Conceivability_What I Learned Exploring the Frontiers of Fertility
Page 27
And then there are the friends that saw me through my “new” baby project: this book. Brandt Goldstein, a writer and lifelong friend, initiated me into the world of nonfiction writing, providing all-important guidance and feedback. John Pollack was at the ready with humor, advice, and a helping hand. Brad Meltzer and Cori Flam were a source of constant support and enthusiasm, not only willing but also seeking out ways to assist me. Ulcca Joshi Hansen brainstormed and commiserated with me. Noelle Salmi has shared her great ideas with me for more than twenty-five years. The members of my now sadly defunct writing group—Carrie Bach, Diana Dresser, Liz and Sue Tencate—got me started on the daunting task. Merry Logan assisted in shaping my very first proposal, while my walks and talks with Rachel Moskovich helped me find my way when I was lost. Nicole Jacques always had a glass of wine and good cheer when I needed it most. And the wonderful talent of Emily Rapp Black and the members of her Lighthouse Writers Workshop Lit Fest gave me a boost when I needed it most, their critical feedback and creative stimulation rallying me toward the finish line.
I owe an enormous debt of gratitude to the many patients I met and interviewed for this project. Your stories moved me, awed me, and inspired me to write a book that might help others avoid some of your—our—pain. For privacy reasons, I won’t name you, but you all know who you are. I am honored that you chose to share your very personal journeys with me.
Many heartfelt thanks as well to the experts who contributed to my understanding of a very complex field. Jane Gregorie of Acupuncture Denver is a Renaissance woman—writer, practitioner, patient, connector, editor, mother—who provided invaluable aid. Dr. Neil Box generously helped me understand some of the underlying genetics concepts. Dr. Lori Bernstein shared her personal journey and groundbreaking research with me. Dr. Joan Manheimer helped illuminate the many painful feelings men and women confronting infertility experience. I am extremely grateful to the organizers of the 2016 ART World Congress in New York (Dr. John Zhang, Dr. Yanping Kuang, and Dr. Keiichi Kato) and the 24th World Congress on Controversies in Obstetrics, Gynecology & Infertility in Amsterdam (Dr. Zion Ben Rafael, Dr. Bart C.J.M. Fauser, and Dr. Rene Frydman) for allowing me access as an observer. The knowledge I gained was invaluable, and I would particularly like to thank the generous specialists who helped me to expand my understanding: Dr. Mark Hughes, Dr. Santiago Munné, Dr. Jacques Cohen, and Dr. Simon Fishel.
As for Catherine Hardy, there are no words. With style, grace, humility, kindness, and compassion, Catherine gave us the most extraordinary gift a person can give. How does one thank someone for, literally, the gift of life? I am forever not only grateful but also genuinely happy that Catherine entered our lives, and brought along her beautiful family: her daughter, Eden; mother, Denise; grandmother, Jess; and sisters, Jac and Nic. It has been the greatest pleasure watching Catherine and Eden blossom as they achieve their own dreams.
And finally, of course, last only in paragraph order, is my family. If I must trace the origins of my stubborn, relentless quest to have children, I must go back to the very beginning. I was blessed to grow up bathed in the unconditional love of a truly wonderful family. Not only my fantastic parents and brother, Ken, but also our grandparents, aunts and uncles, so many wonderful cousins; my cousin Beth, like a sister to me, has been my greatest cheerleader. And then the next generation arrived—my niece and nephew, and cousins’ children—and watching them grow up, I knew I wanted that too. My devoted parents, Wendy and Edward, who have supported me wholeheartedly in all of my adventures, truly outdid themselves here. My mother tirelessly read every draft, served as an unpaid research assistant, connected me with women with stories to tell, entertained her grandchildren when I had deadlines, and throughout it all, prodded me to take care of myself, reminding me that I was her baby.
Richard is my rock, my soul mate, my partner. Little did he know when we said those vows many moons ago what “for better or worse” would encompass. Yet through years of failed attempts, heartbreaking miscarriages, unyielding schedules, he never wavered. He just loved me; propped me up when I was down; helped me navigate our path toward our children. I am so grateful that our challenges drew us ever closer together, and that our success allowed me to add fantastic father to his job description. Alexandra and William, our two modern miracles, I thank for their joy, love, and patience with Mommy’s seemingly never-ending work. Kids, it’s really done this time.
