How to Make a Family: The Blog

Egg-freezing: It's Not Just For Cancer Patients Any More

I had the chance to sit in on a press conference call held by the American Society for Reproductive Medicine this week, just ahead of their annual shindig (which will be in San Diego this year). The call's topic: the removal of the label “experimental” that they adhered years ago to a technique already in use.

Oocyte cryopreservation has only been 'experimental' in name. Reproductive treatment centers have been freezing women's eggs for years now. It's not as if we're talking about Frankenstein-level experimentation.

But in the name of safety and doing no harm, the ASRM approaches the recommendation of various procedures with conservative consideration. That's a good thing, especially here in the Wild West of Reproductive Medicine where just about anything goes, depending on the specialist.

In the press call, the doctors sounded about as old fogey as a doc can get. Still with the line “We can't say it's good for everyone just yet...” The opinion of the group's Practice Committee says even though the largest randomly controlled trial “comparing fresh vs. vitrified donor oocytes in 600 recipients revealed excellent clinical pregnancy rates, no different than in fresh cycles,” – the “data is reassuring” – they want more widespread clinic-specific data on safety and efficacy before universal egg banking can be recommended. 

Sigh.

Their big hangup on not offering egg-freezing to young women as a kind of fertility insurance is based, they say, on balancing (a) the inherent dangers of any kind of medical procedure, and (b) the fact that only a small percentage of young women will actually be infertile and need those frozen eggs later.

But when it comes to all things fertility, women have been taking huge risks – financially, physically, and emotionally – of all kinds for eons. Why? Because there is nothing that any woman can do that has more impact on her entire life than getting pregnant. (Now there's an opinion that I could get hammered on, but I'll stand firm.) So we (women) already do crazy things, like take daily pills that haven't truly stood the test of time and rigorous scientific investigation just to avoid pregnancy, or hitch our wagons to myriad wrong men because our ovaries are commanding us to procreate. The list of wacky pregnancy-related behavior – as women can attest – goes on and on. Trust us: We know how big a deal it is to get pregnant. 

So in my opinion (here we go again), worrying about a young woman's ability to make an informed choice about her reproductive capacity and future is, well, patriarchal and archaic.

I, too, think that the fertility industry has had a hand in steering perfectly fertile people into costly treatment. But some members of the same industry have been trying their damnedest to bring home the message that early detection equals early treatment equals greater take-home baby success. The ASRM got hit hard years ago by some women's groups when their public service program dared tell us that one of the keys to fertility was to stop putting off having babies so far into our future that our eggs were useless.

Unfortunately, except for at the church my son attends (where children are offered comprehensive sexuality and relationship classes that start in Kindergarten and are taught by parents), I have yet to see the American culture pick up the ball on the details of conception education, since most people are sadly mired in the fearful mindset that If You Teach It, They Will Do It.

There was a time when the idea of women having complete control over their reproductive ability was blasphemy. Later on, it wasn't so much heretical as it was just unbelievable. After all, what would women do if they weren't having and raising babies? (As I write this, I keep having visions of big, white men patting little pig-tailed girls on their wide-eyed heads.)

As far as I'm concerned, the unleashing of egg freezing as an option, now declared NOT experimental and actually quite successful, could very well be similar in terms of societal bend as was the birth control pill. Do I envision a Gattaca-like world in the future? No. But then could any of our ancestors imagine our world today?

There's a time for concern and worry and protecting the ignorant. Then there's a time to let go and have a little faith – in nature, in deities, in common sense, in whatever gets you through the night.

I say let 'er rip.

Should You Borrow Money From Your Doctor For Fertility Treatment?

Does it matter to you how your fertility treatment is funded? I'm trying to remember if it mattered to me, 14 years ago. Sure, it's one thing for me to comment now, almost 13 years after finally, finally having that baby that I'd tried to have for 5 years and through 4 miscarriages. 

Hopefully without embarassing my son's dad (we're long divorced now, but still friends and co-parents of The Wonder Boy), I'll let you know that we were not in a financial position to even consider IVF after that last miscarriage. And PGD was in the pipeline, only available within clinical trial, and man, oh, man, was I willing to donate my body to science by that point. Of course, as soon as I started to explore that path (which would've been a long road to nowhere from Houston, I know in hindsight), I wound up pregnant again (our last ditch on Clomid with heparin shots) and he stuck. 

