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After deciding to start a family, I visited my doctor in August 2000. I'd been told to go in for a consultation before trying to get pregnant. He laughed. "If you're 16 and having sex in the back of a Chevy parked alongside a road, you're going to get pregnant like that," he said, snapping his fingers. "If you go to college, start a career, get married and do everything the way you're supposed to - it's going to take longer." It did. Wanting a baby became an ache. In order to fill our empty nest, albeit not an empty heart, Dennis and I opened our home to a foreign exchange student from Italy. A vivacious teenager, Manuela brought energy to our household, which only masked the need for a child. During this time, I assisted my younger cousin during the delivery of her third child, held her baby when he was minutes old and went home with my arms barren. A little more than a year later, we qualified for an infertility program through our insurance. The first step was an orientation with 20 couples of all ethnicities and ages. Next came a series of tests, which meant lots of blood work for me; 12 vials later, my inner arm sported the beginning of what would later be bruises with track marks. Dennis went home with a plastic cup. We discovered that I had an irregular cycle and my husband suffered from "slow swimmers." Now 32, I began the infertility medication Clomid, and the doctor instructed Dennis to cut out the hot baths and wear boxer shorts. We prepared for inter-uterine insemination in fall 2001. Clomid is one of the lowest-level fertility medications. It is taken orally - no shots - and the chances of multiple births is less than 10 percent. Still, there are side effects, the most noticeable for me being hot flashes. The question everyone kept asking was: "Do you really want to have a child that badly?" The answer: "Yes." After taking the medication for five days, I started testing for ovulation. Rather than checking my temperature, a common at-home method for couples who are trying to conceive, we used a prediction kit. Once it was positive, I called the doctor and scheduled the insemination for the next day. I kept Dennis's sample warm by tucking it into my bra, against my skin. We were nervous and excited, but most of all hopeful. The process failed. The next month, we went through the same routine. The test showed ovulation occurred and I went in for my second round of insemination on what seemed to be a fortuitous day: New Year's Eve. In January, during our second round of treatment, we tested positive on our second wedding anniversary. Filled with joy, we told the world, only to miscarry five days later. With the first start of spotting, I called my doctor and was told by a nurse to stay in bed with my legs elevated, that it was very normal and nothing to worry about. I stayed in bed for 24 hours, crying. The next day I called the fertility specialist, who scheduled me for an ultrasound. She took the situation lightly; a little too lightly. As she pulled the sheet up over my legs and got the ultrasound ready, she said she hoped that she saw only one sac. Even though Clomid has a low rate of multiple births, she'd seen several pairs of twins and one pair of triplets. She didn't think the spotting was going to be a problem. And then she turned on the monitor and there was nothing. No heartbeat. No fetal pole. No sac. No baby. The worst had happened, and before I could leave I had to have even more blood tests done to make sure the pregnancy was indeed over. The only thing I wanted to do was go home and be alone. How could we go through so much in order to have a child, get pregnant, and lose it? I didn't understand. It became so bad that I couldn't even look at the children's section in stores. Once I took the elevator just to avoid going past infant clothes. Then came the anger. How could so many people who didn't want children get pregnant all the time? And, what did we do to deserve this? Statistics show that more than 30 percent of all pregnancies end in a loss. When faced with infertility, there's an added sense of unfairness when it comes to pregnancy loss. Friends and family cannot always understand the mourning. My husband understood what I was going through emotionally but there was a physical component there, too, that he just didn't get. For a short while, I had shared my body with another living being. Now, I was alone. Terribly alone. I turned to uncharted territory: bulletin boards. Even though I was familiar with the Internet, I had never been one to join chat groups. When I got pregnant, I signed up to receive a newsletter that would show what was happening with my baby week by week. After my loss, I cancelled the newsletter and received an automatic response saying that if the reason I was opting out was because I had suffered a miscarriage, then they recommended several bulletin boards. I clicked through and found a support group specifically for those who had suffered a loss after infertility. There I found a warm group of women who consoled as well as inspired me. Across the miles, I forged unlikely friendships. Therese in Ohio; Winnie in Maryland; Leah in Illinois; Jenn in Ontario, Canada; and Tam in Melbourne, Australia. All shared the common ground of having suffered a miscarriage; some more than one. And now, all have delivered or are on their way toward holding their "earth babies." After a loss, besides the "why," the next question is: Do we try