Conference turris::womannotes-v2

    There are two discussions of infertility in Womannotes-V1.  They
    are at topics 253 and 719.  
    
    on with the delicate discussion...
    
    -Jody
    

    yes, I.V.F. is successful....... my wife is currently 14.4 weeks
    along and doing fantastic. It took us two attempts....we are with
    
    	Boston I.V.F.
    	One Brookline Place
    	Brookline, Mass. 02146
    	(617)735-9000
    
    	we are with Dr. Michael Alper
    
    frank

    re:< Note 387.2 by VLS1::SMART >
                               -< I.V.F. works >-

    It probably does work....but the statistics are pretty bad.  
    We tried the GIFT program with Boston IVF (with Merle Berger,
    another doctor there) twice with no luck.

    You should talk to them.  BUT if there is a chance you would consider
    adoption I highly recommned you begin looking into that also.
    Perhaps sign up NOW.  A couple of comments on age:  you may be
    discouraged from both attempting IVF and adopting an infant at 42.
    Many agencies want less than a 40 year age difference between oldest
    parent and child.  Many clinics are hesitant at accepting people into
    the program who are not 'problem free' as they want to maximize
    their 'percentage' statistics.  Be VERY careful when you talk to them
    about success statistics (for example....they will quote stats on
    'chemical pregnancies'....this means every woman who had a measurable
    pregnancy response after the procedure...we did both times.  Ask
    about stats for babies born).  There is another good clinic at
    Yale...I don't know the details.  Lastly, be prepared for devastating
    disappointment  when you talk about 'trying it a few times'.  You've
    probably had a taste of this already as you hoped each month that
    your period would not start.  This is MUCH bigger.

    We have adopted two beautiful, wonderful children that if GOD
    offered to trade them for biological children I wouldn't consider it
    for a second.  There area MANY options for adoption...far more than
    your medical options.  some have long waiting lists, some short.  Some
    involve infants and some older children.  There are many types of
    agencies....adoption is changing rapidly in Mass.  There are
    'adoption councilors' (spelling?) who can help you think about the
    wide range of options.  There are seminars that should not be missed.
    RESOLVE can help you find out about these things.  Talk to others
    about there experience.

    These are VERY tough times, involve very difficult decisions.  I
    wish you all the best.....hang in there.
    bob

    I don't know where to post this, and thought this note is probably
    as good a place as any. Moderator, please move it if you feel there
    is a better place for it.
    
    According to an ad in the Boston Globe, IVF Australia will be having 
several seminars to discuss the facts about In Vitro Fertilization.  My 
husband and I are planning on attending the one on Feb 16 in Nashua, and 
I thought that there might be others who may be interested.  The text of 
the ad is as follows:

		IN VITRO FERTILIZATION:  THE FACTS

	You and your spouse are invited to a free Seminar on Infertility 
and In Vitro Fertilization.  For more information and to register, call 
1-800-288-4832

Thursday, February 9, 7:00 p.m. at the Sheraton Tra Hotel, 37 Forbes 
Road, Braintree, MA.

Thursday, February 16, 7:00 p.m. at the Sheraton Tara Hotel, Tara 
Boulevard, Nashua, NH.
                             
A future seminar is planned for Hartford, CT on March 1.

Featured speakers from the IVF Australia Progam - Boston will be 
Patricia M. McShane, M.D., Medical Director, and Beverly J. Freeman, 
Executive Director.

Professionals from IVF Australia, one of the nation's leading in vitro 
fertilization programs, will describe treatment advances.  In addition, 
couples will share their experiences and answer your questions.

Find out how IVF has helped couples with infertility problems such as 
tubal damange, resistant endometriosis, male factor conditions, and 
unexplained infertility.

You'll also find out how the non-surgical procedure employed by IVF 
Australia Programs has resulted in 321 babies born to date.  Finally, we 
will review how the program helps couples cope with the emotional and 
financial stresses of infertility.

There is no fee for the seminarl.  We hope you'll join us.

