Authors: Paul and Shannon Morell
Published in 2010 by Howard Books, New York

In 2009 we read in the popular press that a woman in Michigan was mistakenly implanted with another woman’s embryos due to a mix up at an unnamed IVF Clinic. While this type of mistake is rare, the story was further sensationalized by the revelation that the pregnant woman, Carolyn Savage, intended to carry the pregnancy to term and then turn the baby over to its rightful parents, Shannon and Paul Morell. This was a heartwarming and wonderful outcome from an error that likely would have ended up in tragedy in any other situation.

I finished reading the book less than a week after it was published because I’m keenly interested in the events that led to an error like this. I believe that there is much to be learned from the mistakes of others and I encourage open discussion with the embryologists at PFC to see if it would be possible for us to make a similar mistake. Unfortunately however, the book shares few details of what exactly happened that caused one woman’s embryos to be placed in the uterus of another. We do know that both women used the same last name (Shannon Morell had been treated under her maiden name, Savage), and the error resulted from the thawing of frozen embryos, rather than from the use of fresh embryos. Additionally, we know that Carolyn Savage reported to the clinic for her frozen embryo transfer and somehow the embryos from Shannon Morell (Savage) were thawed and transferred. We do not know if the wrong orders were sent to the IVF lab (“thaw Shannon Savage’s embryos”), if the embryos were inappropriately labeled in the freezer, or if the embryologist simply was not paying attention and thawed the wrong embryos. Whatever the error, it seems likely that having the same last name somehow contributed to the problem.

Regardless of the error that led to thawing the wrong embryos, my opinion is that the major mistake happened when the embryologist went into a room with embryos from one patient and handed them over to another patient. That moment of transfer is the final checkpoint for error prevention. The embryologist is absolutely responsible for confirming that the patient in the room is the owner of the embryos that are to be transferred.

Therefore, even though the book does not share many details about the source of the error, in my opinion, the mistake was made by the embryology laboratory staff. A similar mistake happened in the UK in 2007. In that particular case, the pregnant woman terminated the pregnancy. The Morell’s were aware of this history and worried that the same fate awaited them. All of their frozen embryos had been thawed. Even though the Morells had 2 beautiful daughters, Ellie and Megan, they had planned on using every one of their embryos. Both couples were deeply religious and much is made of this in the book, from praying for a positive outcome to discussions on the embryo as a human being. The book tells a deeply human story and will likely be an emotional rollercoaster for any readers who have undergone fertility treatments.

The book is rich with information on how patients approach, cope with and understand fertility treatments. Shannon Morell appears to have been a typical patient, but with deep religious convictions and a belief that life begins at fertilization. As a sideline to the story concerning the mix-up, she also delves into the story of one of her other embryos that did not make it to transfer or freezing. She was upset that an embryo remaining after an embryo transfer in an earlier treatment cycle was not frozen for later use. Chances are that this embryo had either arrested or was not of sufficient quality to tolerate freezing and thawing. This issue could have been resolved earlier if she had spoken with the MD or embryologist at the time, but she was not aware until much later that the embryo had not been frozen. Similarly, in the pregnancy that is the focus of the book, six embryos were thawed but only three were transferred. Little if any information seems to have reached Shannon on the fate of the other three. It is very likely that these three embryos did not survive, as the freezing technology in use at that time was not as good as what we use today. Understandably with this lack of information, the Morell’s were left with a feeling that mistakes were happening. In sharing their story with the media, they reasoned that perhaps the publicity would force other fertility clinics to be more careful about how they handle embryos, and think twice about the ramifications of their mistakes.