So the question of how I could afford to get pregnant became moot to me. But it's been impossible to stay in this line of work and not think about it every time another related story comes up.

Is the drive to get pregnant so visceral that we really don't care HOW the process is paid for? 

The question came to mind again when I read this Wall Street Journal article by Jessica Silver-Greenberg. She talks about the booming business of fertility treatment financing. Nothing new, and after all, I was employed for several years as the newsletter editor of IntegraMed America, one of the oldest and biggest vehicles for people who aren't flush enough to shell out tens of thousands of dollars for multiple IVF cycles. To clarify, IntegraMed America isn't a bank or even a lending company. Rather, as the article explains: 

"IntegraMed sets up couples with loans through a partnership with Springstone [Financial LLC] and NBT Bancorp of Norwich, N.Y. The partnership's number of loans jumped 41% in 2011 from a year earlier, and totaled $15.4 million."

I have no problem with people financing their medical treatments. In fact, I'm one of the too many in this country without a speck of health insurance. I know very well why the medical loan and medical tourism industries have blossomed. But there's one part of this WSJ article that prompted this conversation with my faithful listener, The Roommate:

Me: "I just read in the WSJ that loans made to patients by companies who are backed by private investors aren't monitored by the same Federal or state agencies that oversee banks."

The Roomie: "Yeah?"

Me: "And what's even crazier is that some of those lending companies are funded by the doctors whose clinics offer the loans."

The Roomie: "Yeah?!"

Me: "Isn't that a conflict of interests?"

The Roomie: "No. That's a coordination of interest."

Me: "And the docs aren't required to disclose this information to their patients!"

The Roomie: "Wow! Those doctors are pretty smart! Win-win-win!"

Is it me?
Signing off, From the Pollyanna Department

And Always Let Your Conscience Be Your Guide

You grew up thinking all doctors were devoted altruists, right? That they go into the medical profession to devote their energy to helping people -- not to make money. Okay, maybe if you grew up in the 80's or later, not so much, but a whole lot of us had those crazy thoughts, which explains the fussing and fretting when docs became legally allowed to market their services.

You didn't know there was a time when that was illegal, huh? (You know, it kinda sucks when I can no longer refer to myself as prematurely gray...)

But yes: Prior to a 1977 U.S. Supreme Court case (Bates v State Bar of Arizona), it was illegal for certain professionals (like doctors) to advertise or market their services or fees. Ah, those were the days.

Granted, most docs were slow on the uptake of selling themselves. That might be a little proof that, indeed, most physicians consider the practice of medicine to be a privilege bound by an ethical oath. But I don't know.

Today I learned that the Association of Reproductive Managers who attend the annual ASRM gathering will be taught the secrets that Disney knows for making happy customers. 

Reproductive Managers go by a few other similar names, too -- for example, Practice Manager or even Executive Director -- but they all share in common the tasks of running the business end of medical practices. RMs are all about keeping the lights on so your fertility specialist can see during exams, and about keeping those nurses paid. 

They're also about managing the creation of more business. After all, even though some of us unlucky infertile souls spend years and years cycling in and out of the clinic doors, most of us are only there for a year or so before moving on, one way or another. And let's face it: reproductive medicine is elective medicine. (You may want to die if you can't have a baby, but you won't really meet your Maker just because you're infertile.) So no matter how many people are struggling to get pregnant, there's always going to be a need to replenish the supply of patients. Kind of hard to believe, isn't it?

Speaking of make-believe: Who better than Disney, American marketing royalty, to impart inspired techniques for bringing both a dreamily hopeful smile and a poignant tear to the faces of millions?

Personally, I'm glad RMs exist. I like the thought that physicians can go about their healing activities without having to worry about (at least on a day-to-day basis) whether the janitorial staff was paid. And now they'll come back from ASRM whistling, "When you wish upon a star..."

I Just Want You All To Have Plain Ol' Health Insurance

At the risk of sounding like a crabby old mama who finally got hers and has no memory left, I feel compelled to finally say what I think about the notion of insurance for infertility treatment. 

Okay, it's not exactly the first time. But it's been awhile, and I don't think I've ever approached the touchy topic from this angle.

"Touchy?" you ask. What could be sensitive about insurance coverage for medical treatments that help men and women achieve what's supposed to be a natural life event, namely, procreation?

