Meet with a Registered Dietitian and:

Nutrition consultations consist of:

 Not sure if you are a candidate for nutritional counseling?

Set up a time for a free 20 minute phone chat with the dietitian to find out!

Ask a member of the front desk or call 415-834-3000 for more information or to set up an appointment.

Alison Boden, MPH, Registered Dietitian

Alison received her undergraduate degree from UC Davis, followed by graduate training in nutrition and public health from the University of North Carolina at Chapel Hill.  As a practitioner of integrative nutrition she takes a holistic approach to wellness, recognizing that the foundation for optimal health and healing begins with a health promoting diet. Her emphasis is on using medical nutrition interventions to create a basis for health promotion and healing.

A lover of good food, Alison believes that a healthful diet should be thoughtful, enjoyable and satisfying.  Each meal does not only provide calories, but is an opportunity to supply our organs with the nutrients and building blocks needed for health. When the body is out of balance, as in the case of infertility, proper food choices can correct deficiencies and bring balance back to the system. What you eliminate from your diet is often as important as what you include. Consultations with Alison will help you address the key components of your diet that may be affecting your fertility and wellbeing, as well as help prepare your body for pregnancy.

Alison has experience assessing and counseling clients related to pregnancy and fertility, weight management, lipid control, food allergies, digestive health, sports nutrition, and chronic diseases such as cardiovascular, kidney disease and cancer. She views each person as a unique individual, and is dedicated to educating patients on natural ways to achieve optimal health and allowing them to take an active role in their health care decisions.

Alison is a member of the American Dietetic Association and the Women’s Health and Integrative and Functional Medicine practice groups.

My husband and I never thought having a family would be a struggle.  His siblings and my cousins were all VERY fertile… why shouldn’t we be the same?  Little did we know, as we said our “I Do’s”, that a condition called endometriosis was wreaking havoc on my reproductive organs.

Such was its devastation, that our 1^st pregnancy was an ectopic, resulting in the rupture of one of my fallopian tubes.  Had we not gotten to surgery in time I could have died.  My husband still reels from the memory of me handing him my wedding ring as they wheeled me into surgery. 

My doctor at the time didn’t see my other symptoms, (missed menses, constipation, heavy menses) and the ectopic as a problem.  The solution therefore was to put me on Clomid.  After a year of trying, a family member recommended finding a new doctor. 

My new doctor stated that my symptoms were consistent with endometriosis but could not be certain without “going in” to make sure.  Thus began the 1^st of 8 laparoscopies (over 6 years) to “clean me up”.  I had 2 surgeries in one month. My endometriosis was so bad that I had organs being pulled together.  After the 1^st surgery my doctor had me begin the Clomid regimen. After 4 cycles of treatment she said that I would need IVF to get pregnant.  Here is where the true shock began.   

My husband and I live modest lives… I’m a Kindergarten teacher and he works in construction.  Although we lived comfortably, the cost of IVF seemed unattainable.  We discussed our options.  IVF meant no more vacations, no more upgrades to our home, and no more “let’s buy it” spending.  It also meant facing the dark reality that we may never have children.  After getting our finances in order we visited the Pacific Fertility Center in San Francisco, which our doctor had recommended.  It was a good visit and was our first step.  We made our plans to undergo IVF that summer, when I would be off from school. 

When the medications arrived we were in awe at the number of needles we had.  We were ready to begin this process… I had but one condition… since I was the receiving the injections, my husband had to give them.  I felt it only fair and would enable him to be very involved in the whole process.  He cried before giving me the first shot in my stomach.  He said he didn’t want to hurt me.  So I cupped his head in my hands and said, “If we want to have a baby, you have to give me the shot”.  He did.  I really didn’t have that many side effects.  What was more bothersome was the bruising and pain at the injection sites.  Of course as blood work and ultrasounds were done along the way, more meds were needed, bye- bye money.  Unfortunately, round 1 was unsuccessful and we discovered that I was not a top egg producer.  Of course my hubby had no problems with his soldiers… it was all me.  Ugh!  I think we had some extra embryos and did a frozen cycle right after… but to no avail.  Since we were committed to not only sticking to IVF but, also only doing it during the summers we had time not only to regroup, but save money.  Sadly, round 2 was also a dud.