Being that medical care, including fertility treatment, is provided by humans to other humans, it is inevitable that random mistakes will happen in fertility clinics, medical offices, hospitals and every other workplace. However, the more we talk about them, study them and increase awareness, the less likely they are to be repeated. At PFC, we study all these cases in great detail, to see what we can learn, to find out if we are vulnerable to similar errors, and to modify our processes to ensure that we cannot make the same mistake. Unfortunately, with many of the errors that have occurred in IVF clinics, the staff appear to wait until the patient has had a pregnancy test to determine whether the embryo(s) have implanted, before disclosing the error. To me, this delay appears a further insult to the patients involved, since it may remove some of their options for remedy (such as taking the morning after pill to prevent the embryo from implanting). The gamble the clinic is taking is that the patient will not become pregnant and then perhaps the error will not seem so bad, or worse still, not be disclosed at all. The proper path is to fully disclose any mistake immediately after it happens, so that all parties can make fully informed decisions and have as many choices as possible. Mistakes, like secrets, only get worse with time, not better. And they never go away. Waiting makes mistakes worse, suggests deceit, and potentially ruins the lives of one or more families.

At PFC we have never had an embryo mix-up incident, and we have never inseminated a patient’s oocytes with the wrong sperm. In our laboratory, we have procedures in place that require a double witness of these and other critical steps in the IVF process. We are also very diligent about personally checking each patient’s identity when sperm or eggs come into the laboratory, and when embryos leave. Additionally, we review all our processes on a regular basis and look for new ways to improve. Interestingly, both the College of American Pathologists (our accrediting agency) and more recently the FDA, now specifically assess our procedures and processes for identifying and tracking gametes and embryos and our ID checks on patients. In fact, the FDA conducted an unannounced inspection here at PFC this summer specifically to look at this area of our practice, and we passed with flying colors. PFC will continue to demand improvements in our protocols and procedures, so that we will continue to avoid errors and continue to provide the same quality of care that we have given for the last 10 years.

Title: The Fertile Kitchen Cookbook

Can diet influence fertility? Can altering your diet help you conceive? Is it true that you are what you eat (and so is your baby)?

At age 40 and after trying to conceive for over a year, Cindy Bailey and her husband Pierre Giauque were told that they were unlikely to conceive. With disconcerting medical test results and failure in conven tional treatment, alternative therapies seemed the best option. After trying a fertility-friendly diet, to their surprise, their son was conceived four months later.

The Fertile Kitchen is one couple’s story of overcoming the odds against conception while using common sense and easily executed measures to optimize health. Using fresh, high quality, organic ingredients, and reducing wheat and dairy; the couple developed a nutritional plan that they feel contributed to their success. These authors found that optimizing the basic ingredients for life, adjusting calories, carbohydrates, fats, and proteins into a regimen that has the potential to optimize pregnancy rates, should be considered in a given fertility plan.

Science is still catching up to medical concerns about fertility and diet. As an example of this emerging science, it is known that women with abnormal body fat levels, either high or low, suffer from lower pregnancy rates, and that improvement in body weight and body fat levels improves fertility rates…Certain types of animal protein are potentially problematic for fertility, whereas vegetable protein sources seem to carry less risk. Calorie source, simple sugar versus protein, makes a difference in treating anovulatory women. Irregular menstrual cycles can be optimized by changing diet. Omega-3 fatty acids are related to uterine artery perfusion pressures, and supplementation seems to provide some clinical improvement in these parameters. Studies are showing a role for B-complex vitamins, folic acid, and dietary fat in regulating ovulation.

It is unfortunate that some people have serious challenges to fertility that cannot be addressed with a change in diet. Diminished ovarian reserve, male factor, and tubal occlusion are problems that go beyond what can be remedied with diet alone. With that said, fertility treatment programs, regardless of the health issues, should include a healthy diet, as a good preventative measure for already healthy women wishing to conceive. The recipes in this book are easy to follow and the ingredients are amply available at most grocery stores.

Fertile Kitchen Media Kit (pdf)

— Philip Chenette, M.D.

Title: Everything Conceivable
Subtitle: How Assisted Reproduction is Changing Men, Women and the World
Penguin Books, 2007. 343 pages, with 57 pages of footnotes and references.
By: Liza Mundy

This is a very interesting book about the current state of affairs in the world of assisted reproduction. It is comprehensive in its coverage of almost all the latest technologies and the author has been very thorough in researching the subject. On most topics, there are insightful observations on the societal implications of current technologies. In this regard, it is a thought-provoking book.

