What Do You Know About Fertility Screening?

Statistics and general truths aside, every woman is unique. Given just how complicated it is to make a baby in the first place, understanding your own body’s reproductive capability and the changes it might undergo from year to year is an invaluable planning tool.

Consider an annual fertility evaluation or screening.
Simply put, the screening involves a few simple blood tests and an ultrasound to assess your ovarian function. These tests have been around for years and are tried and true tools in the assessment of fertility.

We propose using these tests as a screen to prevent future infertility. We recommend that annual screening begin at 30 years of age or earlier if you have irregular menses, hot flashes, difficulty conceiving after 6 months or a family history of early menopause or infertility.

Taken together with your individual and your family’s medical histories, fertility screening helps establish where you are on your personal fertility curve. The first screening establishes your baseline, subsequent annual evaluations will flag changes in key hormone levels and mature follicle and egg production that could signal potential trouble. Mind you, any warning flares are just that and may mean nothing. But they could indicate that follow-up with your doctor, gynecologist or a reproductive specialist is warranted. And if there’s a problem, you’re ahead of the game with the opportunity for early intervention and, where possible, corrective action.

Fertility screening can help identify women whose ovarian function is diminishing so they can get timely treatment. The fact is, some women in their 30’s prematurely age from a reproductive perspective and their fertility may look more like that of a woman in her 40’s.

What Does the Screen Involve?

The screening itself is fairly low-tech.

Part one consists of a blood test to check the levels of FSH (follicle stimulating hormone), estradiol and AMH (antimullerian hormone). The FSH and estradiol must be measured on the second or third day of your period. The granulosa cells of the ovarian follicles produce estradiol and AMH. The fewer the follicles there are in the ovaries the lower the AMH level. It will also mean that less estradiol is produced as well as a protein called inhibin. Both inhibin and estradiol decrease FSH production. The lower the inhibin and estradiol the higher the FSH as is seen in diminished ovarian reserve. The higher the estradiol or inhibin levels are then the lower the FSH. Estradiol may be elevated especially in the presence of an ovarian cyst even with failing ovaries that are only able to produce minimal inhibin. However, the high estradiol reduces the FSH to deceptively normal appearing levels. If not for the cyst generating excess estradiol, the FSH would be high in failing ovaries due to low inhibin production. This is why it is important to get an estradiol level at the same time as the FSH and early in the cycle when it is likely that the estradiol level is low in order to get an accurate reading of FSH.

Part two is a vaginal ultrasound to count the number of antral follicles in both ovaries. Antral follicles are a good indicator of the reserve of eggs remaining in the ovary. In general, fertility specialists like to see at least a total of eight antral follicles for the two ovaries. Between nine and twelve might be considered a borderline antral follicle count.
As you start to screen annually for your fertility, what you and your doctor are looking for is a dramatic shift in values from one year to the next.

What Does the Screen Indicate?

A positive screen showing evidence of potentially diminishing fertility is an alarm that should produce a call to action. When a woman is aware that she may be running out of time to reproduce she can take the family-planning reins and make informed decisions. The goal of fertility screening is to help you and every woman of childbearing years make the choices that can help protect and optimize your fertility.

Although none of these tests is in of and of themselves an absolute predictor of your ability to get pregnant, when one or more come back in the abnormal range, it is highly suggestive of ovarian compromise. It deserves further scrutiny. That’s when it makes sense to have a discussion with your gynecologist or fertility specialist. Bear in mind, the “normal” range is quite broad. But when an “abnormal” flare goes off, you want to check it out.

It’s important to remember that fertility is more than your ovaries. If you have risk factors for blocked fallopian tubes such as a history of previous pelvic infection, or if your partner has potentially abnormal sperm, then other tests are in order. And if, for example you do have blocked tubes, it’s better to have them corrected sooner rather than later when the becoming pregnant is an urgent matter.

Learn More About Your Fertility

Also, make sure you read Part I of our series, What Do You Know About Your Biological Clock?

