Archive for October, 2009

When and how should I seek a second opinion?

Thursday, October 15th, 2009

Suppose you had a friend who was grappling with a cancer diagnosis and kept wondering whether his/her specialist had really considered all the possible treatment angles that might work. Suppose he or she had been receiving some treatment but there hadn’t really been any sign of progress. What would you advise? Probably a second opinion, right?

For some unknown reason, fertility patients seem to struggle with this notion that it’s somehow disloyal to seek a second opinion. Yes, it is awkward. But actually, it’s just good common sense if there’s any little voice inside your head saying “maybe there’s a better way …”  I know several women/couples who have switched specialist within the same clinic and have really agonised over how they are going to “break up with” their initial specialist. But the reality is this happens all the time, and people need to find the fit that’s right for them. My local clinic (FAA) actually makes that transition incredibly smooth and most of the drs are perfectly happy when it happens. [Actually, some may be relieved about getting rid of a “difficult” patient! ;)]

Even if you’re not actually switching specialists, it’s perfectly reasonable to seek out a second opinion if you want to. If you’re publicly funded you may have to pay for the second opinion consult, but that’s money well spent if it’ll give you peace of mind and/or some good ideas that can get you closer to building the family you want.

Remember, just as in any other profession, each individual specialist has certain diagnoses and treatments that they have a particular interest in and more experience in treating. Some gravitate toward the more straightforward cases (early 30s, no tubes, standard protocol, easy success); some specialise in particular issues (endometriosis, PCOS, thyroid problems); some are really passionate about taking on the really challenging cases (women over 40, poor responders, egg quality problems). It’s a good idea to ask around about who’s had success with cases like yours. And that’s a good place to start for a second opinion. Just think, women/couples in the States fly 5 hours from coast to coast seeking a second opinion; we are incredibly lucky that even the other end of the country isn’t that far away! And if travel is really a problem, you can often book a phone consult.

Over the years, one thing I’ve noticed is that the truly professional specialists I’ve spoken to have NO problem at all with my seeking a second opinion. They support my being proactive and are very happy to listen to any ideas I glean from those other consultations. They don’t let egos get in the way of my treatment. While working with my own specialist, I got a copy of all my notes and did a phone consult with a specialist in the States who’s considered the #1 go to guy for women with my particular diagnosis. My specialist in NZ was like nooooo problem – and was very open to the ideas I came back with. We did, of course, have a healthy debate about which of the ideas seemed to make the most sense in my case, but the main thing was that we had that discussion and we made some good decisions together about what to try next.

How do you know you should seek a second opinion?

Well, everyone’s different. For some people, it’s when they’ve just had a failed cycle, they can’t afford to do more than about one more, but the specialist is suggesting just going with the same again. For others, they’ve tried discussing other ideas with their specialist but feel like these aren’t being taken seriously or at least the reasons for not trying these things aren’t being adequately explained. For me, it was feeling like we’d already discussed and tried all the ideas we could think of together, so I needed a fresh perspective, a new source of ideas. Whatever the situation, if there’s a little voice in your head wondering whether you and your specialist have adequately explored all the possibilities, that’s a sign you might want a second opinion. It could just end up confirming what your current specialist is telling you, in which case that’s also useful because it eliminates doubts that you’re doing the right things.

If you think you might want to get a second opinion on your case, here’s what to do:

  1. Get a copy of your notes from the clinic so you know exactly what protocols you have tried already, any testing that’s been done, how you responded to treatment (including E2 levels, follicle sizes, the embryologist’s ratings of embryo quality, etc).
  2. If you can, make a 1-2-page bullet point summary of your history and any testing. This makes it a LOT easier for the new dr to get up to speed quickly on where you are at.
  3. Ask around (e.g. on the Everybody BB’s Infertility forum) to find out which drs at which clinics have had success with your particular diagnosis and history.
  4. Call that dr’s clinic and speak with his/her receptionist; ask for an in-person or phone appointment; ask where and how to send your summary/notes/file.
  5. You don’t have to formally tell your current specialist that you’re seeking a second opinion, but you’ll probably end up informing his/her nurse or receptionist when you request a copy of your file/notes. It’s a courtesy to mention it, but if it’s causing you anxiety then don’t force yourself to. The specialist will understand.
  6. If you are doing a consultation with someone who works at another clinic from your ‘home’ clinic and if you like what they are suggesting as a new plan, discuss with them whether it would be feasible/advisable to (a) ask your current specialist to follow a new protocol; (b) cycle at your local clinic but with the new specialist either calling the shots or providing advice to your own specialist; (c) travelling and doing the whole cycle at the new clinic; or (d) doing egg collection and transfer at the new clinic, but monitoring (ultrasound and bloodwork) locally. All of these options have been done around the country at one time or another.
  7. Don’t worry too much about having to persuade your current specialist to try something new – quite often the specialists will just get in touch with each other and work out how best to work together. Ask your ‘second opinion’ specialist what he/she thinks is the best way to handle this. The politics and the details of this shouldn’t be your problem – you are going through enough stress already!
  8. Don’t worry too much about the ‘disloyalty’ issue either. You have the right to expect specialists (and any healthcare provider, for that matter) to be professional about second opinions and NOT to make you feel guilty about seeking one out. If you find someone is not being particularly professional about it, that tells you more about them than it does about how you handled it. Your priority is to get a baby/family out of this, and their priority should be to help you achieve that dream. The specialists won’t be a part of your life forever, but your babies will!

