How to Make a Family: The Blog

Fertility Experts Breathe 2009 Out. 2010? Deep Breath In and... Hold.

You know that old "when it rains, it pours" feeling? The trick to living is not so much to avoid the rough spots but to learn from them.

It was a rough year for repro med, and the experts are taking some time out today to process  accordingly.

The OctoMom Debacle. Enough said.

Then there's this recent NYT article by Stephanie Saul that highlights the ongoing scary confusion surrounding surrogacy sans boundaries.

Frankly, if I had more time to cruise the Web and find references to all of the metaphorical blazes and infernos that have erupted out of our collectively desperate clinging to notions about baby-making and our related apprehensions toward taking firm stances... well, it probably wouldn't be all that interesting anyway. At least, not to people who just want to have a baby, or maybe only in a sort of 'staring at the train wreck' way.

I'm glad to see that fertility treatment leaders are convening today to sort out "Where we are, where should we go?" at meeting in DC on "The Adequacy of Assisted Reproductive Technology Oversight".

Just to be clear, even regulations on fertility treatment, once they finally come down the pike (and they will) offer no guarantees that people will be anything other than consistently human. The UK's HFEA has been ahead of the game for years, and they still have their share of IVF Blunders.

But man, it's a good thing to see the US docs putting their heads together. No doubt today will feel a bit like a debriefing session with a jittery sigh of relief that this year is nearly gone. I'm looking forward to whatever comes out of DC's Mandarin Oriental Hotel today. I just wish Sean Tipton and his ASRM Media team were better at using Twitter.

Sticks & Stones

Today, the American Society for Reproductive Medicine reminded us that words wield power.

On the same day, I've been asked by separate entities to (a) bend the truth in writing and (b) craft readable messages for patients -- on a gratis basis.

Ah, the life of a Mighty Wordsmith.

First, the ASRM notified us mediafolk that the World Health Organization and International Committee for Monitoring Assisted Reproductive Technologies have released a new glossary of ART terminology. Included is the heavily applauded, clear definition of infertility as “a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.”

Adding 34 terms to the original glossary, the revision (published as a 'special contribution' in both Fertility & Sterility and Human Reproduction) emphasized words that define outcome measures, safety, and efficacy.

Later, the ASRM's Ethics Committee issued a report decrying the use of adoption terminology in relationship to embryos. The vast majority of fertility specialists prefer a strictly clinical stance on the subject of embryo donation.

According to Dr. Robert Brzyski, Committee Chair, "Home visits, judicial review and other adoption procedures are not necessary and not appropriate for a patient whose care entails what is most accurately characterized medically as a tissue donation."

These attempts at careful fine-tuning of our perceptions come just before a national meeting has been called to discuss "The Adequacy of ART Oversight" in December.

This feels like real progress on the parts of fertility industry leaders. Now, let's see if we can get the parallel services (like websites) to recognize the truly crucial value of words.

Sources:

Zegers-Hochschild et al, International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) revised glossary of ART terminology, 2009 Fertility and Sterility,  November 2009, Volume 92, Issue 5, pp. 1520-1524.

The Ethics Committee of the American Society for Reproductive Medicine, American Society for Reproductive Medicine: Defining embryo donation, Fertility and Sterility, Vol.92, No.6, December 2009.

UK Fertility Show Offers Plenty of Compassion Ops

Infertility pros from around the world descended upon London recently for what was apparently well-named The Fertility Show. I have to say, I got a kick out of reading Claudia Connell's 'undercover' piece from the MailOnline.

And naturally, some readers responded with hurt and angry feelings.

I didn't get the clear impression that Claudia was being insulting toward people who seek fertility treatment. Rather, it seemed that her main digs were square on the noses of the fertility industry, healthcare professionals whose lives are supported by offering (promoting?) the use of assisted reproductive technology.
 
She even took a few swipes at psychosocial support group, More to Life, which serves those who in the end are calling the baby chase quits. (Surely the beleaguered MTL'ers who commented on the article are familiar with the concept that 'bad' attention is still attention.)