What Do You Know About Your Biological Clock?

Women have a biological clock. Everyone knows that. The problem is that a lot of the information people think they know about their fertility and reproduction is not true. The blurring of fact, opinion, myth and misunderstanding makes for a treacherous misinformation landscape. The knowledge gap has claimed millions of victims, people who learned about their limited reproductive lifespan too late to help them have the genetically linked offspring they always assumed would be theirs. Armed with essential and accurate information, you don’t have to join their ranks.

What is still not understood across the board is the time line of the biological clock. Most women don’t have a clue about their own.

So, we’re asking the question: What do you know about your fertility? Over the next three days we’ll be learning a lot more about it.

But, right now, if you’re like most people, the answer is not as much as you might believe. Just to give you a little perspective, a spate of recent surveys reveals that the overwhelming majority of U.S. women:

• The trajectory of reproductive capabilities peaks in a woman’s early-to-mid-20s and begins to decline, typically, around 27.
  However wonderfully youthful and fit a 42-year-old might be, her eggs are operating on an independent and fixed timeline.
  The stark truth is women at that age are more likely than not to require medical intervention.
  Sleep, diet, exercise and environment can all impact your fertility.

• Don’t understand the biological clock.

• Mistake overall good health as an indicator of fertility.

• Believe they can get pregnant easily until their 40s.

• Don’t know that lifestyle factors can have a profound effect on the ability to have a child.

This basic information can make a critical difference in the life of every person who dreams of having a child. If you know about your body’s reproductive lifecycle, you can take steps to protect and preserve your fertility and have the children you want – if and when you choose.

Statistics and general truths aside, every woman is unique. Given just how complicated it is to make a baby in the first place, understanding your own body’s reproductive capability and the changes it might undergo from year to year is an invaluable planning tool.

Marking Time: The Biological Clock and You

Each woman’s oocytes (eggs) supply is finite. That means the body doesn’t produce new ones. So the 7 million or so eggs each female is born with is all she’s going to have. By the time the average girl hits puberty, only about 250,000-300,000 oocytes remain in her ovaries. With each menstrual cycle one egg is released, and an additional thousand eggs each month are lost through a process called artresia, the natural breakdown of the eggs by the body. After ovulating an average of 400 times through her life, typically at around 50 years of age, the store of oocytes is tapped out. That’s menopause.

Then there’s the matter of oocyte aging. Eggs age along with the rest of the body. The older oocytes are more likely to have chromosomal abnormalities making them unlikely to become viable embryos. It’s important to note that a fertilized egg with abnormal chromosomes is the single most common cause of miscarriage. As a general rule, women in their 20s have about a 20% chance of having a miscarriage each time they become pregnant, a woman in her 30’s has a 30% chance, and a woman in her 40s about a 40% risk of miscarriage.

The bottom line is the older we get, the less likely we are to conceive and have a successful pregnancy. Fertility starts to decline when a woman is in her 20’s but when she hits 35, it take a sharp downturn. At 40, fertility falls off even more dramatically.

Of course, some women in their late 30s and a few in their 40s conceive effortlessly, and carry and deliver healthy babies. But the likelihood of that happening without medical intervention becomes more remote with each passing year.

For women under 30, the estimated chance of becoming pregnant in any one cycle is between 20% and 30%. When women turn 40, that probability plummets to approximately 5%. Even more significant is that when a woman experiences difficulty conceiving in her 40’s it is a far greater challenge to achieve a live birth using her own eggs even with the best medical technologies.

Learn More About Your Fertility

So, the good news is, there are some steps you can take to preserve your fertility and stay on top of your biological clock.

We’ll be back with:
Tomorrow: Fertility Screening for Your Reproductive Life

You’ve already crossed the bridge from “We’re going to get pregnant!” to “We need help…” But this other side looks filled with more obstacles, including expensive and risky fertility medications.

How far do you have to go just to have a baby?

