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As mentioned in the previous post, state legislators are pushing forward bills designed to limit family building with reproductive technology and to stop all research with embryos or embryonic cells. We are discovering that underlying this legislation is a non-profit group, the Center for Arizona Policy. It is spending millions of dollars in our state to lobby for "Protecting the Family, Preserving our Future". (see the Arizona Republic article from 3/4/10 at: http://www.azcentral.com/arizonarepublic/news/articles/2010/03/04/20100304center-for-arizona-policy.html#commentformS). The goal of this legislation appears to be to establish the rights of an embryo and to limit research with any embryonic cells. There seems to be a disconnect between what our legislators think this legislation will do and how it will impact the citizens of our state. Legislating values and limiting research potential can be hazardous to our futures; physically, emotionally and economically. Read more in the body of this blog.

The Arizona Legislature will be voting as early as Feb 24, 2010 on four bills, Senate bills 1306 and 1307 and House Bills 2651 and 2652. These bills will effectively end donor egg IVF for infertility patients in Arizona and impair our clinic's ability to offer our patients embryo cryopreservation and preimplantation genetic diagnosis (PGD) of embryos. We will also lose jobs in our state and our patients who need donor egg IVF or PGD may have to travel to other states to have these procedures performed. Violation of these laws will give jail time to the offenders as many inflict Class 6 felony charges.

WE NEED YOUR HELP! Please visit www.azleg.gov to review the bills and then look up the names of your state representatives and senator. Call them immediately to voice your concern over these bills. Please urge your family and friends to do the same. It is time for Arizona residents to speak up and let their elected officials know that these bills are punative to those trying to build families.

RESOLVE has created a link that will allow you to immediately send an e-mail to your representatives. In two minutes you can voice your opinion, please visit:

(http://www.resolve.org/site/PageServer?pagename=ta_stleg_home#Arizona)

Thank you for your help. We need to protect Arizona families from legislation that will restrict family building.

 

We are excited to launch our fresh new web site for 2010. We want you to see our new pages: IVF Costs and IVF Cost, Clinic Comparison. These pages allow you to compare the cost of an IVF cycle with other clinics. Soon, we will be launching some new ideas through the world of Social Media. Watch for us on FaceBook, Twitter and Linked In.

Recently, a couple from Oro Valley (outside of Tucson, Arizona) delivered a set of quintuplets in Phoenix. 5 babies at once! Seems like nothing compared to the octuplets delivered in California in January. No Dr. Phil, no paparazzi, just boring, run of the mill quintuplets, not enough for a reality TV show or diapers for life…..To the parents who have been enduring this challenge (the other option for them was to “reduce” the pregnancy by killing off some of the fetuses, is that really an OPTION?) we wish them only the best and hope that their children will overcome the statistics and that their families will thrive. But was it reasonable to for them to face this challenge because they wanted a child and had to go through fertility therapy to acheive that?

At the Reproductive Health Center, this has prompted us to let you know how we feel about multiple births and what our responsibilities are to our patients. As strong as the desire for a child can be, it is well documented that multiple pregnancies and births are dangerous for both the children and parents. Multiple gestations are an adverse outcome of assisted reproductive technology (ART) and ovulation induction therapies and a responsible medical team should act ethicallyby offering the highest probability of pregnancy while minimizing the chance of delivering multiple babies.

In our practice, we will only transfer two blastocysts to women under the age of 40. Women under the age of 35 are strongly encouraged to have single embryo transfers. Our last set of triplets (the highest number gestation from our IVF program) was conceived in 2006. This prompted our current internal guidelines for embryo transfer. We are striving toward single embryo transfer in all of our transfers.

Our position is:

• That we have a responsibility to our patients, their current children and those yet to be born to keep their lives whole and healthy.
• We are aware that fertility therapy associated multiple gestation constitutes a major physical, psychological and financial challenge to couples, their children and society as a whole.
• Fertility therapy associated multiple gestation remains a challenge nationwide. Preventing the occurrence of fertility related triplets in our practice was our initial goal. Reducing the incidence of twin gestations is our current goal.
• Further progress toward reducing the incidence of IVF assoicated twin pregnancies requires patient education and laboratory improvements. We are currently establishing systems for improved means of assessing embryo quality and uterine cavity receptivity to reduce the percentage of twin pregnancies without affecting the overall pregnancy rate. We are educating our patients about the risks of twin gestations so that they can make responsible choices about how many embryos they choose to transfer.
• We think that the quality of an IVF program should be measured not only by its overall pregnancy rate, but by its ability to maximize the singleton birth rate.

As we strive to help our patients be fruitful and multiply, our goal is to do it ONE gestation at a time…….

Wow, the Internet is a vast space full of information and now video. The other day I was looking up some information about injectable fertility drugs and I came across over 100 videos of people giving themselves fertility injections. I was struck by how some of them were using, what I would consider, antique protocols where they were still mixing "old school" medications. There were mislabeled videos, one in particular shows someone getting an IV (intravenous catheter) started in their arm, it was called "inserting IVF". If I had been a potential patient I would have cancelled my appointment with a fertility specialist right then and there! There is a video of a woman giving herself injections (she is rather overweight and probably has an ovulation disorder) for her IVF cycle. Then you see later, how her now third cycle is cancelled because her estradiol level went above 22,000! What? 22,000! I immediately thought, "who was the doctor who would let this woman even get near that level of estradiol?" This is crazy!

