Position Statement on Publicly-Funded IVF Treatment in Canada

The Canadian Fertility and Andrology Society (CFAS) supports fully the provision of publicly funded in-vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatment across Canada.

Infertility has been defined by the World Health Organization as a disease of the reproductive system defined by the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse(1).

Since infertility has been defined as a disease, and its associated diagnostic and surgical management deemed "medically necessary" by provincial medical insurance plans, full infertility treatment including IVF and ICSI must also be made available as a funded service, and easily accessible to all Canadians.

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Fertility Treatment May Produce Fewer Baby Boys

Stock photo by omdur
NEW YORK (Reuters Health) - The number of baby boys conceived by a fertility treatment known as ICSI may be lower than what is produced by Mother Nature, a new study suggests.

On average, there are 105 baby boys born for every 100 girls -- a natural advantage that helps balance out the higher number of deaths among male fetuses and infants. But in the new study, researchers found that this male-to-female birth ratio seems to be reversed when infants are conceived through intracytoplasmic sperm injection, or ICSI.

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I Used an Egg Donor

In every fertility book I've read—and I've read plenty—there's a final chapter called "Other Paths to Parenthood" or "There's More Than One Road to Motherhood" or something similar.

These chapters talk about egg donation and adoption, about grieving the loss of your fertility and accepting a different path. When you're starting fertility treatment, these are the chapters you avoid. You think they're for other people — women who began trying to conceive at age 42 (Hey, what did they expect?) or who lost an ovary to cancer (Unfortunate, but at least they have options).

You suspect it would be awful to be in their shoes, but you barely give the scenario a passing thought. Given all the high-tech procedures you've heard of — IVF, ICSI, PGD — you're confident that something will work for you. Maybe not on the first try, but eventually.

Read more: http://www.fitpregnancy.com/yourpregnancy/fertility_conception/i-used-an-egg-donor-40722747.html

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And Fertility for All?

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U.S. Sen. Kristin Gillibrand (D-New York) has introduced a bill that would require health insurers to pay for advanced fertility treatments the Senator says would help the 1 in 8 American couples affected by infertility to bear children.

Gillibrand’s Family Building Act would require insurers to cover Assisted Reproductive Technologies (ART) treatments including in vitro fertilization (IVF), gamete intrafallopian transfer (GIFT) and Intracytoplasmic Sperm Injection (ICSI). The bill would not confine eligibility for ART coverage within a certain age range.

“Thousands of women struggle with infertility each year, with insurance companies denying access to the fertility treatments that make the difference for so many,” Senator Gillibrand said in a press release.

Read more: http://usgovinfo.about.com/b/2009/06/16/and-fertility-for-all.htm

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Fertility treatment doesn't have to be risky and painful

Fertility therapy via acupuncture has been practiced for over 2,000 years by the Chinese, and can be used to treat both men and women. It is usually combined with herbal therapy, and has been shown in scientific studies to boost IVF (in-vitro fertilization) and ICSI (intra-cytoplasmic sperm injection) by as much as 40% (enlightenedbody.com/fertility).

The Berkeley Center for Reproductive Wellness reports that a combination of acupuncture, traditional medicines and herbs provide for the best chance at pregnancy for struggling couples (American Pregnancy Association).

Read more: http://www.examiner.com/x-10674-SF-Wellness-Examiner~y2009m6d2-Fertility-treatment-doesnt-have-to-be-risky-and-painful

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Luteal Phase Estradiol Levels May Indicate Successful ART Pregnancies

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Early detection of pregnancy could be of great clinical significance and aid in modifying the surveillance and treatment strategies after assisted reproduction techniques.

Now, a team of researchers from the Indian Institute of Technology report that measuring the luteal phase estradiol concentrations could predict clinical pregnancies in patients undergoing in vitro fertilization (IVF) /intracytoplasmic sperm injection (ICSI) - embryo transfer treatment. The study results have been published in the recent issue of the journal, Fertility and Sterility.

Full article: http://www.ivfnewsdirect.com/?p=403

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Fertility at 40

The first time Marie Pearson saw her seven-week-old baby's heart beat, rising and falling on the ultrasound monitor, she couldn't stop sobbing. It's an exciting moment for any expectant mother, but for Marie, the new life represented the successful culmination of a three-year struggle.