We’ve had multiple losses – what should we be asking about?

Wednesday, October 14th, 2009

“We seem to have no trouble getting pregnant, but we’ve had several first trimester losses.” Or, “We put back good-looking embryos every time, but they just don’t stick.” If this sounds like you, here are a few ideas you might want to discuss with your doctor.

Miscarriages can be caused by any one or more of the following factors:

  • structural
  • hormonal
  • immunological/autoimmune
  • environmental
  • genetic

Let’s start (as the drs often do) with the fairly basic hormonal tests. One of the first that’s included in a fertility workup is testing progesterone in the luteal phase. Most drs order this for CD21 (Day 21 of your cycle), but actually you should really have it done at 7dpo (7 days past ovulation). Of course, 7dpo=CD21 if you ovulate on Day 14 of your cycle, but if you usually ovulate late or early, or if it’s unpredictable, you might want to track your ovulation using BBTs (basal body temperatures) and go at 7dpo. If your progesterone (P4) levels aren’t high enough, you may need progesterone supplements (like utrogestan pessaries) after ovulation (O). Some specialists believe this is a VERY common problem with older women and that if you’re over 40 and ttc naturally you should take P4 after O every cycle.

Another important one to test early, especially if you have any family history or tend to feel tired a lot, is thyroid conditions. Hypothyroid (underactive thyroid) does pop up reasonably often as a cause for conception and sometimes miscarriage problems and is easy to test for. You can ask your GP for this if you’re not seeing a specialist.

If you’re ttc naturally you should also check whether you have a luteal phase defect, i.e. once you ovulate it takes fewer than 12 days for AF (your period) to arrive. You can usually figure this out by charting your basal body temperatures (BBTs) – and a really good site for learning how is Fertility Friend. Again, if your LP is too short, this can be easily fixed with progesterone support after O.

There’s a panel of blood tests you can ask for that are used to diagnose some of the possible causes of “recurrent pregnancy loss” (RPL) or “recurrent implantation failure” (when those embies just don’t stick). Broadly speaking, they cover three categories of issues – autoimmune issues (your body may be rejecting embryos as foreign bodies), clotting issues (not sure the exact mechanism for this, but if your blood clots too much, this makes pregnancy loss more likely – some clotting issues are caused by autoimmune problems) and some genetic issues. Here’s the list that we were sent for, and I think it’s a pretty typical list for New Zealand (some countries like the States seem to test for half a dozen kitchen sinks, several of which aren’t available in NZ):

  • Coagulation screen
  • Thrombophilia screen
  • Autoantibody screen incl.
  • antithyroid antibodies,
  • anti-gliaden antibodies
  • Factor V Leiden
  • Karotype
  • MTHFR mutation
  • Anticardiolipin antibodies
  • Lupus anticoagulant
  • … and a karotype for DH (who gets off easy, as usual).

Probably the next logical step is to get either a saline sono (ultrasound during which they squirt saline solution into your uterus to help them see better) or an HSG (similar, but it’s an X-ray procedure where they shoot iodine dye into your uterus and can also check whether you have blocked tubes). Either of these should tell you whether you have any structural issues in the uterus that might be preventing you from achieving or holding onto a pregnancy. Examples include uterine polyps, fibroids, scar tissue, and an unusual shaped uterus. The most likely issues can often be treated with some fairly minor surgery.

The main environmental causes of miscarriages are not usually tested for, but things you should look around you to check your exposure. Some to keep an eye out for include lead, mercury, organic solvents and ionising radiation. Other more common culprits like cigarettes, alcohol, coffee and other drugs should be cut right out (or, down as much as possible) while ttc. Some naturopaths will do things like send a sample of your hair for analysis for heavy metals, which can highlight things you are exposing yourself to without knowing it. They also advise avoiding those forms of radiation and related exposure that we are not often aware of. These include long-haul flights (which expose the body to as much radiation as a full-body X-ray, or so they say) and keeping a cell phone in your pocket right next to your ovaries – think about it!! Well, who knows which of these various things are real causes, but if you want to make sure you try everything you can to prevent another loss, you’ll probably do what I did and take the ideas pretty seriously.

But what if my specialist won’t run all these tests?