For round 3 we had 3 embryos implanted.  And on 7-7-07 we discovered I was pregnant.  My husband said the date was a sign of good luck.  We were so happy and relieved.  We were finally going to expand our family.  Each month went by with no problems.  We had some stress… my work life was getting chaotic and my father was being a difficult patient recovering after heart surgery.  But my pregnancy was flawless.  On week 20 we discovered we were having a boy and by the end of the evening we had named him Lucius. 

However, one week later, while talking with some parents at school about the Halloween Parade guidelines, my water broke.  Even now I weep remembering that very moment.  The hospital sent me home to wait it out, hoping the hole would close.  However, by the third day I developed a fever and was going septic.  I had to deliver my little boy.  I begged with the doctor for a way to save my baby.  She said the waiting 4 more weeks until his lungs might be mature enough for survival was not possible since now I was also in danger.  There I was in the maternity ward waiting to deliver a dead baby. 

All I could think of was that I had failed my husband again.  In the months that followed I wished I had died with my baby.  I felt it was the only way I would feel less of a failure and the pain from my loss would be gone.  My husband would hold me and remind me that if he’d lost both of us he would be all alone.  I even offered to let him divorce me so he could find a wife that would be able to give him children.  I don’t think I’ve ever seen him as angry as when I said that.  He was willing to keep trying if I was.  And he felt that if we couldn’t have a child, then that’s just the way it would be.

So along came rounds 4 and 5, both of which failed.  The strain of infertility on our marriage was slight… but was there.  We were lucky to be able to talk it out.  What was difficult was the loss of Lucius.  There was pain there that lingered in each of us in different ways.  My husband started drinking more than usual and I found myself very resentful of others that had children/babies.  Amazingly, we made it through, pulling each other out of it.

When round 6 came along, with all we had been through, neither of us really expected it to succeed.  But amazingly we struck gold and were on our way to a family again.  However, this time we were on pins and needles.  I honestly don’t think I would have mentally survived another loss.  So we took every precaution possible, my mom even went to work with me 2-3 days a week to help out.  After the first trimester I decided that to be afraid was unfair to my unborn child.  Therefore, we started planning for this baby.  Registering and decorating.  Once we discovered we were having a girl… OMG!  Our joy could not be contained.  Every doctor visit that pronounced us healthy was fantastic.

Other than gestational diabetes, everything was great. Our little Lyra was born March 13, 2011 weighing 7lbs. 8 oz. and 20.5 in. long.  She was perfect!  We were perfect!

So after 10 years of trying, 6 years being IVF, 3 acupuncturists, body talk therapy, an ectopic pregnancy, and our Angel Baby Lucius, our family is now complete.  When I gaze into Lyra’s eyes and see her in awe of me I know she was worth all the sacrifices and tears.    

- Martina & Leandro

In case you missed Dr. Carl Herbert on the Fertility Forum radio show, you can download the Podcast on iTunes or the MP3 version from the Fertility Forum website.  Hear Dr. Herbert talk about the History of ART, Genetics, Fertility Preservation, Egg Banking, and other topics in the field of Assisted Reproductive Technologies. 

We hope you enjoy!

I was born and raised in Shanghai.  My father, a university mathematics professor, was one of the first generation of college graduates in China after the Cultural Revolution.  My mother, though intelligent and bold, never had the opportunity to pursue higher education.  They were “tiger parents” long before that term even existed.   This was the era before China had opened its door to the West, and disposable income was limited.  Nonetheless, they spent every penny towards my education and broadening my horizon.  I was the only child in my neighborhood to take private lessons in Chinese calligraphy and classical Chinese painting.  We spent weekends touring art exhibits and museums.  To ensure that I would succeed in school, my father taught me English and algebra during my summer breaks.

My childhood years spent holding the calligraphy brush played a critical role in helping me stay connected with my cultural roots after my family’s immigration to Canada when I was twelve.  Through the mastery of this traditional art form, I gained a deeper understanding of Chinese history and culture.  It has given me a platform with which I was able to continue my study of the Chinese language and literature long after English had become my primary language of learning.

My family’s immigration to Canada was serendipitous.  My father initially took us abroad for a one-year visiting fellowship at the University of Manitoba in Winnipeg.   It was the summer of 1989, when the communist regimes throughout Europe fell like dominos and in Beijing the bloody suppression of student demonstrators for democracy occurred in Tiananmen Square.  Although we were not politically involved, my family was given the opportunity to seek asylum in Canada. My parents decided to stay.