again? The biggest fear is having another miscarriage. For some, the fear might keep them from trying again. For most, the desire to have a baby outweighs that fear. The first time I laughed after my loss, my husband sighed with relief. He said that he thought I was never going to be the same. I told him I never would be. Because my loss occurred naturally, we were able to continue treatments during my next cycle in March 2002. Our insurance allows three tries before moving to the next level - injections. I didn't want shots. Within a week, I knew it had worked. During Easter, I felt exhausted, lightheaded and clumsy. All three were signs with my previous pregnancy. We tested positive within weeks, and the doctor confirmed the news on my husband's birthday in April. We were due in early December. Because of our history, we did ultrasounds three weeks in a row until the specialist verified a heartbeat, which then labels a pregnancy "viable." The first week we saw a fetal sac, which looked like a black dot about the size of a grape. The second week, there was a yolk and fetal pole. Finally, on the third week we were blessed with a heartbeat. As small as a grain of rice, our baby was alive. I approached the pregnancy with a hesitant excitement. They say that every time is different, and just because I suffered a loss previously doesn't mean it would occur again. Still, fear pervaded. This time, we kept the pregnancy secret those first few weeks, only telling very close family and then some friends. Slowly, as time progressed and we passed the first trimester, it really felt like it was going to happen. Online, my friend Therese and I were "cycle buddies." We conceived at the same time and our due dates were mere days apart. This past Christmas, we held newborns in our arms, exchanged family photos and promised to have our children meet one day. Not only did I meet women across the globe, I even met in person with seven Southern California women who had all been expecting in December. As it ended up, I was the first from our group to deliver. Cassandra Nicole joined our lives four weeks early on Nov. 10 at 10:50 p.m. At 6 pounds, 7 ounces and 20 inches long, our little preemie was anything but preemie. When her warm body was laid across my chest, I knew we had made it. While this story is a journey through the infertility process, the real story is the miracle of our daughter. Literally, from her head to her toes, Cassandra amazes me on a daily basis. She is a combination of my husband and me. She shares his same curled cowlick. With the right amount of twisting, it drops onto her forehead in the perfect Elvis impression. And, she shares my toes, the second one protruding longer than the big toe. Each day brings a new discovery. Today, it was two little curves on the top of her ear lobe. I reached up and ran my index finger around my ear; they are the same. At 4 a.m., when others may despair at lack of sleep, I hold my daughter and marvel at her wonder. Her lips slip into a secret smile in her slumber. At seven weeks, she's taken to laughing while dreaming. I cannot wait for the time when that laughter spills into her waking hours. Until then, I rejoice in all that she is and all that she can be. The road to motherhood may have been long, but my heart is now filled with an overwhelming love and sense of completeness. Parenthood also brought our marriage to a new level; more so than ever before: We are a family. And there is one thing Cassandra, my little prophetess, will always know. She was much wanted, and is very much loved. Marie Loggia-Kee of Long Beach, a former Orange County resident, grew up in Riverside. ETHICS & MEDICINE Doctors ride into an uncertain future By Sandy Bennett Signs of fulfilled dreams for hundreds of couples are displayed throughout Dr. Lawrence Werlin's Irvine office, from the glass-enclosed cases that hold numerous pictures of smiling children to a molded pregnant stomach given as a gift to the fertility specialist from one of his patients. These mementos serve not only as indicators of Werlin's expertise as a nationally renowned fertility specialist, but to improvements and advances in reproductive medicine. Procedures ranging from ovulation-inducing drugs and artificial insemination to in vitro fertilization and surrogacy have led to the formation of hundreds of thousands of families. But as the equation for getting pregnant becomes more of a given, what foreshadows the future as new technologies create profound ethical questions? For now, one popular advancement is a relatively new procedure called preimplantation genetic diagnosis, or PGD, which can ultimately improve the quality of life for an embryo. The procedure offers even more promise to high-risk women. It is performed on embryos before they are implanted into the womb, allows doctors to detect gender-line diseases, cystic fibrosis, Down syndrome and other genetic defects. It also makes sex selection possible. Breakthroughs in cells and chromosome manipulation, including the areas of stem-cell research and cloning and the mapping of the human genome in 2000 will undoubtedly further the ability to not only help a woman get pregnant, but manipulate the outcome. Because along with the hope and help for today's infertile couples comes a growing capability to control what one's offspring will be like. What will the near future's definition be of a "perfect" child? The market for such a son or daughter has long since been established. More than 200 