Archive for October, 2009
Thursday, October 22nd, 2009
I’d like to dedicate this entry to my needle fearing friends. You know who you are. The gal that hears the word “needle” one moment and finds herself hanging upside down from the ceiling fan the next. The thought of having blood taken for some is a minor inconvenience, but, for you, it’s a nightmare equal to that of having a spider crawl in your ear and hang a finely crocheted web on your cochlea. The smell of rubbing alcohol at a doctor’s office triggers a sort of Pavlov’s Dog response to pull down your shirt sleeves and put your veins on lock down. I know who you are because, a few months ago, I was you.
I’ll be honest, when I decided to donate I was so excited about the idea of helping someone have a child that I had sort of “overlooked” the logistics of injections and having weekly blood draws. This honeymoon phase vanished the moment I received my box of medication, which included about 30 needles. I quickly ran over to my roommate and showed her in horror. She shrugged and said, “They’re tiny”. Yeah, okay, tough guy, they’re tiny. But, lest us not forget, they’re still NEEDLES. A tiny cockroach is still a cockroach. Besides, it’s all relative. Your tiny is my huge. Your “it’s just a needle” is my nightmare on ice with a sprig of nausea.
Fast forward to my first injection. The staff at my doctor’s office thoroughly explained the process of how to do a self-administered injection, so I did feel a little more at ease – empowered with knowledge as they say. **Side note: the staff at the office I went through were simply amazing. Take the opportunity to get to know the staff at whatever office you go through. They are an invaluable asset to the entire process, like your medically trained cheerleaders. Back to my first date with the needle: I got home and paced around like an anxious cat who kept hearing its name being called. I looked at the clock, it was ten minutes until I was scheduled to do my injection. I laid out my supplies – the alcohol pad, the needle, the vile of Lupron and (what I will reveal to you as the holy grail of injections, ladies) my slightly frozen can of diet coke. Who would have thought a diet coke could contain such power that, if wielded correctly, could erase a lifetime of fear. I suppose it did skyrocket Cindy Crawford’s career and make us all go cut our jeans into shorts. So here’s the deal: throw a can of soda in the freezer for a bit and let it get nice and cold. Five minutes before your scheduled injection, numb the area. My nurse suggested numbing it for a minute, but for this first go-around I decided to put every last sensation in my skin to sleep…five minutes for me, thanks. I numbed the area, went over it with an alcohol pad, let it dry, and drew up my dose in a syringe. In that moment, I had an epiphany – if Katherine Heigl’s character on Grey’s Anatomy can do it, I can do it. I pinched the skin on my tummy, lined up the needle, took a breath, looked away and put it in (at a 90 degree angle). When I looked back down, the needle was in but I was completely shocked, I couldn’t feel anything. Nothing. Zip. I want to be clear here and say, I am a wus about this stuff and I honestly couldn’t even feel it. I released the tummy pinch, pushed the dose in, removed the needle (pull straight out), wiped over the area with alcohol and did a victory phone lap, calling about ten of my closest friends to tell them that I was a fearless Goddess Warrior who may have missed her calling as a professional shot giver. As strange as it sounds, I was actually looking forward to my next injection.
I think that my greatest piece of advice in regards to how to cope with injection anxiety would be to remember that we’re often our own worst enemies – psyching ourselves out, telling ourselves “I can’t do this”. I’m here to tell you that if I can, you most certainly can. Think of some of the stuff you’ve overcome in your life. In comparison, I’m sure that needle truly is tiny.
-Diana, BHED donor #4829
Monday, October 12th, 2009
During the early years of IVF treatment, it was always assumed that transferring more embryos would improve success rates. Even 20 years ago, it quickly became apparent that this success came at the expense of a high multiple birth rate. In response o this, many European countries and Australia limited the number of embryos that could be legally transferred to woman’s uterus. While laudable, these restrictions tend to be rigid and do not always take into account the age of the producer.