After several attempts with intrauterine insemination and in vitro fertilization injections, expensive trips to reproductive specialists in the U.S., and trying Chinese herbal medicine and acupuncture, 41-year-old Marie was finally pregnant with her second child.

"There's truly nothing like discovering you've conceived after so many disappointments and lost dreams. We're so blessed for our little miracle," says Marie, who lives in Calgary with her husband, Brian Bertsch, 41.

Full article: http://homemakers.com/Health&Fitness/womenshealth/fertility-at-40-n264494p1.html

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Millions Affected by Infertility: How Atlantans Have Overcome the Issues

National Infertility Awareness Week Oct. 19-25

ATLANTA, Sept. 29 /PRNewswire/ -- National Infertility Awareness Week, Oct. 19-25, is a movement to raise awareness about the condition which affects 7.3 million Americans. Metro Atlantans grappling with infertility can consider options available to them that others here have had success.

Infertility, which touches both men and women, is defined as the inability
to conceive after one year of trying with unprotected intercourse for couples
in which the female is younger than age 35 and six months of trying for
couples in which the female is older than 35.

"The good news is that nearly 90 percent of infertility cases are overcome
through today's advanced techniques," said Michael Tucker, scientific director at Georgia Reproductive Specialists (GRS), Atlanta. Recognized as one of the world's top 10 scientists in early human reproduction, Tucker is responsible for pioneering the world's first birth from frozen donor eggs. This
breakthrough freezing is offered at GRS.

There are many faces of infertility. Take for example, Shane McCord, a
recent patient of GRS. At age 3, he was diagnosed with cystic fibrosis, a
disease frequently leaving the patient infertile. After tests revealed McCord
lacked a vas deferens, he and his wife were able to conceive using in vitro
fertilization (IVF).

Another patient, Susan Stegall, and her partner wanted to raise a family.
Stegall received through IVF her partner's egg, which had been inseminated by a sperm donor. Together, they had a son. Five years later, the same process involved Stegall's egg and the same sperm donor and resulted in a baby girl.

Aware that age is a factor in influencing fertility, patient Kurena Hill
came to GRS after she and her husband were unable to conceive. After several unsuccessful attempts at intrauterine insemination, also called artificial insemination, and a miscarriage, the doctor of then 35-year-old Hill extracted nearly a dozen eggs from her, froze them and then transferred thawed, fertilized eggs to Hill. As a result, at age 36, she gave birth to a daughter.

While IVF is far from the only solution to infertility, a recent survey by
GRS of couples facing infertility issues indicates it was the most widely
known treatment among respondents. Virtually all -- 97 percent -- of the women and men surveyed said that prior to receiving infertility counseling they were familiar with IVF. Conversely, only 37 percent were aware of intracytoplasmic sperm injection, which involves the direct injection of sperm into eggs obtained through IVF. Some 57 percent were aware of the process of freezing eggs for later use.

Age is a factor with infertility for both women and men. Almost half -- 45
percent -- of the survey respondents were 35, the age at which fertility
starts declining significantly, or older. These respondents reported they had
been trying to conceive an average of 23 months.

"Our message to couples facing infertility is that most infertility issues
can be overcome with the proper diagnosis and treatment," said Dr. Mark
Perloe, GRS medical director. "A structure as we have provides the patient
with the utmost in testing, counseling and treatment options. Our renowned physicians are here to help fulfill our patients desire to start or expand a family."

Source: http://www.earthtimes.org/articles/show/millions-affected-by-infertility-how-atlantans-have-overcome-the-issues,558684.shtml

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IVF or DE/IVF in Argentina

Found this on FertilityFriend.com:

I came across this in my wanderings, I know nothing about this clinic, but it is affordable, might make a good vacation with some fertility treatment added in: argentinafertilityservices.com

For Donor eggs
They guarantee 4 eggs for $4,300 US, and 8 for $5,500, and donor meds are included in that price

IVF (In Vitro Fertilization) is $3,000 but meds are not included

First office visit (one-time only): US $300
*no other charges for further office visits

