"Infertility and IVF: A Womb with a View"

from Williamsburg Yorktown Daily:

Infertility and IVF: A Womb with a View
Dr. John Janousek, M.D.
Posted: Today

Prior to medical school I worked in reproductive medical labs performing in-vitro fertilization, or IVF. I was an embryologist, the one who joined the egg and sperm together in petri dishes to form human embryos. I saw firsthand the anguish of couples who suffered from infertility and the joy when “miracle babies” were born from assisted reproductive technologies.

The usual course of life for most couples is dating, marriage, then children, and when they cannot become pregnant everything changes. There is terrific emotional stress, feelings of guilt and worthlessness, depression, and frequently marital discord.

Infertility treatments have become very advanced and more successful. IVF has come a long way since the first American baby, Elizabeth Carr, was born 27 years ago after her mother was treated by Drs. Howard and Georgiana Jones here in Hampton Roads at EVMS in Norfolk.

What is infertility?
Infertility is defined as the inability to get pregnant after trying for at least one year. Women who have repeated miscarriages are also infertile.

What are the steps in becoming pregnant?
An egg must be released from a follicle on an ovary (ovulation), and must enter one of the fallopian tubes leading to the uterus. Sperm must be present to fertilize the egg along this journey. Finally, the fertilized egg (embryo) must attach to the walls of the uterus. Conditions that interfere with any of these steps can cause infertility.

How common is infertility?
Very common. About 12% of women have trouble becoming pregnant. In couples, about 1/3 of the time it is a female factor, 1/3 are male factors, and 1/3 are a combination or unknown.

What are the causes of infertility in women?
The most common cause is a problem with ovulation (commonly hormonal). Other causes include blocked fallopian tubes (from pelvic inflammatory disease, endometriosis, or surgery), uterine problems such as a bicornuate uterus (2 compartments) and fibroids. Advanced maternal age decreases fertility as well.

What are causes of infertility in men?
Some men produce too few sperm or even none at all. Others have sperm which have an abnormal shape or impaired ability to move (motility problems). Other sperm appear normal on microscopic exam, but for biochemical reasons cannot penetrate the egg.

Trying, but no baby; what next?
Ok, a couple has been trying for a year to become pregnant without success. What are the next steps? The couple should get an appointment with a gynecologist who has experience in infertility treatment. A woman can contact her gynecologist to ask about an infertility work up or a referral.

What are some of the steps in infertility testing?
To test ovulation, a woman can check her basal body temperature every morning, check her cervical mucus texture, or use a home ovulation test kit. Blood work and ultrasounds can also be performed.

A hysterosalpingogram (HSG) is used to check for blockages in the fallopian tubes. Dye is injected through the vagina into the uterus, and fluoroscopy (continuous x ray) enables the physician to watch its passage. Laparoscopy (surgery) involves insertion of a fiberoptic scope through the skin into the pelvic area to directly visualize the reproductive organs. This is also the definitive method to diagnose endometriosis (abnormal location of cells from the lining of the uterus).

Men typically have a semen analysis done, and they can be referred to an urologist for further evaluation. Some conditions such as a hydrocele (swollen blood vein) may require a minor surgery.

What are some infertility treatments?
Infertility medications are given to women to help them ovulate and to mature and release more eggs from multiple follicles which increases the chance of conception. Artificial insemination involves washing and concentrating a sperm sample with injection into the uterus. Treatments are targeted at overcoming the specific problems identified (see steps in becoming pregnant above). Assisted Reproductive Technology (ART) refers to more advanced treatments.

What are some types of ART?
IVF refers to joining of the egg and sperm with fertilization outside of the body, in a special type of petri dish containing specific culture media. The woman is given hormone injections causing the ovaries to produce many eggs. When the eggs are mature, they are removed usually by needle aspiration and joined with the sperm in the lab. Embryos are replaced through a catheter inserted through the cervix into the uterus about 3-5 days later.

The Jones Institute’s clinical pregnancy rate per embryo transfer procedure is about 43%. Nationwide in the best clinics, there is about 22-32% “take home baby rate” per transfer; this takes into account miscarriages and ectopic (tubal) pregnancies. The CDC has a good site about ART with data from all reporting programs.

Intracytoplasmic sperm injection (ICSI) is used to overcome sperm problems, and involves using a microscope and special tiny needles to inject a single sperm directly into an egg without harming it.

