Tuesday, February 17, 2009

ASRM Response to Octuplets

On Friday, 2/13, The American Society for Reproductive Medicine (ASRM) put out an official response to the Suleman octuplet case. I'd like to share it with you.

I am sure all of us have followed with interest and concern the unfolding story of the Suleman octuplets in California. I wanted to take a moment to share with you some of what ASRM and SART have been doing in response.

Our Public Affairs office began taking calls (after business hours on the East Coast) the evening the birth of the octuplets was announced on Wednesday, January 28. In these early days of the story we focused on reminding the media that while the successful delivery of the octuplets was novel, such a high order multiple birth should not be considered a desirable medical outcome.

On Friday January 30th an interview with the children’s grandmother made it appear that IVF treatment had indeed been involved. That morning we released a statement from ASRM President Dale McClure MD. That statement emphasized that we did not have the facts in this case, but that in recent years ASRM and SART had been working very hard, and with a fair amount of success, to reduce the number of high order multiple births. (That statement, and all our press releases are available at www.asrm.org.) By weeks end the Public Affairs Office had responded to well over 100 calls, and ASRM staff and leaders had done dozens of interviews.

Over the course of the next week, the volume of media calls remained very, very high. However, since no new information emerged, the media questions and coverage became increasingly speculative in nature. Because we did not feel it was responsible to engage in that speculation, we began to curtail our responsiveness. Meanwhile, SART sent a communication to its membership seeking any information anyone had on the situation.

As the Today show began to air its interview with the mother on February 6, she indicated all her children were the result of IVF and all from the same physician, and subsequent media reports named the physician. On Monday February 9, ASRM President McClure issued another statement, again emphasizing the field’s success in reducing the number of high order multiples, and indicating we were interested in looking into the matter. On Tuesday, February 10th I sent a letter to the California Medical Board stating our interest in this matter and our willingness to assist them in their inquiry. SART President Elizabeth Ginsburg, MD sent a letter to the physician named in media reports to ask for information about the treatment of this patient.

Examining and learning from both successful and unsuccessful cases is a vital component of medical education and an important tool in improving clinical practice. We are seeking information so that all of us may better understand how to avoid additional extreme high order multiple births. Moreover, we have all worked too hard to improve care and reduce the number of high order multiples to allow one unfortunate outcome to taint the whole field. Both ASRM and SART have membership standards and disciplinary procedures and should the facts warrant, those procedures will be used.

It is important to note that we do not have all the facts. At present I would say we have very little information, and most of what we think we know has come from sometimes conflicting media reports. All of us need to be very cautious before coming to any conclusions. We will keep you informed as additional information becomes available.

Robert W. Rebar, M.D.
Executive Director
American Society for Reproductive Medicine

Meeting our Egg Donor

Written by Melissa, former Intended Parent with The Donor Source

Continued from Volume 4 Issue 6:
"A New Year's Wish"

… We chose Chelsea as our donor on New Year’s Day 2007.

One detail of the profile we didn’t consider significant at the time of our donor selection was whether or not the donor was willing to meet with us or any children that may result from our arrangement. I couldn’t have imagined that it would ever be an important detail to us…

As it turned out, once I was pregnant and the situation became more tangible, I felt so grateful to this woman for helping us. To some degree, I wanted to have a “real” person to thank and to associate with our success. I felt very strongly that facing the mystery head on would make it less powerful. If I could meet her, hold my head up high and feel grateful, then I wouldn’t be able to feel like I had somehow failed in this major part of my life. I think some people may feel that if they don’t talk about something, it will just go away. This wouldn’t have been the case for me; it would have been my dirty little secret, always nagging at me.

When my husband and I met our donor in a café, I was already pregnant with twins and a little nervous. The donor agency sent a chaperone to maintain anonymity for both parties, which was nice mostly because she helped to break the ice. It was so wonderful to meet our donor, Chelsea, in person. We heard about her life, her interests, and how she spends her time. We talked about books and music, her major in college, and how she likes to rock climb. She was young and pretty, very charming and just what we would wish for our children to become. She commented on our similar appearances, which I felt added validity to our donor selection. At the end of the meeting it was great to have an actual person to think of in relation to the process.