Assisted Reproductive Techniques (ART) with own oocytes (IVF or ICSI): US $3,000

Assisted Reproductive Techniques (ART) with donor eggs (IVF or ICSI):
At least four (4) eggs: US $4,300
At least eight (8) eggs: US $5,500

Assisted Reproductive Techniques (ART) with donor sperm (IVF or ICSI): US $3,300

Included:
Donor medication for ovarian stimulation and egg production
Monitoring and procedures involved in management of both egg donor and recipient
Sperm freezing, if required
Medical and Institutional fees

Not included:
Medication for the IVF patient and the Egg Donor recipient
Surgeries prior to IVF treatment
Embryo cryopreservation

Sperm Retrieval Techniques:
TESE (Testicular Sperm Extraction)
TESA (Testicular Sperm Aspiration)
PESA (Percutaneous Epididymal Sperm Aspiration)
US $1,200
*sperm freezing for future attempts is included

Preimplantation Genetic Diagnosis (PGD):
US $2,200

Source: http://www.fertilityfriend.com/Circles/viewtopic.php?t=1602041

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30th Anniversary of Birth of World's First IVF Baby

FAIRFAX, Va., July 25 /PRNewswire-USNewswire/ -- Genetics & IVF Institute announced today, on the 30th anniversary of the birth of the world's first IVF (in vitro fertilization) baby, that it has created more than 17,000 pregnancies through in vitro fertilization and other advanced techniques.

"Louise Brown, the world's first baby born through in vitro fertilization, was born in England on July 25, 1978, and media outlets trumpeted the news of the first 'test tube baby', says David Wise, president and CEO of Genetics & IVF Institute (GIVF), which is based in Fairfax, VA. "Now, people around the world are enjoying parenthood thanks to the invention of IVF by the remarkable British scientists Drs. Robert Edwards and Patrick Steptoe. We honor them today on the 30th anniversary of Louise Brown's birth."

Founded in 1984, GIVF was one of the first free-standing fertility
treatment centers in America. GIVF pioneered the development and
implementation of many improved fertility treatment technologies and methods, including non-surgical retrieval of eggs and sperm, intracytoplasmic sperm injection and pre-implantation genetic diagnosis of embryos (PGD). GIVF also developed a new, patented sperm separation technique for pre-conceptual gender selection called MicroSort (R) which is currently in an FDA clinical trial. It is the only American infertility treatment center with its own donor egg and donor sperm programs. GIVF also introduced high tech infertility treatment in China and is the only American center that provides infertility treatment in China.

Many of the pregnancies created at GIVF are in patients with particularly challenging infertility problems, including some who have been rejected for treatment by other centers.

"Every pregnancy is a cause for joy. Patients who come to GIVF seeking help to become pregnant are elated when they learn that they have achieved pregnancy and our staff is thrilled to help them," Mr. Wise said.

For more information on GIVF and its extraordinary range of programs, visit http://www.givf.com/ .

SOURCE: Genetics & IVF Institute
http://www.earthtimes.org/articles/show/washington-area-fertility-center-has-created-more-than-17000-pregnancies,481195.shtml

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Dr. Check Consult - Summary of Info

Found this post on Women Over 40 With High FSH:

Dr. Check Consult - Summary of Info

FSH: a Cornell 2005 study said that once someone's FSH has been above 15 (even once) then they must use donor eggs. He doesn't believe this and has had plenty of success encouraging women to try both naturally and with minimal stim cycles. He said once you can achieve a 6-7-8 cell embryo then 65% of the time it should work if you are under 35 and if you are over 35 then 38 - 42% success (in the absence of other factors such as immune issues). A normal live pregnancy rate for someone 41 - 42 should be 20% per cycle (without distinguishing FSH as normal or abnormal).

WHY LOW DOSE STIM: he believes a high dose stim regime doesn't "fry" our eggs but it does somehow affect implantation and this leads to lower success rates.

HOW DOES LOW STIM WORK: their premise is that you don't add FSH on high FSH, ie they like to use estrogen to bring down your FSH if it is elevated. After this he likes to let your own FSH drive your follicle growth - so whether or not they add FSH, and how much, is driven by your own levels during your cycle.