Working as an embryologist was a very interesting and rewarding job for me, although I always worried about dropping the small petri dishes containing human embryos (never happened). The patients were incredibly thankful when the process worked (but of course the doctor got all the credit).

I remember a party I attended at that time, where a woman found out what I did for work. She began telling me loudly and in detail all about her husband’s low sperm count and the problems they had conceiving. The poor fellow was standing there trying to shrink into the wood work!

Remember, infertility is a common problem that can be treated, although even now many couples are not successful. About 85% are treated medically or surgically with only about 5-10% progressing to the point of needing IVF or other ART.

Infertile couples need plenty of emotional support as the inability to produce children is a huge stressor. Sexual union, instead of being an act of love turns into a mechanical process of trying to achieve the elusive goal of pregnancy, with each menstruation bringing on feelings of failure.

The good news: There are a lot of treatment options and we have one of the world’s best infertility centers close by in Norfolk at the Jones Institute. Also, let’s keep in mind another option: adoption; some of the area’s greatest people were adopted, namely ME!

Disclaimer: This does not take the place of regular medical care, and is not a complete review of any medical conditions. Consult with a physician before any treatment or taking any medications. Seek medical attention immediately for any serious symptoms, or call 911. No current or local patients have been referenced, so any resemblance is purely coincidental.

courses change

You may have noticed, our journey has changed it's course slightly. We are now looking into foster/adopting. Waiting for a newborn could take a few more years. We certainly wouldn't turn one away, but we've widened our search to include children up to five years old.

For those of you doing your home study, take note, it cost us $150 to change this on our already completed home study report. It's an addendum to our original report. We had never specified boy or girl, we'd be happy to have either.

Foster/adoption is fostering with the intention to adopt. These children are not going back to their birth parents for whatever reason.

Children in foster care are waiting for their birth parents to get their lives together so their children can come back and live in their home.

When you foster with intent to adopt, you are given a stipend (yes, the first thing I think is this system has the potential to be abused by some) until the child reaches the age of 18. The child is also on medicaid until the adoption in finalized.

Please continue to ask me anything, and PLEASE continue commenting, you comments are appreciated!

nine years

Nine years?

I've been thinking, when else have I worked for 9 years to get something I really wanted. It only took me five years to get a college degree. And less time than that to meet the love of my life.

I want a children, a family and to be a mom so badly, I've worked for 9 years to reach that goal.

What else would/could one possible work for 9 years towards?

I'm prepared to search for 9 more.

May is National Foster Care Month

Did you know there are 513,000 American children in foster care?
May is National Foster Care Month. No matter how much time you have to give, you have
the power to do something positive that will change a lifetime for a young person in need.

Get involved. Make a difference. For more information, visit
fostercaremonth.org or call 1-888-799-KIDS today!

nearly 9 months

We are 2 weeks away from 9 months of adoption journey. We'd hoped it wouldn't take this long. We've hoped for a lot of things.

We've had 2 opportunities.

1. a birthmom in PA looked at our profile. Her baby boy was due April 30. She looked at over 150 profiles. We were not chosen.
2. (sit down for this one) our social worker called us and said that a sibling group was available: a 6 year old by and his 4 year old twin brother and sister. We actually said yes we wanted to be considered for this foster with intent to adopt situation. They had been with a foster to adopt mom who abused the girl. It went to court on Tuesday and all three kids were returned to the abusive foster/adopt mom. We were one of 3 families being considered.

Adoption IS a roller coaster. Oddly, infertility is a roller coaster too... I'm starting to not like roller coasters...

I get SO excited about each opportunity, I don't know how not to. A birthmom friend of mine says it's because I have such a big heart. I think I'm just a glutton.

It's just like when I was pregnant, I want to tell EVERYONE. I find it very hard to keep to myself. But like miscarriage, when these adoptions don't work out, I have to untell everyone.

I am starting to look at adoption like falling in love, we will have to kiss a few frogs before we find our prince or princess.

I will say the last opportunity has opened our hearts to consider older children. We are now thinking we'd like a child up to about 4 years old, maybe 6. If we want to change our home study to reflect this, it will cost $150 so we are going to think about it a bit.

Yes, I do get tired of hearing "your child is out there" but I have to keep believing that it's true.

Let's hope we don't have to wait another 9 months.