About the Author
© KIMBERLY BENFIELD
ELIZABETH KATKIN, a lawyer and mother of two, is a former partner at a large international law firm. A graduate of Yale College and Columbia University’s Law School and School of International and Public Affairs, she lives with her husband, Richard, and their children in Denver, Colorado. Conceivability is her first book.
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Notes
Introduction
1. Nicholas Bakaler, “U.S. Fertility Rate Reaches a Record Low,” New York Times, July 3, 2017.
2. According to the National Survey of Family Growth (NSFG), from 2011 to 2015, 12.1 percent of all women, or approximately 7.3 million women, experienced problems getting pregnant or carrying a baby to term and 14.2 percent of all married women in that period were categorized as infertile, down from 16.2 percent in 2002. See Key Statistics from National Survey of Family Growth at https://www.cdc.gov/nchs/nsfg/key_statistics/i.htm#infertility, accessed December 10, 2017. See also a CDC Infertility White Paper entitled “A Public Health Focus on Infertility Prevention, Detection, and Management” at https://www.cdc.gov/reproductivehealth/infertility/whitepaper-pg1.htm.
3. Ibid. Nearly 2 percent of women of childbearing age had medical visits in a twelve-month period ending in 2002. See A. Chandra, G. M. Martinez, W. D. Mosher, et al., “Fertility, Family Planning, and Reproductive Health of U.S. Women: Data from the 2002 National Survey of Family Growth,” National Center for Health Statistics, Vital and Health Statistics 23, no. 25 (December 2005): 1–160.
According to the NSFG, from 2001 to 2015, 12 percent of women aged fifteen to forty-four, or 7.3 million women, and 17 percent of women aged twenty-five to forty-four (6.9 million women) in the United States had received infertility services. See A. Chandra, C. E. Copen, and E. H. Stephen, “Infertility Service Use in the United States: Data from the National Survey of Family Growth, 1928–2010,” Centers for Disease Control and Prevention, US Department of Health and Human Services, National Health Statistics Reports, no. 73 (January 22, 2014).
Chapter 1
1. For a detailed description of the evolution of the use of hormones, see Debora L. Spar, The Baby Business (Cambridge, MA: Harvard Business Review Press, 2006), 18–21.
2. Quoted in Barbara Seaman, “Is This Any Way to Have a Baby?,” O, The Oprah Magazine, February 2004. Available online, with the permission of the author, on Evidence-Based Perspectives on Hot Women’s Health Issues, https://gilliansanson.wordpress.com/2004/02/07/is-this-any-way-to-have-a-baby-by-barbara-seaman/.
3. Shady Grove Fertility, “Clomid for Infertility: What You Need to Know,” July 13, 2016, https://www.shadygrovefertility.com/blog/treatments-and-success/clomid-for-infertility/.
4. Andrea Manzi-Davies, “Helena Bonham Carter: ‘I would have tried anything, even IVF,’ ” The Telegraph, October 15, 2007, https://www.telegraph.co.uk/women/womens-health/3351623/Helena-Bonham-Carter
-I-would-have-tried-anything-even-IVF.html.
5. According to Christine Lee, MD, who also holds a PhD in developmental biology and an MS in biomolecular organization and serves as lab director of ConceiveEasy, the incidence of twins is approximately 8 to 10 percent for clomiphene pregnancies. Christine Lee, “What are the Chances of Having Twins with Clomid?”, February 19, 2014, https://www.conceiveeasy.com/get-pregnant/what-are-the-chances-of-having-twins-with-clomid-2/. The ASRM advises patients that of women who achieve pregnancy with clomiphene citrate, approximately 5 to 12 percent bear twins. See American Society for Reproductive Medicine, Multiple Pregnancy and Birth: Twins, Triplets, and High-order Multiples: A Guide for Patients, 2012, http://www.reproductivefacts.org/news-and-publications/patient-fact-sheets-and-booklets/fact-sheets-and-info-booklets/multiple-pregnancy-and-birth-twins-triplets-and-high-order-multiples-booklet/.