ANTAGNOSIST VS AGONIST: although there are some published studies suggesting lower success rates for an antagonist cycle, he believes these were earlier studies and it is no longer the case. He believes there are benefits to an antagonist cycle in that it is easier.

ESTROGEN PRIMING PROTOCOL: while he was the first to introduce estrogen to lower FSH before a cycle, he's not in favour of the full EPP because it means a whole month (while you're 1st on BCPs) is lost, ie. it takes 2 months in total and that seems to be wasting time.

BACK TO BACK CYCLES: this is case by case, but generally where there is no risk of hyperstim then it should be OK.

ANY DIFFERENCE IN DRUGS: in their experience (and no studies have been done to confirm), very high doses of GONAL F seem to have had the lowest pregnancy rates. However when you use low doses it doesn't seem to matter whether you are using Gonal F, Follitism or Bravelle - they are all essentially the same ... He does seem to prefer Cetrorelex vs Ganerlix (sp?) though for antagonist cycles.

WHEN IS ENOUGH, ENOUGH? So long as you are producing nice embryos then even if you are over 40 yrs, you have a chance of success with your own eggs. On the other hand he is a "pragmatist" so if you do want to increase your chances in any given cycle then donor eggs could boost success rates to 55%.

ABNORMAL FERTILISATION: I had a 3PN fertilisation on my last cycle and he suggested that it wasn't that my eggs are "suddenly old" but more likely a result of the protocol (very high stim of 900 Gonal F).

ICSI: in general he thinks "arranged marriages aren't that good", ie. your eggs probably know how to pick out the best partner better than we do. But he can see why in my case (where I only get 1-3 eggs) it might seem better to use it - even psychologically, because if you don't use ICSI and then they don't fertilise well you'd be upset (although the same could even have happened with it).

ASSISTED HATCHING: should definitely be done for older than 40 years, as the embryo is avoiding vital enzymes available to it on it's way down the fallopian tube.

DAY 2 OR 3 OR BLAST: on Day 2 you can't hatch embryos so for this reason DAY 3 is better. On the other hand, on Day 3 some think the uterus is more sensitive/cramps more, so ... the only real advantage to blast is if you have lots of eggs and don't have a good freezing program ... on the whole, the best environment for them is inside you not in the lab.

IMMUNOLOGY: his background is reproductive immunology. If you have NK Cells in your uterus then they can have a protein that acts as a progesterone blocking factor and this can cause implantation problems. He thinks the studies show that LIT can work but it is hugely expensive and he thinks something like Intralipids (a free fatty acid from soybeans which can bind to the NK cells and "deactivate" them) works well too and is much cheaper ...

On the other hand he doesn't think there are any tests that reliably determine if you have got an NK Cell problem so it would probably be best to just go off your history (ie, multiple IVF failures etc) ... Basically he doesn't think anything else (like IVIG etc) is needed and he wouldn't advocate them.

STERIODS: no good data to support the use of steriods (prednisone/dex) in IVF cycles. Doesn't think they are necessary.

HEPARIN: only really helps people with implantation issues associated with APA. You can use it but he doesn't really see a reason to do so.

MTHFR: I am homozygous and he says it's quite common and heparin isn't really warranted - especially if you haven't got elevated homocystein levels.

ASPIRIN: he hasn't seen any studies showing a difference in blood flow to the uterus or endometrial thickness based on aspirin. He thinks no aspirin (even low dose) is better.

VIAGRA/VAGINAL ESTROGEN: no good studies showing significant difference in endometrial thickness with use of these, ie. wouldn't bother with them.

DHEA: he knows the Gleitcher (sp?) study showing higher implantation rates but apparently it also showed higher miscarriage rates. Plus, he says it was a study on women around 30 years old where none of them had an FSH higher than 12. In other words, it's not convincing and he think pregnancy rates might be better without it.

ENDOMETRIOSIS: the studies are a little mixed. Some show no lower pregnancy rates in women with endo, some do. 2003 data showed IVF overcomes endo abnormalities and 2005 studies showed endo does inhibit IVF success. If you have had multiple failed cycles w/o IVF then laparoscopy - a study showed 61% of women falling pregnant afterwards vs 18% before. However in my case where I have already had multiple laps for endo he wouldn't advocate any more.