Most readers of this blog already know that most people have no insurance coverage for infertility treatment. It feels unfair to those who want that coverage. Even people with huge policies can't get their fertility treatment paid for. It's an old story and one that's been hammered on for decades now by advocates and patients and, sometimes, physicians who each year encourage legislation at different levels that will presumably, one fine day, make all things equal.

So what nudged me over the edge today?

An innocent Facebook post by RESOLVE, echoing the sentiment of Parents Magazine in wishing that all states would mandate fertility insurance coverage. (For those of my friends not in know, some states already do...)

Anybody ever vote for elected officials here?
Ever heard of "divide and conquer" as a strategy to defeat a group's ideas?

Folks. Are you aware of the current situation in this country regarding plain ol' ordinary health insurance?

From CNN's The Chart, March 23, 2011:

"Almost 50 million Americans are without health insurance– 3 million more than a year ago, according to a report from the Centers for Disease Control and Prevention.  The report finds one in five people were uninsured during some portion of the last 12 months."

You know, I was going to rant on and on like I tend to do, but really, I don't think I need to say anything else. Pretty sure you're all smart enough to figure this point out on your own.

Where I Imply That You May Not Have a "Right to Life" (or anything else, for that matter)

Oh, boy. Another time and post where I set about putting myself out there and quite possibly inserting my foot into my mouth. But at least I'm clear on the risks. 

Let's start here: I think harming other lifeforms is not The Thing To Do. 

And here's another facet of that whole What Do I Believe About Life gem: I think telling someone else what to do with their life is not The Thing To Do.

And how about this addendum: I believe that reasonable, flexible boundaries are a prerequisite for peace.

You can argue against and around all of the above. But I bet nobody would argue against this one: I think every human wants to feel peace.

What does any of that have to do with the infertility industry? This: In our silly national debates over health care, the apparition of rights -- right to access health care, right to insurance coverage specifics, and accordingly, the right to life -- is wafting through it all like the ever-present, silent mist that nourishes a life-filled rain forest (on a good day).

With any luck, we will all get very wet from the debate process. But who's listening?

Three pieces today -- and just three, but there are more; have been and will be -- that conjured up this morning's philosophical nature in me:

My morning ramble's starting point: The video that's making the community's rounds, Is Infertility Treatment a Right or Privilege? 

[insert Big Sigh] How unfortunate that this is a Fox-produced video. I extricated myself from the Hell of TV Watching years ago, so on the occasional glance I take to spy on What Others Are Viewing, I have to remind myself that I wasn't around for the slow, hair-growth-like transformation that TV Watchers underwent in their tolerance levels. After I shake off the unnerving feeling that I'm being yelled at by talking heads, I do my best to watch this drivel with a little bit of calm objectivity. The only good I see coming from such "debates" (how special that the "journalist" is a new RESOLVE Board member! did I hear that right?) is that maybe -- just. maybe. -- thoughts about the bigger picture will be conjured up in a wider swath of minds.

Then, in a media format a little more palatable to my out-of-sync brain, a piece by Liz Zemba on the Pittsburgh Tribune-Review's site, Debate swirls around overseas surrogacy 

It's a good introduction to what Arthur Caplan calls "a weird version of medical tourism." Weird, indeed. Another term you might use is "nauseating." 

My eyebrows first furrowed in paragraph one, where the couple who's started a surrogacy service gave up on adoption "after 22 years of marriage" -- where's the 'why'? On their business website, that's where. The Hui-Wee's cratered under the adoption option because of "too much red tape, too expensive, or too much competition." Their surrogacy journey wasn't a piece of cake, either, but at least they got a baby out of the deal.

On The Telegraph, a review by Jim Endersby of the book "Unnatural: The Heretical Idea of Making People" by Philip Ball

I've always enjoyed using phrases like "making people" (usually "making babies" when I can get away with it) because it brings down to a fine-point all the more euphemistic terms, many of which I generate right here at my laptop, in the field of reproductive medicine. 

Endersby's review is the first I've heard of "Unnatural", and it's a positive one. He does finish his coverage by stating plainly, "I found myself persuaded by Ball’s ethical and practical arguments, yet unconvinced that the benefits of making artificial people are sufficient to justify the costs."

Instead of meander on and on about what I think or how I think the dots are connected up there, I'll just rest my fingertips and let the silence do the talking.