In the epilogue, the writer states, “It was my goal to help readers understand why certain changes in the family are taking place and what their likely consequences might be. Why there is so much demand for donor eggs, now. Why there are so many more triplet sets than there once were. What life is like for those triplet parents. How embryo research and embryo politics are influencing our thought on human life and its origins. What is the real, rather than the imagined impact of medicine and science on families and culture.”

I think this would be an excellent resource if one were a health care policy maker or if one were writing a term paper or thesis on the subject but I don’t really think it’s a book to inform the infertility patient about fertility options or what to expect with treatment. It really does not seem to be intended for fertility patients as the target audience.

However, the book does provide a lot of useful information in a somewhat scholarly fashion. Most of the facts are correct, with some of the usual journalistic license.

Title: The Joy of Pregnancy
Subtitle: The Complete, Candid, and Reassuring Companion for Parents-to-Be
Author: Tori Kropp, R.N.

For many of our patients, who successfully conceive at PFC, a major shift in thinking follows the moment they realize that their pregnancy is viable. Shelving all the fertility literature, now it’s time to get educated about pregnancy. Hundreds of books on the subject of pregnancy can be found, but which one to read?

Finally we have a thoroughly enjoyable, informative and readable book by Tori Kropp, a labor and delivery nurse for many years at our own California Pacific Medical Center. “The Joy of Pregnancy” celebrates the miracle of pregnancy, labor, birth and brand-new parenthood. It embraces these experiences for what they should be: a time of joy and excitement, not of fear and guilt.

Tori has not only worked in Labor and Delivery at California Pacific Medical Center in San Francisco for many years, but she has also taught childbirth classes for thousands of expectant parents. As a mother herself, she has experienced pregnancy and birth first hand. She really has seen it all. Her calm, reassuring manner, helped many parents-to-be welcome the birth experience with knowledgeable assurance.

This book is written in an honest and open style. The medical terminology is minimized and practicality is emphasized. The many “Tori’s Tips” in the book are gems resulting from her knowledge and experience. They serve as little pearls of pregnancy wisdom. A glossary of medical terms at the end of the book is very useful. The questions and answers sprinkled through the book are entertaining, yet filled with practical and informed answers. Special sections for fathers are also included.

The last section of the book is one that is often missing in books about pregnancy: it is all about the first few weeks of parenthood. Breast-feeding and caring for your new baby are covered, again with an eye to being relaxed and enjoying the experiences.

We highly recommend this new book as you journey from infertility to family.

A Few Good Eggs; Two Chicks Dish on Overcoming the Insanity of Infertility is one of the best books about infertility written from the patients’ perspective. Julie Vargo and Maureen Regan have written a very readable and entertaining book presenting the entire gamut of the infertility experience covering diagnosis, procedures and the psychological challenges faced by patients – mainly women – facing infertility.

The book is organized chronologically starting from the early disbelief after realizing that one might be infertile, through the testing procedures, physician diagnosis and ultimately treatments.

Back-up options for those women and couples for whom treatments are unsuccessful are also explored. Along the way, the authors provide stories of their own experiences as well as the experiences of other women with whom the authors have met and talked in order to write the book. These two women personally went through many of the procedures and shared the same emotions that most fertility patients experience, their unique perspective brings a human touch to their writing. This is a refreshing contrast to the books written for the consumer by physicians or other health care professionals that work in the field.

However, because the book is written by patients and not reproductive endocrinologists (REs), there are some areas that not all REs will agree with, such as their perspective on immunology and infertility. The authors also seem to have gone through their treatments some years ago as the list of drugs is not current with some of the drugs now commonly used for ovulation induction. For example, they mention Pergonal, which is not currently available and do not cover the recombinant FSH medications most commonly used today, Gonal-f and Follistim. Plus, I doubt that a reproductive endocrinologist proofread the chapter on medications because they misnamed Repronex as “Repromax.” I also think their description of the side effects of these drugs is frightening and not typical of the side effects experienced by most women using them in treatment.

The book does provide a lot of useful information in a personal and accessible fashion. Most of the facts are correct. And most of all, the publication encourages women not to wait to get help if they think they may be infertile.

– Eldon Schriock, MD