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.

Teaching Ethics to & Instilling Morals in Scientists. After the Fact.

I'm reading Challenges for modern scientific writing and editorship: have we lost our moral compass? on Reproductive BioMedicine Online.

My random thoughts as I read this apparently necessary finger-wagging by the editorial staff of RBM Online: 

They're using Wikipedia to start their definition of scientific misconduct. Hm. Huh. (No opinion here, just stating the facts...) That is certainly reflective of a shift.

I'm often asked how I can write on the same topic (fertility and reproductive medicine) for 15 years without copy-pasting my own stuff over and over. Seriously? I can manage to do that (not plagiarize myself) for things like consumer blogs and magazine articles by the hundreds, but researchers can't do it for high-brow study articles? Maybe it's yet another benefit of my sieve-like brain... I can't remember from one day to the next if this is the first thing I've written about oocyte cryopreservation or the 20th, let alone know on which hard-drive any previous files exist. But ask me what's in my pantry and fridge, any time, any day. 

I will admit this: my own kid, who is precociously bright with an advanced wit of his very own, sometimes posts things on his Facebook page that make me wonder... So I ask. Maybe too often. "Did you make that up?" It's clear that there's a little generation gap on this topic.

Glad to see they're offering "workshops on scientific writing at international conferences that focus not only on how to write a scientific report but how to do so in an ethical and responsible manner." It would be even better, though, to start that educational process a little earlier, like, maybe in elementary school.

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..."

Make Your Mark: Sign Up For the IFRR

I'm not sure why it took so long for me to get around to this, but I finally signed up as a volunteer participant with the Infertility Family Research Registry (IFRR). I'd like to encourage others to do the same. But I know I might be sort of odd this way...

I'm one of those people who actually digs marketing survey phone calls (as long as they're not too long and don't come at dinner time), mostly because I did enough research as an undergrad to have pity on study authors. I've also earned a buck or two over the years in focus groups. What's not to like about getting a check for telling folks' your opinion on products and services?

I don't expect dinnertime calls from the IFRR; in fact, I'm not so sure they'll even be contacting me ever. After all, my experience as an infertility patient is a fortunately fading memory now. But that's just it -- good research often depends on good controls. Current patients might be exposed at clinic visits to queries for study participants, but how often are those of us who've been-there-done-that anywhere near that information pipeline? And frankly, once you've 'resolved' your infertility in whatever way, how inclined to help do you feel after the fact?

The IFRR was announced at last year's ASRM gathering and is fully SART-approved. I've asked around the 'in the know' circle. IFRR is not only legitimate, it's just about the only attempt of its kind. The purpose of this registry is "to maintain a list of individuals who can be contacted about participating in research studies of infertility treatment including health risks." The Registry aims to cull together patients and former patients, but also people who've never needed to darken a fertility expert's door. Naturally, they also want to bring in any form of third-party reproduction -- egg and sperm donors and gestational or surrogate carriers. The fertility gamut, in registry database form.

So I took some time -- all of 15 minutes on the library's Ubernet -- to sign up and fill out the questionnaires. Piece o' cake, and there aren't many of us who don't like being asked a few simple questions about our attempts at pregnancy and our outcomes. Quick multiple choice stuff. So now when some researcher wants to conduct a large-scale study (often the best kind), it may be simpler for them to find the number of subjects needed to render strong conclusions.

Now, I get that some folks are leery about revealing personal data online, and the first thing participants must do is sign (either on paper or online, your choice) a document typical of research studies that, among other things, spells out that you can bail at any time. If I'm contacted by a researcher using the IFRR database, I can choose to participate or not. Also, there are scattered throughout the questionnaire plenty of options to check "Would rather not say" or "I don't know". You can reveal what you want. Then be on-call for studies or not.

I'm pretty sure I missed my calling as a scientist. I'm just enough of a geek to adore research, but I'd really rather yammer about the forest than conduct tree-to-tree studies. And since I'm lucky enough to not only have resolved my own infertility but also to make a living (of sorts) from it, I think the least I can do is put a few of my story's details on a list for future use. 

How to Talk to Pregnant Women (They're why we're here, right?)

While not strictly related to infertility, pregnancy really is one of the industry's goals. Repro med pros may not need to be up to date on the latest must-have's for the nursery or even on the trendiest birthing methods, but they are first OB/Gyn's, right? And RE's do manage pregnancy through the first trimester. So it doesn't hurt for even the most technically-oriented fertility specialist to have an inkling of good bedside manner left for their clinic's success stories.

Enter Megan Hopper, a Ph.D. candidate from the Department of Communications at the University of Missouri. She's doing her dissertation research on the media messages that are directed at pregnant women.

