Limitless Possibilities: Twin Selective Reduction

Being an infertility vet, you get to hear a lot of harrowing stories and meet some incredible women who have had to make difficult choices along the way in their quest to build their family. One that has come up a few times is selective reduction -- a process that reduces the number of fetuses in a high-order gestation, usually triplet and up. It is rare, however, to pursue selective reduction when carrying twins, as twin gestations have become much more common these days. While there are still risks involved with twins, doctors are far more knowledgeable about the necessary precautions to be taken in order to facilitate a healthy pregnancy and delivery. 

The process of selective reduction involves injecting potassium chloride into the heart of the fetus(es), leading it to stop. It is probably one of the hardest decisions one can make: how do you choose which one of your babies should die? In some instances, the results from a prenatal screening makes the choice more obvious (albeit, still as painful), while others leave that decision to the random selection by one's doctor (position and access to the babies). 

I have had friends who were faced with this heart breaking decision; all of whom opted to reduce from triplets to twins. So when I came across this article in the New York Times Magazine by Ruth Padawer -- "The Two-Minus-One Pregnancy" -- I was amazed to read that twin reductions are also common. Similarly to the silence we experience when going through infertility, there seems to be an even greater taboo when it comes to opting to reduce a twin pregnancy to a singleton.

I leave it to you, dear followers, to draw your own conclusions, judgements  and questions when it comes to this specific type of selective reduction, but here were some of my thoughts that I'd like to put out there:

• Not everyone who chooses to reduce a twin pregnancy to a singleton pursued infertility treatments, but for those who did, is the stigma attached to the twin to single fetus reduction not a reminder for the REs to transfer fewer embryos -- ideally a single embryo -- rather than transferring 2,3,4 or more in order to ensure implantation?
• While the final decision of how many embryos to transfer is left to the patient and her doctor, many infertility patients who are receiving either limited or no insurance coverage (i.e., paying out-of-pocket for each treatment) request that at least two or more embryos be transferred to increase the odds of success and not having to undergo any further treatments. If insurance companies covered IF treatments, would fewer women find themselves in this difficult position of having to terminate one or more of her fetuses?
• As infertility patients, do we take the risks of high-order multiples too lightly seeing so many twins and triplets strolling down our neighborhoods or on TV? While each failed cycle leads to the next, are we too quick to want to "complete" our family in one shot and not taking the time to evaluate our physical, financial and emotional limitations? (I am not referring here to women who transfer a single embryo that then splits up.)
• A lot of the language used by the women interviewed for this story refers to their desire to be the "the best mom possible" for their children. Some of these women already had children while others were simply overwhelmed with the idea of parenting twins. Either way, they deemed that having a singleton would allow them to "perform" at the highest standards. I wonder how much of our societal pressures to be "super moms" affected the decisions to pursue selective reduction? Is being an "imperfect" parent truly that horrible? Aren't' all generations brought up by so-called imperfect parents and somehow turn out okay? 

I leave you with a quote about the duality of choices by bioethicist Josephine Johnston from this riveting article that continues to stir in my mind as I put it in various contexts:

 “In an environment where you can have so many choices, you own the outcome in a way that you wouldn’t have, had the choices not existed. If reduction didn’t exist, women wouldn’t worry that by not reducing, they’re at fault for making life more difficult for their existing kids. In an odd way, having more choices actually places a much greater burden on women, because we become the creators of our circumstance, whereas, before, we were the recipients of them. I’m not saying we should have less choices; I’m saying choices are not always as liberating and empowering as we hope they will be.”

I look forward to reading your comments. 

Feminist Views on ART, Surrogacy, Egg Donation and Adoption

C. over at The Infertility Revolutionary brought this fascinating issue of The Scholar & Feminist online, a webjournal published by the Barnard Center for Research on Women, titled "Critical Conceptions: Technology, Justice and the Global Reproductive Market."

The webjournal is comprised of lectures, documentary excerpts and papers presented during a series of conferences dedicated to discussing the new world of reproductive technology from a feminist point of view.

I have had the opportunity to read through most of the material and have found them all fascinating. There are important questions that are being discussed here, some of which I found potentially controversial and others central to our personal debates on these relevant issues.

The topics covered are the "baby making business," the legal aspects of infertility coverage, egg donation and surrogacy in India, the identity implications of donations for the offsprings, our societal portrayal of surrogates and the global "trade" of today's adoption process.