Micro IVF (sometimes called MiniIVF) may be your answer.

The primary point of MicroIVF: fewer fertility drugs, less cost.

Plus you get additional benefits: decreased chances of ovarian hyperstimulation syndrome and of multiple pregnancy.

Additionally, East Coast Fertility patients who choose MicroIVF can increase their savings if they also use our Single Embryo Transfer Program — embryo freezing, storage, and future frozen embryo transfers are free.

Why go Micro?

I learned long ago that pregnancies of twins, triplets, and more can bring heartache to what should be a joyous journey for fertility patients. So the ECF team has dedicated our practice to the achievement of safe, healthy pregnancies.

IUI or IVF?

Intrauterine insemination (IUI) is often considered the first order of business for many infertility patients.

Sometimes called “artificial insemination,” the usual protocol — oral and injectable fertility medications to induce superovulation (of more than one egg in a cycle), followed by insemination via exam room procedure — is believed to be simpler and, therefore, less costly than IVF.

That’s just not true any longer.

The facts now are that success rates can be far better for IVF than for IUI, depending on the individual’s or couple’s cause of infertility. Many women undergo several IUI’s before achieving conception.

Some infertility causes — pelvic adhesions/scarring, blocked fallopian tubes, endometriosis, and severe male factor issues — will not respond to IUI but are treatable with IVF.

Even patients who would otherwise try IUI to get pregnant will find that choosing MicroIVF can result in cost savings and greater safety:

Micro IVF fee (current as of July 2009): $3900

ICSI (if required): $1000

Anesthesia (as requested): $550

IUI with hormone injections: $3500 to $4500

Is MicroIVF right for you?

Each patient’s case is considered carefully and individually. The following are conditions that might respond best to MicroIVF:

Young healthy women with PCOS or who otherwise produce many follicles

Women with pelvic adhesions or scarring, blocked fallopian tubes, or endometriosis

Couples with severe male factor infertility

MicroIVF really is a case of a little treatment going a long way! With it, you can access the world’s most successful assisted reproductive technology at far less cost.

A prophylactic salpingectomy or tubal ligation may be performed laparoscopically, using a tubular scope placed through the abdominal cavity to look inside the pelvis. Other instruments are placed through the lower abdominal wall and are used to remove the tube or close off the tube entrance to the uterus. Laparoscopy is performed under general anesthesia in the hospital.

Recently, the use of a contraceptive device, Essure, has been used to obstruct flow of the inflammatory fluid from the hydrosalpinx into the uterus. The Essure is a small coil that is inserted hysteroscopically through a woman’s vagina without cutting into the fallopian tube. It takes 3 months to induce adequate scar closure of the tube and is as effective as a tubal ligation. A hysterosalpingogram is performed after the 3 month period to prove adequate damming of the flow of inflammatory fluid. This procedure may be performed in an office based surgical unit and is sometimes performed without anesthesia.

Fifty eight percent of infertile couples who chose not to pursue therapy cited cost as the primary reason. About 7 percent of couples with frozen embryos discarded them from October 2008 to March 2009, representing a nearly three time increase from the prior six months. Fifty seven percent of egg donors in 2008 planned to use the money they earned from donation to pay for school, up from 28 percent from 2002-2004.

In the New York Metropolitan area, most programs see only about 20% of patients who do not have insurance to pay for their IVF cycles. Furthermore, it is estimated that for every patient who does an IVF cycle at least another 2 to 3 would also benefit from the fertility therapy. Unfortunately, for those with an insurance cap and for those paying out of pocket there is an enormous financial pressure for these patients to conceive in the fewest number of cycles to minimize the cost and hence transfer multiple embryos with a resulting increase in multiple pregnancies and the complications of premature deliveries; medical, emotional and financial.