individuals in the 1970s, for example, sought the service of a sperm bank for Nobel Prize winners before it closed. Just a few years ago, advertisements started appearing, including one for an infertile couple who were willing to pay $50,000 for a cycle's worth of eggs to a donor who is 5 foot 10 inches or taller and with an SAT score of 1400 or better. The ad ran in elite college newspapers from Stanford to the Ivy League. "That's sort of at the bottom of the slippery slope we're striving not just for the eradication of illness, but for babies that meet our definition of perfection, whatever that may be," says Felicia Cohn, director of medical ethics at UCI College of Medicine. "Certainly in this society you can see a blond-haired, blue-eyed, tall, intelligent, athletic baby. "The vision is that you're going to go to the doctor's office when you're trying to conceive or once you've conceived, and he'll have a checklist for you so you can decide: blue eyes, green eyes or brown; blond hair, brunette, redhead; range of height; preference for basketball ability, wrestling, football; IQ ranges." Indeed, this is the extreme. Some experts, in fact, say it will never happen. At the same time, though, there's no denying medical breakthroughs make for an interesting future. Scientists, for example, recently mapped chromosome 14, which is the site of 60 disease genes, one of which is linked to Alzheimer's. Research has already begun using embryonic cells to replace damaged adult cells found in individuals with previously irreversible medical conditions such as Parkinson's disease. By around 2010, Princeton University microbiologist Lee M. Silver, author of "Remaking Eden," believes parents will be able to genetically ensure their babies won't grow up to be fat or alcoholic, according to emagazine.com. Consider for a moment the ramifications in just two cases surrounding the technology that is upon us. In 2000, a Colorado couple used genetic tests to create a test tube baby that would have the exact type of cells needed to save their 6-year-old daughter. The girl suffered from a fatal inherited bone marrow deficiency, according to a Washington Post report, and needed a perfect match. A deaf couple, one genetically deaf and one deaf due to environmental causes, says Cohn, have already made their wishes known. Though the capability is currently not available, they want to genetically ensure that their child is also deaf. While a loose-leaf set of guidelines has been established by the Ethics Committee of the American Society for Reproductive Medicine, such profound decisions surrounding genetic manipulation are for now being made between patient and doctor. "We live in an Alice in Wonderland world where my neighbor has more say over the color of my house than those more essential questions about what human existence should be," says Auxiliary Bishop Jaime Soto of the Roman Catholic Diocese of Orange. "We're extremely pragmatic and increasingly private about a matter that weaves us all together. It's a tragic irony that the one aspect of human life that is intended to bind us together has become the exclusive domain of private choice." The Benefit The surrounding controversy, though, isn't what weighs on the minds of the vast majority of couples trying to fulfill their dearest dream. According to the American Society for Reproductive Medicine, the national organization for fertility specialists, infertility affects 6.1 million American women and their partners, about 10 percent of the reproductive age population. Loosely defined as the inability to become pregnant in a 12-month period, infertility is complicated by numerous situations: older women trying to conceive; women who have had multiple miscarriages; those who easily conceived a child while in their 20s and years later, had no luck; or those never been able to conceive. PGD offers promise to a number of women who fall within these categories. The genetic-testing tool (a chemical, really) can detect abnormalities in 3-day-old embryos by examining chromosomal makeup before implantation into the womb. This breakthrough procedure aids women by avoiding embryos that will fail in an in vitro fertilization and at the same time helps ensure a healthy birth. Werlin, a veteran in this still new field, headed the only random, perspective study in the United States that was done to evaluate the benefits of doing PGD. His practice, Coastal Fertility Medical Center, is one of only a few facilities in the country to offer the procedure on a regular basis. The cost runs around $10,000 and includes egg retrieval and embryo transfer to fees for office visits and the surgery center facility (medications are excluded). "This is not a test for everybody," cautions Werlin. "And it does have its drawbacks. The most important drawback is that it really only looks at nine chromosomes. There could be a defect in one of the other 14 that we just don't see. So until the technology continues to improve we would again really try to localize its use." According to Werlin, the test is currently offered to four groups of patients: women who have recurrent miscarriages; women who have an advanced maternal age defined as 38 or older; those who failed two or more in vitro fertilization cycles; and those men who have severe male factors. The most favorable results, thus far, have been seen in women who have had two or more miscarriages. Heather Matthies-Yarbro is among the many women who have benefited from the procedure. For