SART Statistics are just spring board – a place to start

With the SART statistics recently published there’s been lots of rumblings about some of our beloved clinics and their success rates taking a hit for 2010. I think before we become too concerned about our clinics and their success rates we need to remember the following:
• No two treatment programs are alike; each clinic has its own set of statistics (success rates), protocols, and procedures.
• SART and CDC success reports are always two years behind. For instance at the time of this writing it’s February 2012, and SART’s reports are for 2010. That means that the success rates you are reading for 2010 may not be at all reflective upon current success rates for that specific clinic.
• Becoming familiar with SART and CDC statistics in instrumental to choosing a treatment program. They are a great place to start and can help you narrow your choice of potential clinics.
• While doing your research, keep in mind that statistics are going to fluctuate from year to year for many reasons. That’s why it’s really important to look for success rate trends: Is a clinic generally improving its success rates each year? Are they maintaining and/or growing the number of (DE) cycles they complete each year? Do the statistics illustrate an overall consistency of success?
• The SART success rates for each clinic report a “live birth rate” or what we refer to as a take home baby rate. Some feel this isn’t entirely fair on the part of the infertility clinic because once your Reproductive Endocrinologist releases you to your OBGYN/Perinatologist they have no control over your pregnancy and cease to monitor your pregnancy or its care.
What I am learning is that sometimes it’s virtually impossible to compare clinics and SART rates. Why?
• Some clinics for instance are under one company name but have clinics in different places and they don’t all use the same lab but SART will gather their statistics and lump them into one big fat statistic.
• Individual doctors are listed by success rate – which I think they should be.
• And SART reports on live birth rates, or take home baby rates which I think is unfair. Your clinic should be rated on initial pregnancy or pregnancy to heart beat as measured on ultrasound, not live birth rate. From week 12 to week 40 there’s a lot that can happen and after the first trimester your pregnancy is out of your clinics hands.
So with all this being said – sure start with statistics. But make sure to do your homework and call the clinic you are interested in being treated at. Ask tons of questions – “Are your success rates based on single DE IVF cycles, or are your success rates based on three attempts at your clinic”. Ask about their FET policies. Does the clinic return emails or phone calls in a prompt and timely manner? Is their staff kind and courteous and accurate in the information they relay to you?

It’s not just about the statistics – it’s about the whole package.

Good luck on your DE journey!

It's Really Not Any Of Your Business How I Created My Child -- Is It?

I was at the lab waiting to get my blood drawn  (you know the yearly lipid panel, thyroid, sugar screen.) and sitting across from  me was a woman obviously pregnant who was clearly in her mid to late 40's, and next to  her another woman (who I will fondly refer to as Ms. Nosey Pants or NP for short) about the same age -- all of us waiting to have our blood drawn. We all smiled at one another  making the usual and customary small talk about the weather, how long we are going to have to wait, would summer ever get here, blah blah blah.

A few minutes passed and Ms. NP  pipes up and says "IVF?"  And the pregnant woman shuffled her feet, shifted uncomfortably in her chair,  made eye contact with me and then looked at her seat neighbor and said "Yep, we needed some help."  NP woman nodded and for a second I thought maybe she was going to smile and high five this mom to be and say congratulations, or right on, or something positive.  But no, she narrowed her eyes and said:

"Your egg? or donor egg?"

This poor pregnant mom to be visibly blanched.  And me being me, (well those of you who know me, I just speak my mind and say what I feel) I naturally spoke up and I leaned forward and I said:

"Really?  Why do you ask?"

The look of relief on the pregnant mom's face said it all, and just in the nick of time her name was called and she was up out of that chair faster than you could say Intra Cytoplasmic Sperm Injection. This left me of course to contend  with Ms. Nosey Pants.

Now if this had been any other subject I probably would have left well enough alone after all, "NP" has stuck her nose abruptly into the nearest Readers Digest and was clearly not comfortable herself and doing her best to ignore me. Not being one to leave well enough alone I said "May I talk to you?"  And NP lowered her Readers Digest and said "Are you talking to me?"  As if she'd never seen me before.  And I smiled ever so sweetly and I nodded my head emphatically and said "Yep, I wanted to know if I may talk to you."  The Readers Digest went down upon her lap, she crossed her arms and said "Sure if you'd like what's on your mind?"  And so I smiled and stood up and walked over and took the chair next to hers.  And realizing this made NP even more uncomfortable I said "Really, it's okay, I don't bite."  And smiled again.

I had in mind what I wanted to say which was "Listen, mind your own business and stop going around making others uncomfortable because you are nosey parker."  But I didn't -- I really wanted to know the psychology behind why people ask personal questions. So I just said benignly, "Why did you ask that mother to be if she used her own eggs or donor eggs?"  NP blinked for a few seconds and then said "I was just curious I guess, she looked a little old to be having a baby."  I replied with "Do you have children?"  And she shook her head no, and went on to say that she never wanted children. I nodded and said "I understand that."  She asked me if I had children and I said "Yes, I have one child that I had through egg donation."  This woman turned white and then red, and began to stammer about not thinking before speaking and she was sorry. I told her it was okay, she shouldn't feel weird and that everyone is on their own path in regards to their family building choices.  And so we started this conversation that began sort of in a stilted way -- she asked many questions about egg donation, and why people would choose this way to create their families.  She went on to tell me that when she sees older women and they are pregnant she almost always assumes they used an egg donor and to her that just seemed to weird.  We ended the conversation with me telling her that perhaps because she has no maternal desire to become a mother that any way of family building would be foreign  to her and she agreed.  Her name was then called and she shook my hand, I handed her my card, and off she went.