IVF Australia Program - Boston at Waltham-Weston Hospital & Medical 
Center.  1-800-288-4832 or 617-647-6263.

    What about a laparoscopy (outpatient procedure to unblock fallopian
    tubes?) Know for certain of its success rate.
    
    If you want more info, contact me directly.
    

    
I thought I'd enter an update to the base note, because a lot has happened 
since I asked Bonnie to enter it.  So far it's all been good.  Our fingers 
are permanently crossed these days.

The very best thing we did was join RESOLVE.  Those people are *wonderful*! 
Not only do they understand what you're going through, THEY HAVE HELP TO 
OFFER!  In the first phone conversation I had with the national chapter 
(before we even joined) they referred us to an infertility specialist who
has turned out to be a godsend! 

The second best thing we did was go to that infertility specialist.  Up to 
then, we had found no doctor who seemed to be in much of a hurry.  "Try 
this for six months, try that for six months" ... and we knew we didn't 
HAVE six months.  The frustration was unbelievable, except to someone who 
has experienced it.

The doctor we're going to now is an endocrinologist, specializing in 
infertility in a large teaching hospital.  On our first visit, we 
immediately noticed a sense of urgency that has grown if anything.  She 
advised us that with the extent of blockage in my tubes, and with my age, 
it's doubtful that tubal surgery would be effective.  To quote her, "You'd 
have the surgery and likely find yourself at age 43 or 44 or 45 still 
trying to conceive."  After reviewing our medical records from a variety of 
doctors, she advised IVF.  Every IVF patient at this institution has to be 
approved by a board of physicians who review their records.  We gained 
approval and are on our way.

It's a funny feeling.  Throughout the whole experience, we've felt very 
much that we're involved in leading-edge technology.  I told my husband 
recently that I feel like I'm starring in an episode of Star Trek, except 
they don't stick people with needles on Star Trek.  It's exciting, scary, 
painful, ... I've felt so many emotions I can't believe it.

One good thing is that it is, from start to finish, a *joint* experience.  
My husband has been present for every single visit and every single test 
that's been run.  And believe me there have been plenty.  He has the option 
of being there when the eggs are retrieved, and he will be present when the 
embryos are implanted.  OK, OK, so it's not as much fun as the traditional 
way of getting pregnant, but when it's all you've got...

Let me relate what has happened so far.  I've had more blood tests
in the past few weeks than in my entire life until we got into this. They've
tested hormone levels, tested for antibodies in both of us that would
attack sperm, tested to see if a mouse embryo can live in my blood serum
(an indication that hopefully a human embryo will also be able to exist in
it), and the list goes on and on.  My blood hormone levels are tested
weekly.  The latest thing was to insert a catheter into my uterus to
measure it, so when the embryos are implanted they will know *exactly*
where to place them without having to move around in there. The embryos are
very delicate and the body will reject them if they are damaged in any way
during the implantation. That was a little painful, but I've had worse.
Anyway, I decided at the start that, whatever it takes, no matter how
inconvenient, no matter how painful, no matter how unpleasant ... well, it
doesn't matter -- I'll do it. 

Now I'm on Lupron.  That's a drug that supresses all sex hormone production 
and puts me into an induced menopausal state.  It's been discovered that 
the fertility drug Pergonal works best in a woman whose natural hormone 
production has been completely supressed.  Why, they don't know.  Anyway, I 
had to learn to give myself an injection of Lupron every day for the next 
two to four weeks.  I thought I'd *never* be able to bring myself to stick
a needle into my own thigh, but I surprised myself.  If I can cross that
hurdle, I can do anything!  When I start on the Pergonal, I have to go to 
the hospital every day for the injection and also a daily blood test.

Getting the prescription filled for the drugs was interesting.  The 
four-week supply of Lupron was something like $268.  Expensive, but not 
outrageous.  But the Pergonal -- it's $50 a vial and they've estimated I'll 
need 50 vials!  A little box about 7 inches long and 4 inches wide holds 10 
vials and costs $500!  I was scared to death I'd have a wreck on the way 
home and damage the stuff!  Thank God for insurance!  Anyway, the Pergonal 
is half of the $5,000-per-try price.