HYDROSALPINX: I recently had my tubes removed due to hydosalpinges (bilateral) and he said this is a good idea as plenty of research shows it impacts IVF success rates.

DIET/EXERCISE/SUPPLEMENTS: doesn't advocate anything special - regulary healthy living etc ... don't have to give up exercise, sugar, meat or use only organic food etc etc etc.

GOLDEN EGG THEORY: the premise behind the high stim approach is the higher the better. The argument is that our bodies are like a lottery such that the higher the number of eggs achieved the higher the probability of getting that "one golden egg" from the (presumably) bad lot. Check feels that our body knows how to identify the best of the eggs in our basket and kicks out this one each month - so even if you use a low stim approach and get only 2 embryos, it's not necessarily a worse outcome than someone using high stim and getting 9 embryos ...

Source: http://www.network54.com/Forum/53068/thread/1216707668/Check+Consult+-+Summary+of+Info+-+(Long)

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Twins - 22 years after he had a vasectomy

Picture by BabyVienna
A 50-year-old man, who had a vasectomy 22 years ago, has become a proud father of twins after a miraculous treatment at a British fertility clinic.

Steven Richardson lost his hopes to have kids with second wife Carol after a reverse snip op failed.

But the couple became parents to twins Annie and William, thanks to Indian-origin medic Dr Rashmi Patel, at the Manchester CARE fertility clinic, who tried an op called ICSI, or Intracytoplasmic Sperm Injection.

Full story: http://www.thecheers.org/news/World-news/news_28520_Man-has-miracle-twins---22-years-after-he-had-a-vasectomy.html

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IVF Clinics in Spain & Services Available

Thanks to Annie of Pregnancy - TTC - Parenting After 50

Here's a listing of the IVF clinics I've been able to find in Spain. The one I was referring to is listed as FIV Madrid, I don't know if it's the same as IVI Madrid. The one clinic in Almeria doesn't do donor egg, so you may need to travel elsewhere for that.

FIV CENTER MADRID
Address: Henri Dunant, 21
City/Town: Madrid 28036
Telephone: +44 913508992 / 91345179
Web: http://www.fivcenter.com/
Services and treatments available
· Egg donation
· Embryo donation
· Genetic screening
· Intra Cytoplasmic Sperm Injection (ICSI)
· Intrauterine insemination (IUI)
· In Vitro Fertilisation (IVF)
· Storage of embryos

Unidad de Reproducción Hospital Virgen del Mar de Almería
Address: Carretera del Mami Km1
City/Town: Almería 04120
Telephone: +950290099/950290625
Services and treatments available
· Intra Cytoplasmic Sperm Injection (ICSI)
· Intrauterine insemination (IUI)
· In Vitro Fertilisation (IVF)

CREA (Centro Médico de Reproducción Asistida)
Address: San Martín 4 (bajos)
City/Town: Valencia 46003
Telephone: +963525942
Web: http://www.crea.ws/
Services and treatments available
· Egg donation
· Embryo donation
· Genetic screening
· Intra Cytoplasmic Sperm Injection (ICSI)
· Intrauterine insemination (IUI)
· In Vitro Fertilisation (IVF)
· Storage of embryos
· Storage of eggs
· Storage of sperm

U. Reproducción. Hospital Madrid-Montepríncipe
Address: Av. Montepríncipe 25 Boadilla del Monte
City/Town: Madrid 28660
Telephone: +34 91 708 99 18
Services and treatments available
· Egg donation
· Embryo donation
· Intra Cytoplasmic Sperm Injection (ICSI)
· Intrauterine insemination (IUI)
· In Vitro Fertilisation (IVF)
· Storage of embryos
· Storage of sperm

IRAGA (Instituto de Reproducción Asistida de Galicia)
Address: Antonio Casares, 2
City/Town: Santiago de Compostela 15701
Telephone: +981574100/981564747
Web: http://www.iraga.net/index2.php
Services and treatments available
· Egg donation
· Embryo donation
· Intra Cytoplasmic Sperm Injection (ICSI)
· Intrauterine insemination (IUI)
· In Vitro Fertilisation (IVF)
· Storage of embryos