Shortly after, the pregnant woman walked out of the lab area and past me and she paused and all of the sudden her worlds just came tumbling out --  "Thank you so much, we did do IVF, and I am older and this is donor egg but I am actually a gestational surrogate for my sister.  I have had three kids, and my sister lost her uterus to cancer so I am carrying her egg for her and I didn't feel like launching into the whole explanation with a stranger, it's her story to tell I am just helping her because I love her."  By the time she finished her explanation her eyes were wet.  I immediately stood up and hugged and said to her that she was doing one of the most gracious and giving things ever and she didn't owe anyone an explanation about anything.  We exchanged names and she went on her way.  By now it was my turn to be poked by the lab vampires.

While I sat in the lab I got the same tech I always get.  She's phlebotomist who's studying to become a midwife -- lovely lady who's 40 and really good at what she does.  After we exchanged pleasantries and I commented on how big her kids were getting from the photo on her wall I blurted out "In your travels with drawing blood from pregnant women do you often wonder if the older pregnant women who sit in your chair are using donor egg?"  And my tech shrugged and said "No, not really, and even if I did, I'd never ask because it's non of my beeswax"  I nodded and smiled and shook my head and said "Of course." And she didn't ask me why I asked the question she just continued to draw blood -- before I knew it I was finished and on my way.

Driving home the conversation between the pregnant mother, NP, and myself continued to play over and over in my head -- it was bothersome to me so much so I continued to think about it for several days.  If I met someone who was bald, especially a woman would I ask her if she had Cancer on the premise that most bald women who don't wear scarves probably are bald due to chemotherapy?

Um no.

How about a woman who's face was bruised -- would I ask her if she was a victim of domestic violence?

Um no.

What about someone who was in a wheel chair, or someone who was clearly disabled?  Would I say "Are you paralyzed?" or "Is your child mentally retarded?"

No, no and no.

We don't ask each other how much money we make.  The last person who asked me who I voted for in the presidential election got an "thanks but I don't discuss politics with anyone outside my family". And we certainly don't discuss who got on top, or anything else connected with sex with complete strangers do we?

So why is it okay for complete strangers to ask  "Your egg or donor egg?" 

It's not -- because at the end of the day it's really none of your business how I created my child regardless of how grey my hair is, or how old I may appear to you.

Are we clear? 

Thank you

Is Egg Donation the Right Choice for You?

by David Tourgeman, M.D., HRC Fertility, February 24, 2011
Perhaps the most difficult and emotional decision a person or couple can make when trying to have a child is choosing whether or not egg donation is the correct route for them. For some people, the decision may be relatively straightforward. Perhaps the adoption process has been met with failure, or the woman has premature ovarian failure or another medical conditions in which the ovaries will not produce eggs.

But in most cases, the parents have attempted artificial inseminations (IUIs) and/or in vitro fertilization (IVF) procedures without success, and have been burdened with the bad news of negative pregnancy tests. The decision to move forward with an egg donor was not how they had envisioned becoming parents.

The Issues of Egg Donation
The biggest issue intended parent considering egg donation must confront is deciding if their genetics must play a part or if having a baby (despite the maternal genetic origin) is most important.

Indeed, there have been attempts at using a donor egg for the shell and transferring the genetic material of the intended mother into the donor egg. Unfortunately, this has not been scientifically successful so we are left with the preceding dilemma.

Known Egg Donors
An option that may be considered is a non-anonymous (known) egg donor. Typically, a sibling or relative is chosen, and ideally that family member is less than 35 years of age and has children of her own. This provides a “bridge” in which there is some genetic input, although it is somewhat removed.

There are many patients who choose not to have a known donor because they do not feel comfortable asking, do not have an age-appropriate relative, or simply do not want anyone to know. In this case, we are left with an anonymous (unknown) egg donor.

Anonymous Egg Donors
Choosing an anonymous egg donor is indeed a challenge. There are certainly many things that parents may want to address. Physical attributes and similarities are often paramount. However, intelligence, nationality, and family health issues are also significant.

From a medical standpoint there are also many desired qualities to optimize the likelihood of success. I typically recommend that the donor be less than 30 years old and that she have had testing for ovarian reserve that returned normal. She should have had all appropriate genetic screening tests and have been evaluated by a mental health professional to make sure that there are no ulterior motives. When counseling a couple, I will tell them that in the best scenario an anonymous donor is “proven,” meaning that she has done a cycle of egg donation in the past, produced 15 eggs or more, and the donation resulted in successful pregnancy.

Being Fulfilled as Parents
The most important thing for the person or couple to consider is whether they will be fulfilled as parents when they decide to use a donor egg. The parents will be able to nurture and nourish the baby the way that had been envisioned. There is also an extraordinary bonding that occurs as the mother feels the growing baby.

The pregnancy experience and birthing process is the beginning of parents understanding that, despite the genetic contribution from the egg donor, this baby is their own.

David Tourgeman, M.D. graduated medical school from the University of Southern California in 1994. He completed his residency in Obstetrics and Gynecology in 1998 and his fellowship in the Division of Reproductive Endocrinology and Infertility in 2001 at the University of Southern California, Los Angeles County Women’s and Children’s Hospital. After his fellowship, Dr. Tourgeman became an assistant professor of Obstetrics and Gynecology in USC's Division of Reproductive Endocrinology and Infertility. He began working with HRC Fertility (then Huntington Reproductive Center) in 2005 and currently sees patients in HRC’s Encino and West Los Angeles offices. His areas of interest and studies include assisted reproductive technologies and oocyte donation in women of advanced reproductive age, alternatives for enhancing embryo implantation, advanced reproductive fertility surgery, evaluation of ovulation induction agents, and vaginal hormone administration.