According to her article, more than 80 exhibitors were present at London's Olympia hall, and some of them had traipsed over from the United States. Frankly, I find that funny -- as we waffle over here about whether or not everyone should have access to life-saving medical treatment, a small contingent of pros break free to go sell, I mean, offer life-making treatment to people with national health care.

My opinion: Claudia snarkily called out the industry with more humor than I could've mustered if I was in her 40-something no-child-yet shoes. Touché.
 

Meanwhile... Coming Soon: Dining & Drinks in Atlanta! It's ASRM Time!

Did I really go all the way through September and half of October sans fresh blogpost?!

:::the Blog Goddesses shudder:::

Yes, and I'd gladly do it again for the same reasons, those being wrapped up in a (for once) pleasingly busy life away from the Blogosphere.

Besides, we're all about to be inundated with the Latest, Greatest, Bestest, Most Advanced, Most Alarming, Most Contrived Reproductive Medicine News that hits the America's every year around this time...

Live from Atlanta, it's the 65th Annual Meeting of the American Society for Reproductive Medicine!

(Check out their count-down to the Big Event... )

So, although I feel a twinge of competitive guilt about my recent blog-silence, my sense of irresponsibility is mildly assuaged just by knowing that the ether will soon be filled with the happiest sounds of baby-making marketing. Again.

(And -- just to clarify -- I will never, ever be posting blognotes by 8 AM each day, even when life is dull.)

AP Reports Fertility Experts Standing By To Assist In Epidemic!

Oh, dear. We're apparently experiencing "an infertility epidemic" -- and I thought swine flu was still all the rage. Even cancer.

But according to Sherman Silber (Infertility Center of St Louis' director), we're smack dab in the middle of a -- depending on which definition you choose -- widely prevalent event that may or may not have spread rapidly to affect many individuals in a population at the same time.

Hm. Okay, I guess technically and in a really scientifically dry way, the incidence of infertility could be referred to as being in epidemic proportions. Seems a stretch to me, though, to use such terminology in this day and age when far scarier things are diffusing through the world. Besides the aforementioned health problems, how about unemployment?

Dr. Silber's not new to romancing the press, and he's had a special focus on avant garde fertility preservation techniques for awhile now. His most recent cry for alarm was published by MSNBC in this Associated Press piece about his attempts at whole ovary cryopreservation. 

I don't have a problem with fertility preservation, even though this particular technique seems a tad outlandish. Some of the report's statements -- like about "fighting" biological clocks and how it's "typical" to remove/reimplant ovaries to avoid cancer treatment's toxicity -- make me curious about which AP editor wrote this report. Still I'm glad to hear Pasquale Patrizio of Yale introduce his brand of balanced foresight to the conversation.

I expect hype in marketing pieces, not in AP stories. But I'm keeping my eyes peeled for more since it's ESHRE time.

I'm also still looking for a swine flu comeback.

Changes On Horizon For Fertile Hope

Fertile Hope is the only organization of its kind, and the work they do is vital to the lives of cancer survivors who long for parenthood. So I'm happy to hear Lindsay Nohr Beck describe FH's upcoming changes with excitement.

As reported in her blog here, FH's hotline and their unique Sharing Hope financial assistance program will be administered by the Lance Armstrong Foundation, just as those of us who caught wind of the changes had hoped.

It is disconcerting (but not surprising) that their programs targeting oncology professionals are "currently on-hold." Word is that Lindsay and her dedicated team have had an ongoing hard time convincing myriad cancer centers to do what sounds like such a simple thing -- make fertility preservation education a standard of care for cancer patients; hence their surprisingly small list of Centers of Excellence. It follows, I guess, sadly, that FH's Professional Education program is also pending.

So the Lance Armstrong Foundation is taking up the FH charge to educate patients -- about how they can have more fulfilling lives after cancer, as parents. Having seen the pervasive disconnect between oncology specialists and fertility experts, with patients caught in the middle, I hope that relationships can be secured so Fertile Hope can continue and even broaden their efforts to educate the professionals serving people with cancer.