three years, she and her husband's attempts to achieve a child brought nothing but heartache. During the first year, Heather became pregnant twice. Each time she had a miscarriage during the eighth week. The doctors told the Murrieta couple, both of whom are in their early 30s, to keep on trying. They did, but never were able to conceive again after the second miscarriage. "I was kind of getting depressed," says Heather, "you know, really thinking it was never going to happen." Today, Heather is five months pregnant. Last year, she underwent in vitro fertilization (IVF), the practice of mixing eggs and sperm outside of the womb, and Dr. Werlin used the PGD process to check the embryos. Heather produced eight embryos. By the naked eye, the embryos seemed viable, but when the PGD test was applied, Werlin found that only three of the eight seemingly healthy embryos did not have genetic defects. The healthy ones were implanted and Heather became pregnant. "We're just ecstatic," says Heather. "It's just beyond words. It was a dream we had serious doubts that we would be able to achieve." Not all couples, though, obtain such results. An independent study by Werlin, for example, looked at IVF failure in women 38 years and older. His data concluded that 70 percent of the embryos in this sample group were abnormal. Of these patients, 30 percent had no healthy embryos at all to transfer. For these patients, the test - which Werlin also refers to as a therapeutic tool - spared them the heartache and expense of more failed procedures. It also opened up an array of new options for them to consider, from donor eggs or sperm to adoption. The Shift Views surrounding such advancements in reproductive medicine are vast. Some find the technology amazing; others, terrifying. At the same time, there are couples who believe the sex of a child should remain a mystery until birth while others seek a boy or girl. Add in societal concerns, religious beliefs and views that stem from one's own personal circumstance and the dilemma becomes even more complex. While Werlin believes there's a potential for abuse, he sees headlines often featured in the media as hype rather than the reality. "When you see an ad in the L.A. Times for a donor egg where it's an Ivy league graduate who's got SATs of 1600, who's 6-foot, athletic, blond hair, blue-eyed, those are the people who get the press because it's controversial," he says. "It's a big splash, the type of thing that makes news. But it isn't what happens on an everyday basis." Some question, however, if this will hold true as the initial shock wears off and as procedures surrounding genetic manipulation become more commonplace. Will the ethical line move as much for convenience and demand as for thoughtful pursuit? Consider just one of the more recent shift in views. In 1999, Dr. Lisa Karamardian, who specializes in obstetrics, gynecology and infertility, attended a dinner at which a specialist was discussing the preimplantation diagnosis of an embryo. The discussion then went to the next step, where a couple could choose the embryos - boy or girl - to implant. None of the doctors in the room believed that was ethical. Those same doctors, she says, wouldn't flinch at the idea today. "It's hard because as a physician you're supposed to give an unbiased opinion and you're supposed to sort of just present your patients with what the available technology is and help them to make an informed decision," says the Newport Beach-based doctor. "But it's really hard not to emotionally get involved with these decisions and not to allow yourself to influence them maybe somehow. You know, you kind of want to but that's sort of imposing your ethics on somebody else. "But you wonder who's really going to be the one to do that. Obviously we're not in the position to. I'm just supposed to say, 'This is the available technology; what would you like to do?' But who is going to be the governing body for all these decisions? And I think, that's the biggest question that's out there. As a physician, it kind of puts you in an awkward position." Who? When? What? And how? UCI's ethicist Cohn believes it's probably going to take some tantalizing event, similar to the birth of the cloned sheep, Dolly, to engage Congress and the public. The more mundane stuff, she says, producing a baby with blond hair versus a whole designer baby, represents areas easier to slip along the slope. She also sees the changes as more subtle than simply moving from accepting medical intervention to accepting cosmetic intervention. Instead, she believes the definition of disease will change. Will it, for example, become a disease to be short? "There are certainly illnesses that stunt the growth of certain children," she says. "And we might argue that someone who only achieves a height of 3 feet as an adult might be a condition we would want to try to correct. "But what about a man who only achieves a height of 5 foot 3? He's certainly short in our culture. He's probably not ill in the sort of publicly accepted or recognizable sense of illness. But he's certainly handicapped in our society because studies have shown that taller men tend to get the better jobs; they're perceived better; they attract women more easily. "So is it a handicap that we need to address? Or is it a matter of the genetic lottery we have to live with?" Questions abound. So are ones being raised by the religious community who remind that having children is not necessarily a right, but a