Our 7 year old daughter sneers when we joke about why she is a fanatic about ice cream: “Because you were a frozen embryo for 9 months.” To our 4 year old twin boys, also conceived by ICSI/IVF, we sometimes say, “double trouble – we wanted one more boy, and we got two!” They, along with our adopted Korean son, don’t realize that they are true miracles, particularly since the most recent IVF attempt was given a 2-5% chance of success by Dr. Schriock, because “age was an issue,” and to our dismay Emily’s FSH level had tripled since our prior successful IVF cycle.

Never as a couple did we predict that we would be challenged with unexplained infertility. Emily took for granted that she would some day have children, having put career and studying as a top priority throughout her second decade. But as a pediatrician and geneticist, we too became part of the Bay Area epidemic of infertility as we struggled to start a family. Each day at work Emily became ever-so-more aware of the challenge as she counseled pregnant women about genetic testing. I myself, a psychiatrist, became concerned about the emotional roller coaster, because Emily seemed obsessed with the goal of having a child.

Despite the lack of control we felt, now that we have completed our quest to be parents, we are truly appreciative of the expertise, wisdom, and compassion of PFC doctors and staff.

We feel blessed by what we have learned:

1. We never take our children for granted;
2. Each child, no matter how he/she came into the family, is loved equally for the joy each one brings – adoption is just as much of a gift as a pregnancy;
3. There are some advantages to raising twins;
4. Our lives are enriched from the relationships we formed with health care providers and friends;
5. Life is precious – we more deeply cherish our own lives and value friendships, hobbies, nature, family time;
6. We have more sensitivity towards others who have similar struggles.

We are also compelled to share what we learned:

1. Don’t hesitate to ask questions or seek multiple consultations;
2. It is useful to record all notes in a journal to help think of questions, and to feel more knowledgeable and in control;
3. Take advantage of scientific journals on infertility, RESOLVE and their resources;
4. Start therapy and counseling if needed;
5. Use the internet to research and read the many available books, but also keep in mind that some information is not substantiated by good, sound data;
6. The field of infertility advances quickly, and given new choices – there is always hope;
7. Look into other options, even though at times it may seem there is no light at the end of the tunnel. Adoption does not have to be a last resort;

Don’t forget, after the challenge of infertility, there is perhaps an even greater challenge – parenting!!!!

– John and Emily, San Francisco

Q:
I am 40 years old and have been experiencing unexplained infertility for about 2 years. I have been reading that PGD may help to improve my chances of success with IVF. Is this true?

A:
PGD, or Pre-implantation Genetic Diagnosis is a technique, when used in combination with IVF, that can help to determine if the embryos have what it takes to successfully establish a pregnancy. As women get older, there are more errors in the chromosomal make-up of eggs. The most well-known of these defects is Down Syndrome or Trisomy 21, a condition in which the fetus or baby has an extra chromosome number 21. Having a missing or an extra chromosome may make the embryo unable to develop much past a few days of life or may result in a first trimester miscarriage. PGD uses a DNA-binding technique to determine if there are a correct number of chromosomes in the embryo. To do this, embryos on Day 3 of culture (5-10 cells) undergo a biopsy to remove a single cell. The rest of the embryo remains in culture in the IVF laboratory. The biopsy cell is analyzed for the correct number of chromosomes. Currently, PFC with its cytogenetic partner, St. Barnabas Medical Center, tests for 9 chromosome pairs which represent the most common abnormalities seen and some of the most serious in terms of a potential birth defect. As this technology continues to evolve, we expect to be able to assess all 23 pairs. IVF with PGD cannot correct defects in chromosomes. It can only diagnose whether an embryo is abnormal for these 9 chromosomes. The embryo could still be abnormal for one of the other 14 pairs. PGD may decrease the possibility of a miscarriage due to abnormal chromosomes. It may allow for the selection of the embryos most likely to implant and cause a normal pregnancy. If a woman has a good number of fertilized eggs to work with, it may eliminate having an excess number of embryos returned to the uterus at any one time and may eliminate having frozen embryos that really are not genetically normal. Because the embryos will have been screened for some of the major chromosomal abnormalities, theoretically, the remaining embryos should provide a patient who is older a better chance at a viable pregnancy. Some studies have shown that the implantation rates (chance that any one embryo will successfully implant) can be doubled with IVF/PGD. Also, miscarriage rates have been reduced by one-half and the delivered pregnancy rate is increased. Women or couples interested in this procedure should discuss it with their Reproductive Endocrinologist. At PFC, we also refer our PGD patients for a special genetic counseling session in preparation for this process.

