High Risk Pregnancy and IVF

Guest: Dr. Regina Arvon
Dr. Lane speaks with Dr. Regina Arvon, a fetal maternal medicine specialist. Together they tackle issues surrounding the preconceived connection of high risk pregnancies after having undergone fertility treatment.

On The Cutting Edge

Emotional_Response_Miscarriage_ChartLast month a survey was published in Obstetrics and Gynecology, the Green Journal. This publication is serves as the primary resource of academic research for practicing OB/GYNs. The survey addressed the issue of public perceptions of miscarriage. I thought it pertinent to highlight this particular article because of its frequency in the fertility world.

The questionnaire was administered to 1084 individuals between ages 18-69 across the United States. Respondents were 45% male and 55% female. Here are there responses. While 15% of respondents reported that they or their partner had  experienced at least one miscarriage, 55% of respondents thought the miscarriage occurred in 5% or less of all pregnancies.

Respondents believed that the following were common causes of miscarriage

When asked about their emotional response after a miscarriage, respondents indicated the following experiences

These responses were generally similar across all socio-economic classes of women from those with a high school education to those with a graduate degree. They both suggest that there are still large misperceptions about the causes of miscarriage and the need for emotional support after they occur.

Miscarriage_Beliefs_ChartHere are some of the realities of miscarriage. Miscarriage is the most common complication of pregnancy in the United States. It occurs in 15-20% of clinically recognized pregnancies, but can occur in up to 40% of pregnancies in women over the age of 40. This translates into 750,000-1,000,000 cases annually. The majority of miscarriage occurs because of genetic abnormality (aneuploidy). This is a failure of the sperm or egg to deliver the correct DNA to embryo formation, or can occur as the embryo itself is dividing in early pregnancy. This is known to be an increasing issue as women age. Other established causes of miscarriage include structural abnormalities in the uterus (such as fibroids or a uterine septum), blood clotting disorders (such as antiphospholipid syndrome), endocrine disorders (such as thyroid disease), and autoimmune disorders (such as antithyroid antibodies).

The emotional impact of miscarriage can be devastating resulting in further delay in conceiving and therefore increased risk in future miscarriage. As a result, early utilization of services such as support groups or therapy can be critical to maintaining your chances for future pregnancy. In addition, it has been demonstrated that women who understand the cause of their miscarriage experience a shorter length of increased anxiety around their miscarriage. Given that the largest cause of miscarriage is genetic abnormality, remember to request this testing if possible should you experience a miscarriage.

For further recommendations on miscarriage go to: http://tinyurl.com/opzr7ft

To read this article in full, go to: http://tinyurl.com/q9d9l3x

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How To Keep Love Alive

In the Midst of Infertility Treatment

By: Qin Fan, PSY.D

When sex goes from being fun to being work, it can play havoc with your relationship. Infertility treatment is often experienced as an emotional rollercoaster, typically becoming an ordeal that either makes or breaks a couple. How can you support and deepen your love for one another in the face of emotional and relational adversity?

1. Understand that the fertility challenge affects every aspect of life. No one can entirely escape from challenges affecting their self-image, intimacy with partner, and sexual lives.

2. Remember that you are in this together. Inform yourselves and learn about what you’re up against so that you can face it together. The more you practice this together, the stronger you’ll become as a couple. Be considerate and tender toward your partner.

3. Recognize that you and your partner may keep a different pace on the fertility journey, and be understanding about it. Keep up the communication and give each other the chance to say what is on his/her mind. Remind yourself that the main thing is your common goal of making a family together.

4. Talk openly with your partner: Sounds easy, right? Yet, so often couples are cocooned in their own emotional anguish, or uncertain about what to say to each other when encountering infertility, that they literally become “speechless,” or shut down. Moreover, infertility can stir up a host of other personal or psychological reactions, including depression and anxiety. It is critical to discuss common reactions such as disappointment, shock, fear, envy, guilty, and rage.

5. Balance the need for privacy & support: What to say to family and friends, if anything at all? It is indeed a delicate dance. Research shows that isolation can be detrimental for couple relationship in the middle of infertility treatment. What is the right amount of disclosure so that the couple may benefit from support from family and friends? Each couple will have to negotiate and determine what is acceptable to them. No matter what you decide to say to others, the main thing is that you two are on the same page. The ability to open up to family and friends can not only ease some of the pressure and isolation but also boost the couple’s morale and overall wellbeing.