What followed was the classic immigrant story, filled with the hardships of survival in a foreign country away from loved ones, and, at the same time, the never diminishing hope and optimism for the attainment of the “American dream”. 

After attending junior and high school in Canada where I excelled in math and science, I applied to colleges in the U.S. with a vague plan to have a career in the sciences.  With this in mind, I was convinced that MIT offered the strongest programs in virtually every scientific discipline.  My years at MIT were the most formative period in my professional and personal development.  My professors and research mentor opened my eyes to the wonders of biology and inspired me to pursue a career in the study of the human body.  I became fascinated by how the body functions, especially the mysterious process by which a single stem cell develops into a complete organism.  At the same time, I continued to pursue my interest in Chinese by taking graduate level courses at Harvard and obtained a minor in Chinese literature along with my S.B. in Biology from MIT.

My interest in the human body led me to study medicine at Harvard Medical School.  During medical school, I conducted research in developmental neuroscience, which led to my honors thesis.  In addition, I became clinically interested in women’s health, a multifaceted discipline with broad psychosocial, political, as well as ethical implications.  I realized that I wanted to take care of women, promote reproductive health, and be a part of building families.  To that end, I completed a residency in Obstetrics and Gynecology at the University of California, San Francisco (UCSF).  During my residency, I learned to treat women of all ages and with every type of ailment from morning sickness to ovarian cancer.   It soon became clear that while I enjoyed delivering babies, I resonated most with patients who could not conceive.  Furthermore, the combination of advanced technology and cutting edge research in reproductive medicine perfectly matched my long held passions in science and technology.  Having come to that realization, I decided to pursue subspecialty training in Reproductive Endocrinology and Infertility, and was accepted into the fellowship at Columbia University Medical Center in New York. 

At Columbia, I was fortunate to be taught by some of the pioneers of the field, Drs. Roger Lobo and Mark Sauer, who have trained many respected Reproductive Endocrinologists around the country, including PFC’s very own Dr. Chenette.  Under their guidance, I conducted research on how follicular hormones affect human oocyte and embryo quality, which has led to several published manuscripts in peer respected journals, as well as my fellowship thesis.  Clinically, I became interested in treating patients with polycystic ovary syndrome (PCOS) and other endocrine disorders, as well as fertility preservation, for patients who desire to delay childbearing for either medical or social reasons.

While I was a resident at UCSF, I met and fell in love with my husband and we welcomed the birth of our daughter last year.  We both love the Bay Area and decided that San Francisco is the place where we want to raise our family.  I have always had the highest regard for the physicians at PFC, one of the most respected fertility centers in Northern California.  Therefore, it is my pleasure and privilege to be able to join Drs. Herbert, Schriock, Givens, Chenette, and Ryan in their mission to help women and families of the Bay Area and beyond in achieving their reproductive potential.

Throughout all these years of training and research during which I learned many exciting new skills and technologies, I still derive the most profound joy and satisfaction from the very first glimpse of a beating heart on ultrasound and the accompanying excitement in my patient’s eyes.  It was not until I held my own daughter and she flashed me one of her toothless gummy grins that the notion finally hit home: life is precious and the love for one’s child knows no boundaries.  I am truly lucky to be in a profession where I have been granted the privilege to take part in the creation of a family, a privilege that I will honor and treasure throughout my career.

Successful conception does not just involve eggs and sperm and the reproductive tract. The reproductive system, just as all other areas of human physiology, works best when the entire organism is healthy and balanced. This includes not just physical health, but mental health and sexual health.