New York State offers a grant for patients in need of IVF that is income based and diminishes the entire cost of the cycle for some lower middle income patients to just a few thousand dollars. However, even this rich program does not cover the cost of frozen embryo transfers and therefore still encourages patients to transfer multiple embryos. Other IVF programs, including my own offer our own income based grant programs and IVF studies significantly reducing the cost of a cycle and making it affordable to nearly everyone in need.

The problem remains that none of these programs discourage patients from “putting all their eggs in one basket” and risking the dangerous multiple pregnancies. Two years ago, I proposed an alternative financial program that does eliminate the financial need to maximize one’s chance of conceiving in a single cycle. It is called the Single Embryo Transfer Program at East Coast Fertility. A couple pays the standard $12,000 fee and the egg freezing, storage and frozen embryo transfers are included for an unlimited number of times until they have their baby. I wonder if patients knew about this program if cost would still stand in their way. The beautiful part is we would avoid these risky multiple pregnancies and according to the CDC, in addition to avoiding the medical, emotional and financial hardships caused by the multiple pregnancies, it would save $1billion per year if this program was utilized by all patients who are candidates for it throughout the country.

Yet another side effect of this economic downturn and lack of insurance coverage for IVF has been the fact that patients can have a gonadotropin/IUI cycle for free with a 30 percent risk of multiples and 5 percent risk of triplets or more if their insurance covers it but not the safer IVF alternative where one can control how many embryos to transfer. For patients paying out of pocket many still choose to risk multiples with the less expensive gonadotropin/IUI cycle despite its much lower success rate.

But, all couples don’t need a full stimulation IVF cycle. Many couples could try a lower stimulation IVF known as “MicroIVF”. The cost of MicroIVF varies but at my program it is offered for example at $3900, approximately the cost of a gonadotropin/IUI cycle and a far cry from the average cost of IVF. MicroIVF does not have the affect on the body that a gonadotropin cycle has nor the high risk of multiple pregnancy. It can be combined with the Single Embryo Transfer Program as well.

It is apparent that we have not done a good enough job communicating to patients about how they can afford fertility treatment with insurance or without. Money can be a barrier to having so many things, let’s not make it a barrier for couples to have families. We have to do a better job of letting them know about the solutions that are available to them so that they can afford to get the care that they need to make their dreams of a family come true.

Dr. David Kreiner of East Coast Fertility is using his conscience and his expertise to provide solutions in the fertility industry. He is the first in the country to offer an In-Vitro Fertilization (IVF) package using Single Embryo Transfers (SET) at one set price to patients, while still providing high quality care. It can save the healthcare industry $1 Billion.

Plainview, NY, September 23, 2009 –(PR.com)– With all of the negative publicity surrounding the fertility industry in the wake of “octomom” and other sensational news stories, it is no wonder public opinion has turned sour towards the doctors and clinics that perform the services. Society now questions the safety, practicality and costs of aggressive treatments that often result in multiple births. So how do infertile couples pursue a more conservative route to parenthood – one that’s safer for them and their baby, still offers high success rates, yet is affordable? Dr. David Kreiner of East Coast Fertility is using his conscience and his expertise to provide a solution. He is the first in the country to offer an In-Vitro Fertilization (IVF) package using Single Embryo Transfers (SET) at one set price to patients.

In a typical IVF cycle, a doctor will transfer two, three and sometimes more embryos back into the uterus, depending on many factors, in order to achieve the highest chance of success. However, this protocol lends itself to a high risk of multiples, making risky pregnancies, long NICU stays, babies with developmental problems and handicaps, and thus extremely high healthcare costs.

With a Single Embryo Transfer, just one embryo is placed back into the woman’s uterus, nearly eliminating the chance of achieving multiples. The remaining embryos are frozen and can be transferred to the woman in future cycles.