Her results should be intriguing for everyone, since pregnant women are certainly prime targets for all kinds of products, services, and very importantly, health alerts. Hopper hopes her online survey will give pregnant women a voice within the conversation. She's aiming for 600 subjects, and all participants who complete the approximately 45-minute survey will receive a chance at receiving a $50 Amazon gift certification.

In this interview blogpost, Hopper adds that survey-takers who reside near Columbia, St. Louis, or Kansas City, Missouri can contact her about a greater level of participation (with compensation) in the study.

For more of Megan's thoughts on the purpose of this research, read the interview on Trailer Park Karma.

The Internet & Infertility: It's Not All Bad

Just to prove that I haven't completely descended into Crazy Old Crone territory, I feel the need to say something nice about what fertility consumers can find in the online race for their attention.

Not many of you know this yet, but there's a relative newcomer to the crowded racecourse of Internet sites for health care information and community. The reason you don't know about it is the very reason that I think it's a worthwhile spot with which to be familiar.

There's usually not a lot of marketing money in University-associated collaborations that are interdisciplinary and transparent. So Medpedia relies on word-of-mouth to spread the good news of their existence.

How do I know about Medpedia?

Before the site went live last year, they made the rounds of fertility specialists and related sideshow folks, like me, asking for volunteers to offer up feedback as Medpedia grows and to field a few community questions. They've been around for about a year now, though they pushed out of the gate pretty quietly. Besides being because of that whole marketing-money issue, the folks who put Medpedia together wanted to be sure it's fully deserving of whatever claims they make about its benefits to "anyone with an interest in health, medicine and the body, including medical professionals, medical organizations (for-profit and non-profit), and the general public."

Speaking of the site's makers, feel free to 'meet' the group that funds and maintains Medpedia -- Ooga Labs. No, not "labs" as in medical laboratory. Ooga's a lab full of geeks.

And since I'm so keen on who's guarding the henhouse, here's Ooga's explanation of where Medpedia is coming from, so to speak:

"Medpedia integrates 1) a collaborative information resource (like Wikipedia, Yahoo Answers, etc.) with 2) a professional network (like LinkedIn), with 3) patient communities, and 4) a HIPPA-compliant tele-health communications platform to tie everyone together in real time. The company is funded by Ooga, run by a team of people inside Ooga, and is advised by an all star roster of Medical luminaries."
[from http://www.oogalabs.com/companies#medpedia]

And for further oomph, check out Medpedia's Record of Merit, which lists all the venerable groups and individuals who first came forward in 2008 to help birth Medpedia.

Why, there's even an Infertility Community. Yes, I'm one of its administrative members. No, those of us involved do not get paid. Near as I can tell, we medical geeks who signed up to hang out at Medpedia are doing so out of a sincere desire to make good information available to anyone who wants to find it. Some of us just like to write a lot, of course.

Why am I just now writing about Medpedia?

Well, my Facebook friends have already heard about it. So it's not exactly the first time. But the thing that's got my attention now is Medpedia's new Clinical Trials platform. You can search for a slew of opportunities where you might participate in research, sometimes with pretty nifty benefits like paid medication.

Besides just being a place where you can kvetch and ponder the plight of your physical condition, I think Medpedia is just about as thoroughbred as a Web community can get. It only needs a few spectators to get the ball rolling and we're talking the Wikipedia of medicine here, folks.

Tag. You're It. Spread the word.

When You're Selling Fertility, Size Matters

The words "corporation" and "national network" conjure up a certain image. Besides the tendency to think "bigger is better" in terms of almost everything, Americans have come to expect constant and huge advancements in medical science. When you add to that the fact that fertility medicine's buzz is just out-and-out sexier than a lot of other branches of medicine, you arrive at a playing field that seems destined for a lot of chest-beating.

In the field of medicine, it's still a fairly shaky consumer relations move to present your company as a behemoth. Half of your 'prospects' (that's just a pithy term used for "people in need of medical care whom doctors hope will brighten waiting rooms one day soon") will be swayed by the 'We're The Biggest' image while half will be deterred.

Perhaps it's more prudent for health care services to just lay low and not bring the issue of size up at all. Maybe it makes more sense to focus instead on what consumers really want to hear -- that is, present how much you care so that they'll care about what you offer.

But what if your showy display doesn't ring true? What if prospects don't really buy that you care about their plights? Will they simply shrug with resignation and buy your offerings anyway?