6. Redefine intimacy to include conversation at the dinner table, cuddling under a blanket, watching a favorite movie, and a hearty hug. Tell your partner when you need that hug and when you are feeling a little deprived. Go out to dinner at your favorite spot and do not talk about fertility for even one second. Reminisce about how you met and why you made a commitment to be life partners.

7. Plan to have sex, and then anticipate it, just like in the early days of your relationship.

8. Take care of yourself and each other: A healthy mind resides in a healthy body. Infertility treatment can be stressful and strain the relationship. Research suggests that setting time aside regularly, say once a week, to take walks, bike, treat yourselves with a couples massage, take yoga or dancing classes together, can help reduce stress and rejuvenate. Physical activities will not only help you boost your overall energy, but also facilitate a better outcome for your infertility treatment.

9. Seek additional emotional support: Infertility is a shared experience. Individual psychotherapy, couples counseling, and support groups can serve as a safe space for you to explore topics that might be otherwise difficult to discuss.

Qin Fan, Psy.D. 870 Market St., Ste. 659, San Francisco, CA 94102
Phone: 415.545.8606 www.drqinfan.com

ABOUT THE AUTHOR

Qin Fan, PSY.D. A licensed clinical psychologist and a member of the American Society for Reproductive Medicine, I support the family building efforts of all clients, including single women and men and same sex couples. Starting a family can be an exhilarating time for many, yet for some it can be an emotional roller coaster. To help you navigating through the fertility treatment maze, I offer psychological psychotherapy for individuals and couples dealing with infertility or fertility preservation; consultation for intended parents and recipients of egg, sperm, and embryo donation; psychological evaluation for your donor or gestational carrier. For more information or schedule a consult, please visit us at www.drqinfan.com

Let’s Get Started

By: Danielle E. Lane, M.D.

Summer has come and is almost gone. We are now into the early days of fall and that means…open enrollment! But before open enrollment, employers re-negotiate their benefits packages with their carriers. Around the Bay Area, competitive benefits packages are a way of life. The better the package the more attractive the company is to work for. As a result, an increasing number of companies are offering fertility benefits that include in vitro fertilization (IVF) coverage.

Some of the biggest employers for our area are Google and Salesforce, and both offer IVF coverage. But while both entities cover fertility services to include in vitro fertilization, that’s where the similarities end.

an increasing number of companies are offering fertility benefits that include in vitro fertilization (IVF) coverage

Through the 2015 year, Google’s healthcare benefits have been administrated by Blue Cross. Their package offers each employee a lifetime maximum of $20,000.00 to be used for fertility services. The savvy patient will find a contracted provider and have 2-3 cycles of care available from that amount due to contracted rates which drop the cost of each cycle to somewhere in the $6000-$8000 price range. At Google, fertility medications are also covered and are NOT part of the $20,000.00 lifetime maximum. As a result, patients are typically only out of pocket the cost of very specialized optional services such as their embryo biopsy.

Salesforce, alternatively, chose Aetna for their administrator. Patients have coverage for 50% of six insemination cycles and 50% of three in vitro fertilization cycles. But wait, first you have to call the company to register with the Fertility group at Aetna. Then you have to submit current laboratory test results, two semen analyses and await authorization which can take up to thirty days. Oh and this only applies if you have had unprotected intercourse for up to six cycles. So single women and same sex couples… beware. Further, once the Aetna fertility nurse agrees with your physician that you need fertility treatment, Aetna (not you or your physician) gets to determine your first step. They still believe in the concept of lesser before greater (ie. Insemination before IVF). That is great if it is in line with what you want to do, but no good if you want to bank embryos (or freeze eggs) for future use. This is also a problem if you wish to perform embryo biopsy to ensure that a good quality embryo is implanted and avoid complications like miscarriage which typically further delay you by months on end.

Google and Facebook continue to lead the way and have gone a step further. Last year, these companies report spending over $9 million in expenses related to high order multiples and fertility complications. Enough! They have carved out the fertility benefits from their respective Blue Cross and Aetna administrators and moved them over to a new PPO that only works with fertility benefits. Therefore, as of January 2016, no more silly hoops to jump. These PPO’s are working with providers to ensure that the packages offered to patients actually make sense. They are including the technology that has pushed our field forward in 2015 such as embryo biopsy and preventative banking of eggs and embryos.

Finally, a plan that makes sense! Kudos to Google and Facebook for seeing the light and here’s to hoping that the other Bay Area corporations catch up in offering plans that truly benefit their employees.