With respect to physical health, most of what we should be doing is just common sense. For women, mild to moderate regular exercise is best. Although data on the level of exercise that is optimal for conception is scarce, probably no more than 4 hours per week of aerobic exercise may be best¹. Much higher levels can lead to too low a level of body fat for women (optimal body fat for women should be about 20% of total body weight). Excessively lean women (less than 10%) have more problems with proper reproductive hormonal functioning when it comes to ovulation. And while speculative, it is likely humans evolved mechanisms to limit female reproduction in times of starvation (low body fat may mimic a starvation mode) and when we are too much on the run as well. A study published in 2002 looked for associations between exercise levels and pregnancy and birth outcomes in exercising pregnant women². The study reported that women who exercised heavily during pregnancy had smaller babies, more labor inductions and longer labor and well as more colds and flu than more sedentary pregnant women. These are surprising results! Despite these studies it is likely that some moderate amount of exercise helps to promote a sense of well-being and the mental composure to deal with the stresses of every day life and the stress of dealing with fertility issues. Cardiovascular fitness can only be a good thing for pregnancy and beyond.

For men, there really are no restrictions on physical activity. The one exception would be too much bicycling for men hoping to conceive with their partner. The current bicycle saddles do affect testicular function in men who are frequent riders. In general, maintaining good physical shape enhances sexual functioning and of course, sex is important for conception! Speaking of sex, for men to have optimal sexual health, it is important to avoid excessive alcohol. While alcohol does lower mental inhibitions, it also inhibits erectile function, so excess alcohol, contrary to popular belief, does not enhance the sexual experience. Long term excessive alcohol also causes liver damage and raises estrogen levels in men. Higher estrogen levels can lead to smaller testicular volume and lowered sperm production. There is no problem with an occasional drink – just be aware of how much. Avoid intoxication, dehydration, hangovers, and the other consequences of excessive alcohol intake.

As many of our patients are aware, the experience of trying to conceive, especially if it’s taking a long time, can take a toll on sex and intimacy in a relationship. It is so important for partners to be patient with each other and make the effort to maintain the romance and intimacy which keep the relationship healthy. Yes, plan to have sex on the most fertile days of the month, but don’t stop having it before and after the fertile times as well! There is no medical evidence that sex is harmful during the post-ovulation or early pregnancy period. Try to keep the sex-as-fun-and-special attitude alive throughout the month, including baby-making sex days. If there are stresses associated with this issue, we can provide referrals to psychologists that specialize in counseling about sexual health and are professionals in this area. Remember that our sex lives will outlive the infertility, the new baby and the growing children experiences. So it is crucial to nurture this aspect of the relationship.

There is no question that having a good sexual relationship promotes intimacy and better communication. This is so important when it comes to supporting each other. Fertility problems can be a crisis time in the lives of young adults. Sometimes the crisis situation can bring a couple closer together and sometimes it can cause them to feel isolated, even from each other. Communication is essential. For most women, communication is usually inherently verbal; she wants to talk about it and about her feelings. For most men, dealing with painful feelings, such as that recent negative pregnancy test or that recent miscarriage can be difficult for him to verbalize. Add to this frustration, the obvious sorrow of his female partner and men can feel helpless. It doesn’t necessarily help to try to force people to talk about these feelings, at least until they are ready. Letting him go the gym or shoot some hoops with some friends might be a better way for him to initially deal with bad news. But when the time comes, talking and acknowledging each other’s feelings and understanding how each person deals with difficult situations can make a relationship much stronger.

References:

1. Effects of Lifetime Exercise on the Outcome of In Vitro Fertilization  Morris, Stephanie N.; Missmer, Stacey A.; Cramer, Daniel W.; Powers, R Douglas; McShane, Patricia M.; Hornstein, Mark D.Obstetrics & Gynecology. 108(4):938-945, October 2006.

2  Antpartum, Intrapartum, and Neonatal Significance of Exercise on Healthy, Low-Risk Pregnant Working Women. Maqgtann, Everett F., Evans, Sharon F., Weitz, Beth, Newnham, John. Obstetrics & Gynecology. 99(3):466-472. March 2002.

We all know that people that are not particularly health-conscious can conceive, many times easily or even unintentionally. However, conception is a much more common event when the involved parties are young, and eggs and sperm are much more likely to be genetically normal. It may also be that the reproductive system has not been subjected to years of accumulated age-related, environmental damage. Successful conception does not just involve eggs and sperm and the reproductive tract. Just as in all other areas of human physiology, the reproductive system works best when the entire organism is healthy and balanced. This includes not just physical health, but mental health and sexual health. 

It makes sense that healthy people are more likely to have healthier babies, and this may be especially true in the later reproductive years. For example, a woman in her forties with mild high blood pressure is going to have a safer pregnancy when she keeps her weight down and consistently takes her medications for blood pressure. Similarly, the liver function may be negatively affected by the cumulative effects of drinking alcohol over many years and the liver is crucial to clearing toxins from the body.