The only moral issue we've encountered involves the embryos that might not 
be needed.  You see, the doctors harvest and fertilize as many eggs as they 
possibly can.  They then implant 5 of the ones that show successful cell 
division.  The others are frozen, and if the first attempt doesn't work, 
the frozen embryos can be thawed and implanted for subsequent tries.  
It cuts down on the drugs and on the cost of in-vitro, etc.  We asked the 
doctor what happens if the first try is successful, and there are frozen 
embryos left.  She didn't have a good answer.  All she could really say is 
"They are yours, and we will do with them whatever you wish."  Well, at 
this point, we're not sure what we would wish.  That's a hurdle we hope we have 
to deal with, since it means we'll have a successful pregnancy from the 
IVF.  But we're not at all sure how we'll deal with it if and when the time 
comes.

Well, sorry to go on so long.  But there might be someone else out there 
who will benefit from our experiences.  The only real advice I have is that 
if you're dealing with a doctor who doesn't seem to be in any great big 
hurry, then FIND A DOCTOR WHO EXHIBITS A REAL SENSE OF URGENCY!!  

As this progresses, I'll continue to ask Bonnie to post updates.  I'm sorry 
I don't feel comfortable identifying myself, but I just don't think I could 
handle the questions, etc. from well-meaning co-workers.  As a matter of 
fact, myself, my husband, our doctors, and Bonnie are the only people in
the world who know what we're doing!

but the trip is worth it!

    Another reply from the anonymous author
________________________________________________________________________    
    
Another update -- the last for a while, I'm sad to say.  I started on the
Pergonal March 20.  The normal dose for someone using it in the
conventional manner is 1 vial per day.  For IVF patients, the normal dosage
is three vials per day, administered each morning.  Because of my slightly
elevated FSH level, my doctor started me on 4 vials per day, 2 in the
morning and 2 in the afternoon. 

The Pergonal treatment is rigorous, for those of you who aren't familiar
with it. I got up each morning and gave myself an injection of Lupron in
the thigh (they cut the Lupron down to half a dose when I started the
Pergonal). Then I drove to the clinic, where I had a blood test and a
Pergonal injection.  Then I went back to the clinic at 3:30 pm for the
second injection of Pergonal.  The daily blood tests eventually cause both
arms to develop sore bruises, and the veins finally just shut down,
requiring multiple "sticks" every day to get the sample.  The Pergonal
injections are given deep in the gluteus muscle - the one in the back just
below your waistline.  The needle is very long (~2-1/2 inches) but very
tiny.  They are low-pain as injections go, but about 2 hours after the shot
the drug itself irritates the muscle tissue surrounding the injection site.
It gets very sore, and stays that way -- so subsequent shots just make it
sorer and sorer.  At one point during the treatment I was actually having
trouble walking.  In addition, headaches are a common side effect, as well
as extreme tiredness -- I would take a nap when I got home every afternoon,
and still was so tired I could hardly function sometimes.  Pergonal therapy
is not fun. 

As a result of this ordeal, we have learned more then we ever wanted to know
about the female reproductive system, and the hormones that drive it. 
Fascinating stuff, but we would have been just as happy not ever *needing*
to know it! 

I stayed on the 4 vials/day dosage for four days, and the blood tests
showed absolutely no response.  So on the fifth day the doctor increased me
to 3 vials in the morning and 2 in the afternoon.  Still no response.  On
the 8th day, we went to six vials: 3 in the morning and 3 more in the
afternoon. Still no response.  On the 9th day, she stopped the Pergonal
entirely and had a conference with us. 