This is quite a common comment from a lot of women/couples dealing with RPL (recurrent pregnancy loss). It may be frustrating, but there is another way to look at this. OK, you may not be able to test for the entire kitchen sink, but maybe you can ask your specialist to consider treating you as if you did have several of these issues going on but they just may well be undiagnosed. That may sound nuts, but there are actually quite a few low-tech options you can ask about that many doctors will agree fall into the “won’t hurt, might help” category. These include:

  • low-dose aspirin (usually 100mg/day) – addresses clotting issues
  • high-dose folic acid (4-5mg/day) – helps prevent neural tube defects
  • progesterone support (usually Utrogestan pessaries) after O on every cycle you are ttc
  • low-dose estrogen support after O too (2mg estradiol valerate, for example)

If you’re doing IVF, each cycle is a bit more high stakes, so you may be able to push for a bit more of a kitchen sink approach. Some other things that people are often allowed to try even if there hasn’t been a definitive diagnosis of a particular cause for repeated losses/failures include:

  • progesterone shots instead of (or as well as) the pessaries – for after egg collection
  • a low-dose steroid such as Dexamethasone – to address any undiagnosed immune issues
  • Heparin shots – Heparin is a blood thinner, so this also addresses clotting factors

Finally, don’t forget that there’s good evidence that acupuncture improves pregnancy and live birth rates for patients undergoing IVF – and good reason to believe this is also true for couples trying to conceive naturally or with IUI. Click on the category Acupuncture and Chinese Medicine in the left-hand column to see more posts on this topic.

Choosing a good acupuncturist

Monday, October 12th, 2009

When I started ttc over the age of 40 and was gearing up for IVF, I decided I should start acupuncture to help maximise my chances. Boy, have I learned a few things since then!

How to tell if your acupuncturist is NOT a good choice:

I initially chose an acupuncturist who was quite close by, whom I eventually decided wasn’t a good choice. To help others choose a good one, maybe it would help to describe what made me think so …

  1. Didn’t ask me what day of my cycle I was on when I went, and didn’t alter acupuncture points according to where I was in my cycle.
  2. Did not have a clear understanding of IUI/IVF, i.e. what happens at different parts of the cycle.
  3. Didn’t seem to have a clear understanding of what happens in a natural cycle, e.g. when implantation occurs (7-10dpo).
  4. Wasn’t able to explain clearly what my Chinese medicine diagnosis was, or the rationale behind the treatment plan. [This wasn’t an ESL issue – the person was a born and bred kiwi.]
  5. In hindsight, seemed to be trying to treat so many things in one acu session (loads of needles; I was a total pincushion) that I started wondering if some of the points used were actually cancelling out the effect of others.
  6. Wasn’t actually formally trained in acupuncture. [I know, I know, what was I thinking?!]

When I switched to another [competent] acu, the difference was just night and day on ALL the above points.

Acupuncture Qualifications and Credentials

The New Zealand Register of Acupuncture has a list of those acupuncturists who are members of the NZRA. If someone is NOT a member of NZRA or another relevant professional association, you should certainly raise an eyebrow. However, the fact that someone is a member of one of these NZ ‘registers’ is NO guarantee of quality. The acupuncturist I mentioned above, who had NO formal qualifications in acupuncture, was (and is) a long-time member of NZRA. Current requirements to join NZRA include a “qualification that meets the NZRA’s criteria” and some form of clinical assessment, but it would appear that several acupuncturists with no formal qualifications appear to have been “grandfathered” into the association early on and not subject to these requirements.

So, who IS a good acupuncturist?

For those of you looking for an acupuncturist, here’s a list of people who come highly recommended by fertility patients around the country (note that I can’t vouch that they really ARE brilliant since I’m not a Chinese medicine dr myself, but am just sharing what others have said). The following interpretation guide should help:

**Absolutely raved about ALL the time by patients (including those who’ve had success!) AND I’ve also heard endorsements from at least one credible expert source
*
At least one or two patients have spoken positively about them AND I’ve also heard endorsements from at least one credible expert source
[no asterisk]
Have been recommended by patients, but I haven’t also heard any expert endorsement about their competence, nor any concerns

Auckland

  • Dr. Vitalis, Mairangi, North Shore, 09 486 5111 **
  • Laura Bradburn, Acudoc, Auckland Central, 09 626 7120 (but she’s apparently on maternity leave in late 2009)
  • Lisa Houghton, Acudoc (above) and the Motherwell Clinic, Mt Eden, 09-630-0067
  • Bessie Lu, Village Acupuncture, Mt Eden, 09 630 3168

Hamilton

Napier

Wellington

Nelson

  • John Black, Nelson Chinese Medical Clinic, 22 Nile Street, Nelson 03 546 8733 *
  • Paddy McBride, Acupuncture Richmond, 40 Oxford Street, Richmond, Nelson 03 544 0411 *

Christchurch

  • Dr. Tracey Bourner (Ph.D. in research), Riverside Acupunture and Chinese herbs, Opawa, 03 981 1683 *
  • Georgia Bryant, Acupuncture for Health, South Brighton, 03 388 7346 *
  • Eleanor Marks in St Albans 03 960 9702
  • Suzy Tapper, Ferrymead Acupuncture, 03 384 8589

What should I ask a prospective acupuncturist before agreeing to work with them?