6. Irene Moy and Geraldine Ekpo, “Clomiphene Citrate Use for Ovulation Induction: When, Why, and How?,” Contemporary OB/GYN, April 1, 2011, http://contemporaryobgyn.modernmedicine.com/contemporary-obgyn/news/clinical/clinical-pharmacology/clomiphene-citrate-use-ovulation-induction-wh?page=full. Although the cause of ovarian hyperstimulation syndrome (OHSS) is not fully understood, having a high level of human chorionic gonadotropin (HCG) introduced into a woman’s system had been established to play a role. While mild to moderate OHSS is more common and usually goes away after about a week, approximately 1 to 2 percent of women undergoing ovarian stimulation develop a severe form of OHSS, which can be life-threatening. Injectable fertility medications are more likely to cause OHSS than Clomid. See Mayo Clinic, “Ovarian Hyperstimulation Syndrome,” accessed December 10, 2017, http://www.mayoclinic.org/diseases-conditions/ovarian-hyperstimulation-syndrome-ohss/symptoms-causes/dxc-20263586.
7. Mark Fainaru-Wada and Lance Williams, “Giambi admitted taking steroids,” SFGate, December 2, 2004, https://www.sfgate.com/sports/article/Giambi-admitted-taking-steroids-2631890.php.
8. Moy and Ekpo, “Clomiphene Citrate Use,” and Shady Grove Fertility, “Clomid for Infertility.”
9. Ibid.
10. E. Hughes, J. Brown, J. J. Collins, and P. Vanderkerchove, “Clomiphene Citrate for Unexplained Subfertility in Women,” Cochrane Database of Systematic Reviews, no.1 (January 20, 2010): article ID CD000057.
11. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group, “Revised 2003 Consensus on Diagnostic Criteria and Long-term Health Risks Related to Polycystic Ovary Syndrome,” Fertility and Sterility 81, no. 1 (January 2004):19–25.
12. American Congress of Obstetricians and Gynecologists (ACOG) Committee on Practice Bulletins—Gynecology, “ACOG Practice Bulletin No. 108: Polycystic Ovary Syndrome,” Obstetrics & Gynecology 114, no. 4 (October 2009): 936–49. Reaffirmed 2015, https://www.acog.org/Resources-And-Publications/Practice-Bulletins-List.
13. National Institutes of Health, “New Treatment Increases Pregnancy Rate for Women with Infertility Disorder,” news release, July 9, 2014, https://www.nih.gov/news-events/news-releases/new-treatment-increases-pregnancy-rate-women-infertility-disorder. R. F. Casper and M. F. Mitwally, “Review: Aromatase Inhibitors for Ovulation Induction,” Journal of Clinical Endocrinology and Metabolism 91, no. 3 (March 2006): 760–71.
14. NIH, “New Treatment.” The study, which had fifty-seven collaborators, was conducted by the Reproductive Medicine Network of NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). R. S. Legro, R. G. Brzyski, M. P. Diamond, et al., “Letrozole versus Clomiphene for Infertility in the Polycystic Ovary Syndrome. New England Journal of Medicine 371 (2014): 119–29.
15. Ibid. See also Shirley S. Wang, “Study Shows Letrozole’s Efficacy in Boosting Pregnancy Chances,” Wall Street Journal, July 9, 2014, https://www.wsj.com/articles/study-shows-letrozoles-efficacy-in-boosting-pregnancy-chances-1404939604.
16. NIH, “New Treatment.”
Chapter 2
1. Richard Sherbahn, “Anti-Mullerian Hormone Testing of Ovarian Reserve,” Advanced Fertility Center of Chicago, accessed December 10, 2017, http://www.advancedfertility.com/amh-fertility-test.htm.
2. See “What Is anti-Müllerian Hormone (AMH)?” in Shady Grove Fertility, “Fertility Facts: Anti-Müllerian Hormone (AMH) Can Help Predict Your Ovarian Reserve,” June 23, 2017, https://www.shadygrovefertility.com/blog/diagnosing-infertility/fertility-facts-anti-mullerian-hormone-amh-can-help-predict-your-ovarian-reserve/.
3. Sherbahn, “Anti-Mullerian Hormone Testing.”
Chapter 3
1. Quoted in Colette Bouchez, “The Ancient Art of Infertility Treatment,” WebMD Feature, October 13, 2003, https://www.webmd.com/infertility-and-reproduction/features/ancient-art-of-infertility-treatment#1.
2. A study in Tel Aviv found that acupuncture and herbs used in conjunction with IUI increased the IUI success rate from 39.4 percent to 65.5 percent. K. Sela, O. Lehavi, A. Buchan, et al., “Acupuncture and Chinese Herbal Treatment for Women Undergoing Intrauterine Insemination,” European Journal of Integrative Medicine 3, no. 2 (June 2011): e77–81.
