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Understanding and Evaluating Reproductive Technologies
Excerpted from The Infertility Answer Book by Brette McWhorter Sember, Attorney at Law ©2005
Reproductive technology has reached a point where there are many options available to help you become parents. These options have given couples a lot of freedom, opened the doors to wonderful new possibilities, and created many families. When you are considering using reproductive technologies to help you become a family, there are a lot of points to weigh and a lot of information to gather.
Understanding Your Condition
If you are considering assisted reproduction, it is important that you come into the process with a good understanding of why natural conception is not working for you and what conditions or problems have brought you here. Understand what your doctor thinks is realistic for you and your partner and what the odds are for you with the different types of treatment. Many times, doctors cannot give you a complete answer as to why you cannot conceive without assistance, but it is important to arm yourself with whatever knowledge is available.
In general, it is best to try the least-invasive procedures first, if they provide real hope for you. This book talks mainly about fertility treatments that involve input from other people, but many couples are able to conceive using their own genetic material. There are many good treatments that are noninvasive, including drug therapies. Be sure to explore all of the options available to you and understand what could or could not work not before progressing to more invasive and complicated treatments.
What Technology Can Do for You
Technology can help you or your partner become pregnant; provide you with genetic material to create a baby if your body cannot do so itself; or, allow you to work with another woman to gestate your pregnancy. These options can seem staggering. Most people begin at the bottom of the totem pole with the least expensive and invasive options and work their way up to more expensive and complicated procedures.
What Technology Cannot Do for You
While technology can offer you new ways to become parents, it cannot change the basic facts of your circumstance. It cannot help you cope with the emotional effects of being unable to conceive on your own. Technology cannot erase basic biological facts. Technology can provide you with a baby, but it cannot always provide you with a baby that is genetically linked to both you and your partner. This can be a big stumbling block for many couples.
For many couples, it is possible to have a child that is a biological child of one of the parents, while using donor material for the other. This raises the issue of whether you and your partner are comfortable with all this implies—having a child who will resemble one of you but not the other; having a child who has an unknown or unidentified parent; and, the inevitable emotional fallout as you process these facts and live with them in the years to come.
Understanding Terminology
The assisted reproductive field is filled with acronyms for different types of procedures. Following are some definitions of these terms that will be used throughout the book.
ART—assisted reproductive treatment. This is the medical assistance you receive as you try to conceive.
GIFT—gamete intrafallopian transfer. Eggs (either belonging to the intended mother or obtained through donations) are retrieved from the ovaries and placed in the fallopian tubes with sperm. Conception occurs in a natural location, but allows physicians to carefully choose the genetic material available.
ICSI—intracytoplasmic sperm injection. A single sperm is injected into an egg and the egg is then implanted into the intended mother.
IVF—in vitro fertilization. Eggs are fertilized with sperm outside of the mother and embryos are implanted into her uterus.
IUI—intrauterine insemination. Ovulation is induced in the woman and sperm is then inserted into the uterus.
ZIFT—zygote intrafallopian transfer. Eggs are retrieved from the mother or donor and inseminated. The zygote or young embryo is then implanted into the fallopian tube.
Other terms you may come across include the following:
• gamete. This refers to sperm or eggs—the building blocks of a baby.
• induced cycle. Ovulation that is induced by medication.
• natural cycle. Ovulation that occurs without medication or medical intervention.
• oocytes. An egg before maturation.
Finding Medical Professionals You are Comfortable With
As you begin your journey into the world of assisted reproduction, the most important thing you can do is select doctors and clinics that you are comfortable with. The process you are entering is very stressful and emotional. If you are working with providers who are not sensitive to your needs or who you just feel uncomfortable with, the entire process will be more difficult for you.
The first place to start is with your OB/GYN. Get a referral to a fertility specialist. If you are not happy with that referral, ask for another. If there is a medical school in your area, call them and ask if the school is involved in a clinic in your area. Talk to other couples you know who have used assisted reproduction about what doctors and facilities they have used.
Before visiting a specialist or clinic, call and ask if the providers are board certified or board eligible in gynecology and obstetrics as well as in reproductive endocrinology. Fertility specialists should be certified in both of these areas. If the clinic has an IVF lab, ask if it is accredited by the College of American Pathologists (whether or not you plan on using IVF). All labs of any kind must be accredited under the federal Clinical Laboratory Improvement Amendment (CLIA). Ask if the physicians are members of the American Society of Reproductive Medicine. Most reputable clinics also have the following specialists on staff:
• reproductive immunologists;
• embryologists;
• reproductive urologists;
• andrologists; and,
• genetic counselors.
Success Rates
When you interview clinics, it is important to ask about success rates. This will let you know how successful the clinic is at producing pregnancies. The most important success rates are the number of take-home babies per year and the number of live babies born per cycle. (The number of pregnancies can be a deceiving statistic because many may fail early in the pregnancy.)
Keep in mind that some clinics may not have high success rates because they focus on difficult-to-treat problems or because they use last ditch methods that may be a couple’s only hope. Make sure you understand why a clinic’s numbers are what they are.
Your Right to ART
Fertility clinics cannot turn you away because of a disability or discriminate against you because of your race or ethnic background. At the time this book was written, a case was being heard in Colorado about a blind woman who was required to show a clinic that she was able to care for a child before they would continue her IVF treatments. The court will consider whether the Americans with Disabilities Act prohibits this kind of discrimination. Clinics that receive federal funds may also violate the Rehabilitation Act if they treat those with disabilities differently than other patients.
Setting Limits
Most couples enter the world of assisted reproduction slowly—first with fertility drugs and then gradual