Instituto Murciano de Fertilidad
Address : C/Olof Palme 9 Bajo. La seda Centro-Médico
City/Town: MURCIA 30009
Telephone: +968282866/968235126
Services and treatments available
· Egg donation
· Embryo donation
· Intra Cytoplasmic Sperm Injection (ICSI)
· Intrauterine insemination (IUI)
· In Vitro Fertilisation (IVF)
· Storage of embryos

Centre de Genètica Girona
Address: Pl. Marquès de Camps, 9-10 4º 1ª
City/Town: Girona 17004
Telephone: +34 972 217407
Web: http://www.centredegeneticagirona.com/
Services and treatments available
· Egg donation
· Embryo donation
· Intra Cytoplasmic Sperm Injection (ICSI)
· Intrauterine insemination (IUI)
· In Vitro Fertilisation (IVF)
· Storage of sperm

Clinic Name Clínica EUGIN
Address: c/ Entenza 293-295
City/Town: Barcelona 08029
Telephone: +34 93 322 11 22
Web: http://www.eugin.net
Services and treatments available
· Intra Cytoplasmic Sperm Injection (ICSI)
· Intrauterine insemination (IUI)
· In Vitro Fertilisation (IVF)
· Storage of embryos
· Storage of eggs
· Storage of sperm

Source: http://www.network54.com/Forum/288399/message/1210459676/Clinics+in+Spain

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The Risk of Major Birth Defects after Intracytoplasmic Sperm Injection and in Vitro Fertilization

Background: It is not known whether infants conceived with use of intracytoplasmic sperm injection or in vitro fertilization have a higher risk of birth defects than infants conceived naturally.

Methods: We obtained data from three registries in Western Australia on births, births after assisted conception, and major birth defects in infants born between 1993 and 1997. We assessed the prevalence of major birth defects diagnosed by one year of age in infants conceived naturally or with use of intracytoplasmic sperm injection or in vitro fertilization.

Results: Twenty-six of the 301 infants conceived with intracytoplasmic sperm injection (8.6 percent) and 75 of the 837 infants conceived with in vitro fertilization (9.0 percent) had a major birth defect diagnosed by one year of age, as compared with 168 of the 4000 naturally conceived infants (4.2 percent; P greater than 0.001 for the comparison between either type of technology and natural conception).

As compared with natural conception, the odds ratio for a major birth defect by one year of age, after adjustment for maternal age and parity, the sex of the infant, and correlation between siblings, was 2.0 (95 percent confidence interval, 1.3 to 3.2) with intracytoplasmic sperm injection, and 2.0 (95 percent confidence interval, 1.5 to 2.9) with in vitro fertilization. Infants conceived with use of assisted reproductive technology were more likely than naturally conceived infants to have multiple major defects and to have chromosomal and musculoskeletal defects.

Conclusions: Infants conceived with use of intracytoplasmic sperm injection or in vitro fertilization have twice as high a risk of a major birth defect as naturally conceived infants.

New England Journal of Medicine: Volume 346:725-730, March 7, 2002, Number 10

Full article: https://content.nejm.org/cgi/content/full/346/10/725?ck=nck

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"Why Don't You Just Adopt?"

Photo by americanradioworks.publicradio.org
GARY AND KATHY, both geologists in Houston, are the grateful parents of twins -- a boy and a girl. The babies have big eyes and tufts of hair that stick straight up, making them look like alert, crested birds. Gary smiles every time he looks at them. "Kathy basically crawled through broken glass to get these kids," he says.

Photos show the development of the twins, from embryos to today's lively babies.
Family Photo Album Page 1 and Page 2

Gary also went through a painful ordeal to produce these babies. A few years ago, he had surgery on his testicles to improve his sperm count. It didn't work. So the couple tried IVF. Kathy took drugs to stimulate her ovaries, then had eggs removed. Doctors cut into Gary's testicles to extract sperm, fertilized the eggs in a laboratory dish, then put the resulting embryos into Kathy's uterus. But she didn't get pregnant.

"I was having trouble with seeing pregnant women, seeing children, going to baby showers," Kathy says. "The thought of that was just, no way. Some days you're fine. But other days you're a wreck."