Sure, particularly in a field of medicine where a sense of desperation prevails among patients. Even in a field where most prospects can't afford the very best technology available, wannabe-patients can at least teeter on the edge of hope for years. Especially if you give great front office. Take IntegraMed America, Incorporated, for example.

Just like with a lot of sexy things in this world, size isn't really the issue. It's a matter of style.

Here, I take a quick step back to acknowledge my relationship to this "national network of fertility centers," which at last look number around 40 reproductive medicine practices from coast to coast. I was the editor of their e-newsletter for six years, and I created and opened their initial Facebook presence.

Am I a disgruntled ex-employee? Yes, and no. I was never an actual employee. Nor was I really a contractor, truth be told, except for the fact that agreements by email hold up in courts. I do not, however, perform work for IntegraMed any longer -- though the company has yet to tell their own affiliate practices that they can no longer expect a consumer e-newsletter as part of IntegraMed's services rendered.

Which brings me back to the front office appeal...

The individual fertility clinics and reproductive specialists that comprise IntegraMed's network are truly worthy of consideration by prospective patients. Ranging from small double-doc practices to several of the oldest and largest in the world, covering nearly every state in America, the practitioners who choose to affiliate with IntegraMed are the type of physicians you want to tackle your infertility.

But who would know about those fantastic individual network components, based on the corporation's efforts at consumer communication up to now?
 
The company's undergoing a bit of overhaul to make up for lost time, fortunately for their affiliates, who pay hundreds of thousands of dollars to IntegraMed for, among other things, garnering the attention of prospective patients. Over the past year, the New York-based company has reached out to Internet marketing pros for help. They've revamped their stale company website, created a new name for their main consumer product (the shared risk refund plan now known as Attain), and will soon be inviting us all to kick the tires on another site that promises to have more community appeal to people who are struggling with infertility. Presumably this new community-oriented appeal -- where prospects become patients who are people -- is starting off by way of a blog.

Hats off to the company's upfront ownership and claims on the blog. Kudos to IntegraMed for putting a qualified medical professional in charge of Fertility Focus. After all, the blog's stated purpose is "to bring clarity" to [readers'] "path through the assisted reproduction process..."  Nurse Practitioner Maureen Gill Higgins' voice and information delivery is on target.

But if, as the blog's purpose statement continues, their "focus is the same as yours: having a baby" -- then I'm completely confused about the rest of the team. Listed are a baffling mix of customer call center employees (one of whom is apparently keeping his last name private), as well as advertising/marketing staff and an intern. Each of their bios appropriately advises readers of their lack of medical training and, in some cases, even any personal experience with fertility problems. So we're left to wonder: why are these the folks IntegraMed chose to start off their new Internet patient community?

If you're a bottom line-watcher, you know that IntegraMed, the Biggest National Chain of Fertility Docs, is faring relatively well through this tough economic period (Public, NASDAQ:INMD). Men and women who are grasping at straws in order to become parents -- and who are now presumably also struggling just to make household ends meet -- have been deftly led to IntegraMed affiliate clinics to apply for loans and shared risk plans. Read through the Fan comments on their Facebook page (now found at "Attain Fertility") and you'll learn that not everyone is qualified for the financial assistance programs, and not everyone is happy about that fact. It's tough to hear "ineligible" when up to that point all you ever heard was how they were offering "a better path," a "proven course," and "the greatest possible opportunity for success." Medical copywriting for patients who feel as panicked as any with a terminal illness -- that's a tricky business.

Hiring at the corporate level is also tricky. It's hardly done randomly with success. One easily imagines that corporations are well-versed in how to appropriately staff departments for optimizing overall achievement. So what can we think when a company that proudly proclaims itself "the largest network of fertility centers in the United States" offers up a webpost on the crucial hot-button of donor egg legalities written by someone who identifies as "a marketing copywriter" responsible for the oversight of "content development for AttainFertility.com"?

What conclusions can be drawn when of the six contributors to the community blog, only one discloses a direct connection to the infertility experience (on a personal level, the last-name-less James) and all are primarily or indirectly charged with driving traffic to the Attain financial product or managing phone and email contacts by inquiring prospective patients?

In short, why pull from your marketing staff -- rather than from health care professionals or even para-professionals with personal experience -- to lead an internet community for people with a medical condition? Is IntegraMed counting on filling in the information gaps with corrective input from other online fertility pros and advocates? Why wouldn't they instead make use of their own huge pool of fertility specialists? Smaller companies that create and run online communities, like Fertility Authority and Fertility Ties, manage to construct strong bases by way of friendly collaboration with professionals and patient advocates. Why can't IntegraMed?