Polyanna & the Real World of Reproductive Competition

For those who give some credit to physicians for our achievement of deep-seated baby-making dreams, it's hard to see those specialists in any light other than near-savior. Without them, we think, our lives would be incomplete. Those who come behind us striving for similar completion are quick to search out our recommendations and hold fast to the emotion-laden comments scattered on Internet forums and by word-of-mouth.

When news unfolds revealing fertility specialists -- especially renowned ones, like those featured in this LA Times article by Alan Zarembo -- as rather typical humans, complete with faults
like greed and deceit... it can bring about a feeling akin to the shivering yuckies. "Ew. He/She played a big part in the creation of the fruit of my own loins..."

Of course, not all of us experience similar moral heeby-jeebies (see previous posts on OctoMom), but I like to think the world has more reasonable and good-hearted folks than money-grubbers.

Am I really just Polyanna With An Attitude?

Recession, Supply & Demand, & Making Babies

A Boston Globe article by Bella English points out the obvious: egg and sperm donations are rising as the economy declines.

There's gold in them thar gonads, folks.

The agencies involved -- those who work hard to match up IP's (intended parents) with third parties such as egg donors, sperm donors, and surrogates -- are ecstatic. Makes part of their job easier, don't ya know.

I'm curious to see if an improbable imbalance comes true. After all, fertility treatment - no matter how bad the desire for a birth child - is elective medical care. We can talk all we like about how infertility is a medical condition. You may think you're dying inside, but the truth is that not getting pregnant and not having a baby won't kill you. My guess is that many folks who find their incomes and reserves trimmed back will be choosing to keep the lights on before they opt for expensive third-party fertility treatment.

But then, having a few thousand extra eggs and sperm waiting around and possibly go unused in the end isn't quite as bad as the 6-figures worth of embryos that are in a similar state of limbo.

Thanks to Amy Demma's Facebook post for drawing attention to this Boston Globe article.

TTC'ers to Tuplets Media Frenzy: Are You Through Yet?

My "regular" i.e. "fertile" friends (which isn't a fair description because some of them very well may be subfertile and not even know it and for a whole lot of them, it's just not an issue at all) are giggling behind my back. They see the frenetic pace and focus of my work for the past few weeks as mildly humorous if not odd.

The octuplet story is starting to sound like the occasional news item about great-grandmother-aged women becoming mommies via IVF. It's becoming an oddball tale.

One final note on a positive ripple -- the story has brought out the Deep Thinkers among the repro med crowd and nudged the industry to focus on its true calling.

Evidence: a conversation held with some of the folks I work for at IntegraMed. After early on deciding to steer clear of the Tuplets Mama and her wayward fertility specialist (being quite the aberration), I approached them again this week to ask about simply listing the many IntegraMed affiliated physicians who have been interviewed about the California Eight. Published expert commentary has targeted Nadya Suleman's fertility practitioner, Michael Kamrava (not affiliated with IntegraMed), and the choices he and the babies' mama made seemingly in spite of the children's best interests.

One of my colleagues said that while documenting the coverage that IntegraMed physicians are getting might be interesting to us, the story is "still toxic."

The pièce de résistance, though, was this from another too-shy-to-be-named source in the same discussion:

"We serve our audience i.e. folks who have been trying for ages to have just one (!) baby and still don't have one. They've been drowned with this 8-baby stuff on the News. Babies, babies everywhere. But none for them. Do we need to chime in and remind them yet again just how many kids they don't have?
... this fiasco must be agony for them. The TV appearances are cool for the docs, but so what?

Should we really tell these folks about all the clever things we do to reduce the number of babies they will have - when they've been trying for five years and have none? This whole message is totally out of sync."

Touché.

All Together Now... and Breathe Out

The LA Times is reporting that the fertility physician who helped create Nadya Suleman's octuplets is Michael M. Kamrava, head of West Coast IVF Clinic (formerly West Coast Infertility Medical Clinic.)

On this LA Times page, you can also view a KTLA video shot in 2006 wherein Ms. Suleman discusses a previous IVF cycle (which resulted in one of her children) and Dr. Kamrava chats about his perspective on the safety of the IVF procedure.

Octuplets' mom identifies her fertility clinic in Beverly Hills | L.A. Now | Los Angeles Times