It is very difficult in the Information Age to discern what is appropriate and inappropriate to read, watch or listen to. There is so much out there and it can be frightening and misleading. I am not saying that information is bad, and certainly knowledge is power, however, in this environment patients, physicians, nurses and families need to be concerned with over information and bad information.

When researching information about fertility treatment there are some tried and true places to get accurate, medically reviewed information. My favorite site is sponsored by the American Society of Reproductive Medicine (ASRM). They have a patient portal with valuable, current information on treatment, fertility related diseases, procedures and many other related topics. Other sites like: Resolve, a national support group and Fertile Hope, a site geared to patients who are cancer surviors or have just been diagnosed with cancer; Fertility Journey, sponsored by Organon; and Fertility Lifelines, sponsored by EMD Serono also offer good, medically reviewed information on a variety of fertility related topics.

So, when you are out there looking in this vast space known as the Internet, be aware of the potential for misinformation. Don’t let yourself be sucked into amateur sites with people’s "fertility nightmares". You want the information you receive to empower you, not frighten you.

Patients are always asking: What can I do to improve my chances of pregnancy?

There are lots and lots of information on the internet about fertility therapy and treatment. Some of it is good information and some of it is not. Here is what we have discovered after many years of treating patients.

1. Seek qualified medical treatment early. If you are having trouble conceiving, seek the assistance of a Reproductive Endocrinologist and Infertility specialist sooner rather than later. Many people wait to seek assistance, often turning what would have been an easy problem to fix into a very difficult situation.

2. Your general health contributes to your reproductive health. Diet and nutrition play key roles in reproductive success. Exercise is also a fundamental of successful pregnancy. Our recommendations are as follows:

Eat a well balanced diet that is primarily plant based. Eliminate junk food and foods that are processed. Read labels, if the label has ingredients that you cannot pronounce or you cannot identify, DO NOT EAT IT. Avoid modified corn starch and high fructose corn syrup, potatoes, artificial sugars and more than one serving of red meat per week. Diets that are rich in salmon and sardines, walnuts, flax seed and other high Omega 3 foods are crucial to healthy conception and pregnancy. Whole fat dairy (equivalent to one 8 oz serving per day) like milk, cheese and yoghurt (without sugar or sugar substitutes) are proving to be instrumental in the production of good quality oocytes (eggs).

Exercise at least one hour per day! There are no excuses. Walking, weight training, swimming, bike riding, dancing, exercise classes, the list is endless. Mix it up, have some fun. Turn off the TV and computer. Not only will this improve your chances of conception, but it will reduce your risk of diabetes, heart disease, stroke, obesity and cancer. We could go on and on….

Acupuncture improves fertility. Patients undergoing IVF who had acupuncture improved their chances of conception from one in five to one in three.

3. Your mind has a powerful influence on fertility. How you think and feel and your stress levels influence your reproductive success. Playing the tape that you are inadequate and cannot have a baby in your head actually influence your ability to have a baby. Stress produces hormones in our body that are contradictory to conception. This goes back to our primitive days when wild animals were chasing us and we had to hunt and gather our food. If a woman did not have enough to eat and was being stalked by a tiger, her body would stop ovulating. Why? Because it would be a very bad time to be pregnant, the baby and the mother would not survive. Our brains have not evolved enough to differentiate between tiger and job stress and panic over not being able to conceive. That is why programs like the Mind-Body Medicine Skills Group were developed. Patients who complete the program are twice as likely to conceive as those who do not. The program actually teaches patients how to decrease stress and focus the powerful energy of the mind on a positive outcome.

Our practice strives to integrate all aspects of fertility treatment; technology and medication with wellness and mindfulness. Infertility affects the whole person, not just the reproductive organs.

Be healthy and fruitful!

With so much information in the popular media about women in their 40’s and sometimes even in their 50’s conceiving and having children, we get many questions from patients about IVF for women in these age ranges.

Your reproductive system ages faster than you may realize. A woman’s fertility potential declines with age, mostly due to the decline in numbers of eggs in her ovaries and their quality. This is why women in their late 30s and 40s have a decreased ability to become pregnant and an increased rate of miscarriage. Approximately one-third of couples in which the female partner is age 35 or older will have some problems with fertility.

So, how are these women getting pregnant in their 40s and 50s? Some are very lucky. Between the ages of 40 and 42, with decent ovarian reserve (there are many ways of testing for this from FSH levels to clomid challenge test to antral follicle count) there is still a resonable chance of pregnancy with in vitro fertilization and/or with ovulation induction and insemination. However, after the age of 42, the chance of pregnancy with your own eggs, regardless of the method of treatment, drops to the lower single digits (between 1 and 6%) per cycle attempt.

Many women over the age of 42 who are doing IVF are doing it with donor eggs (typically from a woman in her 20’s). Using donor eggs increases the chance of pregnancy to above 50% and decreases the miscarriage risk. Women over 40 who are pursuing this option need to be in good basic health and have a physical exam and basic blood work before becoming pregnant.

So, what if you are 45 and want to have a baby? It is possible, it just may not be possible at this time using your own eggs.

Dear Patients and Potential Patients;

We are excited to use this new technology to give our patients information about our practice and to be able to discuss new developments in infertility. As a starting point, we invite you to e-mail us at info@ivftucson.com and let us know what you are interested in learning about. Would you like to know more about nutrition and fertility or about special techniques used to improve pregnancy rates? How about our stand on multiple gestations or how stress influences conception? Your input will be appreciated so that we can tailor this space to your needs.

So, send us your thoughts and check back with us in a few days for the first real posting…..

Cheers,

Dr. Scot Hutchison