A business like IntegraMed has always been hard to define for patients. Are they a clinic? No. Are they a research facility? No. Well, what do they do? The easiest answer has always been that IntegraMed provides support services to fertility clinics.

The idea is to free physicians from the time and entanglements of attention-seeking & patient-procurement tasks in this highly competitive market. Let doctors do doctoring while the support staff drums up noise. Questions about the quality of that support are obviously between the parties in the network, the physicians, the clinic financial officers, and the networking corporation. Patient response is the best measure of that quality. Creating an online community for fertility patients -- finally -- will indeed render a public accounting for this behemoth mixture of medical and financial services.

If anyone knows how little size can matter to something like getting pregnant, and about smoke getting blown up one's skirt, it's a fertility patient.

On Social Media, Dogs, and Infertility Patients

It's no secret: I'm infatuated with social media. I blended into the Facebook game relatively early because of my online copywriting and consumer relations work. By the time I started tweeting in early 2009, it seemed like I was behind the times, though I wasn't -- in April 2009, eMarketer reported through Mashable that a mere 7.4% of adult Internet users were using Twitter, and only monthly at that. Imagine how few were doing the everyday tweet thing.

Just like back in the venture-driven, careening 90's, infertility patients arrived at this new wave's forefront before the pros. Just as we saw back in the day when chatrooms and bulletin boards were filled with querying mama-wannabe's wondering where the caring professionals were lurking, the docs are taking their time. But this time, instead of a queue of tech-timid newbie consumers wondering about the real value of this thing called the Internet, what we have are gadget-savvy emboldened consumers expecting 24/7 action. This is no time for docs to arrive fashionably late -- but that's exactly what most of them are doing.

Even some of the Biggest Dogs are merely meandering toward the banquet.

Being both a long-time dog owner and Internet professional, I have some ideas on why larger spokes in an industry wheel are slower than smaller ones at moving toward their audience.

First, there are the obvious correlations between size, weight, and movement. Plain as day, right? Of course, a consumer may be led to believe the contrary, that the bigger a network of clinics is, the faster, the better, the more successful... After all, those multi-million dollar centers spend a good chunk on steering what consumers think. It's true that you get what you pay for, even in the "free" world of Twitter and Facebook, as detailed by Forrester's Augie Ray last September. But we're talking overhead percentages here -- even with piles of ecstatically happy patients, if you're a small practice, your budget for getting the word out is still practically nil. With traditional marketing, you're lucky if Ms. Happy Patient's cousins hear about your fantastic repro med practice. On the other hand, if you're looming on top of the feeding pile, you can make all the noise you want, of any variety. It's the only sound that most consumers will hear.

Then there are notions about power displays among competitors of different sizes. Big dogs might stand back and watch while the little guys deftly move in for the kill, especially when the prize is an unknown (like social media return-on-investment). If you're big enough, you know that you can wait to see how the new eats are digested, then you can scarf up the smaller competitors with their initial 'wins' (loyal consumers).

So my take is that individual practices have moved quickly into social media, most often using available office staff, while the nationally-networked practices have watched and waited for a couple of years. Now that they see the real results, we'll all see the fertility industry giants bringing their money and action to the consultant table.

That's just how business goes. It really is 'dog eat dog', even in medicine, no matter what we'd like to believe about individuals who go into the helping professions. By now, most of us 'get' that fact, whether by acceptance or resignation. My bet is that 2010 will make social media tools *appear* to be nothing more than yet another box of pliers and wrenches for re-working what health care consumers think.

For now, though, soc med also provides a decent sleuthing pipeline. Individuals can't help but chatter about their pursuits, even (especially?) when things are in a planning or building phase. An example from just the other day -- things anyone can know without knowing the people involved: Lindsay Lebresco, Foursquare user and Account Director for social media agency Converseon, was meeting at IntegraMed Fertility's national headquarters in Purchase, NY today. Kip Finch was there, too, and thought it was a great meeting. My guess is that online infertility communities like Fertility Authority and Fertility Ties will soon see some repro med muscle with which to contend. Or maybe a cozy union is just down the road?

But remember the mid-2000's, after the Internet imploded and tongues clicked about how it was all dog-and-pony show anyway? Out of that mess, when most 'net biz crumbled, those who resurrected did so only because they found a newly educated audience, one that not only reveled in the amount of health information they could access online but who also started looking to separate the wheat from the chaff. Health consumers cared about *who* was giving them information. Behind that 'who' was always a 'why'...

The very thing that makes social media so valuable is the thing that big corporations simply cannot get behind: The Person.

It's not that they don't want to, bless their hearts. They just can't. Ever. By definition.

