer of single embryos (SET) was compared to double embryo transfer (DET) and the rate of pregnancies after the transfer of two embryos was not very different (39.7% vs. 43%). However, many of those opting for SET had to go through an additional frozen transfer cycle to transfer the second embryo.

With regard to twin prematurity, in a French study (Rufat et al., 1994) of 1263 IVF pregnancies, the prematurity rate (less than 37 weeks of amenorrhoea) in twins was 43.8% compared with 12.2% in singletons, the corresponding figures were 13.9 and 2.9% for extreme prematurity (less than 33 weeks of amenorrhoea). Indeed, at least according to this study, having a twin pregnancy more than triples the risk of prematurity. In this article - (the abstract is in English, the article in French), there's some good news - early diagnosis of twin pregnancy by ultrasound and subsequent treatment (resting at home and regular clinical examination of the cervix) was successful in reducing the rate of prematurity.

When I was going through IVF (Rachel's story), it was common to transfer 4 embryos, which I did 4 times. Two of those cycles failed, one resulted in the birth of a singleton and one in the development of three sacs - 2 of which became embryos and resulted in the birth of twins. In my last IVF cycle, I transferred two embryos and became pregnant with a singleton (I later miscarried due to a large uterine hematoma).

My experience was that carrying twins was a bigger strain on the body. During my twin pregnancy I was much more susceptible to illness and even spent a few miserable days in the hospital hooked up to an IV after I came down with a mysterious (non-pregnancy related) virus in my mouth. I was lucky to have an uncomplicated pregnancy that continued through the 39th week, when my doctor decided to strip my membranes to induce labor.

Carrying twins, of course, is not the only issue. Once they're born, you have two babies to take care of... quite a challenge. I read this very insightful blog entry on Infertility Is Funny. I think she captured well what being a new mom is like. Multiply that (at least) times two if you're thinking of twins...

The decision of how many embryos to transfer is not an easy one. I think today I'm actually glad I didn't have all the information in front of me when I made my decision.

IVM - In Vitro Egg Maturation. A Way to Avoid Ovarian Hyperstimulation Syndrome

I just read an interesting article about IVM - in vitro egg maturation. The method, according to the article, isn't new, but so far only about 300 babies have been born using it. Its main advantage is that it allows a short treatment cycle (3 days of medications) after which the immature ova are obtained. This significantly reduces (or perhaps completely eliminates) the risk of ovarian hyperstimulation syndrome (OHSS). For women who have suffered OHSS and are afraid to go through another IVF cycle or have been told by their doctor that it is too risky, IVM can be a last-resort by which they could still have a baby of their own.

The article specifically mentions women with polycystic ovarian syndrome as good candidates for IVM. I actually never knew that having PCOS put women at higher risk for ovarian hyperstimulation, but apparently, as mentioned in this article (by a center offering IVM), it does.

One disadvantage of in vitro egg maturation is that frequently the outer part of the egg becomes practically impenetrable - the sperm just can't get in, requiring intracytoplasmic sperm injection (ICSI) to be performed. Another disadvantage is that the ova are extremely sensitive and therefore need to be tracked very carefully as they are being matured in the lab. Both of these issues raise the costs associated with the procedure (compared to regular IVF), though the cost is likely to be offset by the much lower cost of medications used to stimulate egg production and the savings due to having less blood tests and ultrasounds (because of the shorter stimulation protocol).

IVM can also be used with regular IVF cycles, when despite a regular stimulation protocol many immature oocytes are obtained, so it can also give couples going through IVF more eggs, meaning that they will have more embryos to freeze for future cycles.

I'm always encouraged to hear that there are more and more solutions for infertility. If IVM can be perfected, perhaps someday in the not-too-distant future, it can replace today's method (usually 1-2 weeks of daily injections) that puts a great strain on women's bodies and consumes so much of their time and energy.

Quads or double-twins?

This morning I got an email from my father about an incredible story. Two women (life partners), after many failed attempts to conceive, went through the process of IVF using the eggs of one and donor insemination. The resulting embryos were transferred to both women and they both conceived twins(!) and gave birth a week apart. Their babies are considered quadruplets that were carried by two women - they are full genetic siblings. The story that appears in The Marin Independent Journal includes a picture of the women with their children.

It was encouraging to read that the women seem really focused on raising their children and that they've got things as "under control" as possible (they do have 4 babies under a month old in their house).

It's a pretty unique success story. I wish them a lot of luck and a peaceful night here and there!

Not what infertility treatment is all about...

I read this article (Clinics prepare for 'lifestyle' fertility treatment) in The Guardian. It talks about offering egg freezing and sperm freezing for people who are delaying childbearing as a life choice -- they specifically mention women who will choose to conceive after the age of 50(!).

My first response was to write my mom who I can always count on to agree with me about such matters. I just sent the link and the phrase my oldest daughter coined when she was about 5 (though she used it about someone who'd double-parked badly) - "that is SO 'come on'".

My mom and I both had babies in our 20's and 30's. She gave birth to my oldest brother just before turning 22. I had my first baby (by IVF, after almost 4-1/2 years of marriage) at 24-1/2. My mom had her last baby at 32-1/2. She felt old. I felt old when I gave birth to my youngest daughter last year, at 35. The old I felt wasn't related to my body or the way I look at life. It was the thought that at my daughter's high school graduation I'd be 53. That by the time she has children I could easily be in my 60's. Hardly a young grandmother...

Obviously I believe in fertility treatments for people who are trying to conceive, but I think there's a point at which it's not in the best interest of the baby who is going to be born. Once you've got the eggs of a woman who's now in her 50's thawed, who's going to stop her from transferring 2 or 3 embryos. Imagine a woman at 54 with triplets... You might say, "COOL!" or that it's her choice, but think about the poor kids explaining to the kids in their nursery school that it isn't Grandma dropping them off, or in elementary school with a father who's starting to experience the signs of old age. By the time they graduate college, they might be looking into old age homes for their parents...

I'm 36 and my parents are still young. That's pretty cool. I hope they'll stick around to see my grandchildren and hopefully dance at their weddings. For now, they've got a great social life. They travel. They enjoy their 20 grandchildren (and are expecting another...) and I can call them up whenever I have questions or if I need to comment on the newscaster's bad haircut.

There are choices we need to make in life and if having a family is high on our list of priorities, we should get started before it's too late. I know it doesn't always work and that sometimes things take years, but to delay starting your family until you're over 50 really seems to be pushing it.