 

Spreading More Love, This Time Like Jalapeno Jelly

On another blog where I also ramble in me.me.me mode (but with a focus more on generic family stuff), I recently wagged a finger at myself for how -- well -- just how All About Me I can get on the Internet and how I need to spread more love.

Today's the perfect day to do something similar here, where I yada yada yada about the baby-making industry. My friend and yours, Pamela Madsen, is coming out. Way out. And I can tell you, because I know, that it's been a few years in the prep phase, this Party o' Pammy's -- and just like the best sex, today's 'peak experience' is really just the beginning of a steady heatwave.

Y'all know Pam -- I used to rant against her, right here on this blog. Funny thing about such tenuous connections, they sometimes transform into friendships of the most genuine kind. I give Pam Madsen most of the credit for how I softened up to her. She is one persuasive woman.

Okay, before this gets any gooey-er -- here's the hot stuff: Pam's book, "Shameless: How I Ditched The Diet, Got Naked, Found True Pleasure and Somehow Got Home in Time to Cook Dinner” (Rodale), is finally out. 

Wait There's More: She has also produced, with Circle + Bloom, a companion audio program for the baby-makers among you. Now *that's* hot.

I don't wade around the bookstores or even libraries much any more to see what's on the shelves to help fertility-minded couples get their mojo back. Nor do the related publishers send me the stuff any longer. (Yay! Let's hear it for moving on and down the road of life!) So I could be wrong, but I'm thinking this Shameless Baby-Making program is a first. And you know me -- yawning every morning at the "infertility news" marketing re-treads that are out there... it's good to wake up and see bona fide pioneering Adventures in Infertility.

Have I read the book? Well, not in its entirety yet, but I will. I'll confide this: I got to read a first draft of some parts of it way back when. :::big Yay Me grin::: Have I listened to the audio program? No, and I'll be honest -- I'm almost 50, folks. I love, love, love my one and only hard-to-finally-have child. So while sex may be on the top of my Personal List of Things To Do, baby-making most certainly is not. Still, knowing Pam's "Put It Out There" style and just a tiny slice of her experiences in practicing Shameless living, I'd be willing to bet that even I might need to pull over and take care of business if I were indulging in a listen on one of my long country roadtrips...

Congratulations, Pam. I know you know it, but I also know that some of us cannot hear it enough: you are SO deserving of this party.

Finally. Some Real News. Great Mind-Bodies Think Alike.

So many months have trickled under this blog's bridge. Any bets how often I ponder ditching it?

The reason for such space between posts here is... well, there are two reasons, really. One: it's true that I get bored with what I've been writing about for 13 years. Hats off to those other long-typing bloggers in the field. Two: there's really not a lot of true news in this arena. Seems like most of the writing about infertility/fertility/repro med is regurgitated spun sugar.

Oh, dear, here I go again... whine, whine, whine.
Anyone got some cheese??

Wait a minute -- there it is! It's cheese and bread! No, it's Super Woman joining forces with the Dynamic Duo!

:::self-entertained chuckle:::

This is not paid advertising. This is me, being truly impressed and excited about a new approach in this industry.

Alice Domar (I don't even have to tell you who she is -- and if you're a recent-comer, Google her) is teaming up with Tami Quinn and Beth Heller of Pulling Down the Moon.

Their new gig is called Integrative Care for Fertility: A Domar Center, Inc. 

For now, you can visit their temporary, evolving website for a little bit of preliminary info.
But the real meat of this venture is made clear on this page --> http://domaricf.com/Physicians.html.

Like a lot of you, I've known for years about Domar and her ground-breaking work connecting mind-body responses with fertility. I was fortunate to meet Beth and Tami awhile back when they were just getting PDtM under way. The way I see it, this is a powerhouse team that can spread the gospel of reproductive mindfulness like wildfire, and for very good reasons.

Okay, if you're a patient, you're thinking, "I already know this 'just relax and de-stress' stance about TTC. I've read about it, I've chatted online about it. Whatev."

Listen. It's The Truth. If ever there was a Truth about the whole trying-to-get-pregnant schtick, this is it. If you're not already investing some time in not just de-stressing, but actually thinking more expansively about your life and the life you're trying to create while you're trying to make a little bean sprout, then you're not just missing the boat and spinning your wheels, you aren't aiming toward being the best parent you can be.

Did I just say that out loud?

