October 24, 2011
Infertility or the inability to have a baby can be devastating and affects approximately 10 percent of the female population. There are many conditions that prevent women from having children including and Mayer Rokitansky Kuster Hauser syndrome (or MKHS). MKHS is a rare disorder that affects a woman’s ability to conceive. At present, for every 10,000 women, only 1 to 2 will be affected. Both Sara Ottoson of Sweden and Melina Arnold of Australia have this condition. MKHS is characterized by the absence of a vagina and part of the cervix. Patients with this condition have normal breast development and functioning ovaries. Genetically, they also have female or double X-chromosomes and look like normal women. The problem comes to light during adolescence when a teen fails to have a period. The condition is also known as Vaginal Agenesis because they are born without a true vagina, a problem that can be corrected through surgical and non-surgical procedures. Unfortunately, they are unable to have children and usually adopt or use a surrogate mother. Those options, however, might soon change.
Both Ottoson and Arnold plan to have biological children using those mothers’ transplanted wombs next year. The wombs that these women resided in prior to their birth will potentially be used to nurture their unborn babies. Ottoson and Arnold will be making history in the same manner as Louise Brown did in 1978 when she became the first successful “test tube” or In Vitro Fertilization (IVF) baby. Has a womb transplant been attempted before? Yes, about 10 years ago in Saudi Arabia but it was an unsuccessful procedure. After four months, the 25-year-old patient’s body rejected the transplanted uterus of a 46-year old woman. Ottoson will receive the uterus of her 56 year old mother but will not be able to conceive through IVF until she has waited a full year to make certain that her body will not reject the donated organ.
If womb transplant becomes successful, it will also be a powder keg regarding ethical and legal issues. It would also provide an option to women who are cancer survivors and desire fertility. All eyes will be on Ottoson and Arnold next year. It will be history in the making.
April 11, 2011
Olympic winner and motivational speaker, Jim Stovall once said “Integrity is doing the right thing, even when no one is looking.” In September 2009, I wrote about a blog about Carolyn Savage, a 40 year old woman with a poor obstetrical history. Savage married her college sweetheart and had an uncomplicated first pregnancy. However, her second child was born prematurely. She had 4 subsequent miscarriages and ten years later she became pregnant through in-vitro fertilization (IVF). Because the Savages wanted a large family, they tried IVF again. Unfortunately, Savage was impregnated with the wrong embryo. To their credit, everyone rose to the highest level of integrity. The infertility clinic informed the Savage family as soon as the mistake was discovered and then gave them the option of terminating the pregnancy or continuing it. The Savage family then had to inform the rightful parents of the embryo that were not expecting to have a baby any time soon but was now faced with that dilemma. Savage ultimately delivered the baby and then handed it over to its rightful parent, the Morrell family.
When bad things happen to good people, we are perplexed and often wonder why. I remember feeling despondent as I wrote the blog. A woman had delivered a healthy baby but was leaving the hospital with empty arms. A blatant systems error had reared its ugly again reminding physicians that we are all fallible, despite our years of strenuous training and hard-earned credentials. Yet, the book of wisdom reminds us that everything works for our highest good despite the tragedies that are seen through the lens of our human experience.
Fast-forward 2 years later: the Savages hired a surrogate mother (aka gestational carrier) who was pregnant with their baby but subsequently had a miscarriage. However the Savages didn’t give up and they are now pregnant again, through their gestational carrier with . . . . twins. When Carolyn Savage leaves the labor and delivery suite this time, her arms will be filled with not just one baby, but two. Who says life can’t have a happy ending? We wish the Savage family the very best as they prepare for their joyous occasion.
December 14, 2009
An IVF patient posted a blog complaining about the possibility of only receiving two ultrasounds during her pregnancy and I could feel her pain. Quite recently I had a protracted discussion with an imaging center that kept denying my patients an ultrasound based on Medicaid’s rule of only one ultrasound per pregnancy.
Medicine has become a BUSINESS and many clinical decisions are now based on whether or not someone will be paid. Those who know me or read The Smart Mother’s Guide to a Better Pregnancy know that I abhor “keepsake” ultrasounds that are done for gender determination and entertainment. However, I value legitimate fetal ultrasounds that are reviewed by radiologists because they have saved lives. The earlier the fetal ultrasound is done, the more accurate the fetal dates. This could become an issue if you unexpectedly need an induction of labor.
An ultrasound done at 20 weeks provides information regarding the anatomy of the baby. Is there a 4-chambered heart? Are the baby’s intestines normal? Has the brain developed properly? Everything’s okay? Great, but what happens at the end of the pregnancy? The real-time information that ultrasounds provide to determine fetal well being is priceless. This year alone at least seven of my patients’ were spared stillbirths because we detected poor fetal growth, abnormal placentas, low amniotic fluid and umbilical cords wrapped around their babies necks, thanks to a third-trimester ultrasound.
So how do you get around the only-one-ultrasound-per-pregnancy rule? Your physician must write an order as a “follow-up” of a condition previously detected or diagnosed. Did you have previous abdominal pain or bleeding? Was there a suspicion that your baby wasn’t growing properly? Was the placenta in the correct position? These conditions justify obtaining a follow-up ultrasound. If you have a high-risk condition, don’t hesitate to request a referral to a high-risk specialist who can monitor your baby using 3-D ultrasounds.
Visual access of your baby is extremely important. The one-ultrasound-per pregnancy rule is total nonsense.
October 14, 2009
Stephanie Saul’s New York Times’ article, The Gift of Life, and Its Price, affected me on a personal level. As an obstetrician and a victim of infertility, I am well versed with the inherent risks of IVF. Saul describes the exorbitant costs of fertility treatments and the increased complications of multiple births. We are still recovering from the aftermath of Nayda Suleman’s controversial delivery. It’s miraculous that neither Suleman nor her eight babies died.
In Saul’s article, we follow the Mastera family who conceived twins through in Vitro Fertilization after four failed attempts using artificial insemination. The twins subsequently delivered prematurely at 32 weeks and were in the neonatal intensive care unit for approximately 51 days at a cost of $1.2 million dollars. The average cost of an IVF cycle ranges from $12,000 to $25,000. Is there any wonder why there is a low compliance to follow the prescribed guidelines and attempt conception with just one embryo when the chances of a live birth are improved with two? Unfortunately, the greater the number of embryos, the greater the risk of preterm deliveries, therefore having a twin pregnancy is not a benign act. Even WITHOUT the benefit of IVF, a twin pregnancy is a high risk condition.
Twins are notorious for delivering prematurely, have an increased risk of the placenta separating too soon, increase the mother’s chances of developing hypertension and 30% end up in the NICU. Twin pregnancies should be managed by high-risk obstetricians (aka maternal fetal specialists), yet I am amazed at how many of my OB colleagues attempt to manage these pregnancies alone.
Coping with infertility is an emotional roller coaster, a ride I know all too well. In the end, my husband and I chose adoption and are the proud parents of two rambunctious little boys.
For those who are considering IVF, less is sometimes better than more. Should you opt to use more than one embryo and successfully conceive, PLEASE place your pregnancy in the hands of a skilled maternal fetal medicine specialist. I promise you won’t regret it.