privilege. "What can be done to help nature, the church views as collaborating and cooperating with God's grace," says Bishop Soto. "What causes us concern is when it becomes in a certain sense interfering or manipulating the natural process for pro-creation. Instead of a human person cooperating with God's grace at any given moment, the human person chooses to put themselves as God, determining not only what's good for them, but also in a certain sense, what's good for somebody else. "This technology begins to cross the line from being partners in life to being the arrogant masters of someone else's life." For now, all we have are our own moral compasses and conscience to guide us. Sandy Bennett is OC Family Magazine's senior writer. TREATMENTS Some common medical procedures IVF, or in vitro fertilization: Combines the man's sperm and the woman's egg in a laboratory dish, where fertilization occurs. The resulting embryo is then transferred to the uterus to develop naturally. Usually, two to four embryos are transferred with each cycle. GIFT, or Gamete Intra-fallopian Transfer: Places unfertilized eggs from the woman and her partner's sperm in the fallopian tubes of the woman with laparoscopy. ZIFT, or Zygote Intra-fallopian Transfer: Takes eggs from the woman, fertilizes them in a laboratory with the partner's sperm and transfers the resulting embryos back to her fallopian tubes the day after fertilization. ICSI, or intracytoplasmic sperm injection, in which a single sperm is injected into an egg, to assist men who have so few sperm they are unlikely to impregnate their mate. Artificial insemination: Semen is placed in the woman by one of the following means: into the cervical mucus; through the cervix into the uterine cavity; through the cervix and uterine cavity into the fallopian tube. Ovulation-inducing drugs such as Clomid or Pergonal often are used in combination with the above procedures. Third-party procedures: These would include donor eggs, donor sperm and surrogacy. There are two types of surrogacy: One is traditional surrogacy, in which the egg of the surrogate is used with insemination of the intended father's sperm. The other is gestational, in which the intended mother's egg or an egg donor is implanted in the surrogate who carries the child to term. Sources: The American Society for Reproductive Medicine, Atlanta Reproductive Health Centre, Advanced Fertility Center of Chicago, National Institutes of Health. BY THE NUMBERS Infertility is a complication of the reproductive system that affects male or female. Infertility affects 6.1 million women ages 15-44, about 10 percent of the reproductive age population. The number of American women who have used fertility services number 9 million. The Centers for Disease Control and Prevention estimates that assisted reproductive technology (ART) accounts for about 1 percent of total U.S. births. That number continues to rise. There were 408 ART clinics in the United States in 2000, most of which are located in the eastern states. Of those, 383 submitted data on procedures and success rates Nearly 100,000 (99,639) ART cycles were reported in 2000. For more than 75 percent of these cycles, fresh non-donor eggs or embryos were used and the patient carried or gestated her own pregnancy. ART cycles that used frozen, non-donor embryos were the next most common type, accounting for slightly more than 13 percent of the total. In 10 percent of cycles, eggs or embryos were donated by another woman. A gestational carrier was involved in only 1 percent of cycles. The number of live-birth deliveries resulting from ART cycles started in 2000 were 25,228, while the number of live babies born (includes twins, triplets, etc.) totaled 35,025. - Sources: Centers for Disease Control and Prevention and the American Society for Reproductive Medicine RESOURCES Centers for Disease Control and Prevention: Congress in 1992 passed the Fertility Clinic Success Rate and Certification Act, requiring this organization to publish pregnancy rates for fertility clinics in the U.S. Its latest effort is the "2000 Assisted Reproductive Technology Success Rates." Website: www.cdc.gov American Society for Reproductive Medicine: This is a nonprofit organization dedicated to advancing knowledge and expertise in reproductive medicine and biology. Headquartered in Birmingham, Ala., the agency offers patient fact sheets and information booklets, and a list of member doctors and clinics. Visit www.asrm.org or call 205.978.5000. RESOLVE: The National Fertility Association: This nonprofit agency provides education, advocacy and support for men and women facing infertility. It also offers a nationwide network of chapters. (Orange County residents can visit www.resolveoc.org or call 949.451.8437). Visit resolve.org or call 888.623.0744 for its main office, headquartered in Somerville, Mass. American Infertility Association: The nonprofit organization is dedicated to assisting men and women facing decisions related to family building and reproductive health. Among its offerings is a referral and support Help Line. Visit www.americaninfertility.org or call 888.917.3777. preconception.com: This website offers an array of information for those who are trying to conceive. Dr. Lawrence Werlin of Coastal Fertility Medical Center in Irvine is among a panel of experts who answer a host of questions relating to preconception and reproductive medicine. Website: www.preconception.com |
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