Thanks to family, friends and the kindness of strangers. You know who you are. Your support is greatly appreciated.

quote

Making the decision to have a child is momentous. It is to decide forever to have your heart go walking around outside your body.

~Elizabeth Stone

ah dear internet, the places you take me...

I've started Twittering. I have multiple personalities.

One of me Twitters as someone waiting to adopt. I have met others waiting to adopt as well as a few birth moms. Interesting to say the least.

I've met an 18-year-old. She gave birth last night. The adoptive parents were at the hospital during the birth, I'm not sure if they were in the delivery room or not.

My friend (the birth mom) started sending me messages via Twitter last night from her hospital bed. Once she held her baby, she did not want to let her go, she wanted to keep her.

She asked ME what to do. I found myself in a very awkward position to say the least. For a moment, I felt the weight of the world on my shoulders.

I told her I did not have an answer for her. I told her only she can find the answer in her heart. I told her that her feelings were probably pretty normal for someone who as just given birth. I told her I'm sure her feelings are completely natural.

I asked her to try to look to the future, 2 months from now, 2 years from now, what would be the best for her and her baby. I suggested she try to see beyond her current feelings. She said she would sleep on it and let me know what she decided this morning.

I've not heard from her.

I cried part of the time we were "communicating." I cried for her, her baby and for the potential adoptive parents. They had already held the baby too. I know their hearts will break if the adoption fails.

I cannot put myself in her shoes, no matter how hard I try.

She asked if I hated her because she accidentally got pregnant at 18 and I can't get pregnant. I told her no way! I thought this a typical adolescent question. It did make me laugh a bit.

She graduates from high school in 2 weeks.

We both watch "The Secret Life of the American Teenager."

She pressed me again, begging "please! tell me what to do." I just kept telling her "as much as I'd like to help, I cannot do that." I prayed for her, for her baby and for the perspective adoptive parents.

She told me she wished she'd met me sooner, she would like me to be the adoptive parent. So sweet, so innocent, so young.

This encounter has touched my heart and let me have a brief front row seat to the other side of adoption. For that, I am thankful.

Ah dear internet, what do you have in store for me next...

update #1: She decided to keep her baby. I've wished her all the best.

update #2: her boyfriend/baby daddy proposed, they plan to get married after graduation. Baby is doing well.

update #3: she graduated from high school this week and her baby came home from the hospital. (5.8.09)

i get by with a little help from my friends

My friend John recently blogged about us on his B&B site. Check it out here, and if you are ever planning a trip to Atlantic City, I highly recommend John's B&B, The Carrisbrooke Inn, and tell him Julie & Chris sencha!

waiting to adopt? check out these tees

Adoption Bug - tees for those waiting to adopt. You can find them on Facebook too.

Virginia Women's Center

If you got here from the Virginia Women's Center, welcome. Being from Virginia, I hope you find this blog really helpful. I have tips on fingerprinting, etc, that are specific to Virginia.

Please feel free to comment, ask questions, or just follow along quietly.

I'm happy to help in any way I can.

Welcome!

check me out!

My OB/GYN's office posted a link to my blog on their site! Wooo hooo!

Virginia Women's Center

my quest to understand the other side of adoption

A "cyber" friend of mine who is also waiting to be chosen as an adoptive parent sent me this link.

As potential adoptive parents, we continue to try to understand what adoption is like from the other side, from the birth mom's side. I am trying to understand what a difficult and courageous decision adoption is for her.

'He deserves more'

Get your tissues ready.

i want my MTV!

(How old am I? does anyone else remember that advertising campaign?) :P

Two of my friends told me about a program on MTV called TrueLife and right now there is an episode on called "I Placed My Baby for Adoption."

It was on at 4 a.m. today so we DVR'd it and my husband and I are watching it right now. I wanted to post so you can search for it and hopefully it will still be running for the next week or so.

It is a reality show about 2 pregnant young women and their decision to adopt, but it's just one episode.

We are still trying to learn as much as we can about what it's like for the birth mom.

updated 3.26.09: there is a followup to this program on here. I watched it and it was very good. I feel for the women who have to make the decision to keep or give up their baby. I know it must be difficult to keep in mind what is best for the baby.

nothing to report

I'm just writing to let you know there is nothing to report. We are still playing the waiting game.

Those of you going through the home study, try to enjoy it (LOL), it's better than the waiting! Who would have thunk it! At least you feel like you are doing something, making progress.