At 27 weeks, I had an emergency C-section. Our baby boys were born at 2 pounds, 5 ounces and spent the next 3 months in the NICU. It was a very scary time, but as has been their pattern from before conception, our miracle babies pulled through with no issues. We spent everyday with them, holding them, feeding them and providing as much care for them as was allowed. In their room we posted a picture of them as embryos before the transfer so the nurses could marvel at the miracle. There was a picture of Chelsea right beside it. I was 37 and it had been five years since we started out journey into assisted reproduction.

Three months later we brought our beautiful boys home. They came home a few weeks before their actual due date. It seemed unreal that they were still supposed to have been inside of me, but here they were at home with us after such a long, intense ordeal.

I was a little sad that I had missed out on the end of my pregnancy. After working so hard to get there, I really loved being pregnant. Sure, there were times when it was uncomfortable and it was getting harder to maneuver my growing shape, but it was such an amazing experience to carry those two babies. There was truly never a moment that I felt they were anything less that 100% mine. I am grateful to Chelsea for her contribution, we surely wouldn’t be here without her, but there is no doubt about who our boys’ “mommy” is.

Life with our boys is so much fun. They truly are the light of our life, as well as that of their grandparents and great-grandparents. The boys’ unique conception is common knowledge for our family, friends, co-workers, and acquaintances. Neither my husband nor I felt the need to keep it private. It would have been virtually impossible to keep it a secret with all of the time off work, travel, and planning involved. We joked that if we didn’t tell people the truth, they would have thought that one of us was terminally ill because we had to travel to so many doctor appointments in the city. Even though people know the truth, it rarely comes up in conversation, or even in our thoughts. Someday we will tell our boys the story of their miracle conception.

Now our boys are almost a year old. We wanted to introduce them to Chelsea for a couple of reasons, and I’m not sure I can even explain why exactly. For one thing, I wanted her to see what an amazing thing we had done. I really think of this as a team effort, with her as a member of the team. I couldn’t imagine that she wasn’t curious about them and wouldn’t be totally awed. Who wouldn’t want to see their genetic contribution? In retrospect, I think subconsciously I wanted to make sure that there wasn’t some connection between my babies and their donor. Logically, I knew that there wouldn’t be, but emotionally maybe a little part of me just wanted confirmation? We met Chelsea again, a year and a half after our initial meeting, in the same café, again with our same chaperone, but this time, with our sons in tow.

We had a great visit together. It was very cathartic to have everyone together. She said she saw bits and pieces of herself in each of our sons, and she thought they were happy, well behaved little boys, but it was obvious she wasn’t in “baby love.” As expected, she was polite and sweet as she had been at our previous meeting. I hope the meeting with all of us gave her a sense of satisfaction and accomplishment at her contribution, as well as an understanding of our feeling of appreciation.

The process of choosing and meeting our donor was such a positive experience for us. There is absolutely nothing my husband or I would have done differently. Meeting Chelsea was a vital part of this process for us. Though I realize everyone is different, I would encourage all donor recipients to consider meeting their donor. I don’t think I can adequately express the dynamic that our relationship with Chelsea has brought to the experience. It has been irreplaceable.

Tuesday, February 10, 2009

US Octuplets Drama Triggers Calls For Tougher Regulations

Written by Steve Masler, CEO of Fertility SOURCE Companies

Needless to say there has been huge outcry over the latest octuplets case of Ms. Suleman. Virtually all media outlets have seen fit to make the story day in and day out front page news. Judging from this article and many others of its ilk, the outcry is not necessarily that an IVF procedure resulted in an octuplet birth. The fundamental complaint is one of massive irresponsibility on the part of the mother and of the fertility doctor regarding: (1) implanting more embryos than called for by ASRM guidelines; (2) Suleman's pre existing six children added to by the eight new ones to make 14; (3) Suleman's poor financial condition with consequent presumed difficulty in supporting 14 children; (4) Suleman's status as a "welfare mother" suggesting that the cost of raising the octuplets will fall to the taxpayers; (5) Suleman's apparent search for publicity (she has hired a publicist) to turn her octuplet experience into a money making venture; and perhaps (6) the lack of a committed father since, seemingly, only a sperm donor without any support commitment was involved in all of her pregnancies.

