Some fertility procedures in Canada being performed by doctors lacking proper training, group warns

Fertility specialists are calling for minimum qualifications for doctors offering assisted baby-making procedures, saying some people are being treated by doctors who don’t have the proper training to perform the procedures.

In a new position statement, the Canadian Fertility & Andrology Society (CFAS) says any physician offering assisted reproductive care should have the fellowship training and skills needed to care for patients safely and to recognize the “potential pitfalls and complications” that may occur.

“These complications may include severe ovarian hyperstimulation syndrome, high order multiple pregnancy, injury to internal organs, massive hemorrhage and even death,” it says.

Assisted procreation is highly lucrative. What’s more, with more women postponing motherhood, demand for infertility treatments is on the rise.

“This is about physicians training physicians to provide the highest quality of care that we have available,” said Dr. Roger Pierson, professor and director of research in the department of obstetrics, gynecology and reproductive sciences at the University of Saskatchewan, Saskatoon.

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One of the biggest concerns involves the use of injectable fertility drugs, known as gonadotropins.

The drugs stimulate a woman’s ovaries to produce multiple eggs. However, in some cases, the woman “over responds,” producing so many egg follicles her ovaries grow big, fat and swollen.

Fluid can leak into the chest and abdomen. In rare cases, ovarian hyperstimulation syndrome can lead to blood clots, kidney failure or death.

Gonadotropins are frequently used with intrauterine insemination (IUI), where sperm is injected directly into a woman’s uterus; experts say the procedure is being widely practised outside fertility clinics. Last year, Ontario alone paid for 22,806 insemination cycles performed on 8,725 women.

‘If you can’t do it safely, you don’t do it’
“It’s in a load of different places,” said Dr. Carl Laskin, a Toronto fertility specialist and past CFAS president.

“[Gonadotropin IUI] is easy to do. The problem is it’s also easy to do unsafely and easy to do wrong.”

The risk of a multiple birth — twins or more — can be as high as 30%.

Blood tests and ultrasounds are required to measure hormone levels and determine how many eggs are maturing. If the woman produces too many eggs, the cycle should be cancelled.

“IVF [in vitro fertilization] clinics have the option to convert those patients to IVF,” said Dr. Jason Min, chairman of the clinical practice guideline committee of the Canadian Fertility & Andrology Society.

With IVF, the eggs are removed and fertilized in a lab dish, and the resulting embryo transferred back into the uterus.

“Outside an IVF clinic, their only recourse would be to cancel the cycle,” said Dr. Min of Calgary’s Regional Fertility Program.

But, “it may be very difficult for you to say to a patient who has just spent X number of dollars on so much medication that, ‘I have no choice but to cancel your cycle.’ ”

Egg retrievals also carry risks. “The big one is sticking your needle into an artery,” said Dr. Pierson.

“You have to have the proper sedation. You have to have the ability to recognize an ovary on ultrasound and interpret ultrasound images. You have to have the ability to use the ultrasound probe and needle.

“These are all technical skills that you don’t learn by reading a book.”

Added Dr. Laskin, “The overriding principle is always, you want to get the woman pregnant, you want her to keep the pregnancy and you want all of this done safely. And if you can’t do it safely, you don’t do it.”

Are you too old to have a baby at 40?

Boy I hope not. I just turned 40 and out of my three children, the oldest is four, so you can do the math. But a recent piece on The Huffington Post is getting a lot of attention, and not necessarily the good kind, because a “mother of advanced maternal age” admitted that even though she sought out fertility treatments to make it happen, now she’s over 40 with a toddler and struggling. I hear her, but I feel the opposite way.

Stacie Krajchir, who wrote this very honest post, is also the founder of The See and Sprout Project, an art therapy program originally created to help the children of the 2004 Asian tsunami and has since reached needy children in countries all over the world. This is a woman with a vision. So when Krajchir describes going through the infertility gamut with three hopeful pregnancies all followed by miscarriages, fibroid surgery and finally a fertility procedure called IUI (aka “turkey basting”) you can feel her determination. The IUI was a success, but a little surprisingly, one thing had not truly registered at the time: She’d have her first, and only, baby at 42.

And therein lie the first couple of problems.

