Fertility control

Even with more advanced methods of family planning more easily available, working mothers still struggle to have everything

“My story is not really the typical fertility story,” says Erika, an education researcher living in Grass Valley and a telecommuter for a company in Menlo Park. Erika, who asked to remain anonymous, decided that she definitely wanted the children over time to turn 39. She had been married in her last 20 years and divorced five years later. On her 39th birthday, she had been with her then boyfriend for another five years.

“I really loved the person I was with, but it was as if I wanted children and if we do not have to break,” he says. “The next month I looked for a donor and less than a year later I was pregnant.”

Erika describes her journey as “easy” compared to other women she meets. She became pregnant with the first round of in vitro fertilization (it is not uncommon for women to undergo multiple rounds, up to five, before getting pregnant, while some never get pregnant with IVF), she did not have to deal with Progesterone, and the oral medication she took did not affect her much. She was also in a financial position to qualify for a loan to cover the cost: $ 35,000 between drugs, five failed IUI attempts, donor sperm and IVF.

“I had really good insurance, but it covered almost none of this,” he says. Erika was also at a point in her career where she could take time off and not lose her place on the line.

That is not necessarily the case for all women who have decided they want to balance a career with parenting. While reproductive technologies have given women and families more control and additional tools, having everything still seems a leap away. Treatments are expensive (most insurance plans do not cover much), are time consuming and not always effective. Meanwhile, labor policy has been slow to change and accommodate a growing number of working moms.

The Intricacies of Fertility

Although there are no two women who have the same history of fertility, there is a typical trajectory: A woman tries for some time to become pregnant (usually about a year) and does not happen; She tells her gynecologist, who does a blood test to ensure the woman is ovulating and then prescribes Clomid, a follicle-stimulating drug that helps ensure that her ovaries produce at least one egg a month; She can try that for several months, and if she still does not work, she is referring to a fertility specialist.

The specialist will do more tests, including testing the man’s sperm. The next step is intrauterine insemination, or IUI – depositing the sperm in the woman’s uterus while she is ovulating (for sperm that move more slowly, this usually solves the problem). Most women will try IUI a few times because it is much less expensive and does not require all the medications that IVF does. Success rates can also increase with multiple attempts, but remain in the range of 7-20 percent. Most physicians will recommend moving to IVF after three failed IUI attempts.

The IVF process usually begins with injections of a class of medications called gonadotropins, which contain follicle-stimulating hormone, luteinizing hormone or a combination of the two. This helps the woman produce many more eggs during her monthly cycle than she normally does – because the more eggs are produced, the more opportunities for a viable pregnancy. When the woman’s eggs (called follicles in the medical language) are mature and numerous, a procedure is performed to extract the eggs, which are then fertilized with sperm in a laboratory. After three to five days, the healthiest embryos are transferred back into the uterus (although the embryos sometimes freeze during a cycle if the woman has responded poorly to the drugs). In most cases, the woman should take progesterone shots to thicken the uterine lining sufficient to support a fetus.

Some specialists are concerned that the modern in vitro fertilization process, with assisted drugs, be overused. When IVF was introduced in the late 1970s, eggs were harvested as the woman naturally produced them, without most of the accompanying treatments. According to Dr. Geeta Nargund, an international fertility expert based in London, many women who do not need IVF with drugs are being sold into the idea. “In many cases, the woman does not have fertility problems, it is her partner who has the problem,” he says. In fact, this is true in 51 percent of fertility cases in the United States. “There is a significant population of perfectly fertile women who are receiving fertility treatment and do not need it,” Nargund continues.

Nargund advises women to ovulate on their own and have no problems with their fallopian tubes to try “natural IVF”, which requires the patient to inject hormones only for about 5-9 days, compared to the current standard IVF , Which includes 4-6 weeks of daily injections.