Each or all of the six reasons for outrage listed above have legitimacy as a basis for condemning what has occurred. Perhaps some of the reasons for outrage are mitigated by facts as presented by Ms. Suleman. For example, she claims that every one of her pregnancies via IVF was based on implantation of six embryos. In spite of that, she only had singletons in the prior pregnancies. I do not know if her claims regarding prior pregnancies are validated and if she had only one offspring from each pregnancy naturally or if some or all were due to selective reduction. She also claims that the sperm donor was not the usual anonymous one but instead someone she was close to, enough so that he had contemplated marrying Ms. Suleman.

Unfortunately, after all the outrage is over and all the investigating of Ms. Suleman and/or her IVF physician are completed, we will still perhaps be left with the question: Should a mother (or parents) be prevented from asking for steps to be taken to give assurance that their search for childbirth be fulfilled? If it might take eight embryos to achieve that result, should it be legally barred? If there are no IVF doctors who would carry out the procedure, then so be it. But, making it the law? This is not China with its one child policy.

I don't know, but I suspect that there have been other cases of implantation of eight embryos by respected fertility doctors. However, I suspect again that in most if not all of those cases, the mother underwent selective reduction if too many embryos implanted. If my suspicion is true, and this is only a suspicion on my part, then could it be a crime to implant eight embryos that get carried to term if it is not a crime to implant that number, when some or all fail to make it to the end?


Click on the link below to access the article mentioned above:
US Octuplets Drama Triggers Calls For Tougher Regulations

Monday, February 9, 2009

A New Year's Wish Part I

Written by Melissa, former Intended Parent with The Donor Source

I stopped trying not to get pregnant when I was 26. Two years later I was still not pregnant. I assumed it would just happen, but when it didn’t, my family doctor prescribed Clomid. After several rounds of Clomid and still no luck, it was recommended that I see my gynecologist. Getting to the doctor for a diagnosis wasn’t at the top of my priority list. My husband and I were busy with our business, our dogs, our life; it didn’t seem like a huge rush. And I wasn’t really worried because I was still under 30 and none of my friends had kids. I had plenty of time, or so I thought. When I finally made it to the doctor and it was determined that there were no obvious physical issues standing it the way of pregnancy, I was immediately referred to specialists for further investigation. They diagnosed me with advanced ovarian aging. After the first round of in vitro was cancelled mid cycle, due to ovarian cysts, my doctor told me it would be best to abandon my quest to get pregnant unless I had unlimited “emotional and financial resources.” I was 32.

If I had gone directly to another fertility clinic after I received that diagnosis, things might have gone differently. Instead, I tried to forget about the diagnosis. Then I decided that surely this was something I could change – diet, exercise, supplements, acupuncture, yoga for fertility. I did everything I could find that offered any hope of success. When I finally did go to another fertility clinic, it was indeed too late.

At age 35, my options for getting pregnant were now limited to using donor eggs. Of course, adoption was always presented as an alternative, but I had always seen myself being pregnant. Acquaintances who were adopting couldn’t figure out why that route was not acceptable for me. They felt that with a guarantee of success through adoption, why would we take the chance of in vitro with a donor when it may not be successful? The success rates normally quoted for donor cycles are in the 65-70% range, which we felt were great.

I really could not imagine living my life and never having been pregnant. It was an experience that I had looked forward to since I could remember and felt I could not do without, regardless of the emotional or financial costs. The search for a donor began.

When my husband and I began researching donors, we looked at pictures and read profiles online. We looked at several donor agencies and lots of donor profiles. We really tried to keep our search local, but sometimes a donor from across the country would interest us. In the end, the logistics and finances seemed so much more manageable if we could keep things, if not in our state, then at least in a nearby state. I really battled over which qualities were important to us. Looks? Personality? Values? Interests? All of the above?

I was tormented by what it would be like to have a child conceived with donor eggs from a donor who looked like me. Would it be more honest to myself and the world if I choose a donor who didn’t look like me? I imagined future scenarios in which someone would comment that the child looked just like me. What would I say? Would it be a lie if I didn’t explain that no, the child didn’t actually resemble me, but instead the donor who coincidently looked like me?

In the end, we decided we would make our final donor selection after the holiday bustle on New Year’s Day 2007. We had several donors picked out. Ironically, our final choice Chelsea was not one of those we had initially chosen. I printed out a few profiles and pictures for final review on January 1st, but all of them seemed to have something about them that wasn’t ideal. My husband suggested we go through our donor options online one last time. That was when we found a perfect donor - a great combination of family resemblance, values, and interests. We chose Chelsea as our donor on New Year’s Day 2007.

To be continued...