While SET is the optimal choice for many women, the current cost structure favors transferring multiple embryos over this method. Because transferring a single embryo has a lower success rate than transferring multiple embryos, a patient may have to undergo several SET cycles before achieving a successful pregnancy. Clinics charge for each additional procedure. The patients are expected to absorb what could add up to $100 million per year in extra costs. Thus, patients and programs are pressured to transfer dangerously high numbers of embryos. The real irony lies in the fact that research has shown that universal adoption of single embryo transfers could save the healthcare system a total of $1 billion in healthcare costs. Yet, the patients who choose SET are expected to foot the bill.

That’s all changing at East Coast Fertility. Their Single Embryo Transfer Program attempts to take the financial incentive out of this push to put “all your eggs in one basket.” Dr. Kreiner and his staff are making it cost neutral to transfer only one embryo at a time by offering free cryopreservation, free embryo storage and free embryo transfers until a patient achieves a live birth, all for the cost of a single IVF cycle. ECF absorbs the extra costs in cases where successive transfers are needed. So, the patient can choose the more conservative route without having to worry about the financial implications. Dr. Kreiner believes the benefits to the patient and society are obvious, and he doesn’t feel he is sacrificing the success of his practice. “It is with confidence in our highly successful embryo cryopreservation program that we are able to limit the number of embryos transferred without decreasing the number of births that result from IVF cycles at ECF. We are willing to sacrifice some margin in those cases where patients need successive transfers.”

It remains to be seen if other clinics will follow ECF’s lead. Perhaps society should demand that fertility doctors start doing what is best for the patient even if it means having to cut into their profits on occasion. “Hopefully talking about these issues will highlight some of the negative incentives that exist in the world of Reproductive Endocrinology, and bring about change in the industry,” says Pamela Madsen, fertility blogger (www.thefertilityadvocate.com) and founder of The American Fertility Association. She continues, “It is refreshing to see Dr. Kreiner as an ethical standout in the fertility world – a patient activist who is not letting greed get in the way of practicing good medicine.”

The sobering truth: multiple pregnancies — even with ‘just’ twins — are sometimes dangerous to the health and well-being of both mother and babies.

I was on the cutting edge of IVF development in the 1980’s, a time when assisted reproductive technology was so new and inefficient, transferring six embryos in one IVF cycle was the norm.

Since then, thanks to dedicated research to fine-tune IVF, much has been learned about both clinical practice and laboratory technique. IVF is no longer experimental.

One of the most important recent developments — single embryo transfer, or SET — is being consistently backed up by study after study as the optimal IVF method for patients with a good prognosis.

The SET Program

The safest pregnancy with the greatest chances for an optimal outcome — a healthy baby — is a singleton pregnancy. In 2007, East Coast Fertility started leading the field of reproductive medicine by establishing our own SET Program.

Confidence in our high quality embryology laboratory and immensely successful embryo cryopreservation program has afforded ECF the ability to limit the number of embryos transferred, essentially eliminating the risk of triplets or more.

We understand that you’re anxious for fertility treatment to work. Besides your compelling desire to have a baby, you’re coping with worries about the costs — in time, money, and discomfort — of IVF.

So to encourage patients with good prognosis to utilize SET, we offer the following incentive:

For the cost of an IVF cycle, SET Program patients will receive free cryopreservation of their embryos, free storage and free frozen embryo transfers until you have your baby. This represents a savings of up to over $12,000. It also ensures a much better chance of a healthy baby.

Plus, some patients can take advantage of MicroIVF and save even more money and physical discomfort.

Is SET for you?

Each patient’s case is considered individually. Each factor impacting conception and pregnancy is taken into account, such as:
patient’s age
embryo quality
number of prior failed IVF cycles
use of frozen-thawed embryos

Single embryo transfer is appropriate in certain situations where the likelihood of a multiple pregnancy is high. This may include:
women younger than 35 years
women who conceived with first IVF cycle
women with concerns about multiple gestation
donor egg recipients

Single Embryo Transfer is revolutionizing the practice of reproductive medicine, and the team at East Coast Fertility is committed to their collective pledge to lead the way in creating safe, healthy pregnancies.