“We tend to forget that the field is dominated by men and often take the approach of, ‘Oh, well, women are doing all these injections, but they do not care about that,'” says Nargund. “Well, how do you know?” … Most women are working during this time and I have seen a number of them have to give up because of the intensity of this process – I think we owe women to make fertility treatments as safe and easy as possible ” .

The side effects of fertility drugs can vary wildly from woman to woman. Clomid, for example, is known to make some women feel everything from mildly depressed to absolute psychopaths, but some women experience no side effects. In many cases, doctors do not discuss these potential effects with their patients. Some find Clomid a completely harmless drug, while others believe that women are willing to withstand any number of side effects to treat infertility, which is true in many cases, but that approach can have a real impact not only on patients, but also their professionals.

“It causes so many psychological emergencies in this country, women stop working, cause relationship problems – it should not be taken as lightly as it is,” says Dr. Aimee Eyvazzadeh, a nationally recognized fertility expert who runs a practice in San Ramón.

Leticia McCann Murphy, a Sacramento human resources manager who had her first baby this year through IVF, had exactly that experience. McCann Murphy and her husband started trying when she was 28 years old. After a year without getting pregnant, her gynecologist put her on Clomid. He was not informed of any contraindications. “I had a blood test done to make sure I was still ovulating but that was it – fortunately it did not make me feel crazy like it did with many women in my fertility support group,” he says. After a year in Clomid, McCann Murphy tested four cycles of IUI before finally doing IVF.

That process is common, and also makes many women less likely to opt for “natural IVF”, which although much less expensive (typically around $ 5,000, according to Nargund), could take longer. Fertility is often described as a set of numbers: It is a world dominated by discussion of success rates, number of eggs, number of viable embryos and so on. For many women who see a fertility specialist, there is a certain amount of panic involved, especially if they are over 35 years old. It is a high pressure situation and in it the fastest solution with the highest attractive success rate.

Technology is not always a silver bullet

Success rates are a big thing in the fertility industry, but they can be difficult to decipher. According to the most recent report from the US Centers for Disease Control, the average success rate of IVF ranges from 20 to 30 percent, depending on the age of the woman. Some clinics have much higher rates. The California IVF Center in Davis, for example, has a success rate of 50-80 percent. That broad range is due to a number of factors: Some clinics take more complicated cases, which drives their success rates down. Some women, and the clinics that serve them, are willing to undergo multiple rounds of IVF in their attempt to have a child, which also reduces success rates.

“People do not understand success rates,” says Eyvazzadeh. Most of your patients have very low chances of success because they are a specialist who takes pride in tackling difficult cases. She is seen as a kind of miracle worker for women from San Francisco to Sacramento who seek her when other specialists have failed them. “I tell them they have a 23 percent chance and they think it’s low, but in the world of assisted reproduction, that’s considered really high,” he says.

That is especially true for the many patients who flock to Eyvazzadeh because of their reputation for cracking difficult cases. “My theory is that there is no such thing as unexplained infertility,” he says. There is always a reason.

Ferreting that reason and tackling any contributing health problem is important for ultimate success, according to Eyvazzadeh.

“If we address any contributing factors, then whether and when we will go forward with IVF will have the greatest likelihood of success,” he explains. “I do not want, after the fact, to say, ‘Oh, we should have removed those polyps’ or ‘Oh, your husband should have seen a urologist.'”

Freezing or not freezing, that is the question

One potential tool to extend fertility and improve success rates is egg freezing. Heralded as a game changer that could allow women to safeguard both their careers and their fertility, egg freezing has taken off in recent years, driven in part by Apple’s high-profile ads and Facebook that would cover the procedure at Employee health plans. In 2009, only about 500 women in the United States froze their eggs – by 2013, nearly 5,000 did so, according to the Society for Assisted Reproductive Technology. Marketing Fertility EggBanxx estimates that 76,000 women will be freezing their eggs by 2018.

But neither is the ultimate solution that has been made to be. Although the American Society for Reproductive Freedom removed the “experimental” etiquette of egg freezing in 2012 because advances had drastically improved success rates, it still cautioned against overselling the procedure to women and giving them “false hopes” More control over their future fertility.