A meta-analysis of seven trials found that acupuncture treatments on the same day as embryo transfer increased the odds of clinical pregnancy by 65 percent. E. Manheimer, G. Zhang, L. Udoff, et al., “Effects of Acupuncture on Rates of Pregnancy and Live Birth Among Women Undergoing In Vitro Fertilization: Systematic Review and Meta-analysis,” BMJ 336, no. 7,643 (March 8, 2008): 545–49. See also Serena Gordon, “Acupuncture May Boost Pregnancy Success Rates,” U.S. News & World Report, January 27, 2012, online edition, https://health.usnews.com/health-news/family-health/womens-health/articles/2012/01/27/acupuncture-may-boost-pregnancy-success-rates.
3. See Randine Lewis, The Infertility Cure: The Ancient Chinese Wellness Program for Getting Pregnant and Having Healthy Babies, reprint ed. (Boston: Little, Brown, 2005); Gordon, “Acupuncture May Boost”; Pacific College of Oriental Medicine, “How Does Acupuncture for Fertility Work? Increase Chance of Conception without Side Effects,” updated September 4, 2017, http://www.pacificcollege.edu/news/blog/2015/04/17/how-does-acupuncture-fertility-work-increase-chance-conception-without-side.
4. Jane Gregorie, interview with the author, March 22, 2016.
5. L. E. Hullender Rubin, M. S. Opsahl, K. E. Wiemer, et al., “Impact of Whole Systems Traditional Chinese Medicine on In Vitro Fertilization Outcomes,” Reproductive BioMedicine Online 30, no. 6 (June 2015): 602–12. See also Lewis, Infertility Cure.
6. The American Board of Oriental and Reproductive Medicine (ABORM) was founded to establish and maintain high standards among practitioners; as a result, members submit to a voluntary certification process. ABORM maintains an extensive database of certified specialists on their website (www.aborm.org), which extends far beyond US borders, not only to Canada but also to Switzerland, Australia, and New Zealand as well.
7. Randine Lewis, “The High FSH Craze,” http://fertilefoods.com/the-high-fsh-craze/.
8. Jane Gregorie, interview with the author, March 22, 2016.
9. Elizabeth Stener-Victorin conducted breakthrough studies on reducing hypertension in the uterine artery. E. Stener-Victorin, U. Waldenström, S. A. Andersson, and M. Wikland, “Reduction of Blood Flow Impedance in the Uterine Arteries of Infertile Women with Electro-acupuncture,” Human Reproduction 11, no. 6 (June 1996): 1314–17.
10. J. Johansson and E. Stener-Victorin, “Polycystic Ovary Syndrome: Effect and Mechanisms of Acupuncture for Ovulation Induction,” Evidence-Based Complementary and Alternative Medicine 2013 (2013): 16 pages, article ID 762615.
11. Gordon, “Acupuncture May Boost.”
12. P. C. Magarelli, D. K. Cridennda, and M. Cohen, “Changes in Serum Cortisol and Prolactin Associated with Acupuncture During Controlled Ovarian Hyperstimulation in Women Undergoing In Vitro Fertilization–Embryo Transfer Treatment,” Fertility and Sterility 92, no. 6 (December 2009): 1870–9.
13. See, for example, J. Pei, E. Strehler, U. Noss, et al., “Quantitative Evaluation of Sperma
tozoa Ultrastructure After Acupuncture Treatment for Idiopathic Male Fertility,” Fertility and Sterility 84, no. 1 (July 2005): 141–47.
14. Elizabeth Palermo, “What Is Acupuncture?” LiveScience, June 21, 2017, https://www.livescience.com/29494-acupuncture.html.
15. Quoted in Rachel Gurevich, “How Does Acupuncture Help Fertility? Ancient and Modern Theories on Why Acupuncture May Improve Fertility,” Verywell, updated December 1, 2016, https://www.verywell.com/how-does-acupuncture-help-fertility-1959899.
16. Palermo, “What Is Acupuncture?”
17. Dr. Chang also advocates that acupuncture appears to have a neuroendocrine effect, strengthening a three-way axis between the hypothalamus and the pituitary glands (two areas of the brain involved with hormone production) and the ovaries, which ultimately impacts egg production and possibly ovulation.