I encourage you to read some it when you find a little time. I'd be happy to discuss any specific articles that you would like.

Fertility Wellness Workshop

Fertile Bliss, Inc.  
Presents
a

Red Tent FertilityWellness Workshop

For Women who are looking for a sense of community and tools
 to empower them through their journey towards motherhood.

Have you been trying to get pregnant?

Have you considered alternative methods to enhance your pregnancy possibilities?

Are you interested in learning different ways to support and help you as you go through this process?

If so, come to the Red Tent Fertility Wellness Workshop.

You will learn helpful fertility-enhancing tips, receive a robust gift bag, nutritious snacks, the opportunity to connect with like-minded women and a chance to win free services, jewelry from Schwa Designs and
Circle + Bloom CDs.

Presenters:

Erin Hessel of Esema Healing Arts (http://www.erinhessel.com/) an acupuncturist and doula will provide insight into fertility acupuncture techniques and strategy, as well as reproductive wellness tips such as fertility cycle charting.

Tracy Toon-Spencer of Fertile Life, Inc. (http://www.fertilelifenyc.com/) a yoga instructor and mind/body coach, will lead a gentle, restorative, fertility yoga class and offer mind/body techniques to aid in relieving stress.

Pardis Partow of Hummingbird Healings (http://hummingbirdhealings.com/) an intuitive healer/coach, Reiki Master Teacher and medium, will teach self-care methods to help maintain a healthy, spiritually balanced life, as well as information on Reiki and other healing modalities. 

Hannah Springer of Earth Body Balance (http://www.earthbodybalance.com/) a renowned traditional foods nutritionist, will provide comprehensive pre-pregnancy nutrition education, as well as a packet of fertility recipes and resources.

June 18th, 2011

9:45am-3:00pm

Om Factory Yoga Studio

265 West 37th Street at 8th Avenue, 17th floor

$75.00 in advance (until June 15th ) via PayPal

$100.00 – after June 15th

~Space is limited so book early~

Questions and/or RSVP: Fertileblissnyc@gmail.com
Payments via Paypal.com: Fertileblissnyc@gmail.com

**For more info, you may contact Jes at Baby Step to Motherhood**

"Time to Chill" by Nancy Hass - Vogue Article

Past the glossy pages of this month's issue of Vogue Magazine (May 2011), there's a thoughtful article about egg freezing and what it could represent for women's reproductive future.

Egg freezing in an attempt to stop the proverbial "biological clock" from going off is becoming more and more mainstream thanks in part to a greater awareness of infertility issues and recent scientific breakthroughs.

Some important thoughts and questions are discussed here, some of which have been brought up in earlier articles and blog entries. One that really struck with me was whether egg freezing was giving women a false sense of security of their future ability to have a family when the perfect career and partner have been crossed-off the To-Do-List. Furthermore, while a woman may undergo several cycles in order to accumulate enough oocytes to freeze, how many cycles will it take to guarantee that one will be able to develop into a healthy baby?

I for one have produced well over 80 oocytes (through monitored cycles) and (thankfully) have now only one child to show for my many cycles. If one's odds of conceiving is about 50/50 (at a good clinic), I'm not sure where that leaves us. I know some women conceived on their first cycle, while others have done close to ten and are still trying. Or during one cycle I produced 28 eggs (thanks to PCOS) but none took.

Another important question is how late can you wait until you are ready to have those eggs turn into embryos and be transferred back to you? One of the pieces that I wrote that seems to get the most hits is my "That's not my grandchild" entry, where I discussed older women giving birth/becoming mothers in their 60's and even 70's. I know many were outraged that it was even legal for women who were well into their menopausal years to be given access to donor eggs.

Honestly, I still haven't made up my mind on this one. If you have the foresight of freezing your eggs at 30, have a great career and/or not finding the right partner for you, or simply that you just weren't mentally or financially there yet, then shouldn't you technically be allowed to claim your eggs at 50 to finally take the plunge? Unlike traditional egg donations, these frozen eggs are yours. I'm sure this must be hotly debated amongst bio-ethisits.

I know I'm raising more questions than I'm answering (not the typical format of this blog), but those are all valid questions to ponder and I'm sure you'll have many of your own. Please share them with me.