She feels too old, she says, too out of energy to wrangle a 20-month-old in her mid-40s. Also, as an older parent, the chances that she and her husband will leave her son alone in his early adulthood are higher than some of his friends, and there’s not enough time to give him a sibling. Now comes the obvious question: Why didn’t this occur to her before? She said there were warning signs, that Mother Nature was politely trying to steer her in other directions, but she couldn’t be dissuaded. Well, that too is Mother Nature for you. Most women are hard-wired with the urge to have babies. We just are.

Now I can’t know much about Krajchir’s life and her true story from just this post, but I DO know that it’s hard to raise a toddler. I feel tired for sure, but I also know that EVERY mom feels tired with kids at this age. I challenge any mom of any decade to say she feels light on her feet with a baby who’s about to turn 2. And if I could have coffee with this author, I’d also tell her that the first kid will rock your world because that one little person creates a massive life change by 100 percent. She’s feeling that. But the impact of each baby after that is less, in a way. If you’re already working your day around nap time, what’s another small fry in the house? Now you’ve got a chance to use those hand-me-downs and never underestimate the power of a built-in play date. In some ways, it’s almost easier—but that’s not an option for her anyway.

When I think about my own setup, my own family and my own advanced maternal age, ahem, I’m beyond grateful. I really am, and the moment these kids are big enough to get the full picture they will be too. In my 20s I would have been a lousy mom, in fact I can’t even imagine having a husband. (Hats off to single moms because you are incredible, but in my case, I need one to make this whole thing work.) Overly emotional, silly about money (in fact totally broke) and dying to start a successful publishing career, I would’ve been the worst.

By my 31st birthday, I was a VP in New York City and had at least met my now husband, but that career thing made it hard for us to stay put in one place long enough to make our relationship official. He was in Europe, I was all over the place. But we were doing, striving and achieving. That’s what mattered to me at that age and I’m blissfully aware of how those experiences have shaped me as a mom today. Here’s what I’ll say to my kids when they want to chase dreams of their own, “Think about what would be amazing, what seems out-of-reach because it’s so dang cool. Now go do it.” I only know something like that is possible because I’ve had the chance to do it.

So yes, I’ve had time to achieve a few life dreams (become a VP of a major media company, run the NYC Marathon, move to Europe), and now I’m a part-time consultant and food blogger who mostly wrestles three kids in and out of car seats all week. I guess I’m tired, but honestly, I don’t remember being a ball of energy in my earlier days either. When it comes to parenting, this is my time. This is the season and I’ve never been better prepared.

How to Stay Positive when trying to Conceive- Abigail Natanshon

Lara Fetting from North Ridgeville, Ohio, remembers all too well how difficult it was to stay positive during preconception. It took her only five months to conceive with her first child, but it took over a year with her second. “Combating negative thinking is hard,” she says. “I think the hardest part is ignoring negative people—like my male coworker who asked if my husband was shooting blanks—and trying not to get discouraged when everyone it seems gets pregnant or knows someone who got pregnant the first time they tried. And they all love to tell you about it. I found Web boards a good place to blow off steam and get encouragement. Hearing other people discuss the same frustrations helped a lot.”

The Challenge of Staying Positive
Dr. Andrea Mechanick Braverman, a psychologist and director of psychological and complementary care for Reproductive Medicine Associates of New Jersey, believes it is very difficult to stay positive while trying to conceive. “It is very easy to get negative when trying to conceive,” she says. “We all carry around our own beliefs about how easy it will be to get pregnant. Many of us believe that you simply stop birth control, and you instantly get pregnant. Contrast with the fact that the average woman only has a 20 to 25 percent chance to get pregnant—less if she’s older—and many will be disappointed and maybe even a bit worried with their first try. For those having problems conceiving, there is the monthly cycle of disappointment and hope which can really wear you down.”

Women often protect themselves from this preconception emotional roller coaster by anticipating the worst while they are trying to conceive. This can lead to a decreased desire to get pregnant and/or depression.

The Importance of Staying Positive
Dr. Carrie Jones , a naturopathic physician specializing in women’s heath at Northwest Gynecology Associates in Hillsboro, Oregon, believes that staying positive is vital for a woman’s physical and emotional well-being. “Staying positive reinforces to your body healthy thoughts and emotions,” she says. “Positive thinking attracts positive actions into one’s life. Negativity is a stress on the body, and stress hormones really play into the role of fertility. It’s the idea of fight or flight. Our bodies weren’t designed to become pregnant while running from the saber toothed tiger way back when. Now, the tiger has changed into job stress, money stress, family stress, unhealthy lifestyle stress, and even negative emotion stress. When conception becomes stressful the body recognizes that as a ‘fight or flight’ emotion and reacts accordingly.”