The feeling of lack of control is one of the main issues for women and men facing the challenge of infertility. No one can know exactly when they are going to conceive, but for infertility patients undergoing fertility treatments, even the how of conception is being determined by medical factors that again are out of their control. One way to gain back some control is to take charge of our health and nutrition. Eating healthy and living healthy can only help one’s chances for successful conception. Furthermore, when a pregnancy is achieved, the habits set prior to conception and continued during gestation will provide for the best physical environment to nurture the developing fetus. In this issue, we present information about nutritional needs during pre-conception and early pregnancy. The goal of pre-conception nutrition is to promote the health of the gametes (eggs and sperm) and to set the nutritional habits that will carry on into pregnancy and breast feeding.

Certainly the most important component in eggs and sperm is the DNA, which carries the genetic material from the parents to the embryo. DNA molecules are long linear chains of nucleic acids, sugars and proteins. Damage to and degradation of DNA is a consequence of living.  The energy packets in all our body’s cells, including sperm and eggs, are called mitochondria. Mitochondria contain DNA and produce important enzymes for metabolism and energy production. Molecular by-products of metabolism, oxygen free radicals and nitric oxide species, are constantly forming in our bodies .These free radicals can damage both nuclear and mitochondrial DNA. All living organisms have developed many mechanisms to protect their DNA from the environmental damage of excessive nitric oxide and oxygen free radicals. Anti-oxidant nutrients and vitamins are essential to support these protective mechanisms. Truth be told, we all should be ingesting anti-oxidants throughout our lives to protect our DNA and all our tissues from assaults from the outer (and inner) world, but no time is more crucial for the next generation than at conception and fetal development. There are known substances and chemicals in the modern world that can overwhelm our highly evolved physiologic protective processes. Just one well-known example is phthalate ester, a chemical used to soften plastics such as in disposable water bottles, which leaches into the water it contains. These phthalates have been shown to have toxic effects in animal studies on the reproductive system¹ and have been found in urine and breast milk of pregnant and lactating women². Unfortunately, phthalates are only one of many, many chemicals we are exposed to on a regular basis. So, there are substances to avoid, when possible, but can we really avoid every harmful chemical? Not likely. What we can do, beyond avoiding these chemicals,  is make sure we are getting the nutrients, vitamins and minerals that help our own enzymes and proteins to protect our DNA.

There are numerous books on nutrition for pre-pregnancy and pregnancy. It is not possible to cover this topic exhaustively in this series of two articles. Suffice it to say that there is no one diet that has been conclusively shown to promote fertility. It is common sense that nutritionally empty diets, especially those that promote obesity, are clearly harmful to conception. Diets lacking in essential vitamins and minerals can have consequences beyond infertility, such as very poor pregnancy outcomes and malnourished babies. One recent article from the Netherlands² looked at the diets of women undergoing IVF. They measured blood levels and follicular fluid levels of some essential vitamins and minerals in these women. To paraphrase their findings: In women, two dietary patterns were identified. The “health conscious–low processed” dietary pattern was characterized by high intakes of fruits, vegetables, fish, and whole grains and low intakes of snacks, meats, and mayonnaise, and positively correlated with red blood cell folate (β = 0.07). The “Mediterranean” dietary pattern that is, high intakes of vegetable oils, vegetables, fish, and legumes and low intakes of snacks, was positively correlated with red blood cell folate (β = 0.13), and vitamin B6 in blood (β = 0.09) and follicular fluid (β = 0.18). High adherence to the “Mediterranean” diet increased the probability of pregnancy by 40%. Their conclusion was “A preconception “Mediterranean” diet by couples undergoing IVF/ICSI treatment contributes to the success of achieving pregnancy.”

So avoiding environmental toxins and eating a healthy (possibly “Mediterranean”) diet may be helpful for general health, fertility and pregnancy, but what are the specifics? What to avoid? What to include? For some very general guidelines, see the side bar to this article. For more comprehensive help, I recommend the book “Fertility and Conception” but Dr. Karen Trewinnard³, listed in the References. Please also look for PART 2 to this article next month for more nutrition and health advice and information.