Waiting is what it is: waiting.

7 months

It was 7 months ago today that we decided to adopt!

WOW!

how it works or "what are we waiting for"

Ok, so while we are waiting, I thought I'd try to explain how it works, or at least how it works ideally...

We will hear of an adoption situation from one of you, our attorney, our social worker or whomever.

When a situation arises that we are interested in and can afford, we will submit our adoption profile. (That's why our profile is so important, it is someone's first impression of us, it is why I made myself crazy :D

The potential birth mom will look over profiles (or if she doesn't want to perhaps her parents will or even the birth father). She may have something specific she is looking for like a couple with no biological children or a couple living in a certain geographic location. So I think her attorney or social worker will screen out some profiles before the birth mom views them.

She will decide which prospective adoptive parents she wants to meet. It's like being a finalist in a contest.

After she meets everyone, she chooses who she wants to be the adoptive parents of her baby. Some birth moms allow the adoptive parents to be in the delivery room, some don't. Every situation is unique.

Some birth moms want no contact with the adoptive parents or the baby. Others want photos and letters, some want annual visits, it just depends on what everyone wants and agrees on. Any contact between the birth mom and adoptive parents is called an open adoption. There is no contact in a closed adoption.

We are open to an open adoption and would like our child to have the option to get to know their birth parents when they are older, the decision would be theirs to make at 18 or something.

standard lingo:
BM = birth mom
BF = birth father
APs = adoptive parents

9-year pregnancy?

Maybe in stead of having to wait 9 MONTHS for my baby, I'm gonna have to wait NINE YEARS? Is that the plan for me? I can't help thinking that when I look at my little ticker: 8 years, 7 months and 2 weeks...

Still searching for our Juno...

Adoption seekers using YouTube, Facebook to find birth moms

by Stephanie Chen

(CNN) -- Their paths crossed on YouTube on an August night last year.

Jeremy and Christy Nueman used YouTube to find their adopted baby, Caleb.

Amanda, a college student seven months pregnant, scrolled past a YouTube video of a young California couple seeking adoption.

The couple, Jeremy and Christy Nueman, wanted to adopt a baby after struggling with infertility for five years. But instead of relying solely on newspaper ads or bulletin board fliers to increase their chances of connecting with a birth mother, they created a short YouTube video to show who they are.

Upon watching the video online, Amanda immediately connected with a snapshot of the Nuemans' adorable miniature pinscher named Penny. She giggled when she saw video of Jeremy Nueman dancing happily in his kitchen, which reminded her of her own father.

She played the video over and over again.

"The video was comforting, and I could relate to them" said Amanda, who picked the Nuemans to become the adoptive parents of her baby boy out of hundreds of profiles she viewed online and through adoption agencies. Amanda chose to keep her last name anonymous for privacy reasons. "It's so hard when you are just reading a letter to figure out what are these people like."

With a high demand for domestic infants, adoption experts say the wait for a baby can be months or years. To gain a competitive edge, a growing number of adoption-minded couples are using Web sites like YouTube and Facebook to sell themselves as parents. Going online is cheaper, faster and reaches a wider audience than using just on print advertisements and word of mouth, they say.

Some wannabe parents are uploading YouTube videos featuring a hodgepodge of photos, home tours and interviews. Others are writing on blogs and personal Web sites to give birth mothers a glimpse of their adoption journey. To help spread the word, prospective parents also are utilizing social networking sites like Twitter, MySpace and Facebook in the hope that their friends may know of a potential birth mom.

"Today's teens and young adults looking for adoptive parents are more tech savvy than before," says Jeff Siler, who owns ParentGallery.com, a free site created in 2007 where couples wanting to adopt can post pictures and video online. "Even before teens talk to an adoption agency, they may already be trying to Google for an answer online."

Social media like YouTube, Twitter and Facebook are also gaining traction among private adoption agencies. Bethany Christian Services, one of the nation's largest adoption agencies, which completed more than 730 domestic infant adoptions last year, advises its couples -- including the Nuemans -- to create a YouTube video.

"Having a video makes you feel like you are with them in person," says Dawn Baker, a social worker at Bethany Christian Services in Madison Heights, Michigan, who says the teen mothers she counsels really connect with the videos. Baker added that she matched a 16-year-old pregnant girl with a family in North Carolina after the teen saw their video last month. The adoption is not yet finalized.