In the U.S., we have adopted a voluntary system through the American Society of Reproductive Medicine (ASRM). The ASRM has published guidelines that take into account maternal age and are more flexible. However, as seen in the recent case of the famous octuplets, there are no serious consequences when a poor outcome is attributed to not adhering to these guidelines.
While these measures have greatly reduced the incidence of triplets and higher-order multiple births, the incidence of twins remains high, especially with egg donation. Many patients may think this is fine. In fact, many couples express a desire to have twins. Their preferences are affected by a belief that transferring two or three embryos improves success rates, and, for some, a financial motive that sees twins as a “two-for-the-price of one.”
The success rate belief may be inaccurate. Many European studies, as well as our experience, strongly suggest that the success rates with two day-3 embryos is equal to the success rate with one good quality (day-5) blastocyst. The ASRM guidelines allow either choice. Yet, many clinics are still transferring two blastocysts, with predictably high twin rates. So, what’s wrong with that?
The problem with twins is that they have a 50% chance of being born prematurely. As a result, they have higher rates of cerebral palsy and other complications of prematurity. The combined medical costs from IVF twins due to ICU care and life-long complications from prematurity are easily in the billions of dollars. Furthermore, from conception to delivery, there is a reduced chance of actually delivering two live babies. Even when twins are born close to term and are healthy, there are considerable financial and emotional costs associated with them.
With appropriate statistical analysis, it may be possible to demonstrate that the chance of a live birth is the same after the transfer of one blastocyst compared to the transfer of two embryos.
While twins may seem cute and a bargain at first, patients undergoing egg donation should inform themselves of the risks of twins and discuss the potential merits of single embryo transfer (SET) with their physician.
- Michael Feinman, MD
Medical Director, HRC Fertility
Huntington Reproductive Center Medical Group
Friday, October 2nd, 2009
When choosing an egg donor, it is understandable that women will want to select a donor who is similar to themselves in appearance and ethnic background. As with many aspects of Jewish Law, what may seem obvious and desirable may not conform to rabbinical interpretations of the Law. Ironically, since it is sometimes difficult to find suitable Jewish donors, these legal twists can actually help some people “let go” of their desire to work only with Jewish donors.
There are three concerns that rabbis have addressed in their discussions regarding the selection of egg donors. The first is accidental incest. The second is the legal status of a woman’s eggs. The third, and possibly the most important to recipients, is the Jewish status of the children born through egg donation.
Reasonable concerns exist that due to the anonymity of most egg donation arrangements, the actual children of the donor could accidentally marry the offspring of the woman who received her eggs. Sounds far-fetched, but rabbis worry about such things.
As to the status of the eggs, rabbis have agreed that according to Jewish Law, a husband has a legal attachment to his wife’s eggs. In theory, according to Jewish Law, the resulting offspring could have a claim on the donor’s husband in a Jewish court of law.
While Reform Judaism recognizes that parentage can come from either parent, traditionally most, but not all, rabbis have agreed that if a Jewish woman gives birth to the baby, that child is fully Jewish. The Laws determining a child’s family and religion of origin were established thousands of years ago – long before genetic testing – and so Jewishness is passed from the mother who gives birth rather than from the genetic parents.
Based on these three considerations, the following principles can guide most Jewish couples considering egg donation:
A Jewish donor is not legally required for a Jewish couple. Based on the concerns about accidental incest and the legal status of eggs, a non-Jewish donor may actually be preferable. Accepting this idea can alleviate much of the angst over trying to find a Jewish donor which can be difficult.
If a Jewish woman is chosen, she should be single or married to a non-Jewish man. If she is divorced, she needs a Jewish divorce, including a “Get.”
The process of choosing an egg donor is different for every family. There are an endless number of things to consider in making such an important decision. If observing Jewish Law is a priority for the Intended Parent(s), then finding a Jewish donor is not only unnecessary, but potentially undesirable. Ideally, this will be helpful to some as the pool of potential donors will be enlarged significantly.
- Michael Feinman, MD
Medical Director, HRC Fertility
Huntington Reproductive Center Medical Group