Stuck Between Two Worlds: Pregnancy After Infertility

Countless blog entires and chat room conversations deal with the deep isolation that comes with infertility. The inability to share one's fears and struggles can be debilitating on numerous aspects of one's life. Many of us take solace in our fellow infertile friends we've made through social networking and blogging. It's a tight knit community that allows for meaningful bonds to be formed, where one's sadness is met with endless words of support and virtual hugs.

And then one day, someone finally gets the much desired BFP. It is a day of celebration, shared on some level by everyone. Words of congratulations and excitement are passed around. One of us has finally made it to the other side of the dark tunnel, opening the door for more hope to be experienced by others, and that someday, we will all meet on the other side. Unfortunately, the good news doesn't happen to all at the same time. Some, most, are left behind.

As the initial beta numbers turn into updates of heart beats and ultrasounds, you may find yourself in a different type of isolation: after countless months/years of TTC, you know better than to announce to the world you're pregnant at 7 weeks. And yet, you're also no longer experiencing the grueling day to day of infertility treatments. This infertility to pregnancy purgatory can feel endless and lonely.

There is no right way to move on to this next chapter. There is no magical moment when suddenly you can proudly announce to the world that you too are with child. That time of accepting your undeniable luck can take weeks and even months (it took me over 5 months to finally admit that I was really going to have a baby). Meanwhile, you tread lightly. Trying to take everyday as it comes. Finding friends who can support you during this time can be even harder than finding friends who are coping with infertility. (Early) pregnancy after infertility can ironically turn into a time of longing for the camaraderie you'd shared for so long with other infertiles. Meanwhile, those who are still in the trenches assume that you must be in complete bliss, but in truth you're living in great fear; fear of having to start all over again, fear of finding out that you never "graduated."

My advice would be to find a couple of people (close friends or family) who have been there for you in real life through the tough times (doesn't have to be limited to IF struggles). Sharing the news with someone will encourage you to begin to embrace this new chapter. Don't deny yourself the right to be happy. And remember those who are still struggling and don't forget what it felt like to be in their shoes -- all of those dreadful pregnancy announcements on Facebook are still just as unacceptable now as they were then. Stay in touch with your IF friends and continue to offer as much support as is asked of you. Yes, you will indeed lose touch with many of them (either be it their choice or just the evolution of life), but some will remain your friends forever.

Being pregnant after infertility doesn't mean you no longer belong to the infertility community, it simply means you are a symbol of hope to many and an advocate for infertility to a new community -- the pregnant/parenting community. You still carry a responsibility to raise awareness for the 7.3 million who are still fighting to have a family of their own.

Complimentary Treatments: Infertility Yoga

In case you missed it, The New York Times had an article about the benefits of yoga for those undergoing infertility treatments.

While complimentary Eastern practices were for many years discredited by Western medical establishments, it seems that these days they have become an integral part of infertility treatments.

Acupuncture for one has been scientifically proven to help increase success rates for IVF patients. For others, acupuncture has improved FSH levels, blood flow and overall health.

Herbal supplements, on the other hand, may or may not help with infertility treatments. Some attest that it may actually counteract the intended results of fertility drugs.

As for yoga, besides its clichés of making you more Zen, at least for that hour, it helps keep your mind and body active. The physical aspect of the practice is not to be underestimated, especially when you are restricted from doing any vigorous exercises while undergoing IF treatments. Your body is no longer your own when you're doing IVF, but with yoga, you have the opportunity to do something that has a physical component to it and hence, hopefully give you more control over how you feel about yourself.

I think it's a wonderful thing that clinics are combining Eastern practices with their Western methodologies, but at times it seems disingenuous. Many of these clinics offering complimentary treatments fail to incorporate them in an organic way. The offices and general attitudes of the staff are still very rigid and clinical; devoid of anything that makes you feel at ease or whole. Maybe the future of IF centers will take on a more integrated approach expressed both in the available treatments and attitudes.

While relieving stress and having a positive attitude is essential when coping with infertility, I know it can be very difficult to take the time for yourself. Additionally, you can quickly find yourself caught up in trends that make you feel as though you are not doing enough to increase your chances for success. I fear that this article may insight such feelings. Certainly attending an infertility yoga class can be beneficial, but it is not the only thing that's going to give you access to a more peaceful place. You could attend regular yoga classes (with more modified poses) or just take a class that will tap into your pre-IF self (it's in there somewhere, I promise). Attend a cooking class, a book club, a writing class, or simply close the door for 30 minutes everyday and meditate. The point is, try to get out of your own head for a little bit everyday and surround yourself with supportive people.