Okay. That's just me. You may be content with the Treadmill Version of life. I tend to lean more toward the Expect Great Things plot. And one can't expect greatness if all one does is the tried-and-true. Sometimes -- a lot of times -- you have to not just think outside the box: you have to climb the side of that garden wall and get your shoes dirty in the glorious pasture beyond.

Waxing poetic about an industry. I think it's this coffee...

So. Back to the bored, been-there-chatted-that patient. As the inventive ICF women will tell you, if you give them a chance, reading and thinking and even talking about mind-body related topics won't get you far. It's actually practicing a few of these things, even just one, that will really open your eyes. And maybe your fallopian tubes. Oh, no, not really -- please don't think they've said anything like that to me or anyone else. I repeat: ICF does not claim to open any body parts with their programmed techniques. But... the science behind what ICF will soon be offering through various fertility clinics is documented in black and white.

What's really cool about this union: there are tons of small one or two-doc fertility practices all over the country that don't have the resources and access to services like Pulling Down the Moon. They may want to refer patients out for holistic fertility support, but there may be nothing near enough. Even contracting with an outside provider to bring services to the clinic may be geographically impossible. While, granted, the availability of ICF will also be distance-limited initially, just imagine the fruition of their hoped-for destination of Everywhere. Just as the two most widespread financial fertility networks, ARC and IntegraMed (Attain), are slowly blanketing the U.S., the potential is great for Integrative Care for Fertility to do the same for holistic reproductive medicine services. And spreading the reality of how connected our bodies and minds are can only be a good thing, especially within the realm of creating more new mind-body beings.

And that's news I find exciting.

Goodbye Ugs. Hello Unicorns.

From The We're So Shallow Ain't We Grand department, the tacky social site, Beautiful People, is now becoming a way station for the genetic material of their clients.

Glad to hear that folks who would frequent such a venue are wanting to procreate. Really. The world needs more beautiful people. What's really heartwarming is how the company has opened their new, potentially very lucrative egg and sperm donor connection to The Ugly.

That's right. Even you and I could take our ugly mugs and find the doors open wide to the Inner Sanctum of The Gorgeous. After all, says founder Robert Hintze, everyone, "including ugly people -- would like to bring good looking children in to the world..."

Sort of a new take on "the golden unicorn" concept, I guess. The Golden Unicorn's Genes.

Suddenly, I feel a song wafting through my ugly brain...

The Fun You Can Have With YouTube and Ov Tests

A good example of the fun you can have from combining stream-of-consciousness Internet-seeking with a highly distractible student in the midst of producing a final math paper:

I have to give credit to my Editor for stumbling upon this... indescribable... video of singing/dancing ovulation sticks.

I just want to know why the sticks appear to be male.

Keep Trying? Really? Happy NIAW

Everybody loves a gadget, and free online surveys that let you assess your fertility are really fun for a few million people (mostly women; go figure.)

So after getting their press release, I flocked like so many others are probably doing to check out IntegraMed's new gizmo -- Free Fertility Check -- just released to coincide with RESOLVE's National Infertility Awareness Week.

Here's what the wiz behind the ether curtain had to say after I answered 3 questions:

Your Results: Keep Trying

It looks like you don't need to see a fertility specialist right now.

However... you should see a specialist right away if you're worried about a health condition that may impact your ability to conceive.

There are many causes of female infertility. The sooner you get a fertility evaluation, the sooner you can address any potential problems.

AWEsome. Who knew that a 49-year-old who'd only been trying to conceive for less than six months could "Keep Trying"!

Of course, since I'm pretty nosy about such things, I also clicked on the "Next" button, which then rendered this copy:

However... see a fertility specialist if you don't get pregnant after trying for 6 months.

As you age, your chances of getting pregnant significantly decrease. It's important to get a fertility evaluation as soon as there's a question about your ability to conceive on your own.

OH.
Hm.'k.

So my next "Next" click gave me a chance to give IntegraMed my email address -- which I did so I can "receive an emailed copy of my quiz results." And then I had the chance to give IntegraMed my friends' email addresses, so they can come and find out whether they have a chance in hell or not of having a baby as they approach 50.

You know, even though I'm just today celebrating the birth of my one and only precious kid, and I haven't wanted another child since that day in 1999, I'm so glad to know that if I did, I'd only have to "Keep Trying".