In the past, adoption advertising, which is allowed in at least 34 states, traditionally relied on newspaper and radio advertising as well as brochures, fliers and business cards, adoption experts said. In the digital era, these media no longer have the reach they once did. Newspaper ads can be costly, running hundreds of dollars a month.

Maria Kwarta and her husband, Nathan Kwarta, both 26, of University City, Missouri, saw the Internet as a natural way to reach potential birth moms.

"We were trying to do what was familiar to us. We already had Facebook and MySpace accounts, so why not just use that," said Maria Kwarta, who has been discussing adoption with her husband for more than five years.

The two are also sending Tweets every few days, seeking potential moms on Craigslist, documenting their efforts in Live Journal, updating their Xanga profiles and posting on CafeMom.

"Get to know us a little better," says the Kwartas' three-minute YouTube video with upbeat music in the background. Their video shows a photo montage of the couple with brimming smiles at baseball games and ski trips. The video ends with contact information so the birth mother can reach them directly. Watch the Kwartas' YouTube video

The Nuemans and Kwartas aren't alone in their relentless efforts to find a baby. While there is no federal data tracking the number of private domestic adoptions each year, adoption experts estimate that about 15,000 private domestic infant adoptions are completed in a year. Yet experts said the number of couples trying to adopt is even larger than the adoptions that are finalized.

White American infants continue to be in the highest demand, adoption experts say, but the number of domestic infants available for private adoption has dropped as women have more access to contraception and the social stigma against single parenting has lessened.

For example, from 1989 to 1995, the percentage of children born to never-married white women who were placed up for adoption dwindled to 1.7 percent, a steep decline from 19.3 percent of children going up for adoption before 1973, according to the Evan B. Donaldson Adoption Institute in Massachusetts, a nonprofit that tracks national adoption trends.

"The more people who know you are looking, the better your prospects," explained Adam Pertman, executive director of the Evan B. Donaldson Adoption Institute, who has seen more prospective parents start using the Web to spread the word in the last few years. "It's a crapshoot, and you are trying to improve your odds."

Seth Edlavitch, 38, and his wife had waited for a baby for nearly three years. They had made a paper flier to find a birth mother, and on a whim, they uploaded it to Facebook last December. His wife, Melissa Segal, 39, was unable to conceive and had a devastating miscarriage years before.

It took only two weeks before a friend of a friend, who knew someone who wanted to give up her child for adoption, found the flier online.

"It's just one of those right place and the right time situations," said Edlavitch, who brought their newborn son, Noah Edlavitch, to their Maryland home on New Year's Day. "I never would have anticipated that it would work the way that it did."

There are some downsides to advertising online. Driving traffic to the site can be tough. The blogs, videos and profiles need to stand out to be effective, says Lori Dowd, who owns an adoption consulting Web site, ProfilesThatGetPicked.com.

Karen Greenberg, president of the American Academy of Adoption Attorneys, a national association of adoption lawyers, warns that advertising on Craigslist and Facebook can be a "hotbed for scams." The academy is trying to create a national "adoption information clearing house" where attorneys, agencies and eventually couples looking to adopt can use the site to check the birth mother's status. The site is planned to be launched this year.

"There aren't any regulations to oversee what's actually going on when you go at it alone," she said.

Back in their home in San Diego, California, the Nuemans have celebrated their first Thanksgiving and Christmas with their new son, Caleb, a playful, chubby, brown-haired, blue-eyed baby. The adoption was finalized in October 2008.

"I remember walking through the door with Caleb the first time we bought him back," said Christy Nueman, 29. "Just the thought that our family was going to be full-grown -- it was a sweet moment knowing this would be our new family."

FYI IVF

Before we started using infertility drugs, our doctor discussed with us, the possibility of multiples and told us that for the health of the babies and me, we should consider selective reduction if I were to become pregnant with more than two babies.

We could not afford IVF, it is not mandated that insurance cover fertility treatment in our state, so we were told one IVF cycle would cost between $25,000 and $40,000 (we saw a few doctors).

I know some of my readers don't know as much as me about IVF, so I thought I'd share.

just a thought

Before you are allowed to adopt, you have to go through an extensive Home Study, why not have something similar for people who want to have multiple embryos implanted.

2.27.09 - updated
For instance, we had to show that we had one bedroom to provide in order to qualify to adopt one child.