Catching up with my Rambling Thoughts: The Urge to Have a Baby

I must apologize for my absence. The last few months have been a whirlwind and despite my best intentions, I seem to have neglected one of my favorite things: this little blog of mine. Infertility related topics are on my mind daily, but I just haven't been able to sit down and write something compelling.

Not writing has now filled me with a million thoughts and for better or for worse, here's the latest installment from my disjunctive mind:

While enjoying a pile of magazines at Gate 32 on my way to LA, I read a really interesting piece in ELLE written by Corrie Pikul, titled "The Clock-Watcher." (February 2011) In it, Pikul talks about how confused she feels about not feeling a natural pull/desire to have kids and whether that's indicative of a woman who doesn't really want any kids.

'For huge cataclysmic life decisions, like getting married or having a baby, I think people do want to be taken over by a feeling. Otherwise, how do you ever figure it out? If you don't have that part of yourself that irrationally wants to go ahead with this, how do you make decisions?' 

asks psychologist Daphne de Marneffe, PhD. 

It got me thinking, did I ever truly feel that urge or did it turn into an obsession only once I found out I couldn't have a baby the old fashioned way?

I must admit I was never one of those kids who dreamt of her wedding day, of the white picket fence, the dog and the two gorgeous kids bounding across freshly cut grass. Having found the love of my life, getting married felt like a natural progression. Today, I couldn't imagine my life without him, but marriage itself is still not what validates our bond.

So when we decided to try to conceive, I don't recall any urges per se. Similarly to getting married, it was a natural progression of our relationship. We had moved out of the city because the underlying expectation was to start a family. That's what people do, right?

Don't get me wrong, being a mother is truly the most rewarding experience -- the clichés about parenthood are unfortunately truly, so I'll spare you. But this article has lingered with me for the last week. How much of our lives do we actually owe to undeniable desires and how much of it is just us letting the river carry us to the next big ocean?

There's nothing like coming face to face (or should I say ass-cheek?) with a 1 1/2" needle filled with a thick oil to make you think whether having a child is truly something you want to do. (Infertility treatments take commitment and test every aspect of your identity and relationships.) And yet, every time I said, "That's it! I'm done with this shit!" I found myself begging for more. Could we save some more money for the next attempt? Could I find some strength buried deep down inside of me to do this all over again? What if the next cycle is the one we've been waiting for?

What is it that drives us to take on such torture month after month if not for a genuine urge to have a child?

Many times my husband offered that we stop trying; that we had each other and perhaps that should just be enough. I know it hurt his feelings when I told him that was not an option. Having a child would be the only way to complete the circle and that I needed to experience motherhood in what ever form it came in.

A cost-benefit approach was never discussed, because, I believed at the time, that becoming a mother was the ultimate way to define myself as a woman and a wife.

It's probably a good thing that we don't make pros and cons lists for all the big decisions of our lives, otherwise, we'd probably be left devoid of what makes life meaningful.

An Article, a Friend: Two Stories of Hope via Third-party Reproduction

I've often talked about the close bond that form despite the great challenges that we face in the infertile community. Some of those bonds break past the anonymity of chat rooms/blogs and flourish into real life friendships. Well, such a friendship was formed between my friend Sunshine and me.

Whether it's the years of trying, the losses or the countless invasive procedures, each of our journeys are painful and emotionally debilitating ones. Well, of everyone I know, my friend Sunshine has been through hell. Pure, unforgiving hell. You only have to glance at her infertility journey recap page to get the picture.

Beyond the numbers and figures, I see the true image of a determined soul who never completely gave into despair and always fought through the blizzard (both figuratively and literally) to finally hold two babies in her arms.

This last chapter of her IF journey introduced us to one other pivotal character -- a gestational carrier named Kelly. She has proven to be the most benevolent and dedicated carrier one could hope for. I read each of Sunshine's entries with great interest and admiration. The decision and experience of going through a gestational carrier was a very rewarding one, and one that has resulted in the births of twins.

I feel the need to point out that not all experiences with carriers are as affable and yield such exceptional outcomes. Stories of carriers who take the money and vanish; carriers who sue the parents to get the child back; carriers who smoke and drink during the pregnancy. Like all diverged paths to parenthood, the one of third-party reproduction can be fraught with challenges.

There must have been something in the infertile air, because on the same weekend that Sunshine announced that her little miracles were finally here, I came across this article in The New York Times Magazine: "Meet the Twiblings" by Melanie Therstrom.