References:

SIDEBAR: 

What to Avoid (a much-abbreviated list):

1. Drinking from plastic water bottles.
2. Microwaving food in plastic (and especially stryofoam!) containers
3. Pesticides and herbicides – whenever possible, buy organic, when not possible, wash fruits and vegetables well.
4. Heavy metals such as lead (soldering, stripping old paint from walls), mercury (in high-food chain fish) and cadmium (cigarettes, solder materials, pesticides)
5. White foods: too much white bread, refined sugar, white rice, potatoes 
6. Too much salt and butter, fried foods
7. Caffeine – it’s a blood vessel constrictor
8. Alcohol – more on this next issue.

What to Include (somewhat abbreviated):

1. Olive oil rather than butter
2. Fish that do not contain mercury (e.g. salmon, most shellfish, halibut, flounder)
3. Organically-grown fresh fruit and vegetables
4. Whole grains
5. Omega-3 Fish oils
6. Anti-oxidants such as blueberries, cranberries, tomatoes (lycopene)
7. Pre-natal vitamins containing at least 800 mcg folic acid and 2000 IU of Vitamin D3 (for a more thorough discussion of the essential vitamins and minerals, see the website www.essbeg.com)

Terry L. Cranford, Life & Yoga Coach, is a passionate advocate of yoga and is a certified Ashtanga Yoga Teacher who studied with Master Shri K. Pattabhi Jois in India.  She has a 15 year focus customizing yoga programs that honor the uniqueness of her clients.  Her commitment to Yoga and her clients is exceptional.

•  
  • Relieve psychological stress
  • Gain a feeling of control
  • Create empowered thought patterns
  • Establish a more loving connection with your body
  • Gain confidence, self awareness and inner stillness

As a professional Life & Yoga Coach, Terry L. Cranford will also offer tools that will inspire you to change your thoughts in order to change your experiences.

Complimentary Class

Join Terry for an introductory ‘Yoga for Fertility’ class.  Bring your partner! Bring a friend!

Saturday, July 9^th

9:00 a.m. – 10:00 a.m.

If you really enjoy this introduction, then register for a full session:

Session I Class Dates

Saturday, July 23^rd                             Friday, August 12^th

Saturday, July 30^th                             Saturday, August 20^th

Saturday, August 6^th                                         Saturday, August 27^th

Saturday Classes -  9:00 a.m.  –  10:30 a.m.

Friday Class -  6:00 p.m.  -  7:30 p.m.

Tuition: $180

Classes are held at Pacific Fertility Clinic.  There will be a maximum of 10 participants.  Clients of PFC and non-clients are welcome.  All major credit cards are accepted.  Your payment of $180 is required ten days prior to the start date of each session to reserve your spot in the class.  Reserve your spot now! See the front desk members or call 415-834-3000 to register.

*Class if refundable if cancelled by Monday, July 18^th. 

Senator Kirsten Gillibrand (D-NY) introduced The Family Act of 2011, S 965 to the U.S. Senate just 2 weeks ago.  This bill will provide a tax credit to offset the high costs of some infertility treatment for those trying to have a family. There is a significant financial burden associated with  infertility because of the lack of insurance coverage.   This bill would help thousands of people diagnosed with infertility overcome the financial burdens of family building. 

According to RESOLVE, they are now working to secure Senate co-sponsors for this legislation.  This does not happen unless members of Congress hear from their constituents. A letter from you to your Senators is critical.

What YOU can do

1. Contact your two U.S. Senators right now.  It takes 3 minutes through RESOLVE’s Action Alert System. PLEASE review the online letter and personalize it with your story.  Personal content is far more impactful than a form letter.  You can add as much or as little information as you want in the body of the letter. The RESOLVE Action Alert System will do the rest!

2. Ask your friends and family to send letters too! Forward this link so they can take action today.  www.resolve.org/taxcredit

3. Share the information about the tax credit on your Blog or Facebook page! 

To learn more about The Family Act of 2011, S 965, visit RESOLVE now!

It’s been another busy week at Pacific Fertility Center. Since Monday, we have done 13 egg retrievals, 11 embryo transfer procedures and one hysteroscopy. One thing is certain – our lab is very hard working. I’m really proud of our embryologists. We have 8 embryologists, including 2 PhDs. They are very enthusiastic and never complain about the work load. They put in the hours and virtually never make mistakes. They really are professionals.