Dr. Jones believes that if the emotions running through a woman’s body are ones of frustration, anger, hopelessness, blame, and sadness then that’s what you’re going to get. Combating negativity and staying positive during preconception, even through assisted reproductive therapy (ART), can go a long way in keeping your stress levels down. Holistic thought believes that keeping your stress levels down can make pregnancy more likely.

5 Tips for Combating Negative Thoughts
Dr. Jones gives the following tips on combating negative thinking while trying to conceive:

Take time for yourself every day. Even if it’s five or 10 minutes where you put your feet up and zone out, it allows your body a quick recharge. When your life centers around trying to conceive the focus changes to the end result instead of the process. Don’t forget you are a part of the process, and it’s important you remain healthy, clear, and balanced.
Journaling is very important. It gets those negative emotions out of your head and allows you to check in with yourself about what is going on and then how you can flip it around to the positive.
If you are having a hard time staying positive during preconception, then put up note cards with positive words and phrases on them. At least you will read them and your brain will take note of them several times a day. Place one on your bathroom mirror, on your computer, in your car, taped to the back of your cell phone, etc. Repeat them aloud or in your head. Use words such as “create,” “beautiful,” “healthy body,” “balanced,” “normal cycle,” “healthy eggs and sperm,” “healthy cervical fluid,” “regular ovulation.” Try phrases such as “I am a healthy woman.” “My uterus and ovaries are ready to create a baby.” “My partner and I are wonderful parents.” Try using any word or phrase that makes you smile when you see them.
Don’t forget about date night. Another way to enjoy the preconception process is to re-create courting. Surprise each other with little gifts or cards. Go out to dinner, catch a movie, drink sparkling cider under the stars. It’s OK to have sex on your non-fertile days if you need to release some pressure!
Eliminate the negativity around you. Connect with positive people, read positive books, watch happy, positive movies. Don’t let negative people or images drag you down while you’re trying to conceive. Create healthy boundaries and buy yourself a “no” button. It’s OK to say “no” and put yourself first.

Freezing Eggs and Hoarding my Fertility- New York Times

When I awoke in my fertility clinic’s recovery room after having nine eggs extracted and frozen, I felt a profound calm settle over my body. I could not make the man I had fallen in love with at the time want kids. But at age 36, I could soften the fallout. By stashing away some good eggs, I had found a way to keep alive my dream of having a family.

The relief was short-lived. Within a few weeks, my anxiety over losing the chance to have children was replaced by a new kind worry: Had I had frozen enough eggs?

My panic, I’ve learned, is not uncommon. Women’s emotional reactions after egg freezing are complicated. In a study of nearly 500 women who had frozen their eggs between 2005 and 2011 at New York University Langone Medical Center, while 53 percent felt the experience was empowering, 36 percent found it both empowering and anxiety producing.

Many women I profiled in my book about how freezing their eggs affected their lives said their low-level unease about whether those eggs would give them babies later on never really went away. The chance of success depended on the quality of your eggs when they were frozen and the expertise of the people taking them out and putting them back in you. Obviously, you wanted to give yourself as many chances as possible.

I had nine eggs. That wasn’t a lot of chances. I would be lucky if a handful survived thawing and fertilization and grew into thriving embryos. What if I miscarried? What if there was something wrong with my uterine lining, and the precious embryos couldn’t attach? But the possibility that bothered me most: What if I loved motherhood so much that I wanted several children? By the time I met the right man and got going, I would likely be out of time, and my meager stockpile would only go so far. I was the oldest of four, and I loved being part of a big family. I liked the sense of belonging, the symmetry of kids and parents in the car on long trips, the big dinners with people who got your jokes.

When I was younger, I always wanted three children. But that was before creeping age and a hard breakup forced me to renegotiate my desires: Maybe you could be happy with one, I told myself. Maybe you’ll get lucky and conceive twins. But I had yet to know what it would feel like to hold my firstborn. Would I have awakened a deep longing too late?