Welcome to The Personal Brand Era, proposed by Ed Schipul last October. What I really love about the idea as described by Ed is how social media tools seem to have a real, tangible (even while virtual) impact based not on competition, but collaboration, a biz model that's gotten a lot of hot air in the recent past with little real-life play. Of course, as those who know me well can attest, I also dig nearly any idea that charges forward against that status quo.

I'm mesmerized by the melding of individual lives by way of these communication blips cast out to whomever wants to scoop them up. When you combine the relative anonymity of tweeting with the more socially confined Facebook status rendering, it's fascinating to compare responses from the differing circles that ripple out from one individual.

My friends (even those who are "only Facebook amigos") kindly watch as I display my circus-like personal life all over the Internet by way of hastily shot photos and commentary. Some have cringed out loud, though, because they know I combine work colleagues with loved ones in my social media roux. As a long-time telecommuting contractor, that means I have a lot of folks who (a) don't really know me, and (b) are sometimes employing me or who may be considering such a relationship, all jamming along with the daily exploits of my home-schooled son, other family members, and loved ones.

It means that the people who hire me have the opportunity to really know me, really well, via Facebook.

Tweet followers, on another hand, are privy to less revelation about me and mine, and we all know how far titillation can go toward beckoning someone closer.

I daresay, as Ed and others are alluding to, that soon enough one of the shiniest facets of the social media gem will wind up being personal accountability. The individuals who make up an organization or business -- and their 'character' as revealed in their brand -- will matter more. Sort of a Karma Transducer.

The bigger a company, the scarier that kind of talk will be. Reproductive medicine specialists -- the individuals -- tend to become more conservative in their approach to both medicine and business as they become more ensconced in bulkier settings. The bigger the bottom line, the higher the fear factor. It's only human.

ASRM Run-Down for Tuesday, Nov 11, 2008

A quick breeze-through of some interesting tidbits that were presented today at ASRM:

Skip the plastic

Specifically, Bisphenol A (BPA) is showing up more often as a possible culprit in reproductive problems. BPA is found in containers of food and beverages. Yum.
http://www.asrm.org/Media/Press/AM08_bisphenol.html

Eat your tomatoes

Reproductive tissues seem to like a lot of lycopene, found in tomatoes, among other foods.
http://www.asrm.org/Media/Press/AM08_lycopene.html

How's life?

ASRM has teamed up with the European Society of Human Reproduction and Embryology (ESHRE) and big fertility meds producer Merck-Serono to create an internationally validated instrument to measure infertile folks' quality of life.

In 1998, the World Health Organization defined quality of life (QoL) as "...an individual's perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns...".

You can take a gander at info on the creation of and hopes for this test, but you can't take it yourself. You'll have to let a pro gain access to it; then it's a self-report questionnaire.   http://www.fertiqol.org/

One at a time, please

There's no getting away from it - singleton pregnancies are better for everyone. You will not find studies to the contrary. Still, infertility patients clamor for the best chances at any amount of offspring above zero from every treatment cycle.

The pros are struggling to convince you otherwise, and there's plenty of backup evidence on their side.
http://www.asrm.org/Media/Press/AM08_SET.html

The ASRM Says

Finally, here's a list of newly released/revised guidelines and recommendations from the ASRM Practice Committee, all published in the November 2008 issue of Fertility & Sterility, the official ASRM professional journal:

2008 Guidelines for gamete and embryo donation: a Practice Committee report
Fertility and Sterility
November 2008 (Vol. 90, Issue 5, Pages S30-S44)

Guidelines on number of embryos transferred
Fertility and Sterility
November 2008 (Vol. 90, Issue 5, Pages S163-S164)

Guidelines for development of an emergency plan for in vitro fertilization programs
Fertility and Sterility
November 2008 (Vol. 90, Issue 5, Pages S131-S133)

Revised guidelines for human embryology and andrology laboratories
Fertility and Sterility
November 2008 (Vol. 90, Issue 5, Pages S45-S59)

Guidelines for reducing the risk of viral transmission during fertility treatment
Fertility and Sterility
November 2008 (Vol. 90, Issue 5, Pages S156-S162)

Essential elements of informed consent for elective oocyte cryopreservation: a Practice Committee opinion
Fertility and Sterility
November 2008 (Vol. 90, Issue 5, Pages S134-S135)

Revised minimum standards for practices offering assisted reproductive technologies
Fertility and Sterility
November 2008 (Vol. 90, Issue 5, Pages S165-S168)

Ovarian tissue and oocyte cryopreservation
Fertility and Sterility
November 2008 (Vol. 90, Issue 5, Pages S241-S246)