After undergoing infertility treatments, Therstrom and her husband decided to turn to third-party reproduction options. They opted for an egg donor and for the embryos (donor egg + Therstrom's husband's sperm) to be transferred to two gestational carriers. The babies were born just days apart. It is a fascinating and thought provoking journey. And like all infertility stories, there were many expressions of the loss of hope, the coping mechanisms and the retrospective look on the journey that resonated with me and I believe will resonate with you as well -- the common threads that connect us all.

Here, a few highlights from the article:

"For many couples, the most crushing aspect of fertility treatment is not all the early morning blood-draws but the haunting feeling that the universe is telling them that their union is not — in a spiritual, as well as a biological, sense — fruitful."

"We were careful to refer to the fetuses as the “drafts” rather than our chosen names to remind ourselves that they were notes toward the children we wanted, but if they died, they were just beginnings like all the embryos had been, and we would start again."

"Plan A — making babies with the tools you have around the house, as they say, the fun, free tools — faded into the background, and Plan B became foreground. I can count the ways Plan B is a less-desirable way to have children — the route seems to take you off the edge of the world and into the land of scrolly dragons. But when you actually go there, the map shifts. The brain’s ability to rewrite — to destinize, as it were — the birth story and turn a barn into a manger is so powerful that Plan B, all its unsexiness notwithstanding, became the best plan, because Plan B created the children that we have and are convinced we had to have."

Follow Friday

I knew when I made the decision to start a weekly "Follow Friday" entry -- featuring fellow blogger entries that resonated with me -- that I would find myself in a bind. Too many of you are fantastic writers and so eloquently describe the various emotional stages you're experiencing. 


So, I'm not going to limit myself (or you, dear readers) to just one entry. I'm going to feature as many as I'd like. I will attempt to summarize the entries and share some of my favorite quotes/passages. 


After that, my hope is that you link back, read the full entries and comment. 


*************


Jess at "A little blog about the big Infertility"-- "Sharing":


After TTC for the last 5 years, Jess and her husband have decided to pursue embryo adoption. With this decision, she has written a beautiful letter to her loved about about the decision, in which she highlights her hopes, the complexities of their decision, and addresses head the pain of infertility, but that in the end they are resolute and hopeful.


"Be sad with us and be happy with us, but don't pity us. [...] We do get sad sometimes, but there is always joy in our lives. [...]  The road to our inner peace will be paved with or without children, but I do believe they are on their way -- eventually."


Jessica at "Waiting for a baby bump" -- "Separated from the wolf pack":


In this entry, she talks about feeling left behind, specifically by her friends who have moved on to motherhood, and how those friends are still supporting one another through teething and breastfeeding issues, while not taking the time to acknowledge Jessica's pain. I think this post, poignantly written, will hit home with so many of you. 

"They've had their babies, they are mommies and I am not part of the mommy club. I feel like I am in Jr. High all over again and it makes me want to puke. I am wiser (a little wiser), older (much older) and less likely to get my feathers ruffled by stupid comments about IF, but the ignoring, I can't take it anymore. I know, I know, they probably don't know what to say, or don't want to bring it up or talk about their kids for fear upsetting me... nice and thoughtful they all must be, but I don't think so. I really think that I have been forgotten. In fact I know that I have been forgotten. I am the odd-woman out and the fact that most of them, whom I have known for over 20 years, have no idea how to relate to the woman who can't get her ass over the infertility fence before their kids go off to college."

Sloper at "Park Slope Purgatory" --  "Unblocked; or things I didn't accomplish before I turned 30":


Sloper, like many of us, made of list of things she wanted to accomplish by the time she turned 30. Some milestones seem so far away until you turn the corner and realize you've only checked off a few (at best) of those items from your list. Sloper's list included having a baby, which she's undergoing treatment for, and getting published. She has found a new drive to pursue this dream. Like so many of us, along with the death of hope, infertility robs us of our aspirations. I applaud Sloper for focusing back on herself and her dreams, and not letting IF take everything away from her. 

"And yesterday, for the first time in ever, I thought to myself that maybe it would be okay if I couldn't have a baby soon. Maybe I still have other dreams I can pursue. Maybe I'm still young enough not to throw in the towel on everything. [...] I want to fight for it. I have the will to win at something again and the need that's maybe strong enough to overcome the fear."