Before I started freezing, I felt helpless to stop the slow fade of my fertility. But when a nurse handed me a Post-it with the number 9 circled, the value of my eggs became crystal clear, and freezing more became a mission. I once heard a doctor at a conference speculate that women could become addicted to egg freezing. That makes sense to me on some level. That sense of security and control over my life was one of the best feelings I have ever experienced. I had been given a second chance, a reprieve. Suddenly, anything else that money could buy – a house, a wedding, a vacation – seemed to pale in comparison to safeguarding my chance to have children.

Fertility doctors don’t have a consensus about how many eggs you should freeze; I was told I should aim for anywhere from 12 to 30. That would be enough for two to four embryo transfers, each of which has a 30 percent to 50 percent chance of resulting in a pregnancy. But banking in bulk hasn’t been an option for most women. Each retrieval cycle costs $10,000 to $12,000 and usually nets eight to 14 eggs. At some clinics, prices have dropped to $7,000 per cycle — still out of many people’s reach. One new program begun last month at Shady Grove Fertility, which has clinics in the Washington, Baltimore and Philadelphia areas, offers freezers under 37 the chance to put away 20 eggs within four cycles for $12,500.

For the next near, I froze in a frenzy. I plundered my savings. I accepted help from my parents. I got a package deal in Canada. I tried two kinds of stimulation methods in New York. I bought generic fertility drugs from Spain through a British online pharmacy. I spent more than a year bloated in fat pants and cranky from hormones. But $50,000 later, I had stashed away 70 eggs. I won’t know until I try to thaw them in the next few years whether my actions were obsessive hoarding or the smartest decision I have ever made.

Sarah Elizabeth Richards is the author of “Motherhood Rescheduled: The New Frontier of Egg Freezing and the Women Who Tried It.“

20 Things I couldn’t tell my Fertility Doctor when I was her patient- Huffington Post

Dear Fertility Doctor,

Here are some things I wish you knew, that I couldn’t say when we met three years ago:

1. I do not actually want to be here, which is weird, because I just put $15,000 on my credit card to do so.

2. Any calm and charm I exude is a façade. My super-crazy side is reserved for my husband and anonymous infertility friends online. Anything casual you say about my chances of conception will be parsed for hours and days.

3. I respect you, but I also see an acupuncturist, a hypnotist and a psychic.

4. Though my FSH levels are “data” to you, that high number feels to me like it’s a low SAT score, like I’m branded and doomed. No matter how much you explain it, I don’t understand why you can’t be happy if it goes down.

5. I look at the Internet. A LOT.

6. Infertility hurts so far beyond the baby. It’s about my marriage, my friendships and my ability to picture a future. It’s about my body, and whether everything I’ve been told about personal power is true.

7. My period feels like a miscarriage every month.

8. I want to feel important to you, even as I know you are successful no matter what happens in my case.

9. It’s really weird that we have to do a rectal exam ten minutes after meeting, though I understand the social contract demands we both act cool about it. I never thought that district of my anatomy would be part of getting pregnant.

10. Part of me thinks I can solve this with wheatgrass.

11. I know you want me to grasp statistical reality, but I wouldn’t be here if I didn’t think I could beat the odds.

12. Probably you were that straight-A pre-med student while I leisurely pursued my English major. I’m intimidated by you, even though I used to pity you for having to toil in organic chemistry when literature seemed much more relevant.

13. I try to act cool about the ultrasound wand, but I’m pretty sure I have PTSD.

14. I don’t understand why I have to wait for you without my underwear. I feel everything is skewed that I have to be half-naked while you get a crisp lab coat. OK, I understand, but I hate it.

15. The waiting room is a quiet, tense, darty-eyed purgatory where every minute feels like an hour.

16. It’s not the shots that are hard. I would inject myself in the eyeball to get news two weeks earlier.

17. I appreciate when you quote that study saying infertility is as stressful as cancer. I’ve never had cancer, but I do sometimes feel like I’m dying.

18. Bless you for not telling me to “relax.”

19. Despite all these things I just said, I entrust you with my hopes, dreams, ovaries, husband’s sperm and maybe even our embryos. Please don’t mess with any of these things.

20. Thank you, forever, for helping us along, and finally off, this dark, rocky path.

Follow Kathryn Kefauver Goldberg on Twitter: www.twitter.com/kathrynkefauver
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