In the rest of this issue, you will find a guideline to preparing for your first fertility appointment, a savory end of summer recipe, some advice of keeping your relationship intact during your fertility journey, and the findings of a recent survey on how patients experience miscarriage. We hope you will find the answers to some of your questions.

Enjoy!
ABOUT THE AUTHOR

Danielle E Lane, MD, Reproductive Endocrinology and Infertility specialist. Dr. Lane attended McGill University before completing her medical training at the University of Pittsburgh school of medicine, her residency at Yale-New Haven Hospital and her fellowship at the University of California, San Francisco. She opened the Center for Reproductive Health at Kaiser Permanente in Napa-Sola-no in 2005. In 2009 she founded Lane Fertility Institute. The Institute has grown to a four physician, multi location practice with a state of the art embryology laboratory. She is committed to providing education for women about preservation of their fertility and developing lower cost models to improve access to care.

FAQ’s for our New Moms

By: Sandra Cisneros, RN

Sometimes getting pregnant is just as scary as the journey itself. After all the work to get to pregnancy, couples are petrified of anything that could jeopardize the pregnancy. The good news is that most pregnancies that have had two normal ultrasounds with a good fetal heartbeat each time and good interval growth between the first and second ultrasound have a terrific chance of reaching live birth. Here are some of the most common questions that we get from patients.

What foods should I avoid?

The American College of Obstetricians and Gynecologists (ACOG) has developed a document to assist patients with understanding the safety recommendations around food during pregnancy. If provides the most current evidence based research on this topic. It can be found at this link (http://www.acog.org/Patients/FAQs/Nutrition-During-Pregnancy)

Can I have intercourse?

In general, the answer is yes. By the time that you leave your fertility physician, you are likely between 6-10 weeks pregnant. The pregnancy is well implanted by this time. In most cases, intercourse is fine. However, if you have had vaginal bleeding during the first weeks of pregnancy or have had bleeding after intercourse, your physician may recommend that you abstain from intercourse.

When should I see my obstetrician?

You should plan to see your obstetrician between 8-10 weeks. Each office will have specific guidelines. This allows your physician to order certain blood tests and ultrasounds to further confirm the health of the pregnancy.

Am I now considered a “high-risk” pregnancy?

In general, the use of fertility treatment to conceive does not make your pregnancy high-risk. There are specific reasons that you may, however, fall into that category. Some examples include high-order multiples (more than twins), diabetes, maternal age, or high blood pressure to name a few. Typically, your obstetrician will refer you to the high-risk service if they deem it necessary.

When should I tell people that I am pregnant?

This is a very individual question and there is no right answer. Usually couples wait because they are trying to ensure that the pregnancy is “ok” – meaning that the risk for miscarriage or genetic abnormality is low. In general, pregnancies in which there have been two normal ultrasounds, which show good interval growth and positive heartbeat, are likely to reach live birth. Many couples already know that their pregnancy is genetically normal from embryo biopsy. If you are using non-invasive prenatal testing, chorionic villus sampling or amniocentesis, you may want to wait for those results. If the only parameter is time, typically most miscarriages happens within the first trimester (by then end of 12 weeks of pregnancy).

Can I exercise?

The American College of Obstetricians and Gynecologists (ACOG) recommends that women become active and exercise at least 30 minutes on most, if not all, days of the week. This will decrease symptoms of pregnancy including backaches, constipation, bloating and swelling. It may help prevent or treat gestational diabetes. It will improve your mood and energy.

Safe forms of exercise include walking, swimming, cycling, and aerobics. Women who were runners prior to pregnancy can likely continue during their pregnancy. Activities to avoid are generally those with a high risk of falling. Examples include gymnastics, water skiing and horseback riding. In addition, downhill skiing, contact sports and scuba diving are not recommended.

For further information refer to the ACOG document

 

ABOUT THE AUTHOR

Sandra Cisneros, RN, Ms. Cisneros is an IVF Nurse at Lane Fertility Institute. She has been in the field for almost 20 years. After receiving her nursing degree from the College of San Mateo in 1993, she began her career in the field of fertility. She has worked at Pacific Fertility Center and UCSF Center for Reproductive Health prior to her current position. Ms. Cisneros’ goals are to help patients achieve their dreams of being parents. She strives to lessen their stress along the way. She is currently very interested in empowering women to take control of their future fertility with egg freezing and embryo banking.