The afternoon before, she had conferred with a Dr. Matsen (sp?) in Redondo
(sp?) Beach, CA, the endocrinologist who pioneered Lupron therapy with IVF,
and one of the most knowledgable doctors in the field.  My doctor had been
fortunate enough to study with him while she was learning to do egg
retrievals, and he became something of a mentor to her.  Now, when she has
a very difficult case, he advises her on what to try next.  Anyway, he felt
that there was no point in continuing the current treatment.  He
recommended that we stop for about six weeks.  Then on day 2 of my 2nd
period, we'll start with 6 vials/day of straight FSH, with no Lupron, and
no LH (which is the other ingredient of Pergonal).  She said his comment
was "You've got to really *hammer* those ovaries when they don't want to
respond." 

I was devastated.  My husband was too worried about me to be particularly
devastated himself; his depression set in later.  After the conference
with the doctor, I wasn't able to come to work.  I drove home and cried for
a while, felt sorry for myself for a while, lamented the unfairness of
life, called my husband to see how he was doing, then called RESOLVE. 
Those people are lifesavers!  They have a medical counsellor available who
makes it her business to stay on top of new medical developments in
infertility.  I talked to her just for a sanity check on what my doctor had
recommended, and she verified that the straight FSH treatment is very new,
but has been successful in some cases where Pergonal failed.  I then talked
to some of their regular counselors and got a list of clinics that will do
IVF with donor eggs; mine isn't one of them unfortunately.  I felt better
and went to work in the afternoon, after saying a little prayer that it
would be a quiet afternoon with little or no added stress.  My prayer was
answered, and I made it through the day. 

While my disappointment was about as severe as I've ever experienced, being
off the Pergonal treatment has been something of a relief.  No more sore
hips and arms, no more headaches, no more needles, no more weekend trips to
the doctor -- at least for a while. 

In about 6 weeks you'll be hearing some more from me when we start the new
FSH therapy.  Please cross your fingers, and if you're the prayin' kind,
say a little prayer for us around the middle of May. 

Thanks for listening!

-----------------------------------------------------------------------------

On Pat's behalf, I just thought I'd ask Bonnie to post a final update to
the note string about infertility.  This note is about resolution.  The
RESOLVE organization talks a lot about resolution, and if anyone out there
is a member, then you've been hearing about it at the meetings and in the
newsletters.  Anyway, the following are Pat's words, entered by her husband
Steve ... 

On January 19, 1990 a little boy was born in Fort Worth, Texas.  On January
23 Steve and I went to the hospital and got our son, Michael Henry Resende,
and took him home.  It was the culmination of our dream, and the beginning
of a new journey for all three of us. 

It's funny ... One thing Steve and I had both thought about was how we'd
feel when we went to pick up our adopted baby.  Though we hadn't really
talked about it a lot, we both thought the same thing:  that we'd feel for
a while like this was "somebody else's" baby, and that over time the
bonding process would make him seem like ours.  Well, we were both totally
surprised.  From the moment we laid eyes on him through the nursery window,
he was OUR SON. 

Our infertility doctor was very interested in the path we followed toward
resolution.  She wanted to know how we felt about going through the
in-vitro fertilization attempts, since they all failed and we ended up
adopting in the end ... was it all worth it, or did we have regrets about
all we went through?  What we told her was that without the in-vitro
attempts we might not have felt we had done everything we could, and we
might never have really resolved our infertility and put it behind us.  It
wouldn't have been fair to bring Michael into a home where his adoptive
parents were still wondering "what if?"  But we did everything within the
realm of medical possibility, and that is all a vague memory now.  Instead
of thinking about infertility, we're watching our son grow and learn and
change every single day, and it's the most fascinating thing either of us
has ever encountered. 

I left Digital to be a fulltime Mom, though I have high hopes of resuming
my DEC career when Michael starts school.  I'm at home now changing diapers
and mixing formula, and (when there's time) keeping house.  And I'm as
happy as I could possibly be. After an 11-1/2 year career with Digital,
Steve was worried that I'd regret leaving ... and I do miss all the people
... but in retrospect it was the right decision for me and for the three of
us. A long-term leave of absence would certainly have been preferable to
quitting, but that simply isn't an option at Digital at this time, so I did
what I had to do. 

We've learned a new way to love...