"I was more worried about Kathy than I was about having a child," Gary says. "This is pretty stressful, particularly when you're loaded up on all the drugs they pump into you. It was getting pretty stressful for both of us, so, being a guy, I wanted to find a solution. By God, let's just go out and adopt a baby."

Kathy and Gary looked into adoption, but found it could be as expensive IVF (a single IVF cycle costs $7-15,000). And they feared the birth parents might someday demand the baby back, even though that almost never happens. The couple worried about the prenatal care an adoptive baby might receive. What if the birth mother drank or smoked? Besides, Kathy wanted to experience pregnancy.

"Well meaning people who just don't understand," Kathy says. "They see what you're going through and they say, 'Why don't you just adopt?' And my answer is, 'For the same reason you didn't.' Because they are invariably people who have their own biological children. 'Why didn't you adopt?'"

Gary adds, "It's something that's inherent in everybody, in all species. You gotta go out and procreate."

When the couple learned of a less painful technique for extracting sperm from a man's testicles, they decided to try IVF again. This time the technology worked. In March 1997, Kathy gave birth. The first picture in their baby book is a black and white shot of what looks like lumpy soap bubbles. It's the twins as embryos, photographed through a laboratory microscope.

Kathy plays with their baby boy at bedtime.
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Today, they're energetic babies. The boy kicks and babbles as Kathy changes his diaper, shrieking with laughter when she coaches him to "gimme five!" The girl waits her turn, cuddled in Gary's arms.

Gary says the money he and Kathy spent to have their twins was worthwhile.
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"They're perfect," Gary says. "Not that we have a particularly objective opinion." Gary doesn't want more children, but there's no question in his mind that the twins were worth all the trouble, pain and expense. "Knowing what we know, would we do it again?" he asks. Both of them answer, "Yeah."

Next: Genetic Mandate or Social Impulse?

Source: http://americanradioworks.publicradio.org/features/fertility_race/part2/narr_adopt.shtml

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Fertility technique common, despite doubts

WEDNESDAY, July 18 (HealthDay News) — The use of a fertility technique called intracytoplasmic sperm injection, which involves injecting a sperm directly into an egg, has increased dramatically in the United States since 1995, despite uncertainty about its effectiveness and risks, researchers say.

A study published in the July 19 issue of the New England Journal of Medicine analyzed data on fertility treatments from 1995 to 2004. The study included all in vitro fertilization (IVF) cycles involving fresh embryos from non-donor eggs in women younger than 43.

The team found that while the proportion of patients receiving treatment for male factor infertility has remained stable, the percentage of IVF [in vitro fertilization] cycles that used intracytoplasmic sperm injection (ICSI) increased from 11 percent to 57.5 percent during the 10-year time span.

"Despite its added cost and uncertain efficacy and risk, the use of ICSI has been extended to include patients without documented male-factor infertility," the study's lead author Dr. Tarun Jain, assistant professor of reproductive endocrinology and infertility at the University of Illinois at Chicago, said in a prepared statement.

When compared to states without mandated insurance coverage, states with mandated coverage for infertility (Illinois, Massachusetts and Rhode Island), had higher rates of ICSI for reasons other than male-factor infertility.

Jain said some physicians may feel ICSI is appropriate for patients who had prior IVF cycles that failed, for those who have very few eggs available, or to overcome barriers to the normal fertilization process.

But, according to Jain, the largest study to compare traditional IVF with ICSI in patients without male-factor infertility found that patients who underwent ICSI had lower rates of embryo implantation and pregnancy than patients who did not have ICSI.

There is also limited research evaluating the routine use of ICSI and the possibility of associated risks, such as genetic disorders and congenital abnormalities in babies conceived with this technology.

"Further studies are needed to better understand the proper role of ICSI, and perhaps guidelines may be useful to determine what the best indications are for the use of the technology in patients without male-factor infertility," Jain said.

In addition to their findings on ICSI, the researchers found that the number of fertility clinics and number of fresh-embryo cycles has increased, as have pregnancy and live-birth rates.

Source: http://www.babycenter.com/204_fertility-technique-common-despite-doubts_5169915.bc

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