Whether or not a prospective acupuncturist is on the above list, it’s always a good idea to ask them a few questions before you agree to work with them. Here’s a list of questions to help get you started:

Where did you train? What acupuncture or Chinese Medicine qualifications do you have? Have you done any advanced training or courses since then? Are you a member of the New Zealand Register of Acupuncturists or some other professional association? [The ‘gold standard’ would be a bachelor’s degree in acupuncture from a reputable school in China or elsewhere PLUS some advanced training (master’s degree or other), preferably specifically in acupuncture and Chinese medicine for fertility PLUS some sort of certification that actually evaluates competence. Note that being “registered in New Zealand” simply means being a paid member of a professional association and is no guarantee of competence.]
[Assuming this is at a first/introductory appointment:] What is my Chinese Medicine diagnosis? Please explain (in lay terms) what it means and what your treatment approach would be. [Just my view, but if someone can’t explain what they are doing in understandable terms, that’s a good indicator they don’t REALLY have a good understanding of it themselves.]
How would my treatment differ before vs. after ovulation in my cycle? [Wrong answer: It wouldn’t. A good answer might include explanations like: The follicular (pre-O) phase usually emphasises kidney yin treatment, whereas in the luteal (post-O) phase we typically treat kidney yang. Also, points used after O should be those that would support a pregnancy; some of the ones used before O are good for that phase of the cycle but not safe if you might be pregnant.]
How would my treatment differ during an IVF/IUI cycle vs. during a natural cycle? [Wrong answer: It wouldn’t. A good answer would show some thoughtful logic such as: You’d generally tend to use less aggressive acupuncture treatment while someone’s on stims – you don’t want to make their ovaries blow a gasket!]
What successes have you had with women/couples of a similar age and with a similar Western diagnosis to mine/ours? Please describe one or two recent success cases. [Obviously, more success cases similar to yours are better. But keep your ears tuned too for evidence of the kind of systematic detective work a good practitioner would use to ‘listen’ to how the body responds and tweak the treatment. A fertility-challenged body is like a squeaky old violin that needs to be worked with carefully to make it sing the sweetest tune it possibly can.]
What professional associations are you a member of? Which Chinese Medicine-related conferences and seminars do you regularly attend? How else do you keep up with new developments? [You want to make sure you are working with someone who understands Chinese Medicine as not just an ancient tradition that you get trained for once and that’s it, but as a growing discipline that creates new knowledge all the time. If your acupuncturist isn’t making an effort to keep up with the field, that’s not a good sign.]
What would you say are the two or three most important advances in Chinese Medicine for the treatment of infertility in the past few years. Do you have a copy of a good recent article I could look at? [If your prospective acupuncturist can’t rattle off a few really interesting recent developments that are relevant to your case, that’s a sure sign he/she isn’t keeping up with the play. And beware of someone who doesn’t want to give you an article “because you probably won’t understand it” – first, they may not actually have any relevant articles because they don’t keep up with the field, and second, that’s a hint that they don’t see you as an intelligent and active partner in your own treatment.]

If the choice is not clear cut after asking the above questions, I’d suggest doing a session or two with each possibility and seeing which one seems like a better fit for you. Even the raved about acupuncturists on the list above have some patients who just don’t ‘click’ with their style. So, make sure the person you choose feels right for you.

· Where did you train? What acupuncture or Chinese Medicine qualifications do you have? Have you done any advanced training or courses since then? Are you a New Zealand registered acupuncturist?

[see Qualifications and Credentials, above for how to evaluate answers.]

· [Assuming this is at a first/introductory appointment:] What is my Chinese Medicine diagnosis? Please explain (in lay terms) what it means and what your treatment approach would be.

[Just my view, but if someone can’t explain what they are doing in understandable terms, that’s a good indicator they don’t REALLY have a good understanding of it themselves.]

· How would my treatment differ before vs. after ovulation in my cycle?

[Wrong answer: It wouldn’t. Correct answers would include: The follicular (pre-O) phase usually emphasises kidney yin treatment, whereas in the luteal (post-O) phase we typically treat kidney yang. Also, points used after O should be those that would support a pregnancy; some of the ones used before O are good for that phase of the cycle but not safe if you might be pregnant.]

· How would my treatment differ during an IVF/IUI cycle vs. during a natural cycle?

[Wrong answer: It wouldn’t. Correct answer: You’d generally tend to use less aggressive acupuncture treatment while someone’s on stims – you don’t want to make your ovaries blow a gasket!]

· What successes have you had with women/couples of a similar age and with a similar Western diagnosis to mine/ours? Please describe one or two recent success cases.

[Obviously, more success cases similar to yours are better. But keep your ears tuned too for evidence of the kind of systematic detective work a good practitioner would use to ‘listen’ to how the body responds and tweak the treatment. A fertility-challenged body is like a squeaky old violin that needs to be worked with carefully to make it sing the sweetest tune it possibly can.]

· What professional associations are you a member of? Which Chinese Medicine-related conferences and seminars do you regularly attend? How else do you keep up with new developments?