East Coast Fertility is offering a free seminar: What You Need to Know Now If You Are Trying to Have a Baby: Innovations in the Treatment and Financing of Infertility. There is no charge for attendees, and all are eligible to receive a free fertility consultation with Dr. Kreiner and a discount coupon for some fertility medications. Don’t miss this chance to learn from these renowned fertility experts.

Plainview, NY (PRWEB) September 14, 2009 — East Coast Fertility is offering a free seminar: What You Need to Know Now If You Are Trying to Have a Baby: Innovations in the Treatment and Financing of Infertility. Attend this special night of hope and information and get answers to all of your questions. The seminar is hosted by fertility pioneer Dr. David Kreiner, founder of East Coast Fertility, and Pamela Madsen, founder of The American Fertility Association. They will be discussing topics such as Micro IVF, Single Embryo Transfer, Intrauterine Insemination (IUI), and Grant Programs to help finance treatment. There is no charge for attendees, and all are eligible to receive a free fertility consultation with Dr. Kreiner and a discount coupon for some fertility medications. Don’t miss this chance to learn from these renowned fertility experts.

There are two opportunities to attend the event: Thursday, September 17th at 6:30pm at the Marriott Long Island Hotel & Conference Center in Uniondale, NY and Monday, September 21st at 6:30pm at Danford’s Inn Marina Conference Center in Port Jefferson, NY. Questions about the seminars can be directed to Karen Malamud at (516) 939-BABY.

Dr. Kreiner and Ms. Madsen are offering these seminars to highlight Micro IVF as a more successful alternative to IUI and a more economical choice to IVF. Micro-IVF lowers the cost of in vitro treatment by more than half, and Dr. Kreiner believes that its success rate is much higher than the 10% chance of achieving pregnancy through a single IUI treatment. It is also more favorable for patients, as the procedure usually requires less fertility medications to be administered. Join them for this seminar to learn about what options are best for you. For more information on Dr. Kreiner and fertility treatments, visit East Coast Fertility.

ABOUT East Coast Fertility: East Coast Fertility is the premier center for infertility care on Long Island. Conceived by Dr. David Kreiner, a pioneer of IVF, their program utilizes the most recent developments in reproductive technology and has evolved to become a leader for highly successful and personalized infertility and IVF care. The center prides itself on combining the best technology and expertise with compassion for its patients. They offer many convenient locations throughout Long Island, Manhattan, Brooklyn and Queens.

Patients often seek my help, desperate to try In-Vitro Fertilization (IVF) after having a previous cycle cancelled at an outside clinic. These patients stimulated with fewer follicles and therefore due to their lower pregnancy expectations were not allowed to proceed. We presented our data on IVF performed on patients with 3 or fewer follicles at the American Society for Reproductive Medicine (ASRM) (insert hyperlink to www.asrm.org) in 2008. Our pregnancy rate was 15% for this group. Though this is admittedly low, for those who were successful in having a baby using their own eggs it was felt by them to be miraculous because they were either not allowed to cycle at other centers or had their cycles cancelled.

We counseled them regarding their lower odds for success but some elected to give it a try. Previously, most of these patients were offered Intra-Uterine Insemination (IUI), a much less successful option that does not affect the programs reportable pregnancy rates.

Unlike most other fields in medicine, IVF results are subject to public reporting since the passage of the Wyden Bill in 1992. The intent of the CDC (Center for Disease Control) report and SART (Society of Reproductive Technology) report was to help infertility patients by informing them of the relative success of different IVF programs. Unfortunately, what sometimes creates the best IVF statistical outcomes in pregnancy rates is not always what is in the best interest of the mother, child, family and society. Now that prospective patients are comparing pregnancy rates between programs there is a competitive pressure on these programs to produce the best reportable rates. This means that patients with lower odds of success are less likely to be offered IVF retrievals and are diverted to IUIs or donor egg cycles.