Many people wonder why IVF is so expensive. One reason is that, unlike other medical procedures, it’s often not covered by insurance, so patients have to pay out of pocket and that can hurt. If you were undergoing, say, a kidney transplant procedure, with the attendant technological and complicated procedures involved, no one really questions the costs, mainly because medical insurance covers so much of it. Until infertility is seen as a medical condition for which treatment should be universally covered, we are unlikely to see a change in the perception of the high expense. Although IVF does cost about $15-20K for one cycle, with all possible expenses included, the increase in costs over the last 20 years have not risen to anywhere near the extent that other medical services have risen in this time period. This is because we all try to do what we can to be as efficient as possible, mindful of what it costs patients out of their own bank accounts.

Last night, the MDs and PFC managers met for our monthly meeting (usually a 3-4 hour marathon meeting!). We have managers for the following departments: nursing, billing, IT, medical records, the Egg Donor Agency, HR, clinical research and our Laboratory Director. One of the topics under consideration is how we are going to wire the Center to accommodate a large diesel generator we just purchased. We never really use the generator, it’s only there for emergency power losses. Yet we must have a functioning generator to keep the Center running in case of minor power losses, or heaven forbid, the big quake that damages significant infrastructure. We decided last night to go with the “Cadillac” plan for re-wiring, allowing us to run the entire Center for several days off the generator and allowing for flexible allocation of the electricity to some or all areas. The difference in cost was $25K for basic wiring and $39K for the most extensive and flexible arrangement. Along with rent, salaries for 70+ employees, including some very highly educated staff, these are some of the “hidden” expenses that are essential to running a world-class IVF center.

Stillbirth, loss of a baby at delivery, is a painful challenge.  The suffering associated with the loss of a child, even before birth, can be overwhelming.  Especially acute for women that have conceived utilizing assisted reproduction, the loss of a pregnancy fought through reproductive technology can overwhelm a couple.  Stillbirth is a rare risk of pregnancy; the challenge facing us as reproductive medicine experts and obstetricians is how to reduce that risk.

The technologies of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) have enabled pregnancy for thousands of families with sperm, egg, and uterine problems.  With IVF, egg quality can be optimized using fertility drugs to produce more eggs.  Blocked fallopian tubes can be bypassed.  Weak sperm can achieve pregnancy by ICSI, where, using a microscopic needle, the sperm cell can be introduced into the egg.

No-one should expect these techniques to be foolproof.  While mechanical problems can be improved, other weaknesses in the reproductive system cannot.  Small deviations in the genetic code of the sperm or egg, missing chromosomes, aging, uterine defects, etc cannot be fixed by treating the sperm cell or embryo.

Thus the problem – these pregnancies established by high technology, are at higher risk.

A recent study from Denmark looked at stillbirth in children born after IVF/ICSI  and found that the risk was higher in children born after IVF/ICSI than natural pregnancy.  Out of 16,525 births to fertile women the chance of stillbirth was 0.37%, that is, 3.7 out of 1000 births.  Out of 742 babies born to women after IVF/ICSI there were 12 stillbirths, 1.62%, that is 16.2 out of 1000 births.

But more importantly to our patients, the liveborn baby rate after a successful IVF/ICSI treatment  and pregnancy is 98.4%.  The liveborn baby rate after a successful natural conception and pregnancy is 99.6%.  Almost all of the successful pregnancies after IVF/ICSI are liveborn.

Reproductive technologies, like IVF and ICSI, are enabling pregnancy and family building where it was not possible before.  All of our patients must be informed of and recognize the risks associated with fertility treatment.  These risks should not, however, dissuade anyone from considering these therapies.  On the contrary, the overwhelming likelihood is that, once a pregnancy is established, it will progress successfully to delivery and a healthy child.

We need to recognize these risks to provide help understand and take measures to reduce the risks to all children.  We will continue to watch these studies carefully in our ongoing effort to assure our patients of excellent pregnancy rates, at low risk.

Footnote:

1. K. Wisborg, H.J. Ingerslev, and T.B. Henriksen  IVF and stillbirth: a prospective follow-up study  Hum. Reprod. Advance Access published on February 23, 2010.