[You want to make sure you are working with someone who understands Chinese Medicine as not just an ancient tradition that you get trained for once and that’s it, but as a growing discipline that creates new knowledge all the time. If your acupuncturist isn’t making an effort to keep up with the field, that’s not a good sign.]

· What would you say are the two or three most important advances in Chinese Medicine for the treatment of infertility in the past few years. Do you have a copy of a good recent article I could look at?

[If your prospective acupuncturist can’t rattle off a few really interesting recent developments, that’s a sure sign he/she isn’t keeping up with the play. And beware of someone who doesn’t want to give you an article “because you probably won’t understand it” – first, they may not actually have any relevant articles because they don’t keep up with the field, and second, that’s a hint that they don’t see you as an intelligent and active partner in your own treatment.]

Acronyms

Monday, October 5th, 2009

Ever wondered what on earth the infertility veterans are on about? Well, here’s a list of the main terms used on NZ and overseas boards (and here on this site) …

@@ or (.)(.) – boobs
AF – Aunt Flow (period)
AH – Assisted Hatching
AMH – anti mullarian hormone
amnio – amniocentesis
ART – Assisted Reproductive Technologies
BBL – be back later
BBT – Basal Body Temperature
BCP – birth control pill
BD – bonking daily / baby dancing (sex for the purpose of getting pregnant)
beta – blood prehnancy test (beta-hCG)
BF – breastfeed(ing)
BFN – big fat negative [pregnancy test]
BFP – big fat positive [pregnancy test]
BH – braxton hicks contraction
BI – buserelin injections
BIL – brother-in-law
BP – blood pressure
BT – blood test
BTW – by the way
CD – cycle day (CD1 = cycle day 1 = first day of AF)
CM – Cervical Mucus
CUC – constant undies checking (during 2ww and early pregnancy)
CVS – chorionic villi sampling
D&C – dilation and curettage
DD – Darling Daughter
DE – Donor Egg
DF – Darling Fiance
DH – darling husband, dumb husband etc
DHAC – Don’t have a clue
DOR – diminished ovarian reserve
DP – darling partner
DP – depo provera
DPO – days past ovulation
DPW – dreaded pink wipe
DS – Darling Son
Dx – Diagnosis
E2 – Estradiol
E2V – estradiol valerate (progynova)
EBB – Everybody Bulletin Board
EC – egg collection (a.k.a. egg retrieval)
EDD – estimated due date/estimated date of delivery
EPO – evening primrose oil
ERPOC – evacuation of retained products of conception
ET – Embryo Transfer
EW – exercise week
EWCM – egg white cervical mucus – here are some pics: http://www.tryingtoconceive.com/
F+ – Fertility Plus (Auckland)
FA – Fertility Associates
FAA – Fertility Associates Auckland
FAH – Fertility Associates Hamilton
FAW – Fertility Associates Wellington
FET – Frozen Embryo Transfer (=TER)
FF – Fertility Friend
FIL – father in law
FMU – First Morning Urine
FS – Fertility Solutions
FSH – Follicle Stimulating Hormone
FUCA – Friends/Family Unwanted Comment Attack (e.g. “I’m sure if you just relax, you’ll get pg” Or “You should be glad you don’t have kids, mine are such nightmares….”)
GF – Gonal F (injections)
GL – good luck!
hCG – Human Chorionic Gonadotrophin
HPT – Home pregnancy test
HSG – hysterosalpingogram
IB – implantation bleeding
ICSI – Intra-cytoplasmic Sperm Injection (injecting sperm directly into the egg, in IVF)
IF – Infertility
IMHO – in my humble opinion
IMO – in my opinion
IUI – intrauterine insemination
IYKWIM – if you know what I mean
JCD – Jenny Craig day
LASS – life’s a sh*t sandwich
LH – luteinizing hormone
LMAO – laughing my ass off
LSC – low sperm count
LOH – Life On Hold
LOL – laugh out loud!
LP – Luteal Phase
LPD – Luteal Phase Defect
MC or m/c – miscarriage
MIL – mother in law
Mrs Mumu – Another term for Menses/AF/period
MS – morning sickness
MTB – mother to be
NFP – natural family planning
NT scan – nuchal translucency scan
NTTC – not trying to conceive
O – Ovulation, ovulate
OC – ovacue
OPK – ovulation prediction kit
OT- Off Topic
OTT – over the top
PCOS – polycystic ovarian syndrome
pg – preggers
POAS – pee on a stick (usually HPT, could be OPK)
POF – Premature Ovarian Failure
ROFLMAO – rolling on the floor laughing my ass off
RMC – recurrent miscarriage clinic
Rx – Prescription
S/A or SA – Sperm/Semen Analysis
SAHM – stay at home mum
SFP – small faint positive
SIL – sister in law
SNAFU – situation normal all fu**ed up
SO – Significant Other
TATTC – thinking about trying to conceive
TER – Thawed embryo replacement
TMI – too much information
TOTP – top of the page
TTC – trying to conceive
TTLW -trying to lose weight
US or u/s – ultrasound
WR – waiting room!
WTF – What the f**k…..
(generally used in reference to a FUCA!!)
WW – weight watchers
1WW – one week wait
2WW – two week wait
4dp3dt – 4 days past 3-day transfer (IVF)

Infertility Humour – IVF Barbie

Monday, October 5th, 2009

No idea who the original author of this is – it’s all over the net. But definitely one of the classics!!!