The high order multiple birth rate was also fueled by competition in the field to have the highest success rates. The Wyden Bill results in competitive pressure to transfer more embryos to increase pregnancy rate as reported. Despite the fact that there is evidence that a program can achieve similar live birth rates by transferring a single embryo each time, the Wyden Bill creates a disincentive to do so. It is no surprise that the clinics with the highest success rates have also had the highest triplet rates. Live birth rates are reported per fresh cycle and those from subsequent frozen embryo transfers are not included. It is true that live birth rates are reported for frozen embryo transfers separately but again it is per transfer motivating programs to transfer multiple embryos to enhance their success rates. If live birth rates were reported per fresh IVF stimulation and retrieval (that part of IVF with risk) including those conceived from subsequent frozen embryo transfers then programs would be likely to provide the less risky option of single embryo transfer to patients.

William Petok, Ph.D the Chair of The American Fertility Association’s Education Committee reported on Single Embryo Transfer (SET) “Single Embryo Transfer: Why Not Put All of Your Eggs in One Basket?” He stated that “at the ASRM meeting in November of 2008 … data was reported that looks favorably at SET. A Center for Disease Control researcher said that although multiple rather than single embryo transfer for in-vitro fertilization is less expensive in the short run, the risk of costly complications is much greater. Universal adoption of single embryo transfer would cost patients an extra $100 million to achieve the same pregnancy rates as multiple embryo transfer, but this approach would save a total of $1 billion in healthcare costs.”

The risks of prematurity and pregnancy complications are far higher in multiple pregnancies than in singleton pregnancies. The financial and emotional costs to families and society are enormous. These multiple pregnancies result in much longer hospitalizations, NICU admissions, complications resulting in handicapped children and occasionally death. They often do not have a happy end including increasing the incidence of divorce. So does it not behoove insurance companies to make IVF available in such a way that encourages SET? Should not the government enforce the recommendations of SART regarding the number of embryos to transfer?

At ECF, we have, since 2006 offered our Single Embryo Transfer program to cover the financial cost for transferring one embryo at a time. For the fee of one IVF cycle, we offer free cryopreservation, embryo storage and unlimited frozen embryo transfers until a patient achieves a live birth.

We offer MicroIVF, minimal stimulation IVF, for $3900, less than the cost of 2 IUIs with three times the success rate and ¼ the risk of hyper stimulation syndrome. Since minimal stimulation does not result in as many eggs, many programs are uncomfortable offering it and therefore lowering their reported pregnancy rates.

If we are going to report pregnancy rates with IVF as is required by the Wyden Bill, let us put all programs on the same playing field by enforcing the number of embryos to be transferred and promoting minimal stimulation IVF as a safer and more efficient treatment than IUI.

The Wyden Bill without the teeth to regulate such things as the number of embryos transferred and reporting success per stimulation and retrieval and not by isolated embryo transfer does more harm than good. Let us support efforts to reduce the number of embryos transferred by removing the added costs to the patient of cryo-preservation, storage and subsequent frozen embryo transfers and by absorbing them ourselves as a profession. This will go a long way in eliminating multiple birth pregnancies, and will do the right thing for the patients, their families and for society. It’s time for us doctors to “Man Up”.

This is one husband’s story about living with a woman on hormones. It is not always this dramatic but the stress can be very difficult for a couple and many relationships benefit from professional support when going through fertility treatments. Imagine dealing with the stress, frustrations and cyclic disappointment couples feel when trying unsuccessfully to start a family. Add to this that your wife is being pumped up with hormones that have the potential to lower her threshold of rationality and sanity. Outbursts of anger directed at especially those closest to them are very common. Under normal circumstances most of us can control our reactions without letting our emotions get in the way. Hormones can greatly diminish our ability to control our behavior when circumstances become tense and stressful. Hormones have even been used as a defense in murder cases. My recommendation is to get rid of any guns in the house and not respond to apparent emotional outbursts. This should pass when the cycle is completed and the hormones have faded from the system. If not…?