Ernest Zeringue, medical director and founder of the California IVF Fertility Center in Davis, has some tips for women who plan to freeze eggs as a fail-safe test. “Egg freezing services are relatively new,” he says. “It is no longer considered experimental, but that does not mean that clinics are competent at the same time. There are many centers, I would say most of the centers that freeze eggs, have not yet thawed them and tried to get pregnant.” In other words, they still do not know if eggs will be viable once defrosted – something the woman will not discover until years later.

Zeringue explains that at its center, it took quite a bit of time and effort to get to an egg freezing process that they know works: “We did trials of different techniques and tested eggs after thawing to see if fertilization rates and pregnancy rates Were the same as with fresh eggs, “he says. “Using commercially available materials and protocols, most of the eggs failed to make good-quality embryos.”

It was only after several adjustments in its process that its center was able to ensure a higher survival rate after egg freezing. However, about 75 percent of the frozen eggs survive the freezing and thawing process. “Without checking their techniques, egg freezing places may not offer any real benefit to patients,” says Zeringue.

In addition to not being guaranteed effective, freezing eggs is not cheap. It costs about $ 10,000 for the egg harvest, a procedure that is typically done after a woman has taken many of the same follicle stimulating drugs taken during IVF, which can cost up to $ 1,000 depending on her insurance. Then the storage fee is around $ 500 per year. If and when you decide to use the eggs, you will still have to go through the implantation procedure and, if you are single, you will have to pay for sperm. Women who undergo IVF often end up paying for the storage of fertilized embryos as well, which will have to decide at some point whether to use, donate or destroy – a decision that has increasingly uncertain legal implications.

For Erika, although she is pretty sure she does not want any more children, “especially as a single mother,” it has been difficult to decide what to do with her embryos on ice. “Destroying them is a difficult decision to make, and then donating to someone would be strange as well – it would be a brother to my son, and he related to me – and I’m pretty positive that I do not want to have more, but I keep putting the decision away,” he says.

The Career Question

Planning for a family as a career woman is complicated. Some women have heads with whom they can be open and a schedule to attend medical appointments when necessary. But even if you have both for them (which tends to be a luxury), dealing with the fertility process can be difficult in your professional life.

For McCann Murphy, the human resources manager, she had a flexible schedule and her boss and her closest colleagues were aware of her fertility trip. However, “it’s different when you can say a week or two weeks ahead of time that you have an appointment with the doctor, compared to this, which is” you’re ovulating so you need to get in immediately, “he says.

And there is another unforeseen inconvenience for colleagues to be intimately familiar with their reproductive life. “There were no secrets kept when things did not go well, or when they did, I knew by five weeks that I was pregnant and everyone else knew it right away,” says McCann Murphy. “So instead of waiting for the usual three months to make sure everything was fine and then telling people, we had everyone in it from the beginning.”

However, the support almost stops once the mother goes back to work. Neither McCann Murphy nor Erika work for an employer who provides or subsidizes child care (doing so is so rare that companies often send press releases if they choose to offer such benefit to employees) and both struggle with balancing motherhood And career. McCann Murphy is fortunate to have family in the area who helps take care of her four month old daughter three days a week while she has found a nearby daycare to cover the other two days. Erika pays for the full-time nursery for her son and says she trusts other moms at work when her son is sick and needs to take care of him.

“We’re constantly tagging in and out covering the work for each other,” says Erika. “But it’s really unfortunate when parents at the office discharge night or weekend people work without children.It’s unfair, and I do not feel good.There’s all this secret burden they bear because nobody has really solved how Really support working parents. ”

Because there is no family leave paid by the government, companies often use other employees to cover the leave they pay, which means that mothers usually fall on the ground the second time they return to work.

“Everyone loves a pregnant woman and everyone loves a baby,” says Erika. “But then it’s kind of like OK, now you’re on your own.”