Not a completely accurate reflection of the kiwi situation, since there’s no such thing as health insurance that covers infertility here. Also, in the States they refer to fertility specialists as REs (reproductive endocrinologists).

Still, lots of parallels and I am sure those of you who’ve done the IVF rollercoaster will recognise the various Barbies and Kens and get a laugh or two out of it. Enjoy! 😉

————————————–

When Mattel were looking to design their new Barbie, IVF Barbie, they soon realized that there was not one universal Barbie that would accurately portray the spirit of IVF Barbie. So they decided they would come out with a few variations thereof.

Newbie Barbie:
Newbie Barbie, also known as BabyDust Barbie is a bright, perky, Barbie, filled with optimism and confidence that IVF Will Work. She is thinner and usually younger than the other IVF Barbies. Her accessories include rose-tinted spectacles, a positive bank balance, healthy insurance coverage and a million questions. Newbie Barbie has lots of other Newbie Barbie friends and they congratulate each other on a job well done. This Barbie only says pleasant, optimistic things and believes that Attitude is Everything. Their motto is Think Positive!!

Pregnant Newbie Barbie:
Pregnant Newbie Barbie is the big sister to Newbie Barbie. She is still slim, now with a cute belly. She is proof that IVF Does Work, usually the first time. She also comes with rose-tinted spectacles, a positive bank balance (only very slightly depleted) and total confidence that All Will Be OK. She glows when pregnant and liberally uses baby dust when playing with her sisters, the Newbie Barbies. She comes with Very Cute maternity clothes, a double stroller, and a fully decorated nursery even though she is only just a few weeks pregnant. Her motto is ‘See! Thinking Positive Works!!’. Newbie Barbie and Pregnant Newbie Barbies are great playmates and you can collect them as a set.

Joiner Barbie:
Joiner Barbie is cousin to Newbie Barbie and Pregnant Newbie Barbie. Joiner Barbie comes with a group of friends just like her, and this group calls themselves by the name of a furry animal or has reference to a season. Think Spring Blossoms or Bubbly Bunnies. Accessories include a chart or table of some sorts, lots of smiley faces, baby dust (a glitter-like tub of ground up positive attitude that apparently has the power of hocus pocus to make one pg), declarations of eternal friendship and love and lots of ((((hugs)))).

Veteran Barbie:
Veteran Barbies are not at all related to the Barbies above. Veteran Barbies are the Anti-Barbie. They are a whole lot plumper than the Newbie Barbies, less perky (in boobs and attitude), have grayer hair, a largely negative and over-drawn bank balance, plenty of bruises and marks and a slightly cynical attitude. They are dressed in comfy track pants with elasticated waistbands. Their accessories include a wealth of knowledge of reproductive procedures and protocol, the ability to practically do their own cycle, a snarky attitude, little tolerance for stupidity, a well defined sense of humor, the ability to laugh at themselves, a fondness for wine/beer/crack and an aversion to pineapple, baby dust and Newbie Barbies. This aversion in its more severe form can be allergic and acerbic. Veteran Barbies tend to swear quite a bit (especially when playing in the Barbie House with Newbie Barbies and Pregnant Newbie Barbies) and parental guidance is advised.

Pregnant Veteran Barbie:
Very similar to Veteran Barbie, only now with an added dose of neuroses and paranoia. Continuously and obsessively over-analyses every twinge, convinced that the end is nigh. Only buys stroller and decorates nursery when in eighth month. Accessories include disbelief and a sense of not quite belonging, and 10 home pregnancy tests just in case the first one was faulty or the clinic made a mistake with her beta. Pregnant Veteran Barbies have been known to pee on the sticks up until the day before giving birth just to see the two lines.

Celebrity IVF Barbie:
Celeb Barbie comes in two versions: Denial Celeb Barbie and Out of the Closet IVF Barbie. Denial Celeb Barbie does not play with the other Barbies and pretends not to be an IVF Barbie at all. She drops the IVF part of her name and thinks ‘Donor Eggs’ is a swear word. She pretends that her twins at age 49 are Natural and she did it all On Her Own. She also claims her boobs are her own and that she has never had a face lift, hence her credibility is not at an all time high. Out of the Closet IVF Barbie is the preferred Barbie. We like her.