I have learned that things in life do not always turn out the way you might have thought that they would. What seems to be the “standard” life may not be so easy to attain. I just turned 45 years old and have just found out that I am pregnant for the second time since working with Dr. Chenette. We have a four year old son who we conceived the “old-fashioned” way after Dr. Chenette removed a polyp from my uterus. We wanted a second child, and somehow I thought that if we did it once, we could do it again. I have of lost track of the cycles, but over several years, we have done IVF at least 3 times with several incomplete cycles and hysteroscopies in between. After failing the 2nd IVF, egg donation came up in our meeting with Dr. Chenette. My husband was ready to do it the next day because the odds were much better. I was more hesitant and felt that I needed to try a 3rd IVF cycle with “my eggs” first. In the meantime, we entered counseling and I joined a donor support group. The counselor was wonderful and so was the support group. The idea of egg donation grew comfortable for me as an option. After our 3rd cycle failed, we started looking for a donor. Although a strange process, something became clear. The look, the height, the intelligence etc., were not as important as just finding a nice, happy person who seemed to approach life the way that I do.

I looked for “nice eyes”- for I believe they tell you about a person. We found a donor and I really like her. Now, everyone probably works through this process in their own way, and that is the point. To find what you and your partner are comfortable with, and to take it one day at a time. I try not to worry – it’s easier and more fun to be positive. I envisioned myself at this point in my life to be like a Mrs. Cleaver with a couple of kids and a fancy hairdo like a grown-up. But I met my husband later in life (and learned a lot up until then…). I still feel young. I am healthy and we all really want a second child. We are hoping that it is meant to be, and we are grateful to Dr. Chenette, the special nurses (Sue, Ann, Pat, Carol and the rest), and the nice staff at PFC for their services and their support.

–A.W. in Oakland

My husband and I had always wanted children, but did not marry until age 40 (we are the same age). My mother had seven healthy children, the last one at age 40, so I had always assumed I would have no problem conceiving a child. We tried for several years, then had some tests done at my gynecologist’s suggestion. A few problems were corrected, and we tried for another year, using an ovulation predictor kit. Finally, at age 45, we turned to Dr. Ryan for help.

We tried artificial insemination once, without success, and then immediately chose IVF with a donor egg, due to our age. We wanted the healthiest donor we could find, and we luckily found a woman similar to me in ethnic background, appearance, and many interests and traits. At age 46, we were blessed with a beautiful, very healthy full-term baby girl on our first IVF cycle. She is very active and alert, and ahead in most developmental milestones, yet doesn’t sleep as many hours as the average baby, so we have our hands full.

Because I gave up my career to become a stay-at-home mom, we are now stretched financially. Due to our circumstances and age, when our baby was 5 months old we made the difficult decision to not try for more children. Having decided this, we wanted to give some other couple the chance to become parents, and give our apparently very healthy embryos a chance to develop into fetuses, and, hopefully, babies (born to people who want children as much as we do, but may not have the ability to conceive their own or pay donor, agency and donor meds fees). So with the help of Dr. Ryan, we put our 17 embryos up for adoption. –L.F., Belmont, CA

It is our policy to match the extraordinary generosity of some of our patients, like the couple above, with eligible PFC patients who have tried to conceive, but have more or less reached the end of their rope. Everyone’s circumstances are unique. Stay tuned to this column in the next couple of months to find out more about how embryo adoption benefits infertile couples! –Isabelle Ryan, MD