IVF Ken:
Ken is a wanker. Sorry to sound so harsh, but besides being a wanker there is very little that Ken does in IVF land. Sometimes Ken administers shots, hands out tissues and occasionally accompanies the Barbies to their Dr’s visits (normally during the first few cycles only), but mostly he is just a wanker. If you choose an IVF Ken, then try and get one that also cooks or does DIY. Otherwise just sit him down in front of your Barbie TV and let him know when it is time for him to do his, um, contribution. Mostly the Barbies love their Kens, unless Ken is being particularly insensitive or obnoxious, then he becomes a wanker in all senses of the word. Some IVF Barbies don’t even have a Ken and they do just fine. If you do find a good Ken, hang on to him, don’t swap him with your other friends.

RE Ken:
RE Ken is the all knowing, all seeing Ken. He might be a wanker, or not, but here we are talking about being a wanker in the figurative sense. He could also be very nice. He may call you by your first name but you may only call him Doctor. His accessories are many and wonderful. He comes with a zooty new car (normally very expensive), a smart house, a very healthy bank balance and a holiday home or two. RE Ken knows every thing and is considered second only to God. Some RE Kens are kind, some are not. They are all rich. Ken’s office is filled with fun toys like ultra sound machines, dildo like probes, waiting rooms filled with the different types of Barbies (some annoyingly come with miniature Barbies or Kens in tow), medicines, procedures rooms etc. RE Ken also comes with a free Nurse (Ratchet) Barbie, who will not return your calls, will hand out annoying platitudes and generally add to your frustration levels. When purchasing RE Ken you will get Ultrasound Ken and BloodDrawer Ken. Unfortunately they come as a package deal and you are not able to get RE Ken without them, they aren’t as much fun. However, you will need a RE Ken if you are going to play the IVF Barbie game.

Mattel foresee a big demand for these Barbies and say that for extra fun and lively interaction, collect the full set of IVF Barbies, put them in the Barbie house together and see the sparks fly.

What low-tech things can we do to increase our odds?

Saturday, October 3rd, 2009

Maybe IUI and IVF aren’t an option for you and you’d like to try and increase your odds generally while ttc naturally. Or maybe you’re gearing up for – or in the middle of – IUI or IVF treatment. Or on one of those interminable waiting lists!

Is there anything you can do NOW that can help improve your odds?

Yes! There are a number of things you can do to get your bodies readier and more likely to succeed than they currently are for conception and pregnancy. Many of these take several months or more before you see the full benefits, so remember, it’s never too early to start AND it’s never too late to start because every little bit helps! If you’re on a waiting list for IVF (or waiting to get on one!!), this is a fruitful way to make the most use of your time.

Things men can do to improve sperm quality

Let’s start with the guys, for once! Get them out of those briefs and into boxers for starters, and no long spa baths or sweaty bike rides!! Sperm don’t like being overheated. Guys are also supposed to get their BMIs in a healthy range – usually quoted as 19-25, but bear in mind the number can be misleading if you are athletic and carry a lot of muscle. A hilarious recent example is that about 25% of the All Blacks are considered obese and the rest are ALL overweight!

There are also a bunch of supplements that are known to improve sperm quality. Here’s the list that was recommended to us by a naturopath:

  • a multivitamin called V2000
  • CoQ10 100mg (the more bioavailable gel type)
  • Vitamin C 1000mg/day (twice a day if he had a cold)
  • Vitamin E 200mg w/Selenium
  • Flax seed oil 2000mg I think
  • zinc complex (at night)
  • L-carnitine 500mg

I’ve also seen several people also recommend Vitamin B complex and folic acid (800mcg). And most naturopaths would also advise giving up smoking (anything!!), cutting right back on drinking and cutting out coffee (even decaf) if at all possible. Tea is better, green or herb/fruit tea even better.

Does it work? Well, after our IVF#3 failed my DH was so disappointed he went on “vitamin strike” for 3 months. By the time we tried IVF#4 his count had dropped from 90mil/ml to 18mil/ml. After that, no more vitamin strike!!! 😉

What can women do to improve their odds of conception?

The clinics will give you a few basic tips here – cut RIGHT down on coffee and alcohol, stop smoking and other drugs, exercise moderately three times a week, and aim to get your BMI between 19 and 25 to maximise your odds. [However, bear in mind that BMI is a bit overly simplistic for some body types, e.g. very tall women or those who carry a lot of muscle.] Click here to access Fertility Associates’ advice on boosting your fertility.

Acupuncture and Chinese herbs can also be a great way to prepare yourself for IVF. As you can see from this summary of research on acupuncture and fertility, it can be used to treat all sorts of conditions, from endometriosis, PCO/PCOS and sperm counts/quality to advanced maternal age, high FSH and poor eggs. For more information about how and why it works in general and for various conditions, find related blog posts by clicking ‘Acupuncture and Chinese Medicine’ under Topics (in the left column of this page).

What about supplements for women? Well, there is a huge and overwhelming range available depending what diagnoses you are struggling with, so probably the best advice is to see a good fertility naturopath to help you pick out the best mix for you. Having said that, here are a few that seem to be recommended in many/most cases, from what I can tell …

  • a good multivitamin
  • folic acid, at least 800mcg, but if you’re ‘older’ or have had multiple losses or implantation failures, ask your specialist to prescribe you the 5mg dose
  • Vitamin C 1000mg/day, twice a day when you have a cold
  • Vitamin E with Selenium
  • Coenzyme Q-10 (aka CoQ10) 100mg, preferably the more bioavailable gel caps
  • Fish oil or flax seed oil, 2000-4000mg/day
  • zinc complex
  • iron supplement if your levels are a bit low (ask your GP to test)

For an additional truckload of ideas, follow this link to read about low-tech things women can do to increase the chances of conception. And if you fish around that site you will find a lot more info about low-tech methods for couples and some of the basics of conception (most of which you’ll already know, of course). Unfortunately their tips for guys was down when I last checked, but I’ve emailed them about it and will add a link to this blog if it comes back online.

IVF – the hurdles

Friday, October 2nd, 2009

So you’ve read the IVF manual and are all ready to start a cycle. What are some of the “wish I’d known that” snippets that veteran IVFers can share with you to help fill the knowledge gaps about what to expect? Well, one that comes up a lot is having a clear understanding of the not-so-straightforward hurdles involved in an IVF cycle. Here’s a typical comment from an IVFer …

When you start this journey you read the “ivf manual” and all sounds so easy – take some drugs, grow some eggs, have them collected, fertilised and put back in and voila! a baby. Ha!! They don’t tell you about the things that go wrong. Or the things that don’t work the way they should.

So, what are the main hurdles you face in an IVF cycle?

  1. Downregulation or precycle suppression might take longer – some gals do their downregulation blood tests after several days on Buserelin and find they need to keep downregulating for several more days before starting stims. If you’re on no precycle suppression or something very mild, you may find that you have a dominant follicle or a cyst at the beginning of your cycle and it may not be a good idea to proceed with stims.
  2. Assuming you get out of the starting blocks, your first hurdle is whether your ovaries will respond to the stims. This is assessed with blood tests (for estrogen, or E2) and an ultrasound. If you grow too few follicles or your E2 is too low or the follies don’t grow fast enough or your E2 doesn’t rise enough, the clinic is likely to cancel your cycle for poor response. The good news is that you may do better on another protocol – see an earlier post on IVF protocols for more information …
  3. Some women have the exact opposite problem to poor response – they overrespond. They grow too many follicles and their estrogen shoots dangerously high. In this case the clinic will either drop your dose of stims or stop stims altogether (this is called ‘coasting’). The blood tests continue, and if your E2 drops to a safe level they will let you trigger and go ahead with your egg collection; if the levels stay too high for too long, you may be cancelled for your own safety because you are at high risk of OHSS (ovarian hyperstimulation syndrome). Even if you make it to egg collection, you may be told it’ll be a freeze-all cycle – research shows that women at risk of OHSS are at higher risk if they do a fresh transfer and get pregnant.
  4. You make it as far as egg collection (a.k.a. ‘retrieval’) and have 10 follicles. That’ll be 10 eggs, right? Unfortunately not. Not all follicles yield an egg, and some women have major problems at this hurdle, getting only eggs from only 50% of their follicles, or sometimes fewer. [See Empty Follicle Syndrome] Others have a 100% strike rate just about every time. So, it’s just the luck of the draw. In any case, you shouldn’t expect to get an egg from any follicle that was smaller than about 15-16mm at trigger, and you shouldn’t expect all your mature (large) follicles to yield eggs.
  5. Yay, we got six eggs!! That’ll be six embryos, right? If you’re lucky, yes, but there are more hurdles here too. First, it’s possible not all of your eggs were mature. Only the mature ones can potentially fertilise. And not all of them do. Some couples get 100% fertilisation just about every time, and others get a very low %. Some also get abnormal fertilisation, such as when two sperm enter one egg. ICSI can improve fertilisation rates if there are sperm issues or if the eggs have hard ‘zona’ (eggshells).
  6. The day after egg collection, the embryologist will usually call you to let you know how many of your eggs were mature and how many have fertilised normally. From there, you are in a waiting game to find out how many of those embryos will make it to Day 3, and how well they divide. Some may ‘arrest’ (stop growing) along the way, some will divide more slowly (or quickly) than is optimal. The best possible result is to have 4-cell embryos on Day 2 and 8-cell embryos on Day 3. The survival rate from fertilisation to Day 3 is not usually too bad.
  7. If you’re taking your fresh or leftover embryos from Day 3 to blastocyst stage, there is a VERY high die-off rate at this point. Before deciding to do this, I strongly recommend you read the post on this issue (2-day, 3-day or blast transfer?), discuss it with your doctor, nurse and embryologist, and make your wishes crystal clear.
  8. Once the embryos are transferred back to the uterus, you are in the dreaded 2ww (2-week wait). Arrrghh! Enjoy the first week because you are going to drive yourself insane in the second week obsessing about every twinge. 🙂

Well, those are the main hurdles for an IVF cycle. The bad news is that if you DO get a BFP there’s a whole other set of even more hair-raising hurdles to clear! But we’ll save that for another post …